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Universal Health Coverage
Posted by: Dale Franks on Wednesday, April 26, 2006

Jon emailed McQ and I with a message about this blog post at Healthy Policy Blog.

Jon wondered:
I'd be curious to know:

1) what you think of it, and..

2) ...why France, et al, have "better outcomes", lower costs and no appreciable waiting times.

I'm not arguing that universal coverage is an optimal policy by any means, but I think it's fairly clear that what we have now is also not an optimal policy and in a choice between sub-optimal policies, the French/German model doesn't seem bad.
OK. Well, let's see.

Divider

First off, France doesn't have a national health care system of the type employed in Canada or Great Britain. The government health care system in France is one where the public system is incomplete, so nearly 90% of the French populace also has a private supplementary insurance policy.

In most cases, this private health coverage is provided by employers, which is also treated favorably in corporate taxation. Dental and Optometric care is basically uncovered in the French state plan, Couverture Maladie Universelle, and all CMU services require a co-pay. (OK< officially, dental and optometric services are covered, but at such a low rate of reimbursement that, well, who cares?)

Even with that, the CMU has staggering deficits. As a result, in 2003, the government proposed increasing responsibility for health coverage in the private system. Since the 1980s, private health insurers have taken up and increasing portion of French medical care. The government's main spending is in hospitalization and prescription drugs, while private insurance covers a larger portion of other medical services.

In addition, most private insurers do have explicit waiting periods before coverage is extended. For instance, most private insurance contracts don't cover pregnancy for the first 9 or 10 months of coverage.

So France has a public insurance system that requires a range of co-payments, and which is buttressed by a private insurance system in which about 90% of the public participates. Indeed, even among people who receive coverage solely from CMU, nearly 20% of them elect to obtain their coverage through private insurers, rather than the government.

So, comparing the French system—which is essentially an odd sort of state-subsidized private insurance system—and a single-payer system just isn't valid. In many ways, the French system is closer to the American system than the British NHS.

Oh, and here's another interesting point about the French system: Prior to the CMU, it was a completely reimbursement-based system. When you go see a doctor, you pay the fee at the office, and the Doctor endorses your CMU form. Then you go to the pharmacy, and pay for a prescription, where the pharmacist also endorses your SMU form. Then, you go home, and fill out the rest of the CMU form, pasting the little stickers from your prescription bottles on it, and you mail it into the social security administration. Then, the government will mail you a re-imbursement check for the amount over and above your co-pay. One of the reasons why the French have increasingly moved to private insurance is that private supplementary insurance covers many of the point of service payments, substantially reducing out-of pocket expenses at the point of purchase. Prior to the implementation of the CMU in 2000, the French Government estimated that up to 25% of the population delayed getting medical care for financial reasons. Let's call that an "unofficial waiting list".

That's a little extra cost-containment right there. Now, under the CMU, the government goes ahead and covers those out-of pocket expenses for about 1 million of the poorest people in France, while an additional 5 million or so receive supplementary coverage from CMU.

Germany, on the other hand, doesn't actually have a state-run healthcare system at all. Instead, the Federal government specifies levels of coverage, the state governments run hospitals, and health insurance is provided by private, for-profit insurers. The government doesn't oversee these insurers. Instead, they are overseen by both regional and national boards of oversees that are composed of both payers and providers. These boards also negotiate with each other for payments and coverage, so that one board can't unilaterally raise coverage or premiums without all the rest agreeing. The system is not funded by mainly taxation, per se, but rather by both compulsory and voluntary health care insurance premiums paid by the public. Government funding amounts to about 20% of the cost of German health care, the rest comes from co-payments or insurance premiums, or additional private health insurance outside the state-mandated system of coverage.

The Federal government's sole responsibility in the German system is to set the legislative framework that defines what levels of coverage are required, and to set the rules regarding the bargaining process that the health care boards use to set premiums. Everything else is controlled by the health boards, who govern insurers in their region, or the states, who run hospitals.

