Health insurance

alastair

MayoSalmon wrote: »

I have a simple question, do you not think that healthcare should be provided by the free market much like the rest of the services we have in society?

No. Just as education should not be.

MayoSalmon wrote: »

And do you think the costs would rise or fall if the private sector took over the industry?

The answer to that is evident from the disaster that is the US system. Obamacare offers a partial remedy to that disaster, but it's a complete national mortification regardless.

MayoSalmon

alastair wrote:

The answer to that is evident from the disaster that is the US system. Obamacare offers a partial remedy to that disaster, but it's a complete national mortification regardless.

Eh the US spends 20% of its GDP on Healthcare, it should be performing miraclously according to you.

alastair wrote:

No. Just as education should not be.

Well education is a prime example of an industry that the government continually adds no value, teachers going on strike looking for more tax payers money all the while depriving children of their education shocking really. Privatise the industry, give people back their taxes, allow them save for there children's education, allow schools to compete on tuition and staffing costs. Society will benefit from better quality education, facilities and teachers.

alastair

MayoSalmon wrote: »

Eh the US spends 20% of its GDP on Healthcare, it should be performing miraclously according to you.

Because it buys in an effectively unregulated free market, and has to pay crazy costs as a consequence. The 'free market' effectively becomes a pharma/health services cartel. If it had properly regulated universal provision system (socialised healthcare), it would break that cartel.

alastair

MayoSalmon wrote: »

Well education is a prime example of an industry that the government continually adds no value, teachers going on strike looking for more tax payers money all the while depriving children of their education shocking really.

Private schools are unionised too. Teachers still strike.

Anita Blow

MayoSalmon wrote: »

alastair wrote: »

The socialised health provision models in pretty much every other advanced nation in the world?

Which are all complete failures.

I hardly need to point out of the substantial cost per captia in delivering the system here, spiraling costs, the long wait lists etc

Ireland ranks 25th for healthcare expenditure per capita (compared with the US at number 1) and 19th for quality of healthcare (compared to the US at 37).
In fact, the US spends more on public funds on healthcare than the Netherlands, Germany, UK, France, Ireland yet has worse outcomes across the board than these countries.

The average cost of a Total Hip Replacement in the US is $30,000-70,000, yet in Ireland costs the HSE 12,600 euro with no difference in 5 year outcomes. The same country has hospitals charging $100 for 400mg of Ibuprofen, which equates to ~$4000 for a pack of neurofen. Efficiency is not a word you can associate with the free-market approach taken by the US

In 2011, the Royal Society of Medicine ranked Ireland as Number 1, followed by several other publicly funded systems in the top 10 as the most efficient system for acute medicine in the world, with more lives saved in acute medicine (Cancer, emergency treatment, necessary medical care) than any other in the world.

MayoSalmon

alastair wrote: »

Because it buys in an effectively unregulated free market, and has to pay crazy costs as a consequence. The 'free market' effectively becomes a pharma/health services cartel. If it had properly regulated universal provision system (socialised healthcare), it would break that cartel.

So costs are higher because the market it unregulated and free

alastair

MayoSalmon wrote: »

So costs are higher because the market it unregulated and free

Precisely. Without regulation the companies formed a cartel and price fix.

MayoSalmon

alastair wrote: »

Precisely. Without regulation the companies formed a cartel and price fix.

Where is your evidence of any of this???

alastair

MayoSalmon wrote: »

Where is your evidence of any of this???

It's been widely publicised, and highlighted in congressional investigations, but the U.S. government has no power to legislate against it. There's your free market in action.

http://www.forbes.com/sites/epatientdave/2013/07/22/the-cartel-whose-secret-meetings-set-the-price-of-u-s-medicine/#3ef54317753a

http://www.slate.com/articles/news_and_politics/prescriptions/2009/09/the_fix_is_in.html

Overheal

MayoSalmon wrote: »

So costs are higher because the market it unregulated and free

Have you never heard of Monopolies and Oligopolies? Collusion? It's not like opening up a dollar store, there are only so many actors that can produce drugs.

ancapailldorcha

MayoSalmon wrote: »

So costs are higher because the market it unregulated and free

MayoSalmon wrote: »

Where is your evidence of any of this???

