Join In On The Action "Register Here" To View The Forums

Already a Member Login Here

Board index Forum Index
User avatar
Statesman
 
Posts: 10979
Joined: 15 Aug 2000, 8:59 am

Post 08 May 2017, 1:45 pm

ray
Why can't there be competition in health care? There are many doctors, hospitals, pharmaceuticals, etc. to choose from. We have competition in food and we often cannot delay that purchase.

When you go into a store the prices for the products are on the shelf. Same with most other products or services offered to consumers...
When you go into a doctors office.... or a hospital, the prices for a medical procedure are rarely advertised. (A rare exception being laser eye surgery which is entirely optional. And which, because there is true elasticity in demand, has gone down in price.) I think if pricing is not a feature of the marketing of a medical service, or practitioner, then its self evident that price competition is not occurring.
To argue, why not? as you do, is not offering evidence that there is actual price competition now is it? (If ever there was an unsupported argument its "why not?" ..)

The reason there is no competition is because doctors and hospitals don't really want to compete on price. And because patients aren't empowered to shop like any other commodity. ( def: a substance or product that can be traded, bought, or sold:)
If you want to prove that wrong, find evidence that there is transparency on pricing ...
Just so you know; the AMA forbade advertising by doctors until 1982....
A major component of a competitive market place is advertising and marketing... It doesn't do much good to compete on price, when you can't tell the market place you are doing so...
And interestingly, since a 1982 SCOTUS ruling that allowed advertising .... there has been no significant change. Price and cost are not a feature of medical services advertisements .
You ask why not? Because they don't have to compete on price. So they don't.

Rayjay
Also, are you now arguing that health care should be a regulated monopoly?

Right now, in the US, health care sector is an unregulated oligopoly. Not that there aren't lots of competitors, its just that they really aren't competing, at least on price to the end user.
That's why medical procedures and pharmaceuticals are so much more expensive than in nations where the industry is regulated. Comparisons here.
http://www.investopedia.com/articles/pe ... ntries.asp

Regulated industries come with their own problems, but right now runaway cost is driving more and more Americans into difficult decisions. Even Trump noted that he would negotiate better drug prices .... in several of his rambles. When medicaid was not allowed to negotiate with pharmaceutical companies .... you've got an oligopoly protected by Congress.
Here's how drugs are an oligopoly...
Drug manufacturers in the U.S. set their own prices, and that’s not the norm elsewhere in the world.
The US allows “government-protected monopolies” for certain drugs, preventing generics from coming to market to reduce prices.
The FDA takes a long time to approve generic drugs.
Sometimes, state laws and other “well-intentioned” federal policies limit generics’ abilities to keep costs down.Pharmacists in 26 states are required by law to get patient consent before switching to a generic drug, the authors wrote. This reportedly cost Medicaid $19.8 million dollars in 2006 for just one drug: a statin called simvastatin whose brand name is Zocor. Costs ran higher because pharmacists didn’t get patient consent and Medicaid had to pay for the costlier brand name drug even though a cheaper product was available.
http://time.com/money/4462919/prescript ... -too-high/

rayjay
Who should own the 18% of the US economy that provides health care?

The reason that 18% of your GDP is taken up by health care, is because of ideology.
In other countries its 9 to 12% ... Because people decided that
1) health care is a right, not a product or commodity.
2) regulation ensures that providers and service vendors can be profitable despite and sometimes because of regulation.
3) heath insurance companies provided administrative costs and overhead without providing value.
Administrative costs accounted for 25 percent of hospital spending in the United States, more than twice the proportion seen in Canada and Scotland, which spent the least on administration. Administrative costs were notably higher in the Netherlands (20%) than in other European nation.