Again, the German system is not a single-payer system, either.

For more info, see this study by the UK public policy group Civitas, or this one by the OECD.

Now, as far as Canada goes, I wouldn't get all giddy about how wondermous the Canadian health care system is. What do you do in Canada if you need surgery, for example?

Well, you wait. And wait. And, according to the Fraser Institute, a Canadian think-tank, that's not the only problem.

I guess the answer is that, if you posit that our only choices are A) the current system; B) a British NHS-style system, or, even worse, a Canadian one; and C) a system more like the Germans or French have, then I guess my preference, in order, would be A, C, B.

But I don't like any of those alternatives. And I certainly don't want to se a US health Plan that turns into TennCare writ large.
 
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That initial blog you linked is a crock. I grew up in a Canadian border city. Canada’s (Ontario’s actually) healthcare system is a mess. The author’s main rationale for the Canadian system not being broken is based on Canadians not seeking care in the US.

Canadians don’t seek care in the US for several reasons. Primarily the government won’t pay for it and that means a Canadian would likely have to pay for it out of pocket when they never planned for being in that position. Since they’ve paid for healthcare through their taxes, there’s a hesitation to pay twice. There are other reasons, but that is the primary one.

Also, the Canadian coverage is more like the French system you describe. Dental isn’t covered. I believe vision is a mix depending on the procedure. Most people have suppliment health insurance.
 
Written By: jpm100
URL: http://
Also, the Canadian coverage is more like the French system you describe. Dental isn’t covered. I believe vision is a mix depending on the procedure. Most people have suppliment health insurance.
Actually, it’s not all that similar. Until the recent Canadian Supreme Court decision, private medical coverage was absolutely outlawed, and the state had a monopoly on the provision of health care. In fact, Canada was the only OECD nation to ban private health care.

While the majority of health care expenditure in France comes from the government, this is because the government covers inpatient care and prescription drugs, which are the lion’s share of spending. Even so, 30% of France’s health care expenditure comes from private mutual insurance or for-profit insurance coverage.

And, of course, in France, you can have completely private health care coverage.

In Canada, the reverse is true. Indeed, according to the New England Journal of Medicine, Canada "is unique in the world in that it bans coverage of these core services by private insurance companies, allowing supplemental insurance only for perquisites such as private hospital rooms."

This is nothing at all like the options available in the French system.
 
Written By: Dale Franks
URL: http://www.qando.net
I think this whole debate is a case of not seeing the wood for the trees. The point of a healthcare system - be it a market system or a state-run system - is to maintain the health of the people as much as it can. Success in this endeavour should not be measured according to whether the system adheres to one’s own preferred economic ideology, but on defined and quantifiable clinical results ie what are you trying to cure/fix and how successful have you been. Clearly this will vary from country to country. I’m sure that there are real-world examples of both free-market and state-run health industries that achieve good results, and those that achieve bad results. The debate needs to focus not on who pays for healthcare and how and who makes money from it, but on whether it gets the job done.
 
Written By: Blewyn
URL: http://blewog.blogspot.com
So Blyewn, you’re implying that if Bill Gates, Warren Buffet, and the next several richest people in the country pay for everyone’s health care it is okay, as long as the results are good?

Are you happy to pay for my healthcare, as long as you know I’m getting good results? Send me your address so I can send the bill with my thanks!



 
Written By: Unknown
URL: http://
The state of Louisiana had a system that actually worked well for many decades until the local politicians found a way to loot the system. They gave special tax breaks and subsidies back in the 1940’s and 50’s to build several Charity Hospitals. The Hospitals were run by donations and state and local government grants. They charged people according to their means (like good little socialists)
But the system worked. Poor people in Louisiana had decent health care and it was not too costly, (Until about fifteen years ago).
 
Written By: kyle N
URL: http://impudent.blognation.us/blog
Dale, perhaps my info is dated. I gladly left in the early ’90’s. But I clearly remember a plaque in my Dentist office all while I grew up into my late teens there reminding patients Dentists do not participate in OHiP (Ontario Health Insurance Plan).

