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Winners and Loosers in a single payer national health care system

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I have noted a number of letters to the editor lately that laud a single payer government run health care system. I have seen numbers associated with such an approach that defy credibility. I can not comprehend how we can include another 20-40% of the population and reduce the costs by 66% for any form of creditable system.

Certainly there is waste in the current system. But like earmarks waste is in the eye of the beholder. If you have diabetes you want coverage at standard prices while someone else might want that coverage to cost a lot more or be withdrawn since they perceive you are ill by your own actions. You can get to a 66% savings if all you provide is coverage for the healthy. If you have sick people in the mix I seriously question such savings. If you want to investigate real cost savings I suggest you look at the following for a comprehensive and thoughtful discussion of what we might do to improve health care and reduce costs. The offerings will not add up to 66%.
http://www.aarp.org/research/legis-polit/elections/i7_health_costs.html

Since this is obvious to anyone with a brain I have been cogitating about who is writing those letters. At least one portion of the populace that might be guilty is the young just leaving home who are no longer covered by their parents insurance (if they ever were). We have a lot of those here in Lawrence. Anecdotally, I have noted for a many years that this cohort does not participate fully in health insurance programs offered by employers. Statistically they represent a significant portion of the uninsured of whom we are constantly reminded.

Since health insurance is currently handled as insurance everybody pays the same for the same coverage. The young rarely need the programs while the old consume the lion’s share of the available services. This means that the young subsidize the old. One can argue that you pay up front for the more costly care required when you are older. Many seniors have been paying into programs for a score of years or more. To the young the up front cost is significant.

However, since the coverage is not mandatory, many young entry level individuals forgo available coverage and bet on the come. Most get away with it. A few get caught and are billed for medical costs resulting from something totally unexpected. Since they generally can not pay, they declare bankruptcy and leave the residual unpaid bills to the rest of us. I wonder what percentage of the health care bankruptcies we are regularly reminded about result from this situation? To belong to an insurance program for the entry level cohort does require sacrifice (cheaper car, no cell phone, etc.) and many of this cohort do not think they should have to do that.

Hence a cry for a national health care system. They (probably correctly) perceive they will get basic coverage for a lot less than current commercial insurance will cost them. As long as they in general remain healthy the bill matches the service provided. Of course this approach fails to pay for the ill, disabled and elderly. The young presume that care for this latter grouping is either rationed, paid from the general tax pool or requires a greater individual cost.

From this perspective the real motive is greed. I want someone else to pay the costs of services I demand. Perhaps this is the way we should go. After all, this is the “wall street” approach. I got mine I could care about the rest of you! This notion can be very unsettling for those who are high cost under the current system. Will I suddenly and unexpectedly have to pay a lot more for my care (money I may not have) or will I not receive the care I paid for all these years? The inter-generational battle lines are drawn!

I would suggest a few general guidelines to consider if we want universal coverage:

o We not provide care to those who are not citizens. o We demand that everyone participate - and pay as if it were insurance. o We demand that responsible and cost effective changes be implemented to reduce costs. o We demand that health care not exceed a rational percentage of a family’s income o We demand the process not reduce the quality of care that about 50% already have. o We demand that everybody get the same coverage whatever it is (how about what the Congress now enjoys) o We demand that there be no rationing as there is in other national health care systems o We demand that the new system be prohibited from doing anything to favor/penalize groups or individuals. o We demand that the care provided be professional, timely and current and not treat the patient as a supplicant o We demand that service providers be paid responsibly for the sophisticated care they provide that has taken them long and costly years to acquire. o We demand that the program must always be fully funded so that accidental rationing does not happen as it has in present day government programs such as the VA, Medicare, Medicaid or TRICARE. o We demand there be no other alternative for the really rich to use to bypass what the rest of us get.

With what part of the above do you disagree? How would you do it? Will it really be cheaper? Who pays? Who wins? Who looses?

