I am a Continuig Care Manager in a clinic and help people with pulmonary diseae manage their care. I used to be able to negotiate with insurance companies, no longer.

The best insurance is Medicare and Medicaid, they have the lowest copay and the best coverage.

Why don;t you ask people on the front line about care and what occurs?

Don’t be stupid. People don’t go to the doctor just for fun. Hypochondriacs have a legitimate mental condition, but there’s hardly enough of them to justify the idea that health care is not “self-limiting.” Almost nobody seeks health care unless they need it (indeed, the number of people who do need it but do not seek it is a much, much more pressing problem.) And, indeed, the problem facing us right now is one of waste and unnecessary treatment, because we incentivise doctors and hospitals to provide (and charge for) treatments, not improve health.

The vast majority of roads in this country are utilized as less than 10% of capacity (probably less than 1% in most cases). Even though the the roads are free (of marginal cost to the user), the demand for them is generally self-limiting. There is generally no need to prioritize access to the roads for people who need them most, since everyone could drive most roads as much as they would want without conflict (of course, people generally only want to drive on roads that will take them where they want to go, and people generally only want to make a certain number of trips).

By contrast, the amount of health care that people would like to get is not self-limiting to an extent that’s anywhere close to the level of resources available. No matter how much is spent, there will be someone who would have liked to have received more service than he got. Since resources are finite, their allocation must be prioritized via some method (whether by chance or other bad means, or by some good means). Allocating resources by people’s willingness to pay for them isn’t perfect, but it’s far better than many other alternatives.

Suppose two people could both benefit to some extent from a treatment. Given a choice between receiving the treatment or having an extra $500 in his pocket, person #1 would rather have the $500. Person #2 would rather have the treatment. Would there be any reason to treat person #1 and not person #2? If one were going to do that, one could make both person #1 and person #2 happier by instead giving person #1 the $500 and person #2 the treatment.

Steve: I’m glad other people like France’s system.

The french system is one of the best, if not the best, in the world. However, it should be pointed out that the french system is not sustainable. They are having the same problems we are, just not at the same rates. I like to compare it towards driving towards a cliff. We are going 50 mph, France is going 20 mph. Clearly switching is preferred, but not a viable solution for too long.

Sure, so did I, until he kept my car for two whole weeks so he could “order a part” which he never did order. I took it back to the dealer and they had it on-hand, took an afternoon. Never been back to the other guy.

It turns out that two or three oil changes weren’t an adequate sample of his work, especially in regards to body repair. The same problem exists with your doctor. Sure, he’s good with your kids and knows a lot about your aches and pains, but the time you need him to accurately diagnose your cancer is liable to be the only sample you ever get of his cancer-diagnosing ability, and it’s kind of crucial that he gets it right the first time.

The truth is that, of all the people who might be involved in that transaction, you’re the one who knows the least, and is therefore the least suitable consumer. Medical choice seems like a really stupid place to make your stand against public health care; for starters, the system we have doesn’t provide much choice, and secondly, it’s not clear that putative patients are the best-suited to choose. That’s assuming you’re even conscious at the time you need medical attention, which is often not the case. How are the unconscious supposed to choose?

I’d love to get a public plan like France has. As one of the healthy people, I’d have no problem paying taxes that are getting people in to see doctors. Even if I never need it.
Especially since I strongly doubt the taxes could be much higher than my insurance payments. Most of which go towards making the insurance company. Is that a better goal than poor kids seeing doctors?
I only keep insurance just in case…car accident or unforseen illness and all that. At which point they’ll probably just deny everything and cancel my policy when I complain. I’d switch companies, but they’re all like that.
Your “choice” is shopping around for the one that charges a little less and who’s least likely to cancel your policy the second you start costing them money. Free market for the win!

You never took anything than a basic econ class right.

Okay, lets run through some basics of insurance.

You have a pool of people in it. Some healthy, some not. If the insurance companies can’t tell the healthy from the unhealthy they will charge an average rate based on the average cost if people get sick.

Now, suppose people can leave the pool and signal that they are healthy by say…having a higher deductible. Now what happens? The healthy people leave the pool and you now have what economits call a seperating equilibrium…i.e. two equilibria, one for the healthy and one for the unhealthy.

So a public/government plan gets the sick people, the healthy buy private insurance. You’ll then have to tax the healthy to pay for the unhealthy becuase otherwise the unhealthy public plan will be too expensive for many of the unhealthy. This is especially true when dealing with pre-existing conditions. In that case the premium would be equal to the cost.

In the end, with taxes and their premiums healthy people would likely return to the government plan, and the private market would be very small to non-existent. Depending on which sort of government plan we get it could be very good (France) to very bad (England).

I agree with you but… as long as there is a 3rd party payer, be it government or an insurance company, individuals have no incentive to shop around. That’s the reason you cannot currently get an accurate quote, the providers are not negotiating with you because you aint writin them the check.

I always wondered where COBRA got all their money. I also wondered why Hot Wheels cars can handle a 2 story fall with minor paint damage while dad’s car gets all smashed up simply backing into the garage door.

“Nobody, not even the status-quo-defending glibertarians here, advocates putting seniors back on a private system and eliminating Medicare.” – I personally find it rather offensive that I pay for my parent’s health care, even though they make roughly twice what I do, even in retirement. Not all seniors eat cat food for dinner, why should the taxpayers at large foot the bill for those with ability to pay their own way? Sell the $300K RV when you get cancer.

