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Right, good luck with that.

In one recent issue of the Wall Street Journal there is an article reporting on the health care plans of Obama and McCain. The story relates the results of a study by the nonpartisan Tax Policy Center. Its conclusion is that Obama’s plan will add about 34 million people to those covered by health insurance and will cost $1.6 trillion over 10 years (yikes, that even more than AIG’s assets). The McCain Plan will cost $1.3 trillion over the same period and would, in their view, add far fewer people to the insured roles, only about 5 million temporarily.

In the same issue of the paper, there is an opinion piece by a Harvard professor who is an advisor to the Obama campaign. He says that the Obama plan will save money, lower premiums by $2,500 for the typical family (that is nearly 25% by the way), plus employer costs will fall by $140 billion (because of more people being covered).

How will these savings be achieved? Well, better information about the best health care providers will be available, Medicare and Medicaid payments will be based on outcomes thus rewarding the better doctors and hospitals (except that has nothing to do with the vast majority of what Americans pay for health insurance), pooling, that is allowing small groups to pool their risk. Not a bad idea really, but one that may lower some premiums and does nothing to affect underlying costs and finally, there is preventive services, screenings, lifestyle information, etc. Most large employers have been pushing this one for years and investing heavily in the process with little to show for it. In fact, there are studies that show this can actually increase costs in the short run and there is no evidence showing that even over the long run there is a cost benefit.

None of the above ideas are new of course and yet for nearly fifty years Congress has failed to do anything other than to create programs that simply add to costs. However, I have to say, the view presented is consistent with a 50,000-foot view on how to solve every problem.

So, ya pays your money and you takes your choice¦just base your decision on the facts please. Where did they put those by the way? :rolleyes::rolleyes:

The problem with these figures is that most other developed nations provide *more* health services at *less* cost than we are already spending (less meaning less percentage of national spending).

The report assumes that we are keeping with the current health care system and policies. That is not Obama's proposal. What fundamentally needs to happen is a shift from disease treatment to disease prevention. As it is, we don't have a "health care" system at all, but an industry that makes more money the sicker people are.

But to put a dollar amount into perspective ... 1.6 trillion is probably about half the cost of the Iraq war (to date):

http://www.pbs.org/newshour/bb/military ... 03-26.html

According to the WSJ and PBS, we just spent 20 years worth of health care for Americans on killing one person (and Saddam wasn't even an immediate threat). Kinda sick isn't it?

yaaarrrgg;986577 wrote: The problem with these figures is that most other developed nations provide *more* health services at *less* cost than we are already spending (less meaning less percentage of national spending).

The report assumes that we are keeping with the current health care system and policies. That is not Obama's proposal. What fundamentally needs to happen is a shift from disease treatment to disease prevention. As it is, we don't have a "health care" system at all, but an industry that makes more money the sicker people are.

But to put a dollar amount into perspective ... 1.6 trillion is probably about half the cost of the Iraq war (to date):

http://www.pbs.org/newshour/bb/military ... 03-26.html

According to the WSJ and PBS, we just spent 20 years worth of health care for Americans on killing one person (and Saddam wasn't even an immediate threat). Kinda sick isn't it?


That simply is not true, they do not provide more they effectively ration care in one form or another by limited coverage (supplemental coverge is necessary) or care is simply delayed or not provided to some people. There is a lot wrong with our health care system, over use is one of the main factors because we incent providers to provide more care not the right level of care.

But feel good nonsense about saving a lot of money on prevention and education etc. is not going to save money. Just look at the tons of information out there now about healthy lifestyles, exercise and all that goes with it. Most health plans have expanded coverage to include many screenings as has Medicare. Do you see an abatement of health care costs? There isn't any and basing savings on that premise is just pie in the sky, just like nearly 16 years ago when Clinton held up a mock health care ID card that was going to coordinate health care records and services. Have you got yours?

I know, change is coming. Don't count on it.

Personally I like Germany's system. They provide more care, as in more people are covered. Wait times are reasonable, if not better than U.S. And it's cheaper:

http://www.npr.org/templates/story/stor ... d=91971406

The issue isn't making our health care system work harder, but smarter.

ETA: Nearly every German has ready access to doctors, cheap drugs, high-tech medicine, dental care, nursing homes and home care. All this — and Germany spends about half what the United States does per person.