Comments

Ryan Neuhofel 5 years, 9 months ago

I'm not sure if health care is an issue of "winners and losers", but I think we can all agree on the goals to strive for - quality, value, accessibility, etc. Unfortunately, most of your "demands" are measurements of end-points, not policies to achieve such goals. I have written numerous entries on the economic mess in health care (see my previous posts), but would outline the following policies to achieve the best health care system:

1) Universal access to TAX-FREE MEDICAL SPENDING ACCOUNTS that can be used on any health care expense including health insurance premiums. Available to everyone (similar to IRA) regardless of employment (ending unfair advantage of employer-purchased plans). 2) Reform public "insurance" programs (Medicare, Medicaid, S-CHIP, etc) to allow recipients to take the option of "medical spending accounts" (like food stamps) in lieu of the government ran insurance plan - with the amount determined by income, age, pre-existing conditions, etc. The account could be used to purchase care directly or insurance premiums - ending the two-tier system of care we've created. 3) Encourage direct-medical care (without utilization of "insurance") for primary health care (preventive, routine, minor) - with a goal of utilizing "insurance" less than 20% of medical transactions. Not a specific policy here, but I think a truly free-market (via policies 1 and 2) would create such a system.

These may be "simple" solutions, but changing the economic framework would drastically reduce costs, improve quality and ultimately provide "universal" health care to all Americans while minimizing tax burden.

George Lippencott 5 years, 9 months ago

neuhofel (Anonymous) says:

Your comment seems designed to reduce cost by transferring much of it to the individual. How would you handle the less affluent - would they also have to pay for their basic preventive care? Medicaid supports at least some of this group.

medicare pays little toward preventive care. How much of the other costs would you transfer to the individual? How do you address those that have paid for medical care that has now transferred them to medicare and serves as a form of supplement? There are expectations?

Would there be some cap on out of pocket expenses or would your program favor the young and healthy at the expense of the ill and older?

Yes, I stated end points. I am not sure we can afford them but I would hope we would start from some understanding of the desired and consciously back off so we know who is getting hurt and how? As you can see i am unsure how your proposed program would impact the rest of us?

TacoBob 5 years, 9 months ago

Ack! Pet peeve on the most common misspelling in blogdom.......change it!

Ryan Neuhofel 5 years, 9 months ago

George, I am not sure if you are intentionally making this a personal argument about my "heartless nature", but I will try to reply to your questions (I'm not really sure you read my proposals anyway) . . .

I specifically said that the "less affluent" (as you call them) should be given benefits as "medical cash" instead of a government agency acting as a third-party payer to the provider (if they choose). I did NOT propose reducing or eliminating "public assistance" - just changing the mechanism of delivery.

And since I know you will ask - YES, I believe adults (even poor people) have the intelligence and insight to spend money on their health care to maximum benefit - including preventive care.

With regards to "preventive care" - I believe this type of care (expected expense by definition) should NOT be "pre-payed" to an insurance entity (public or private). However, people should have the freedom to waste their money and "line the pockets" of insurance CEOs if they choose!

"at the expense of ill and older"? Wow! You should just claim I eat puppies for breakfast and beat my grandma! Again, I never proposed reducing benefits or assistance to the elderly or sick!!!! (maybe you should actually read my post). Like the "less affluent", old people should be given the freedom to shop (with public assistance, of course) for health care/insurance if they choose.

Providing benefits in the form of "cash" vs. "government program" is no different than how we distribute "food assistance". There is a reason we give people "food stamps" instead of "government cheese" nowadays! Oh, and I'm also for "school choice" . . . which I'm sure makes me "anti-education" in your assessment

George Lippencott 5 years, 9 months ago

neuhofel (Anonymous) says I did read it but I admittedly didn't understand it. Yes, I am playing devil's advocate. How much "cash" to whom and what happens after it runs out? Who pays for that? Who controls the cost of medical services - now for better or worse controlled by the insurance companies and the government?

George Lippencott 5 years, 9 months ago

Thank you for noting my latest misspelling/word misuse. I have always been a very original speller. I also depend too much on spell-check. I guess I am just one of the many failures of the American Educational system. Or, maybe I have been too lazy to go back and learn to spell.

Ryan Neuhofel 5 years, 9 months ago

George, don't worry - I too am a product of the public education system, but had to learn everything I know about economics for myself! I still think you are looking at reform through the prism of how "third-party payers" can "control" costs. We often feel the need for a third-party (government/insurance in this case) to determine the price so that we can "control" the system. This makes sense on a superficial emotional level, but is a fatally flawed economic philosophy - You don't need to be John Maynard Kaynes or Friedrich Hayek to understand the economic impacts of a third-party versus a direct payment system. I think this is an unfortunate by-product of the "mess" we have created in health care . We need to step back and look at the larger picture.