http://www.commonwealthfund.org/publica ... tive-costs
User avatar
Statesman
 
Posts: 10979
Joined: 15 Aug 2000, 8:59 am

Post 08 May 2017, 2:10 pm

Fate
Thank you for refuting an argument I DID NOT MAKE

You said "most people..." SO what.
It doesn't matter whether its employee provided health insurance or private insurance. The battles with the insurance companies are similar. The motivations are the same. Increased profit.
Some of the nation’s biggest insurance companies—
Allstate, AIG, and State Farm among others—have
denied valid claims in an attempt to boost their bottom
lines. These companies have rewarded employees who
successfully denied claims, replaced employees who
would not, and when all else failed, engaged in outright
fraud to avoid paying claims.

https://www.justice.org/sites/default/f ... actics.pdf

And the administrative costs for doctors and hospitals dealing with insurance companies are similar.
The complexities of health insurance are designed to work in the favor of the Insurance companies. Both by denying claims, slowing claims and discouraging patients in pursuing rightful payment.
Moving to medicare for all could not be worse. Medicare has no profit motive.


Fate
Oh, and even Canada is imperfect!

That's true. Norway, France Japan...pretty much every where but the US is better than Canada.
You may be interested, (well maybe others will be) in the outcome to the unfortunate Ms. Shamblaw,
Her case was one where medical practitioners argued over the efficacy of the proposed treatment (relapsed patients versus those in remission.)
It was never about cost.... And her family never incurred a medical bill.

May 2, 2016 /
TheStar.com – News/Canada – Health Minister Eric Hoskins lifts the ban on U.S. transplants for “relapsed” blood cancer patients and promises to open an extra transplant centre at Sunnybrook.
May 01 2016. By: Diana Zlomislic, News reporter

http://spon.ca/ontario-opens-access-to- ... 016/05/02/

In a democracy where the provincial government needs to be responsive to voters, the health care system needs to be responsive. So a solution was arrived at,....
Not perfect.
But, on most metrics, better than whats on offer in the US.
User avatar
Ambassador
 
Posts: 21061
Joined: 15 Jun 2002, 6:53 am

Post 08 May 2017, 4:14 pm

rickyp wrote:Fate
Thank you for refuting an argument I DID NOT MAKE

You said "most people..." SO what.
It doesn't matter whether its employee provided health insurance or private insurance. The battles with the insurance companies are similar. The motivations are the same. Increased profit.


Wrong. Just wrong. If socialized medicine were better, you and your ilk would have not shrunk from the fight in 2009. Obama, the great salesman, didn't even try.

The truth is most Americans with insurance are satisfied. They don't want "Medicare for all." It's only ideologues and the young (who don't know better) who are clamoring for it.


But, on most metrics, better than whats on offer in the US.


So, stay out of our country. And, it's not really "better" in Canada if one cannot get treatment.
User avatar
Ambassador
 
Posts: 4791
Joined: 08 Jun 2000, 10:26 am

Post 09 May 2017, 5:23 am

Fate:
The truth is most Americans with insurance are satisfied. They don't want "Medicare for all." It's only ideologues and the young (who don't know better) who are clamoring for it.


Although we totally share profound annoyance at Ricky including his inaccurate use of language and dishonest rhetorical style, I do think you are missing what is going on here. For those of us without employer or government provided health insurance, this is a crisis. If you worked for an organization that provided health insurance till age 65 and Medicare kicks in, you are immune. Otherwise one is basically forced to continue working or arrange their affairs to go on the dole. Even moving interstate will be challenging. This has gone from the theoretical to impacting my life plans. (I used to think I would retire when my youngest went off to college. Now I can only retire when my wife clears 65 so we can both move on to Medicare.) Health insurance is now a big risk for anyone engaged in entrepreneurial activity.

Yes, the ACA made it worse. Yes, a rational government policy with respect for market forces would be better. But we are now in the worst of all possible positions with heavy government intrusion coupled with heavy profit motive (which is different than a free market). Trump's plan doesn't significantly change that. It does save oodles of money. It does get rid of some of the oddities of the ACA. But it also creates many more people who will not have health insurance in the 50 to 65 range when employment gets tougher and tougher, and health insurance gets more and more expensive.
User avatar
Dignitary
 
Posts: 3219
Joined: 02 Oct 2000, 9:01 am

Post 09 May 2017, 6:48 am

Ray Jay wrote:Fate:
The truth is most Americans with insurance are satisfied. They don't want "Medicare for all." It's only ideologues and the young (who don't know better) who are clamoring for it.