Coverage is also somewhat below people’s expectations. I believe perscriptions weren’t covered for most. A hospital stay was in a 6 person ward. People had Private insurance to augment their government insurance. I had a Blue Cross card through my Father from where he worked. I presented both the Private Insurance card and my OHIP card anywhere I went for treatment. The list of things not covered may be big or small, but there is a list. I’m sure the poor has additional coverage through some government benefit.

I also used ’more like the French’ system to mean it isn’t pure 100% coverage. It is incomplete relative to people’s expecations. Dental and additional coverage is required by the private citizen. Private insurance is almost a must if you want decent unencumbered coverage while you travel. While in the US, my Canadian Blue Cross card gave me US level coverage.

And you could opt out of the Canadian system although your benefits through any workplace required that you must take it. Sort of like US Retirees must take Medicare and then their retirement health benefits cover the remainder. You would also be paying for healthcare twice if you refuse it. If you showed up at an Ontario hospital without your OHIP card, they’ll take your credit card in a snap. In fact, you pay before you get treatment.

My point was that the Canadian system doesn’t cover as much as people might think it does and it is still expensive and a shambles.

 
Written By: jpm100
URL: http://
Do those "better outcomes" include 15,000 deaths during a heat wave?
 
Written By: SaveFarris
URL: http://
As someone who lives on both sizes of the border with all the tax and other issues that brings, let me add my personal view.

The health care system pays for core services, no dental, since 2 years ago, no vision, and no prescriptions/drugs (except those admitted).

If you want to see a doctor, she end up waiting 1 to 2 weeks for an appontment as there is a doctor shortage. All surgeries (except emergencies) are between 8 months to several years away. Partly because there is a shortage of health care beds and a serious shortage of nurses.

To exacerbate this, it is much more difficult to get accreditation as a doctor or nurse in Canada for foreign trained professionals. So even though they don’t have enough health care professionals the professional organizations make it almost impossible to become one in Canada. Most try, then throw up their hands and move to the US where it easier.

Part of the problem is because the goverenments give the hostipals a set amount per patient per day for hospital stays. The amount is just under 3k per day. This is a flat amount and there is no requirement to break it down and justify it. So waste and abuse occur.

As well, the politicals of this are truly nasty. For example the province of Quebec is allowed a number of privately funded procedures. No other province is so allowed. The province of Alberta tried to enact the same policy as Quebec but was told they could not and they were trying to destroy one of the pillars of Canadian society.

Health care in Canada is nice if you don’t get seriously sick.

 
Written By: capt joe
URL: http://
Success in this endeavour should not be measured according to whether the system adheres to one’s own preferred economic ideology, but on defined and quantifiable clinical results ie what are you trying to cure/fix and how successful have you been.
Ah, but that position conveniently ducks the question of cost.

To oversimplify a bit, healthcare works out to "Quality of outcomes, universal coverage, reasonable cost - pick any two". There are tradeoffs among those factors. (Software development folks will recognize this as a variant on the "time-features-resource" triangle.)
 
Written By: Billy Hollis
URL: http://
My ’preferred economic ideology’ is ’efficient, fair, and sustainable.’
 
Written By: Achillea
URL: http://
Please read the following comprehensive rebuttal at Ezra Klein’s weblog.

http://ezraklein.typepad.com/blog/2006/04/the_french_heal.html

The basic gist is that the critcisms leveled at the French system by Mr. Franks are unjustified & misleading and that the French system:

1) covers everyone vs. our 15% uninsured
2) gets better outcomes - it is ranked #1 in the World by the WHO vs. our 37th (even though we spend the largest % of GDP on the planet)
3) costs less in absolute terms and as a percentage of GDP (see above)
4) Is substantially public (OECD reports that roughly 75% of total health spending is publicly funded, 10% is paid for by supplementary insurance (mostly mutual insurers), and the remaining portion is paid for directly by patients)

That being said why does Mr. Franks order of preference have the US system ahead of the #1 health system in the world - the French System?

