Why is American health care more expensive? Is European health care the fiefdom of publicly held corporations? I don’t think so. What happens when corporations run health care? You get demands for unrealistic levels of growth and profits from Wall Street. You get American levels of executive compensation. You get corporations who are so afraid of someone getting care that the insurance company doesn’t want to pay for that they generate more red tape than the government ever dreamed of and the expense for processing this paper work is shoved off to the doctors and hospitals as much as possible. In addition there is that additional cost that gets spread through virtually the entire system because of the people who don’t go to the doctor until it’s time for the ER.

Also, in a related issue that far too many people forget about doesn’t anyone remember the study a few years back that showed that there was a relation between the infections and other problems from bad teeth and heart attacks and other general health issues?

As so preventative care, I would argue to factor in lost economic activity as well. Of course it all depends on the numbers, but I think it might be more like $100 for preventative care and $10,000 for an emergency room visit. Although there could be a large difference between what is charged and what the costs are to the system.

I’d also be fine with a basic system for everyone that paid for general check-ups to catch developing pathologies, and free treatment for life threatening problems while leaving optional treatments for things like flu or strep on a optional, multi-payer system.

Kevin, authorizing the reimporting of drugs would work, too, and I have no problem with that. My proposal is simpler, to pass a statute that the government would pay no more for a drug under Medicare/Medicaid than the manufacturer charges for that drug to government health care systems in Europe or Canada.

On preventative care, here’s the thing… while it undoubtedly saves money when looking at individuals who ultimately require emergency room care, there’s no guarantee that it saves money for the system as a whole. Take all the people who get strep throat. The vast majority of them will get well, eventually, without treatment. Let’s assume for argument that it costs $200 for treatment. Let’s also assume, just to pick a number at random, that for those who do need emergency care, the cost will be $2,000. At that rate, providing the preventative care will save the system money only if about 10% or more of those with strep throat will need hospitalization. Take a sample of 100 people. It will cost $20,000 ($200 * 100) for preventative care. If nobody got treatment and 10 people needed emergency room care, then that also would cost $20,000 ($2,000 * 10). If only five people get sick enough to need emergency room care, then the system would pay only $10,000 ($2,000 * 5) for emergency room care, half the price of providing preventative care.

I don’t of course know what the numbers are for all the types of preventative care available, just pointing out that providing more universal access to preventative care won’t necessarily reduce the overall cost of health care.

Another point I like to make in health care debates is that different solutions may be needed for different types of health care. How we control costs and guarantee access to end-of-life care for the elderly may be very different from how we should provide routine health care services, which itself will be different from how best to provide on-going care to chronic conditions like diabetes.

sorry if I’m not terribly clear today.

Pat, I think you’re point about people not USING preventative care even when it’s available is an important one too. I’ve seen some studies that indicate this is a big problem (though I don’t remember the source- anyone know of data on this?) It’s certainly something to mull over, because even if we figured out a system of making preventative care universally available, what then if people don’t avail themselves to it? Do we mandate checkups and screening tests?

before it and

after it.

I liked the idiot buttons better too though, esp for links where the code is longer.

Here we have a rare instance where the humanitarian and the practical go hand in hand. Under the current system, every single American is “insured” by the laws prohibiting Emergency rooms from turning people down. Therefore, I don’t agree with the position that universal health care will significantly increase demand. I thin the real benefit of universal health care is to get more people into efficent health care.

Emergency rooms are the least efficent way of meeting health needs because:
1) Conditions that require emergency treatment are futher progressed and therefore harder to treat. and
2) The risk of expensive complications, both from secondary infections and phyician error greatly increase in the high pressure, messy ERs.

I think health care costs are high in the US both because of this inefficent use of the system, and because we subsidize the pharma industries R&D, even when compared to europe. I think Universal health care would actually bring prices down because of the first reason. As for the second, we could either wait 17 years until many of the patents on drugs from the current biotech revolution exprire, or we could have the FDA change inspection rules to align with various other countries such as europe or canada which would atleast spread the subsidies to those countries as well.

One other point, I think that health care must be either universally required or free of charge for the simple psychological reason that people think that they are imortal. Noone assumes they will get sick, but if someone chooses not to get checkups and undergo preventative care, the high costs are shared by everyone.

Another part of the whole problem has nothing to do with insurance companies. As much as you rail on and on about them, they pay billions and billions of dollars of claims every year, day in and day out. Millions and millions of people have absolutely no problem going to the doctor, paying a modest co-pay of $10 or so, and having the rest paid by insurance, without ever having to fill out a form. If you want preventive care, most policies provide that; you simply have to decide to go get it. And that’s a big part of the problem. A lot of people, for reasons ranging from lack of education to an inability to take time off work, simply don’t try to get preventive care, even when it is available.

CStanley, thank you for understanding my point about the massive subsidy we’re giving Canada and Europe on pharma R&D costs. So far, you’re one of a very small number of people to get it.