Although we totally share profound annoyance at Ricky including his inaccurate use of language and dishonest rhetorical style, I do think you are missing what is going on here. For those of us without employer or government provided health insurance, this is a crisis. If you worked for an organization that provided health insurance till age 65 and Medicare kicks in, you are immune. Otherwise one is basically forced to continue working or arrange their affairs to go on the dole. Even moving interstate will be challenging. This has gone from the theoretical to impacting my life plans. (I used to think I would retire when my youngest went off to college. Now I can only retire when my wife clears 65 so we can both move on to Medicare.) Health insurance is now a big risk for anyone engaged in entrepreneurial activity.

Yes, the ACA made it worse. Yes, a rational government policy with respect for market forces would be better. But we are now in the worst of all possible positions with heavy government intrusion coupled with heavy profit motive (which is different than a free market). Trump's plan doesn't significantly change that. It does save oodles of money. It does get rid of some of the oddities of the ACA. But it also creates many more people who will not have health insurance in the 50 to 65 range when employment gets tougher and tougher, and health insurance gets more and more expensive.


Absolutely true. Every word. Though I would go further and say that it's not only broken for individuals like Ray and myself, but it's also broken for larger employers, who are paying more and more for their health insurance benefits rather than increasing profits or paying their workers more.
User avatar
Dignitary
 
Posts: 3219
Joined: 02 Oct 2000, 9:01 am

Post 09 May 2017, 6:51 am

Doctor Fate wrote:The truth is most Americans with insurance are satisfied. They don't want "Medicare for all." It's only ideologues and the young (who don't know better) who are clamoring for it.


The only people in America who are satisfied with their insurance are either people who don't pay for it, and/or don't use it.
User avatar
Statesman
 
Posts: 10979
Joined: 15 Aug 2000, 8:59 am

Post 09 May 2017, 7:51 am

fate
Wrong. Just wrong. If socialized medicine were better, you and your ilk would have not shrunk from the fight in 2009. Obama, the great salesman, didn't even try.

It seems to me that there was an enormous effort made. For several decades. Your political system isn't all that responsive to the needs of the electorate, meeting the needs of lobby groups and interest groups more readily.
America's healthcare industry has spent hundreds of millions of dollars to block the introduction of public medical insurance and stall other reforms promised by Barack Obama. The campaign against the president has been waged in part through substantial donations to key politicians.

https://www.theguardian.com/world/2009/ ... are-reform

And yet you ended up with the ACA. Admittedly an improvement but not a great solution.
And a solution that was apparently more popular then Obama Care.
https://www.nytimes.com/2017/02/07/upsh ... .html?_r=0

Still it is apparently better than what House republicans and Trump have on offer....
An AOL News poll finds 57 percent said they prefer the Affordable Care Act (Obamacare). Meanwhile, only 30 percent of respondents said they prefer the AHCA. Another 13 percent of respondents said they weren't sure which legislation they preferred.

https://www.aol.com/article/news/2017/0 ... /21904839/

The fact is that the US has reached a tipping point on this issue.
Presented with three separate scenarios for the future of the Affordable Care Act (ACA), 58% of U.S. adults favor the idea of replacing the law with a federally funded healthcare system that provides insurance for all Americans

http://www.gallup.com/poll/191504/major ... ystem.aspx

Ray
Yes, a rational government policy with respect for market forces would be better

Market forces in health care are like unicorns.
You believe these market forces exist in the health care industry, even though there is no evidence they exist. Or worse they actually do exist but are such that they create conditions such that only the wealthy are really in the market.
Its the inability to admit what the rest of the modern world recognizes that has taken the US to this point.
18% of GDP versus 9% to 12%...
freeman3
We spend far more on health care than other advanced western countries, we don't live as long, and we have more chronic disease. http://www.commonwealthfund.org/publica ... erspective
User avatar
Adjutant
 