Who "controls" the cost of computers? They have become cheaper, better and more accessible over the past 20 years - they went from a fairly useless novelty toy for the "rich" to nearly indispensable tools that are affordable to the "poor" in a short period of time. Why? Did some third-party dictate what types of computers should be produced and how much they should cost? Or did some "invisible hand"? (read Adam Smith)

"How much “cash” to whom"? I guess you are looking for the "specific dollar amounts" that would distributed as "benefits"? As I originally stated the "amount (need) determined by income, age, pre-existing conditions, etc". I don't have a specific formula devised or number to give, but as a general rule - we could divide the sum of money currently spent on the various programs and distribute that amount to the individuals based on factors stated above. The individuals could use that "credit" to purchase health care and insurance as they see fit - even if they want to buy the "private pre-payment HMO/PPO plan" or the stellar "Medicaid, Medicaid, VA" services (which I'm sure would NOT happen!)

"what happens after it runs out?" I'm also NOT advocating to eliminate "health insurance". In fact, everyone should have some type of coverage against catastrophic health events. (whether purchased with their own money or their neighbor's money) The amount of risk (or self-insurance) that someone will take upon themselves should depend on their specific financial circumstances. You obviously don't want to "risk" getting a yearly physical or check-up of hypertension.

Now that I have extensively and exhaustively detailed my plans for real changes in policy, I'd still love to hear your specific policies to achieve the "utopian" health care system.

George Lippencott 5 years, 9 months ago

Hi,

  1. We will never get to the utopian health care system I postulated. That, of course, is the point. As long as those pushing a single payer system can dodge what it provides, who pays, and what we get it sounds wonderful. When you fill in the blanks it gets either too expensive or too limited.

  2. I kind of thought you were pushing a market based solution similar to the Republican plan. I was born into such a system here abouts 60 some years ago. I rarely saw a doctor as my parents (and many other middle income people) self-rationed and many people died of easily curable diseases.

  3. For the market to work it must be able to respond. We have a limited supply of doctors because it costs a lot to be one and because not everyone can. Not sure we can change that. If there is a shortage than it is unlikely that individual choice will drive down costs but will more likely become a form of self-rationing - see 2 above.

  4. If you modify the market based system as you described you essentially punish those who work for a living and do reasonably well. The less affluent will have little incentive to "invest" wisely as they will get to the insurance quickly and are from the data I have seen more likely to have expensive self-afflicted medical needs. The really wealthy will self-insure as they do today. The middle will self-ration as presumably they will not get to the insurance so quickly? If they do get to the insurance quickly they have no incentive to "invest" wisely. Since the middle is the biggest group I am not sure they will buy what I think I understand you are advocating as they will be big losers over the current system where they have health insurance.

  5. There are other ways to save money but no one has the interest to adopt many of them. For example using PAs or Nurse practitioners to screen everyday problems should reduce costs. Have to do that today within a practice as they need a doctor to ratify there conclusions. Doctors do not want to reduce the income of the practice. And so on.

staff04 5 years, 9 months ago

I guess I will pose the same question here that I posted on the other healthcare story today:

Why shouldn't the government be allowed to sell insurance that competes with current private plans?

Again, I thought that competition benefits consumers.

George, no one other than Merrill is proposing what you allude to, which is purely government, no private companies can offer insurance under Merrill's spam. Obama, Sebelius, Kennedy (and many other credible healthcare players) want a public option, not a mandated public plan.

Ryan Neuhofel 5 years, 9 months ago

Responses - George, thanks for the reasonable nature of your concerns. I hope you have enjoyed this discussion as well! (I may have to break this into 2 parts)

1) Huh?

2) What I'm promoting is certainly not a partisan plan and generally not supported by Republicans (elected officials at least) or Democrats. In fact, the rise of "managed care" was started with the HMO Act of 1973 - supported by most Republicans and Democrats (promoted by "experts" of the day!) and signed into law by Richard Nixon. The third-party system has been propped up by politicians on both sides since then.