The French system is expensive, yes, but nowhere near as expensive as ours (we spend twice as much at $5,600 per capita vs their $2,900) and at least they are getting value for money.

As Mr Klein says "Sometimes I wonder if the free market [ideolgy] isn’t faith-based."

Food for thought.
 
Written By: Terry
URL: http://
Well Terry ours isn’t a market-based system.... in a market-based system the CONSUMER uwld pay the bills. Automobiles, housing, fast food, tend to be better examples of market-based industries than health care. I don’t pay the bulk of the health care bill when it comes due...my insurance company does. So there is not as much incentive for me to shop around for the best health care deal, unlike houses, cars or lunches.

I guess bottom-line is: it’s straw man to say the US has a Free Market approach to health care. What we have here is a system that emerged from the Second World War, designed to supplement the otherwise frozen wages of US workers, supplemented by a "progressive/liberal" movement to nationalize health care, on top of one insurance company created by and for doctors, Blue Cross/Blue Shield, created to ensure that doctors got paid, all topped off by a society that wants to live long and prosper...but it’s not anything near a market-based system.
 
Written By: Joe
URL: http://
Joe,

I can see your point there but that does not explain why anyone would rank the current US system ahead of the French system for anything but dogmatic ideological reasons?

Also is it not true to say that (for all but those with extraordinay means) in the case of major illness the consumer cannot practically "pay the bills" directly meaning some form risk sharing (insurance) is absolutely neccessary (either public or private)?

Now if we agree that for major illness at least "insurance" is required then I do not understand why public risk sharing is such an anathema that we must resort to private insurance for a fundamental public good as essential as hospital healthcare (for the people by the people so to speak)?

A private system seems to add all of the administrational and profit margin overhead that the hundreds of private insurers introduce to the system (like our current system’s perhaps 30% admin overhead) and yet to ensure universal coverage by private companies a complex regulational framework madating no risk rating (so the sick can afford coverage) and universal coverage (mandatory private insurance along with subsidies for the poor) is neccessary (see MA).

All that this complex plan does is (inefficently) mimic a successful public backbone like France’s.

I can see how an HSA/HDHP framework supports your idealogical world view but on the ground there is evidence that "consumers" may not have the medical know-how to spend wisely and may forego the preventative care they should consume (for fear of overspending) and end up costing us all more in the long run(because we are, ulimately, all in this togehther in a shared risk scenario). Also these plans work better for the well off and maybe not at all of the poor and certainly not at all for the indegent.

Speaking of which in a public backbone system any care deemed appropriate for any resident of the US (e.g. the indegent) can be fitted into the shared risk budget whereas a private insurance system will likley end up delivering this care only in a costly & ineffcient hospital ER setting & shifting
the cost to the insured/those with means as is currently the case.

I am NOT married to the idea of a public system - "all" I want to see is universal coverage for all Americans :) via public or private means - but it seems to me so far that a public backbonbe makes much more PRACTICAL sense - not idealism.

Perhaps we could look at Germany’s model for a functional Private system? Is their system private?

Is there any functional market based/non public system that provides universal coverage that we could look at as a model?
 
Written By: Terry
URL: http://
Joe~

Nothing prevents you from the paying your health care bills now. You are perfectly free to shop around for the lowest cost health care you can find. Why don’t you do that? Because you choose to insure. Why isn’t that free market? In a free market, people insure against risks. I assume you have car insurance and fire insurance for your house. Now if you are arguing that the form of our insurance isn’t efficient because it is largely employer provided, there may be something to that, but then I’m putting words in your mouth. But to argue that our system isn’t free market based because insurance companies pay the bills is pretty ridiculous.
 