Posts: 3047
Joined: 17 May 2013, 3:32 pm

Post 09 May 2017, 8:40 am

Thought you guys might find this study interesting as it tries assess whether there are sub-groups of patients that generate a high-percentage of all overall health care costs. The biggest sub-group of people they identified are those with chronic conditions and--as opposed to those people in the last year of life or those who have a temporary condition like a heart attack or treatable cancer whose condition thereafter becomes stable--those patients have high health care costs for multiple years. I suspect that while costs will go down under single-payer we're still going to be at the top-end of health care costs (compared to other western nations) because of an overall poorer diet, more stress on people due to a more competitive society, a weaker safety net, and more income stratification.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4638261/

I think Ricky has made persuasive arguments that health care does not lend itself to the type of market competition that will hold down costs. As he noted, health care providers do not compete on cost (quality, yes). Before insurance, demand at least was more elastic. When people had to pay money out of their own pocket they thought about incurring health care costs. Insurance changes that calculus. You just think about getting the health care you need and health care providers have the incentive of providing all of the care you need. So demand is very inelastic, which drives up costs.

Once a society transitions to insurance with regard to paying for health care, demand becomes inelastic, there is insurance to pay for it so there is no incentive for patients or health care providers to hold down costs, and there is every incentive to provide more and more care. Administrative staff increases on both the medical provider side and insurance side to deal with increased claims. Costs skyrocket. The only way to rein that in is to go single-payer and force a sort of triage, cut down on administrative costs, and cut down on unnecessary care because either it will not be reimbursed or at a low enough rate to discourage it. Medical providers adjust and focus on providing essential care. You see that already with Medicare.
User avatar
Ambassador
 
Posts: 21061
Joined: 15 Jun 2002, 6:53 am

Post 09 May 2017, 9:55 am

Ray Jay wrote:Fate:
The truth is most Americans with insurance are satisfied. They don't want "Medicare for all." It's only ideologues and the young (who don't know better) who are clamoring for it.


Although we totally share profound annoyance at Ricky including his inaccurate use of language and dishonest rhetorical style, I do think you are missing what is going on here. For those of us without employer or government provided health insurance, this is a crisis.


Friend, I'm not in disagreement with you. Again, look at my wording.

"most Americans with insurance are satisfied."

Previously, I'd said something about employer-based insurance.

Here are the facts:

"Of the subtypes of health insurance, employment-based insurance covered the most people (55.4 percent of the population), followed by Medicaid (19.5 percent), Medicare (16.0 percent), direct-purchase (14.6 percent) and military health care (4.5 percent)."


So, excluding government-provided healthcare, we're talking about, what, 80% is employer-based?

If you ask most of that 80% if they would prefer "Medicare for all," you'd get a hearty "NO!!!"

That's my point.
User avatar
Ambassador
 
Posts: 21061
Joined: 15 Jun 2002, 6:53 am

Post 09 May 2017, 10:01 am

rickyp wrote:fate
Wrong. Just wrong. If socialized medicine were better, you and your ilk would have not shrunk from the fight in 2009. Obama, the great salesman, didn't even try.

It seems to me that there was an enormous effort made. For several decades. Your political system isn't all that responsive to the needs of the electorate, meeting the needs of lobby groups and interest groups more readily.


What rubbish.

Sorry, you can agitate for a rising of the proletariat, but I'm not buying.

America's healthcare industry has spent hundreds of millions of dollars to block the introduction of public medical insurance and stall other reforms promised by Barack Obama. The campaign against the president has been waged in part through substantial donations to key politicians.

https://www.theguardian.com/world/2009/ ... are-reform

And yet you ended up with the ACA. Admittedly an improvement but not a great solution.
And a solution that was apparently more popular then Obama Care.
https://www.nytimes.com/2017/02/07/upsh ... .html?_r=0


No, the ACA was not an improvement. It was a system destined, and some say designed, to fail. It is impossible to cover more people with the same resources (facilities and personnel) for less money.