"60 years ago" Medical knowledge was very limited and outside of a few vaccines and antibiotics, the average doctor could do very little to actually improve or extend life. In fact, health care costs (adjusted for inflation) did not significantly start rising until the 1970s (multiple graphs found online) - inversely with the "reduction in out-of-pocket" expenditures, coincidentally.

3) "Supply of doctors" is a legitimate concern. What IS certain to limit the supply of anything (products, labor, etc.) is "price-fixing". Prices will rise if supplies (physicians) are "short", but the natural reaction is to increase supply (train doctors) where profits (doctors salaries) are high. By intervening with artificially "low prices" the shortage will worsen. Or will import more foreign physicians (already occurring).

The other issue is the "distribution" of physician workforce. We have already seen a dramatic decline of physicians entering Primary Care fields because of "price-fixing" by third parties. (I am one of those idiots who chose Family Medicine despite the fact!) Our health care system is entirely too dependent on "specialist" care - a situation created by a solution to "control costs"!

"Self-rationing" is the true essence of this debate. Who can make more informed and cost-effective decisions about their necessary health care? The individual in consolation with their doctor? Or a committee of "really smart" experts located 1000 miles away?

Ryan Neuhofel 5 years, 9 months ago

4) I'm not sure I fully understand your logic, but there is no dobut that the "less aflluent" have more "self-afflicted' health problems (alcohol, drugs, non-compliance with doctor recommendations) - I know this all to well! But I think the paternalistic nature of Medicaid has created a system where the individual has no "ownership" of their care and actually disincentives health prevention/maintenance. Even if tax-payer supported, "ownership" would increase with direct-subsidies to individuals.

5) "other ways to save money but no one has the interest to adopt many of them" You are 100% correct! Most people (and doctors) will demand the newest "brand name" medication or treatment despite medical evidence that it's minimally (if at all) more effective than the old generic which is 80% cheaper. Why is this? We (doctors and patients) usually have no clue of the actual cost of the medication! "Its only $10 more for a Level 3 copay" . . .When in reality it's $80, but the difference is hidden in premiums. With more price-transparency (along with "self-rationing") more cost-effective decision would be made.

Obviously, as a Family Medicine physician I am biased, but using mid-level providers (PAs/NPs) to "screen everyday problems" is a bad idea on many levels. I certainly see a role for mid-levels, but leading "primary care" is NOT one of them. The most important aspect of medicine is to identify (diagnose) problems early in the process - in terms of health outcomes and cost-effectiveness. The primary distinction of mid-levels versus physicians is the understanding of mechanisms and larger scope of health and disease - which is absolutely vital to process of diagnosing. I actually believe NPs/PAs are fantastic at administering protocols for treatment, but that's typically the role of "specialty" care.

George Lippencott 5 years, 9 months ago

staff04 (Anonymous) says…

Hi, I hope you are right. My read is that what they are saying and where they want to go is different. Under the proposed 010 budget Mr. Obama's people are raising the costs of all current government health care programs (except Medicaid) significantly. I read that as an effort to move most of the recipients of those programs to the new government insurance program. I suspect that program will be a bit more complicated than current insurance as to how one draws benefits in order to reduce costs. The problem I see with a government insurance program is keeping the playing field level so competition is real. The temptation to initially undersell commercial insurance is real. Business will not complain. And then we all wake up insured by the government. Tell me a government program that doesn’t start to lose its shine after implementation. The devils as almost always will be in the details and over time. But who knows - we will just have to wait and watch.

George Lippencott 5 years, 9 months ago

neuhofel (Anonymous) says…

Lot to think about.

1.) I have lots of PA and NP time with the military and VA. I think the screening of simple problems under a doctor’s supervision is well within their capacity. That is my anecdotal observation.

2.) The problem with owning your care is that you really have to own it. If significant portions of the populace are covered by government provided cash and then government provided insurance there is no ownership.

3.) I acknowledged that your proposal would work as you describe it for those who have significant amounts of their own resources in it. However, they will revolt if they get stuck with the bill for the group above while having to self-ration their own and their loved ones' care. We also have to consider whether the self-rationing is in the best interest of society or will we be reducing real and needed medical care.

Interesting topic and I see that I am dealing with an expert in the field.