Written By: Steven Donegal
URL: http://
First let me say I don’t do health economics or even economics, I’m just a vaguely libertarian/conservative Republican. And I don’t want to seem that I am "Attacking" you at all, not my point.
I can see your point there but that does not explain why anyone would rank the current US system ahead of the French system for anything but dogmatic ideological reasons?
Because average life expectanancy is INCREASING in the US and that the average life expectancy of the US citizen is now the HIGHEST in the world, is one reason to place it there. I mean the proof, in part, is in the pudding, isn’t it? We live longer, so something must be going right here.
Also is it not true to say that (for all but those with extraordinay means) in the case of major illness the consumer cannot practically "pay the bills" directly meaning some form risk sharing (insurance) is absolutely neccessary (either public or private)?
Not sure that this is true. What many folks point to is bood jobs (one of MY personal favourites) and LASIK. These are procedures that are privately funded, being considered "elective" surgery and not covered by most insurance. The price of these operations is NOT excessive and is paid by the consumer, now I grant you, saline implants AREN’T brain surgery, but they demonstrate that with consumer paying bills, directly, health care IS affordable. Most cosmetic surgery is financed. So many would point out that when people actually shop around for care options and actually pay the bills, the bills aren’t suddenly so massive.
A private system seems to add all of the administrational and profit margin overhead that the hundreds of private insurers introduce to the system
As compared to the EFFICIENT delivery of services made by FEMA or governmental agencies? Or alternatively, wouldn’t it make sense to have a single-payer system of fast food restaurants then? After all, all those hundreds of individual, chain and franchise restaurants must have HUGE and duplicative overhead costs, and yet, I believe we’d all agree that buying lunch is cheaper under the current system than with a sytem akin to a Canadian or British National Lunch Care System, or even a public-private program a la France. Bottom-line here is that market competition keeps costs lower, even though there are more players in the system.
I can see how an HSA/HDHP framework supports your idealogical world view but on the ground there is evidence that "consumers" may not have the medical know-how to spend wisely and may forego the preventative care they should consume (for fear of overspending) and end up costing us all more in the long run(because we are, ulimately, all in this togehther in a shared risk scenario). Also these plans work better for the well off and maybe not at all of the poor and certainly not at all for the indegent.
I’m not a realtor, but I bought a house. I’m not financier, but I have a retirement plan. There are many things I am NOT, smart, kind, good looking, and the like, yet some how I manage to survive in a complex, option-ridden technical society. Some of my choices are standard or even sub-optimal, but generally I survive, though I am not an expert in a host of modern technical areas of life. How can this be? Well, most folks aren’t experts in MY AREA OF EXPERTISE, they pay me to provide them the goods and services I uniquely-OK, not uniquely- provide. In turn, I exchange a portion of my goods and services received for advice, and goods and services from other folks, technical experts in THEIR areas. So I don’t have to be a doctor to make health care choices, just as doctor’s aren’t experts in drywalling, but manage
to have housing. So when we examine other portions of our lives we can see that technical expertise is NOT a barrier to the efficient provision of services.
"all" I want to see is universal coverage for all Americans
I realize that you were being a little facetious, but ask yourself this, WHY UNIVERSAL COVERAGE? If I don’t need a car I don’t get a car...If I don’t need something why ought I have it? I realize that health care is a little different, but a single man 16-30 has almost NO NEED FOR HEALTH CARE INSURANCE. His only value is that he contributes premiums that help provide cooverage for those groups, older people, women with children, etc. that utilize the health care system. I think many folks would say, let people make the decisions on the amount of coverage be an individual one. I’m not sure that there IS an "optimum" degree of coverage for a society.
 
Written By: Joe
URL: http://
In addition to all of the problems with our employer based health care system mentioned above let me add some externalities caused by our system that help make many US firms less efficient producers that their international competitors.

1. US firms pay for health care. Forign firms do not (to the same extent)
2. People who would be more effective in new jobs can’t change because someone on their plan may have a preexisting condition.
3. People who would be more effective starting a new business can’t because healthcare costs for small new businesses are nuts.