This isn't feel good rhetoric. If we were smart, we'd cherry pick the best parts of working systems.

yaaarrrgg;986890 wrote: Personally I like Germany's system. They provide more care, as in more people are covered. Wait times are reasonable, if not better than U.S. And it's cheaper:



http://www.npr.org/templates/story/stor ... d=91971406



The issue isn't making our health care system work harder, but smarter.



ETA: Nearly every German has ready access to doctors, cheap drugs, high-tech medicine, dental care, nursing homes and home care. All this — and Germany spends about half what the United States does per person.



This isn't feel good rhetoric. If we were smart, we'd cherry pick the best parts of working systems.
Their practices are un-American, for lack of a better word. This was linked off yours, talking about keeping doctors on a budget.

How Doctors Get Paid

Nearly all hospital-based doctors are salaried, and those salaries are part of hospital budgets that are negotiated each year between hospitals and "sickness funds" — the 240 nonprofit insurance companies that cover nearly nine out of 10 Germans through their jobs. (About 10 percent, who are generally higher income, opt out of the main system to buy insurance from for-profit companies. A small fraction get tax-subsidized care.)



Office-based doctors in Germany operate much like U.S. physicians do. They're private entrepreneurs who get a fee from insurers for every visit and every procedure they perform. The big difference is that groups of office-based physicians in every region negotiate with insurers to arrive at collective annual budgets.



Those doctor budgets get divided into quarterly amounts — a limited pot of money for each region. Once doctors collectively use up that money, that's it — there's no more until the next quarter.



It's a powerful incentive for doctors to exercise restraint — not to provide more care than is necessary. But often, the pot of money is exhausted before the end of the quarter.

We need LESS gov't interference, not more. If we had let AIG and the insurance system collapse we'd have been in far better shape in the long run. Costs would have dropped without insurers arificially propping up prices.

Also, Germany's 1/3 the population of the US. If a state wants to adopt Germany's system, I say fine, but keep the federal gov't free to do the job they're assigned by the Constitution.

I don't have a problem with this being done at the state level, but there still needs to be a regulatory structure at the federal level so that all the states can speak the same language. Germany's government mostly handles the regulation ... they don't pump near the amount of money into it as we do (I'm talking percentage of national spending).

What we are lacking is regulation...or at least regulation that's designed to help drive the cost down rather than up.

One interesting difference is that German doctors get financially rewarded for preventing disease, not merely treating it. Meaning they get more money, the healthier their patients are. It's tough to do that in a free market system.

The pay issue is worth looking at.

American doctors aren't necessarily making a lot more, even though we are paying them more. When we talked to our OBGYN a few years back, she said she had to quit her previous practice, because she wasn't even making minimum wage after she paid for her malpractice insurance.

The article says German doctors get an *average* income of $123,000/year. Given that we are pumping twice as much money/per person into the system, it strikes me that we could pay doctors twice as much as Germany does. And that's already in line with what U.S. doctors make.

Table 1. Total compensation of Physicians by Specialty; 2002

Anesthesiology -- $306,964

Surgery, general -- $255,438

Obstetrics/Gynecology -- $233,061

Internal medicine -- $155,530

Pediatrics/Adolescent medicine $152,690

Psychiatry -- $163,144

Family Practice -- $150,267

From Physicians and Surgeons. Medical Group Management Association, Physician Compensation and Production Report, 2003.

yaaarrrgg;987289 wrote: I don't have a problem with this being done at the state level, but there still needs to be a regulatory structure at the federal level so that all the states can speak the same language.
Why? I don't see the need.

Accountable;988277 wrote: Why? I don't see the need.


If you have insurance in Germany, you can go any country in the EU and you are covered. We need the states to be seamlessly integrated, so that if you are injured in one, it's no hassle.

If we leave it purely up to the states, we're going to end up with 50 different systems, without any guarantee of interoperability. We don't even have consistency across healthcare providers, let alone hosptitals. It's also a big reason why a lot of hospitals keeps records on paper rather than computer, because their systems are a big mess even internally.

But if you are talking "need" as in why do we need electricity and running water, you are right. We could go without. I don't see the need for roughing it though, just for the sake of being a minimalist.

posted by yaaarrrgg

This isn't feel good rhetoric. If we were smart, we'd cherry pick the best parts of working systems.