Ryan Neuhofel 5 years, 9 months ago

George, I am certainly NOT an expert and offended at the assertion! I have zero formal training in economics or any related field. I am a newly graduated doctor who also has a degree in Public Health - which ironically promotes fully "socializing" health care (in general). . . .My teachers did a poor job of convincing me, huh?! Most of my fellow physicians (of all political persuasions) also think I'm crazy with talk of "over-insured" people, as you can imagine.

"whether the self-rationing is in the best interest of society"

"Rationing" is the very foundation for the study of economics. An economist I read often perhaps defines economics most appropriately as "the allocation of scarce resources which have alternative uses". Most people believe that economics is the study of "capitalism, private companies, profits, etc.", but it is a much deeper study that applies to all systems of governance (including socialism). We don't live in Utopia and many resources (land, materials, labor) are not "unlimited" and "scarcities" (not to be confused with shortage, a market phenomenon) do exist. The question is how do we most efficiently allocate those resources to provide the greatest good for all of society (rich and poor alike).

Thanks again for the hearty discussion.

jonas_opines 5 years, 9 months ago

"Public Health - which ironically promotes fully “socializing” health care (in general)… "

Public . . . . health. Not sure I see the irony.

average 5 years, 9 months ago

neuhofel -

Your 4:29 post fascinates me.

In one point you say that people need to "own" their care. As in your other posts in this and other threads... they need to make informed decisions of cost. Seek second opinions. Seek more affordable care. Utilize the market. Find the right doctor. Use the internet. Make good decisions about catastrophic insurance. Shop around for medical care like people buying computers.

Then, in the same post, you say that even NP/PAs, people with 5 or 6 years of medical training, aren't even really qualified to make those kinds of determinations.

See where that's kinda messed up?

Ryan Neuhofel 5 years, 9 months ago

Jonas, the irony is that I, generally a believer that the free-market is the best way to achieve the greatest public good, have an MPH, a field that promotes socialization to achieve the greatest public benefit (which I disagree with).

Average, glad I could fascinate you, but I'm not sure my points are "messed up". I'm not really sure how my two opinions contradict one another. I never said that individuals shouldn't have the freedom to choose the health care provider of their choice (physician, PA, NP, chiropractor, naturopath, barber, butcher, or otherwise!). I, unlike you (I assume), don't want to dictate anything to anyone!

If you can't see the training/education difference between physician (MD/DO) and NP/PAs, then you have no concept of science or medical training. I have many friends and colleagues that are mid-level providers that are honestly probably more intelligent than me and do fantastic work for their patients . . . but they do not have the training of a physician.

average 5 years, 9 months ago

Adam Smith only claimed the free market works by mutually fully-informed participants.

By your definition, 99% of the population is entirely uninformed as to medicine. How do you suggest they make any kind of decisions at all? Their best decision-making strategy is "well, I remember that drug was on the side of the Penske car... sign me up, doc".

And, no, I'm not dictating so much. You are aware that a doctor can hang a shingle and go into private practice, even in crazy commie Red Canada. Patients are fully welcome to pay someone half-a-millon dollars for toenail fungus if they like. Totally legal. There are even private insurance schemes (that vanishingly few people bother with).

Ryan Neuhofel 5 years, 9 months ago

Average, I think we have found some common ground!

The concept of "mutually informed participants" is of great importance to a functioning market - which is something the current third-party health care system actually discourages! (haven't I made this point multiple times already?). I do NOT think people are "incapable" of making their own health care decisions . . . .even Nascar fans! (nice off-topic jab by the way)

I'm sure your also aware of the concept of "by-proxy informed consumer". For example, I really don't understand the inner-workings of my computer or internet service! I think it works by a combination of software (code, graphics, etc.) and hardware (motherboard, CPU, etc) but could never actually build such a product for myself. But I know that it performs the function I want! Does this mean I'm not capable of buying a computer or internet service? I know very little about the internal combustion engines and carburetors, but I know my Honda Civic is reliable transportation. How? Did I inspect the engine for myself and determine it mechanically sound? I can barely change my own oil!