In short, our healthcare systems add to the cost of american products both by their premiums and their encouragement of workers to hold on to their current jobs and become dead wood.

 
Written By: cindyb
URL: http://
Steve Donegal, look at the last bit of my posting and Cindy’s and you begin to see that insurance doesn’t equate to free market, anything. The current health care system has emerged over the last 60 years from a number of impulses, but not really free market decisions.

Also much of insurance, ISN’T FOR ME. Insurance is for someone else. Think on it, you have auto insurance, especially if you have a loan outstanding, to help ensure that if the car is wrecked the lien holder gets something. Private mortgage insurance, is FOR THE BANK, not me. Blue Cross Blue Shield was a program built by doctors, IIRC, to ensure that DOCTOR’S BILLS GOT PAID. It was SOLD as insurance for YOU, but it was designed, in part, to provide income for doctors. So focussing on insurance as a sign of competiton is not really an accurate picture, as I say a lot of insurance is designed to provide coverage for the person ultimately responsible for the bills, not for the consumer of insurance, you or me. In fact I read a neat take on insurance that sparked this response, but I just can’t remember where. I believe the thrust of it was really reduce insurance coverage, for health care, insurance markets work best where there’s someone else who benefits from the insurance you buy.
 
Written By: Joe
URL: http://
Joe:

1) "Because average life expectanancy is INCREASING in the US and that the average life expectancy of the US citizen is now the HIGHEST in the world"

Not close to true (probably for many reasons *including* healthcare). I have never seen US ranked #1

(From World Factbook 2005 estimates)

Japan #4 - 81.15
Australia #6 - 80.39
Canada #9 - 80.10
France #11 - 79.60
USA #29 - 77.71

2) Boob jobs & lasik are self contained, non-emergency, elective proceedures for which a free market approach works well.

I bet that if major complications arise however (e.g. infection w/ septicemia, heart failure or whatever) resulting in a possible ER visit and weeks long stay in the ICU & costing possibly hundreds of thousands of dollars) then the patient will fall back on insurance (if available) or the federal mandate that ER treatment cannot be denied based on ability to pay (thus the cost is shifted to the insured)

There is such a massive difference between a self contained elective proceedure that you choose to undergo as and when and if you can afford it and emergencies (for example aggresive cancer, heart attack or trauma) that I find it strange you would even attmempt to cmpare them?

3) I have seen NO evidence that "market competition keeps costs lower" in the healthcare context and comparing an aneurism to buying a big-mac makes even less sense than comparing it to a boob job!

I know that FEMA was mismanaged but other governmental/quasi-governmental systems are reasonably well run e.g. Federal Reserve, Medicare/Medicaid (underfunded & overburdened but look at "customer satisfaction" rates in these systems), or even better look at the #1 in the world French public healthcare backbone - if public institutions are intrisically badly run then why do the French get so much better outcomes with 1/2 the capital outlay?

4) You can absloutely make your own decisions on healthcare but to argue that including a cost disincentive for utilization (HSA plan) *improves* medical decision making seems to be false - The use of preventative and primary care servies may drop under HSA insurance (potentially increasing cost & strain on the HC system in the long run)

And the main question:

5) "WHY UNIVERSAL COVERAGE?"

Universal coverage is essential because, like it or not, we are all in this together in an even slightly-compassionate system (like the current US system).

You say that "If I don’t need a car I don’t get a car...If I don’t need something why ought I have it?" and "a single man 16-30 has almost NO NEED FOR HEALTH CARE INSURANCE. His only value is that he contributes premiums that help provide cooverage for those groups, older people, women with children, etc."

The young man you mentioned WAS a child, WILL BE an old person and MAY BE run over by a bus tomorrow.

If Mr. 16-30 gets viral meningitis or is run over by a bus then he will utilize a great amount of $ and if he is uninsured the hospital ER, the ambulance etc. must still treat him (Federal Law).

The cost will then be passed on from the hospital to the insured - the hospital cannot print money to make up this deficit.