Post more constructively please. You're approaching soapboxing territory. Other posters have cited sources to reinforce their opinions. I suggest you do the same.

Manic Moran

It seems evident that there is not enough competition, the epi-pen saga, recently, was cause for analysts to point out that for competition to result, and not an oligarchy, at least three, maybe four competitors are required. Only two companies make Epi pens.

That said, it is possible to reduce costs by regulation or incentive, as opposed to moving to a government healthcare system. The Government runs the VA healthcare system, which has not been a shining example of late. Even with the advantage that by law they negotiate drug prices as 10% less than normal. Not sure I'd like them running a national one, even if they could afford it.

Peregrinus

MayoSalmon wrote: »

Where is your evidence of any of this???

Lots of evidence has already been posted; have you not noticed?

As others point out, you haven't posted any evidence at all; just flat assertions. It's an article of faith for you that an unregulated free market will always produce lower costs, but if you had any interest in examining the question you'd have long ago discovered that the US healthcare market is the textbook example held up to demonstrate that this isn't universally true. The US healthcare system is famously inefficient; they spend vastly more than other countries and get much lousier result, and this remains true whether we look at overall health expenditure, or just at taxpayer-funded healthcare.

Seriously, you've been interested in free markets and this has never come to your attention? Unless you're the ecomonic equivalent of a biblical fundamentalist, this is absolutely bread-and-butter stuff. The challenge for the right is not to deny that this is so, but to account for why it is so, and what can be done to change it.

n1ey

Anita Blow wrote: »

The average cost of a Total Hip Replacement in the US is $30,000-70,000, yet in Ireland costs the HSE 12,600 euro with no difference in 5 year outcomes. The same country has hospitals charging $100 for 400mg of Ibuprofen, which equates to ~$4000 for a pack of neurofen. Efficiency is not a word you can associate with the free-market approach taken by the US

Every hospital is allowed to set its own prices. They also know that the spigot will not turn-off. Health insurance provides unlimited funds in a sense. They must tap those funds. This is not a free market scheme.
it is a subsidy scheme. It creates a distortion.

In a sense free market issues have created larger doctor/hospital groups. However, these are really driven by distortions. There are tax savings to be had! You incorporate as a nonprofit 100 physician group and save on income tax, sales tax, & property tax. You don't reduce costs because every Doctor still has a support staff. You tell the insurance company that they must pay or they lose access to 100 physicians. They use their market power with enhancement due to distortion. The customers do not know the actual prices or the level of quality.

Your doctor's group works a deal with a hospital group. You start performing regular procedures inside a hospital. You require a separate doctor for airway and sedative monitoring. The doctors manipulate the system. Doctors set the pricing in Medicare. All insurance companies base their codes on Medicare. The EOHHS inspectors allow a wide leeway from the medicare prices. Everything is reasonable as long they are not 1000% above the Medicare code charge. However, they can charge $1000 for something that costs $135, elsewhere?

How many Doctors are required to perform a colonoscopy in Ireland? How many are actually required in America? Often 2 doctors are there! Plus, you need at least one nurse. The Doctors mandated this.

The pharma actually collect the lions share of profits in the US. They sell at lower prices in Ireland. So, the American customer subsidizes the Irish customer. Big Pharma often make deals to access countries and sell their medicines. The governments set prices. The only one that does not set prices? It is the U.S. We pay top dollar but they are willing to take 75% of the price in Ireland.

The solution? Price control. Uniform prices are required within the same geographical region. For instance once hospital should not allowed to charge $75 for an x-ray while another charges $375; the second is only 12 miles away. Everyone should charge $75. This is actually especially important with MRI systems.