Actually in Canada, private (for-profit) health care/insurance was illegal from 1984 - 2006 when the Canadian Supreme Court ruled that citizens can legally pay for private health care/insurance - although many restrictions still apply and would be false to call it a "free" market. Basically, the Canadian system created an uncontrollable black-market of health care providers to address the demand for care.

Sorry to imply you would dictate care, but I am the only one here who actually provides ideas about health care reform!

Let's hear how we could most effectively design a single-payer system? With actual structure and policies - not your goals or demands of such a system's outcomes.

George Lippencott 5 years, 9 months ago

neuhofel (Anonymous) says…

Didn't mean to offend - clearly you are an expert on the medical side of this issue - quality of care and the like!

I will try to make a point again:

If the market can not respond to the demand - and I don't think it can - then it does not function as a market. To some degree that is way I think we got to where we are!

Ryan Neuhofel 5 years, 9 months ago

George, regardless of your political opionions, you cannot seriously believe that we have a "free" market in health care - at least in the past 50 years. Should I review the history again? Managed Care (HMOs, etc.) would have NEVER existed in a free market driven by the consumer - they were created and propped up by politicians! And now the same experts are claiming they can fix the mess they've created.

My entire thesis is that interference in the free-market (with good intentions and all) has caused these problems - inflation (reducing access) and decreased quality, etc.

I will await your solutions to a better "non-market" system.

average 5 years, 9 months ago

And my thesis, neuhofel, is that without Nixon's interventions (group plan tax incentives, managed care, HMOs, etc) putting plaster on the problem, everyone would know lots more medical 'untouchables' entirely screwed over and killed-by-poverty, and the nation would have demanded and won single-payer coverage 30 years ago.

Ryan Neuhofel 5 years, 9 months ago

So your thesis is that the Government intervention (managed care, etc.) was an attempted solution (albeit a poor one) to fix the problem of medical inflation and reduced access? I also didn't pin you as a Nixon supporter (just kidding)

Although that sounds like a perfectly logical rational, the entire premise (inflation) upon which action (intervention) was taken is patently false - health care costs did NOT rise above regular inflation until the early 1980s and then really skyrocketed 1990s. The statistics don't lie, but if you'd like to challenge your preconceived notions check out any historical graph of "Medical Inflation vs. Consumer Price-Index", found many places online, but a good one here for 1970-2006. . . . http://images.publicradio.org/content/2008/08/04/20080804_inflation_33.jpg

I will preemptively refute your next claim . . . (forgive me) "So who really care's about inflation? I care about people! The sick, old and poor were dying needlessly because they couldn't get access to health care/insurance, so we had to do something"

Life expectancy (admittedly a very poor tool to evaluate quality of a health care system, but single-payer advocates use it on a regular basis, so I'll indulge) since 1900 from the CDC found at . . . . http://www.cdc.gov/nchs/data/hus/hus07.pdf#027 1900 = 47 1950 = 68 1990 = 75 2005 = 77

From 1900 - 1950, with NO Medicare/Medicaid/employer-sponsorship/SCHIP/HIPPA/Medicare Part D, life expectancy increased from 47 to 68 - an obvious dramatic increase, primarily due to "public health" measurements (with some assistance from government, which I'm NOT opposed to for the record) and a few antibiotics/immunizations.

From 1950 - 2005, after the introduction of all of the above programs, we have seen a modest increase in life expectancy even with dramatic advancements in medicine/technology.

To re-state, I actually think that "life expectancy" is a generally a poor marker of health or health care, but the fact remains with virtually NO central (federal) planning or control of personal health care (1900-1950) the general population (rich and poor) lead healthier, longer lives.

By the way, are civil, intellectual conversations even permitted by the LJW? I'd better throw in a few petty political insults to keep the masses interested . . . "Obama is a secret Muslim!" . . . "Sarah Palin faked her own pregnancy and baby's disability for political gain!"

George Lippencott 5 years, 9 months ago

neuhofel (Anonymous) says…

I do not believe that we have had a free market since my childhood

My reading of your suggestions is that the word "ownership" relates to "choice, selection, and other factors you noted.” I define that as a free market solution. I don't believe we can get to a free market given limited availability of providers and heavy subsidy of the less affluent. My ownership of anything is meaningless unless I can actually leverage that ownership to improve care or reduce costs without loss of care.

If that is a political position, who am I supporting – I honestly do not understand your comment!?