And THAT is why you must have something you "do not need" - because you may need it.

The only way your system could work (financially) is if you were injured or sick and did not have your insurance card in your pocket or a big wad of cash you would be left on the road to die by the Paramedics - nice huh?

-terry
 
Written By: Terry
URL: http://
Actually, I think the thrust of Joe’s position is that if Mr. 16-30 year old chooses not to buy insurance and doesn’t have any other significant source of funds to pay his medical bills, when he gets hit by the bus, the ambulance should just leave him along side the road. That would be evidence of the free market in action.
 
Written By: Steven Donegal
URL: http://
Well Steve, that’s not entirely correct, but close... Terry Mr 16 y.o. generally DOESN’T NEED INSURANCE... he’s there to provide capital to the insurance pool for those of us who do use it.
3) I have seen NO evidence that "market competition keeps costs lower" in the healthcare context and comparing an aneurism to buying a big-mac makes even less sense than comparing it to a boob job!
Actually it does Terry, YOU JUST WON’T ACKOWLEDGE IT APPARENTLY. Big Macs, Boob jobs, open-heart surgery, are all goods and services. Boob jobs and Big Mac’s have a much more competitive market and cost FAR less, I’d say that’s prima facie evidence that market forces can reduce costs. The Boob job price includes the surgeon’s non insubstantial medical mal-practice insurance, which will be covering the infection from a bad boob job, so the eventuality you mention actually IS covered int he boob job.
The young man you mentioned WAS a child, WILL BE an old person and MAY BE run over by a bus tomorrow
When he WAS a child let’s hope his parents had insurance, when he HAS a child let’s hope he gets insurance, and for the bus, well let’s hope he gets catastrophic insurance or a very high deductible, low premium insurance, then... akin to what I had until I got married and then turned 35, all of which made it reasonable to change my insurance coverage.
) Boob jobs & lasik are self contained, non-emergency, elective proceedures for which a free market approach works well.

I bet that if major complications arise however (e.g. infection w/ septicemia, heart failure or whatever) resulting in a possible ER visit and weeks long stay in the ICU & costing possibly hundreds of thousands of dollars) then the patient will fall back on insurance (if available) or the federal mandate that ER treatment cannot be denied based on ability to pay (thus the cost is shifted to the insured)

as and when and if you can afford it and emergencies (for example aggresive cancer, heart attack or trauma) that I find it strange you would even attmempt to cmpare them?
The use of preventative and primary care servies may drop under HSA insurance (potentially increasing cost & strain on the HC system in the long run)
Possibly and if you have evidence to support this please provide it, honestly it’s not my area. Otherwise my response is that the space aliens will vaporize those who don’t utilize the preventative services...See I’m making an unsupported claim, just as you were. They might or might NOT spend money wisely, monkeys might or might not fly out of their butts. We need something more than mights. Beyond snark I’d would say you make a medical decision or mis-decision out to be a life altering catastrophe, it needn’t be. No more so than buying a house poorly or leasing a car and discovering that always renting and never owning a car was, for you, a financial mistake or as my best friend did, to have no insurance, but then to crash his airplane AND badly hurt his passenger... from all these things we can learn, and do better the next time. A bad medical decision CAN end your life, but most times it just is like any other bad decision you make, you kick yourself in the butt and try to do better the next time. And that iterative, learning from yours and others mistakes IS a part of the market system.
Boob jobs & lasik are self contained, non-emergency, elective proceedures for which a free market approach works well.

...
There is such a massive difference between a self contained elective proceedure that you choose to undergo as and when and if you can afford it and emergencies (for example aggresive cancer, heart attack or trauma) that I find it strange you would even attmempt to cmpare them?
Uh because THEY ARE MEDICAL PROCEDURES, Terry. Medical procdures that can blind you, maim you, leave you dead... like any other medical procedure can, and YET they are not so expensive as other procedures. One difference, a major one, being that the open market sets their rates of compensation.
I think fundamentally you have medicine as some GREAT THING... it’s not. It’s a good or service like any other. You need food, water, shelter to live to and the provision of those VITAL SERVICES seems to flow best from market-oriented solutions, why not health care as well?
 
