Medicare is a Good Model?

[QUINNSCOMMENTARY]

I am still waiting for someone to define “affordable health care,” but that is another story. Let's try something else for now.

Before I go with some ideas on fixing health care in America, let us agree on what is wrong (maybe).

Argument number 1

A major portion of the cost is the administration fees by insurance companies especially when compared with Medicare. Wrong

While Medicare has lower administrative costs that is largely because much of what Medicare does to run the program is not counted in the administration costs like an insurance company, things like advertising, promotion, and salaries of many people. In addition, Medicare serves a different population and large percentage of its costs are in-patient with different administrative processes. On top of that, many experts think Medicare’s costs should be higher to better control fraud and abuse and handle customer service. I got that from speaking with a former Director of the OMB.

Coincidently, today’s paper reports on Medicare payments of $100 million to scams using dead doctors. In addition, the Department of Health and Human Services reports that Medicare improperly paid out $12.1 billion in claims in 2005 and $21.7 billion in 2004. That’s a B mind you.

Okay everyone makes mistakes, but this problem was first reported to the Feds seven years ago and nothing was done. Do you think an audit report in a private company would go ignored for seven years? Not likely especially if it involved money out the door.

For example, I recently learned that our health plan administrator found upon audit that they were not paying claims properly for our retired employees and overpaid $5 million over four years. They acknowledge the error and agreed to reimburse us in full and not to seek reimbursement from our retirees, we signed an agreement and I had the money in a few weeks. That is because both of our necks were on the line.

In the bureaucratic government few people care because they do not have to, they are secure, buried under layers of government or will move on with the next administration.

For the 70 million Americans covered by private self-funded employers, administrative costs average about 8%. That is to pay claims, check for fraud, maintain networks of doctors, process enrollments, etc. and payments for these services are made on a per employee per month basis so that the company (typically a large insurance organization) paying claims has no incentive to pay more or less in claims, but rather to pay them correctly. The higher costs for small employers and individual policies can be resolved by consolidating coverage and allowing employers to aggregate into larger groups which in many cases is not permitted now.

I know, some insurance companies have been fined and otherwise gotten into trouble for questionable practices, but that seems to reinforce the point that when there is a problem, it is fixed, not so with the federal government too much of the time.

Why would anyone want a federal bureaucracy running anything if it could be avoided?

[Accountable]

Nothing's wrong with our healthcare. We have some of the most skilled and brilliant medical professionals in the world, and our facilities can match against others worldwide.

The problem is paying for it.
The problem is that drug companies are restricted from making a profit in most of the rest of the world, so they make up their margins here, where there's freedom.
The problem is that people no long think that healthcare is important enough to take an active interest in; rather they've bought into the notion that taking care of their own health is the responsibility of the government, insurance companies, employers, or anyone other than the individual.
The problem is that our culture promotes spending and devalues saving.

The fix?
Outlaw insurance. That'd be a good start. Taking that option off the table leaves us choosing off the Kama Sutra menu, because we're screwed no matter what.

[QUINNSCOMMENTARY]

The problem is paying for it.
The problem is that drug companies are restricted from making a profit in most of the rest of the world, so they make up their margins here, where there's freedom.
The problem is that people no long think that healthcare is important enough to take an active interest in; rather they've bought into the notion that taking care of their own health is the responsibility of the government, insurance companies, employers, or anyone other than the individual.
The problem is that our culture promotes spending and devalues saving.

The fix?
Outlaw insurance. That'd be a good start. Taking that option off the table leaves us choosing off the Kama Sutra menu, because we're screwed no matter what.

Unfortuantely, that is not accurate, many studies have shown that as many as 50% of patients do not receive the correct care from their doctor. An as much as 50% of care provided is not appropriate or necessary.

[Accountable]

Originally Posted by QUINNSCOMMENTARY

Unfortuantely, that is not accurate, many studies have shown that as many as 50% of patients do not receive the correct care from their doctor. An as much as 50% of care provided is not appropriate or necessary.

What's not accurate? How does that (debatable) 50% number compare with other countries?

[QUINNSCOMMENTARY]

Originally Posted by Accountable

What's not accurate? How does that (debatable) 50% number compare with other countries?

Nothing to debate. Check out these sites if you are interested.

http://www.commonwealthfund.org/publ...?doc_id=221238

http://www.ncbi.nlm.nih.gov/pubmed/9879302

Then look at the US ranking on infant mortality rate, we are 180 on the list with the best standing at 220, the worst is # 1 So 40 countires have a better infant mortality rate than the US, including Spain, Japan, Germany, Isreal, Iceland, and Australia.