Still it is apparently better than what House republicans and Trump have on offer....
An AOL News poll finds 57 percent said they prefer the Affordable Care Act (Obamacare). Meanwhile, only 30 percent of respondents said they prefer the AHCA. Another 13 percent of respondents said they weren't sure which legislation they preferred.

https://www.aol.com/article/news/2017/0 ... /21904839/


Oh brother. No one even knows what's in the AHCA. That's just a stupid poll, but which I mean "stupid, as in uninformed." When you ask people an opinion on something they've not had an opportunity to study, how valuable is their opinion?

The fact is that the US has reached a tipping point on this issue.
Presented with three separate scenarios for the future of the Affordable Care Act (ACA), 58% of U.S. adults favor the idea of replacing the law with a federally funded healthcare system that provides insurance for all Americans

http://www.gallup.com/poll/191504/major ... ystem.aspx


If true, good for the socialists.

However, when people find out the displacement and costs involved, they are going to scream. We live in a coddled nation. People expect more product for less money.
User avatar
Ambassador
 
Posts: 4791
Joined: 08 Jun 2000, 10:26 am

Post 10 May 2017, 6:54 am

Doctor Fate wrote:
Ray Jay wrote:Fate:
The truth is most Americans with insurance are satisfied. They don't want "Medicare for all." It's only ideologues and the young (who don't know better) who are clamoring for it.


Although we totally share profound annoyance at Ricky including his inaccurate use of language and dishonest rhetorical style, I do think you are missing what is going on here. For those of us without employer or government provided health insurance, this is a crisis.


Friend, I'm not in disagreement with you. Again, look at my wording.

"most Americans with insurance are satisfied."

Previously, I'd said something about employer-based insurance.

Here are the facts:

"Of the subtypes of health insurance, employment-based insurance covered the most people (55.4 percent of the population), followed by Medicaid (19.5 percent), Medicare (16.0 percent), direct-purchase (14.6 percent) and military health care (4.5 percent)."


So, excluding government-provided healthcare, we're talking about, what, 80% is employer-based?

If you ask most of that 80% if they would prefer "Medicare for all," you'd get a hearty "NO!!!"

That's my point.


Got it. Makes sense.

http://www.nationalreview.com/article/4 ... ree-market

Making my point on "free markets".

Now, it should be noted that state-created and state-sponsored risk pools are not “free-market measures.” If they were, then so were Obamacare exchanges. People are capable of collectively bargaining over health care — employers do it with insurance companies every day, and cooperative health arrangements such as religious health-care co-ops do the same. But state-run programs in which the state bargains in behalf of consumers using taxpayer subsidies are not free markets. They are subsidies to insurance companies. Tax credits are also not free-market solutions. Handing $2,000 to someone who doesn’t pay that amount in income tax amounts to a back-door entitlement.


Read more at: http://www.nationalreview.com/article/4 ... ree-market

My own view is that the system is so bad at this point, and it would be so hard to start over, that we should enable people over 50 to buy into Medicare at some sort of average rate.
User avatar
Ambassador
 
Posts: 21061
Joined: 15 Jun 2002, 6:53 am

Post 10 May 2017, 7:04 am

Ray Jay wrote:My own view is that the system is so bad at this point, and it would be so hard to start over, that we should enable people over 50 to buy into Medicare at some sort of average rate.


I think this was somewhat intentional. No one could have looked at the ACA and thought, "Oh, THIS is the program that will end the problems!"

In fact, the holes in the ACA were pretty obvious. I don't think Democrats cared if it worked or not. Passing the bill made healthcare seem more like a "right." So, if fixing the situation forced people into thinking "single-payer," what Democrats would have objected?

Answer: none.
User avatar
Dignitary
 
Posts: 488
Joined: 26 Sep 2006, 10:19 am

Post 24 May 2017, 10:21 am

Thanks for the replies. Always good to get a different perspective on stuff