Written By: Joe
URL: http://
"The price of these operations is NOT excessive"

As you have pointed out about some of my assertions :) YOU have not presented any evidence that elective proceedures are any more "competitively" priced than non-elective (although one source of ecconomy would be that the plastic surgeon is not obliged to treat the uninsured).

I do not have the studies to hand WRT utilisation & HSA/HDHP but I will search the ’net & attempt to find them again.



"When he WAS a child let’s hope his parents had insurance, when he HAS a child let’s hope he gets insurance, and for the bus, well let’s hope he gets catastrophic insurance or a very high deductible, low premium insurance, then..."

The million dollar question is WHAT IF HE DOESN’T BUY INSURANCE?

The only way to make this system fair (without compulsory private or public insurance ) is to DENY EMERGENCY TREATMENT if insurance is not carried, right?

Otherwise we have spiraling costs for hospital proceedures because the uninsured must be paid for by the insured.



"One difference, a major one, being that the open market sets their rates of compensation."

I think that a more substanital difference is that one is NECCESSARY TO PRESERVE LIFE & LIMB and one is ELECTIVE?


Once again - would you advocate denial of care to those who do not carry insurance? If not then your plan does not make sense (and is certainly not fair) and will result in overcrowded ER’s & ER closures and spiraling costs as care for the uninsured is cost-shifted to the insured.

 
Written By: Terry
URL: http://
I believe that the high cost of health care is probably the stickiest wicket in politics today because there isn’t one cause of the problem. There are many. However we could probably achieve a good result by doing four things:

1. Deregulate insurance. Eliminate legal barriers to entry and force insurance companies to compete.
2. Transform the FDA from a regulatory agency into an information only agency. The future of medicine is drugs, and having the government add $billions of dollars and absurd delays to the cost of developing medicines is buying us nothing while it often literally kills.
3. Provide an open, liberal Federal licensure program for health care professionals. A holder of a Federal license being able to practice in all 50 states. The AMA controls the medical boards of all 50 states and has used that power to restrict the number of practioners, a demonstration of their conflict of interest.
4. Eliminate all federal business taxes for any business that provides comprehensive health insurance to all of it’s employees. Consumers end up paying all business’ taxes anyway, so what the hell.

yours/
peter.
 
Written By: Peter Jackson
URL: http://www.liberalcapitalist.com
Joe, "average life expectancy of the US citizen is now the HIGHEST in the world"?

Where did you get that idea?

Average life expectancy:
France 79.73
Germany 78.8
US 77.85

All data: CIA world factbook.

Now, I don’t think the 2-year difference between those countries is very significant for the quality of the healthcare system, since there are too many other factors involved. Think of percentage of smokers in the population, obesity, homicide rates, food patterns etc etc. But if you claim that there is a coincidence, at least your data should be correct. Everything else is dishonest spin.
 
Written By: Gray
URL: http://
The Civil Rights is a moot point. Drop it guys. Don’t you hier Tsunami alarms?
This is not right time to discuss the nature of Tsumami. Do something!
The problem is there is no place to run. Everybody can do something.
Look at our brave Congressmen. They did it, and they withstood the onslought
of the Senate. I have high hopes.

At this time the States are are comming up with new laws, epecially dealing with employers that hire illegals.

Our best bet is to put pressure on senators. Forget the party line.
Check where they stand. Contribute and Participate in BS. Yes, you guest right. I did not abbriviate it. Check the web. Full name is:

BS of Mcaine and Kennedy.

Go for it! Thanks for reading this important warning!. Eugene
PS. Drop all your debates. Next November we have issue!
We have to get rid of people who stand for slave labor.
I am familiar with the concept. I was a slave in German Raich.





 
Written By: Eugene Pererwa
URL: http://

 
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