[Accountable]

Originally Posted by QUINNSCOMMENTARY

Nothing to debate. Check out these sites if you are interested.

http://www.commonwealthfund.org/publ...?doc_id=221238

http://www.ncbi.nlm.nih.gov/pubmed/9879302

Then look at the US ranking on infant mortality rate, we are 180 on the list with the best standing at 220, the worst is # 1 So 40 countires have a better infant mortality rate than the US, including Spain, Japan, Germany, Isreal, Iceland, and Australia.

Those are awesome sources. Thanks. I'll check the second one in our school's databases to see if I can find the full text.

Okay, we suck in some (maybe many) areas, but we are stellar in others, otherwise people wouldn't come here for medical care.

Now, in addition to imperfect healthcare, we have a payment system that is horrible. IMO it has severely damaged our culture.

[Nomad]

Originally Posted by Accountable

Those are awesome sources. Thanks. I'll check the second one in our school's databases to see if I can find the full text.

Okay, we suck in some (maybe many) areas, but we are stellar in others, otherwise people wouldn't come here for medical care.

Now, in addition to imperfect healthcare, we have a payment system that is horrible. IMO it has severely damaged our culture.

Pharmacuetical companies cant be ignored in the cost of health care in America. The profits they seek are directly related to the ability to pay.
Any given drug may cost $$$$ in America but the same drug manufactured by the same company might cost only $$ in Mexico.
Why ? Isnt that price gouging ?

In countries like Canada the government manages the health care system and hence the bypass heart surgery cost in these countries is less. The bypass heart surgery cost also increases because of the cost of the medications in the United States of America. The cost of the surgical bed is also higher in US than in other countries. These components of the heart surgery increases the bypass heart surgery cost.

http://www.surgery-guide.com/bypass-...gery-cost.html

[Accountable]

Originally Posted by Nomad

Pharmacuetical companies cant be ignored in the cost of health care in America. The profits they seek are directly related to the ability to pay.
Any given drug may cost $$$$ in America but the same drug manufactured by the same company might cost only $$ in Mexico.
Why ? Isnt that price gouging ?

In countries like Canada the government manages the health care system and hence the bypass heart surgery cost in these countries is less. The bypass heart surgery cost also increases because of the cost of the medications in the United States of America. The cost of the surgical bed is also higher in US than in other countries. These components of the heart surgery increases the bypass heart surgery cost.

http://www.surgery-guide.com/bypass-...gery-cost.html

We have to ask the question "why". Why are prescription drugs so high that the average customer can't afford them? Why such astronomical prices in the land of supply and demand? Wouldn't it make sense that since people can't pay those prices for drugs that drug companies would naturally have to lower their prices? I think the answer would be yes if not for one factor:

Insurance companies.

People have come to depend on insurance companies and the convenience they bring. They can depend on insurance for emergencies and so they don't feel the need to save. That part of the budget is paid for. The insurance companies, in turn, establish payment standards with drug companies. Companies naturally charge the maximum allowed. It's become an automatic system with built-in increases that virtually no one pays attention to. The same goes for other medical services as well.

Take away the insurance company and prices will drop like the proverbial stone. Of course it won't happen because there's no trust of our fellow man anymore. People trust politicians more than their own neighbors.

[Nomad]

People trust politicians more than their own neighbors.

That I will take exception to.
(Except for the neighbor that flicks cig butts on my lawn, them I dont trust)

[QUINNSCOMMENTARY]

Originally Posted by Nomad

Pharmacuetical companies cant be ignored in the cost of health care in America. The profits they seek are directly related to the ability to pay.
Any given drug may cost $$$$ in America but the same drug manufactured by the same company might cost only $$ in Mexico.
Why ? Isnt that price gouging ?

In countries like Canada the government manages the health care system and hence the bypass heart surgery cost in these countries is less. The bypass heart surgery cost also increases because of the cost of the medications in the United States of America. The cost of the surgical bed is also higher in US than in other countries. These components of the heart surgery increases the bypass heart surgery cost.

http://www.surgery-guide.com/bypass-...gery-cost.html

Other countries fix the price of drugs so drug companies make up the difference in America, the result is the American consumers subsidize much of the rest of the world. Now, if you want the US to cap the prices as well, then you risk the reduction in research, because the financial incentive is not there.

When you say "the government manages the health care system" you really mean that it controls prices and then directly and indirectly it controls the care that is being rendered and when.

No government can control health care costs without some form of rationing. Health care providers make less, less health care is provided and/or some people do not get all the care they may want. Take your choice.