Bill

Chuchote

Atul Gawande (one of the world's top cardiac surgeons) has an interesting (loooong) piece in the New Yorker about why GP care and 'incremental care' (ongoing medical service to a patient) is more important than dramatic intervention by specialists; he tells this story from his own family:

http://www.newyorker.com/magazine/2017/01/23/the-heroism-of-incremental-care

I see the stakes in my own family. My son, Walker, was born with a heart condition, and in his first days rescue medicine was what he needed. A cardiology team deployed the arsenal that saved him: the drips that kept his circulation going, the surgery that closed the holes in his heart and gave him a new aortic arch. But incremental medicine is what he has needed ever since.

For twenty-one years, he has had the same cardiologist and nurse practitioner. They saw him through his first months, when weight gain, stimulation, and control of his blood pressure were essential. They saw him through his first decade, when all he turned out to need was someone to keep a cautious eye on how his heart did as he developed and took on sports. They saw him through his growth spurt, when the size of his aorta failed to keep up with his height, and guided us through the difficult choices about what operation he needed, when, and who should do it. Then they saw him through his thankfully smooth recovery.

When he began to struggle in middle school, a psychologist’s evaluation identified deficits that, he warned us, meant that Walker would probably not have the cognitive capacity for college. But the cardiologist recognized that Walker’s difficulties fit with new data showing that kids with his heart condition tend to have a particular pattern of neurological deficits in processing speed and other functions which could potentially be managed. In the ensuing years, she and his pediatrician helped bring in experts to work with him on his learning and coping skills, and school planning. He’s now a junior in college, majoring in philosophy, and emerging as a writer and an artist. Rescue saved my son’s life. But without incremental medicine he would never have the long and full life that he could.

In the next few months, the worry is whether Walker and others like him will be able to have health-care coverage of any kind. His heart condition makes him, essentially, uninsurable. Until he’s twenty-six, he can stay on our family policy. But after that? In the work he’s done in his field, he’s had the status of a freelancer. Without the Affordable Care Act’s protections requiring all insurers to provide coverage to people regardless of their health history and at the same price as others their age, he’d be unable to find health insurance. Republican replacement plans threaten to weaken or drop these requirements, and leave no meaningful solution for people like him. And data indicate that twenty-seven per cent of adults under sixty-five are like him, with past health conditions that make them uninsurable without the protections.

InTheTrees

newacc2015 wrote: »

The fact is many Americans get free healthcare or low cost from the Government when they are ultralow income and old such as Medicaid and Medicare.

Not really. There's old age healthcare which is under threat from republicans.

And there's not much else. Without obamacare if you have some long term condition, like diabetes you're just out of luck.

Without the affordable care act we will revert to poor people having to get healthcare from hospital emergency rooms, which just drives them deeper into debt.

InTheTrees

MayoSalmon wrote: »

So costs are higher because the market it unregulated and free

Before Obamacare the US "free market" meant that if your healthcare costs got too high then you declare bankruptcy and the hospital writes the debt off on their taxes and the US Taxpayer foots the bill.

Which is why the US spends more on healthcare then anywhere else and has worse results.

Save

InTheTrees

MayoSalmon wrote: »

I have a simple question, do you not think that healthcare should be provided by the free market much like the rest of the services we have in society?

I think the problem with a really "free market" approach is that you really have to let those that cant afford care to go without.

But society has decided that poor people dying in the street isnt acceptable so Hospitals are legally required to provide emergency care without asking for payment first.

Chuchote

InTheTrees wrote: »

I think the problem with a really "free market" approach is that you really have to let those that cant afford care to go without.

But society has decided that poor people dying in the street isnt acceptable so Hospitals are legally required to provide emergency care without asking for payment first.

The other problem with the "free market" approach is that it makes things much more expensive for those who have to pay to support a limited system. Economies of scale work better.

It's like why dragon fruit are expensive but kiwis are cheap - zillions of kiwis are imported and they can be sold for less, compared for the few dragon fruit, which don't have a system set up so you pay €2.50 per fruit.