Since so may commenters are demanding a suggested system here is mine: amortize the expected health care costs over your entire lifetime. At current rates, it looks like my employer will pay at least 3/4 of a million dollars in premiums over my lifetime. If I had the freedom to let Walmart treat my boo boos now, I could save quite a bit for my end time, certainly more than 22 thousand dollars.

Car repairs are never enjoyable either, but I’ve got a great mechanic I recommend to all my friends.

There’s a big difference between a flat tire and a broken foot. As far as price shopping goes, when a person is unconscious or otherwise unable to act on his own behalf, who does the price shopping? If I get hit by a car and get severely injured, how many hospitals should I call before for price comparisons?

Have you heard of vaccination and herd immunity? Universal vaccination* is the perfect example of a public good.

Similar with treatment for TB and other communicable diseases. Early treatment for one infected person is much cheaper than crisis care for that same person, plus care for all those he manages to spread it to before he goes into crisis.

* no I don’t want the government to force it on you at gunpoint. Just to pay for it if you want it. But you’d better keep your disease-infested unvaccinated kids the hell away from me and mine.

#25:

Your assertion that private care and insurance are illegal in Canada is wrong. Here, let me google that for you: http://www.google.com/search?hl=en&q=private+insurance+canada

Although, in all fairness, it seems that it was illegal in Quebec (not all of Canada, just Quebec) until 2006. Their federal supreme court struck down that law as a violation of their charter of human rights.

No one is going to “sing the praises” of any system of medicine, because medicine is never a purchase you feel good about.

Car repairs are never enjoyable either, but I’ve got a great mechanic I recommend to all my friends.

No one is going to “sing the praises” of any system of medicine, because medicine is never a purchase you feel good about. You go out and buy a new novel, and the process is positive from the get-go: you’re anticipating a great read, you can’t wait to get it home, and afterwards it was as good as you hoped, or even better.

But with health care, you don’t look forward to going to the doctor. Medicine is never enjoyable. You have a problem, you’re in pain or having symptoms, or maybe your very life is at risk, and you go in, and at best you’re brought back to normal, no better off than before; much more likely, you walk out of there with exactly the same pain you had before, only with the promise of abatement in a few days.

Nobody likes going to the doctor. Nobody derives enjoyment from their medical system. Nobody is going to “sing the praises” of any system, public or private. On the other hand, when we look at objective metrics, public health care wins out every time. Nobody, not even the status-quo-defending glibertarians here, advocates putting seniors back on a private system and eliminating Medicare. Well, if it’s good enough for grandma why isn’t it good enough for me?

One of the biggest problems I see in the medical world today is that no one can tell you what the actual price of a service is going to be.

In countries with single-payer health coverage, they can. The answer is “free, and do you need some money for transportation?” On the payment side, there’s much less price variability because the government negotiates rates, like it does for Medicare. On the hospital’s side, the vast paperwork overhead is reduced because they no longer have to keep track of whose insurance you’re on before they can tell you how much it’s going to cost.

One of the biggest problems I see in the medical world today is that no one can tell you what the actual price of a service is going to be. They can be estimated, but even then the estimates can be hundreds if not thousands of dollars off. Theoretically a person should be able to call a doctor/hospital/lab and ask “how much is this going to cost me?” They should be able to shop around and find the best deal for their money, just like any other service. Unfortunately shopping around only seems to work on medications, and only limited to generics, due to the fact that if a company has a new drug that hasn’t hit the patent date your only option is the brand name. Maybe we actually need a little government regulation to state that prices for services should be readily available, wither it be a doctors visit or an x-ray. Not what the prices should be, just that they should be available, and it shouldn’t fluctuate just because you’ve got insurance or not. I’ve run into enough cases where a service was one price for the insurance company (due to deals in the medical communities not to go above a certain amount) and something completely different for the uninsured.

So true. Often the only solutions you see here to any given problems are 1. “deregulate,” 2. “lower or eliminate taxes,” and 3. “there isn’t really a problem”.

P.S. those GI JOE PSAs are absolutely hilarious.

*Except the poor and most of the middle class but they don’t count.

That’s a tenet of faith, not a rational argument, and it seems to ignore the very real phenomenon of limited resources. Very often the market cannot provide any good at any price. And the market incentives are all wrong, here, because health care is something you will often die if you do not get.

That doesn’t lend itself to lower prices, to say the least. Just wanting something usually isn’t enough to get someone to sell it to you at the price you want. Indeed, wanting it bad enough usually prompts them to sell it to you at a much higher price than you would prefer.

If you like G.I. Joe-related humor, seek out the PSA video mash-ups originally posted at heavengallery.com.

“Now you know.”

I can point to data that says people in some of those countries with universal coverage aren’t happy with it, except even more people are more unhappy with our system. Which isn’t too surprising, since it looks like we’re paying as much for public funds on top of all the private spending, and manage to have crappier care. People are right to say we aren’t working with a free market system, but we seem to have combined a lot of bad features and gotten rid of the advantages that could have come from the government getting involved (yeah and most people here are probably going to say there are no advantages right?).

I’d be interested in hearing someone explain how a system with no government intervention would be an improvement over other options (other than saying less government is inherently good). Personally from what I’ve heard I wouldn’t mind seeing something like a Dutch system. It still relies on people choosing coverage from private companies, but puts in regulations to ensure everyone can get some decent care. Yeah the government is putting in money to distort the market, but it distorts things so companies have an incentive to take care of sick people instead of finding excuses to pay for it.