Ryan Neuhofel 5 years, 8 months ago

George,

The Nixon comment was a joke! as noted by the (just kidding).

Regarding "ownership", it is the most important factor of all in economics. . . ."The most important decision of all is who shall decide", Thomas Sowell

I don't know how old you are . . . so your "childhood" is sort-of "non-specific" as it relates to time. However, there has been a steady increase in government spending and regulation starting in 1940s, so I would assume you have never lived in a full "free-market" health care system. The federal government (through various programs) currently accounts for half of all health care expenditures.

"unable to get to a free market given limited providers"? So how (or why) would a single-payer/government-ran system increase the number of providers? Physician salaries would certainly decrease under such a system . . . I'll take a wild guess that will decrease the number of young people (whom are notorious greedy) choosing the medical field. Every country that has a government dictated health care (single-payer or otherwise) has seen a steady decline in physicians . . .usually supported by importing foreign-trained doctors or utilizing more mid-levels and nurses. Or maybe we could just demand individuals who show an aptitude for science become doctors? (I'm being facetious to make a point)

Further more, we have already seen the negative impact of "salary controls" (indirectly via third parties) in the American health care system. Primary care docs (family, peds, internal medicine, OB/GYN) have not seen an increase in income in the past 10 years (adjusted for inflation) despite being desperately short in supply (especially in rural states like Kansas). And the number of medical students choosing these fields continues to decline.

Many people feel that physicians make TOO much money and their income should be decreased through government intervention if necessary . . .therefore decreasing the cost of health care for the consumer. But this is a very short-sided position for the exact reasons I outlined above . . . decrease doctor salary . . . decrease number of doctors . . . then what?

I will admit that will never accomplish a truly "free-market" with every single person paying for their own care/insurance (full ownership) - nor do I think that is necessary or desirable. Believe it or not, I'm not a heartless person or an anarchist. As I have said from my first post, we should help people of low incomes (especially children) and the elderly (if necessary). We can argue about what percentage of people really "need help", but I think it's way more important to understand how to best provide that "assistance" and how it effects the rest of the market.

I also realize you (or most people!) will never support what I'm advocating with regards to policy, but I appreciate you critical thinking about the issue and engaging in intellectual debate. . .which is much more than most of my fellow Americans do!

George Lippencott 5 years, 8 months ago

neuhofel (Anonymous) says

1943 and it was pretty much free market limited by availability and understanding

I do not believe in a single payer system for a lot of reasons

Universal coverage is a dream without consderable coersion and a lot of inequity (in reverse)

I do not have an answer. Some hybrid that we can sell to the populace perhaps.

V/r Gel

Ryan Neuhofel 5 years, 8 months ago

George,

I'm very confused whether you believe we have had a free-market in health care or not?! You said the "free-market" caused the current problems ("market unable to meet demand") and now you are saying we haven't really had a "free-market" since 1940s? What gives? Have I finally convinced you we've never really had a "free-market" in health care?

In 1943, personal medical care had just recently become a fairly worthwhile service (in terms of actually improving morbidity/mortality) . . . understandibly there wasn't much demand from the public or a "market" until that time . . .thus the "limited availability". Even in 1943, a physician was very limited in their tools.

The first government intervention into the health care market was 1942 with the employer-tax exemptions that accompanied WWII wage and price controls. Thus, I don't believe we have EVER had a fully consumer-driven market in the history of America.

I also don't believe we must create a single-payer or government-payer system to achieve "universal" coverage. In fact, I think implementing some of the principles I have promoted could achieve "universal" care while improving quality and with much less burden on the taxpayer.

While I can appreciate the virtue of compromise, a "hybrid" system is what we have now. For better or worse, health care will be "reformed" in the near future. Unfortunately, I think the American public has such a distorted view of history and has misidentified the culprits of the problem. . . and we will likely continue on the same path as we have for the past 60 years. . .increasing government involvement slowly with compromise.

Politically, my personalized vision of health care is very unlikely to occur. I do not trust any politician to "fix the system". . . we will undoubtedly get a half-baked "compromise" with no major changes. However, I think physicians should do everything possible to create a more patient centered medical practice regardless of the obstacles . . . which is what I plan on doing.

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