Why don't you just do that? Seems instead of just deciding what would be the best way to provide healthcare you send all your time debating whether you even have the right to consider it at all. You notice there are no European countries discussing copying you.

from the article

Germans really hate any hint of unfairness in health care. The fundamental idea is that everybody must be covered and, preferably, everybody should get equal treatment. So the fact that 10 percent or so can buy some perks is an irritant — something Germans complain about but manage to put up with.


That's a sentiment you will find elsewhere in europe. Americans don't seem to have any real sense of social justice-that people should be treated fairly when it comes to things like education and medical care.

gmc;988727 wrote: posted by yaaarrrgg



Why don't you just do that? Seems instead of just deciding what would be the best way to provide healthcare you send all your time debating whether you even have the right to consider it at all. You notice there are no European countries discussing copying you.

from the article



That's a sentiment you will find elsewhere in europe. Americans don't seem to have any real sense of social justice-that people should be treated fairly when it comes to things like education and medical care.


I've never heard a single person that moved here from another country, my husband included, that said they had it better in the country they came from.

sunny104;988739 wrote: I've never heard a single person that moved here from another country, my husband included, that said they had it better in the country they came from.


We rank just above Slovenia, in health care (from the World Health Organization report). Our infant mortality rate is the worst of all developed countries. We don't live as long either. We are the most unhealthy, overweight country on Earth.

I hope we are still competitive in some areas, but health is not one of them.

gmc;988727 wrote: That's a sentiment you will find elsewhere in europe. Americans don't seem to have any real sense of social justice-that people should be treated fairly when it comes to things like education and medical care.


I totally agree.

The difference in mindset is that Americans are fearful that some "poor sap" is going to get a free lunch. But what they don't realize is that they when our politicians refer to that "poor sap" they are referring to 95% of the population. We've ended up cutting off our nose to spite our face. It's destroying the middle class slowly but surely. Sooner or later, we will all be that sap, as the dice will fall differently at different times.

If the U.S. collapses, I think the main cause will be short-sighted selfishness, and greed. These have been elevated to high virtues here. It's how we clawed our way to the top. But it will also be our demise. Not a day goes by, that a giant chunk of the country falls off into the ocean. Right now it's the economy collapsing.

Medical bills are the biggest reason for bankruptcy here. When my son was born he was in the hospital for three weeks and needed a surgery. It ended up costing well over $250,000 dollars (seems a bit overpriced, but that's just me). Fortunately I had health insurance that paid most of it. But what if a person loses their job and health insurance the week before? It's not fair to someone if that happens, and it could have very well have been me. But Americans don't think about the other guy who's not as lucky. It's only by luck of the dice it wasn't me.

yaaarrrgg;988660 wrote: If you have insurance in Germany, you can go any country in the EU and you are covered. We need the states to be seamlessly integrated, so that if you are injured in one, it's no hassle.



If we leave it purely up to the states, we're going to end up with 50 different systems, without any guarantee of interoperability. We don't even have consistency across healthcare providers, let alone hosptitals. It's also a big reason why a lot of hospitals keeps records on paper rather than computer, because their systems are a big mess even internally.



But if you are talking "need" as in why do we need electricity and running water, you are right. We could go without. I don't see the need for roughing it though, just for the sake of being a minimalist. :)What you're discribing isn't a regulatory structure. States honor each other's drivers licenses, etc. There should be no reason they can't honor each other's insurance, if a given state decides to offer it, that is.

Accountable;989384 wrote: What you're discribing isn't a regulatory structure. States honor each other's drivers licenses, etc. There should be no reason they can't honor each other's insurance, if a given state decides to offer it, that is.


You might be right, in that it could work. Although I'm just thinking from a practical point of view, that we should take a working system (like in the EU) and emulate the best parts of it. The BMV is not a great model of how to run a government agency.

yaaarrrgg;989691 wrote: You might be right, in that it could work. Although I'm just thinking from a practical point of view, that we should take a working system (like in the EU) and emulate the best parts of it. The BMV is not a great model of how to run a government agency.
That's my point; the EU doesn't have a system. Its states have their systems. Unless I'm wrong, if an American goes to another state and becomes sick or injured, her insurance is still honored, so that part's already in place. If voters (even Texas ones) decide that they want their state to turn (more) socialist and take over citizens' individual responsibility for healthcare, then I'd honor that decision. The federal gov't is specifically barred by the Constitution from taking the same action..... or at least it was when it was still in effect.