The Key To Our Healthcare Need is “Quality”
The Key To Our Healthcare Need is “Quality”
by Jim Bell
When President Franklin D. Roosevelt signed into law the Social Security Acton August 14, 1935, the national focus on taking care of its citizens began with a simple idea to create a mandatory annuity with payroll deductions which, had they gone to an insurance policy, would have paid a much greater dividend in the end than what citizens can now actually expect to see. While it is true that what FDR envisioned is not exactly what came to pass, it is perhaps the single most important piece of legislation ever enacted with our life long security in mind.
Since then there have been many attempts by the Democrats and several Presidents to initiate some form of national health care. All of the programs that would have been beneficial for the American public were defeated. Instead what became law were different variations of business ideas for either the medical professions or the Insurance companies. Over the last few weeks I have seen several postings in the blogosphere and videos on You Tube from conservative Senators and Representatives who first of all assure us that they want to make sure we are all taken care of by seeing to it that everyone gets good quality, available health care.
These speakers go on to state that they don’t want the healthcare to wind up a government program because our government will only botch it by creating a bureaucratic night mare that will result in longer waits for doctor visits,the loss of the ability to see the doctor of our choice and stagnated advancements in scientific progress caused by a lack of competition. They believe that it is through competition that new ideas flourish and it is through competition that the public will see the best possible health care available. These ideas seem on the surface to have merit, but it is possible that private enterprise doesn’t belong in every aspect of our lives.
In the area of medical care, the U.S. doesn’t even rank in the top ten countries in the world in health care quality. This is not because we don’t have the best quality health care here, but because it is not as readily available to the average individual as it is in other countries. Our health care system is in the hands of the private sector now and is dominated by the insurance companies, not the medical profession. And the insurance companies don’t make money by providing coverage; they make money by denying it. Every Insurance company in the health care industry makes their decisions about covering the costs of treatment for individuals based upon costs.
Any time your doctor feels you need something-from a drug treatment to an MRI to a hospital stay, the decision to go ahead with the treatment is made by the insurance companies. The deciding factor is always about money, never about the quality of care. Insurance is a business; and as such all decisions are made to provide a favorable report to a board of directors.
This means that all decisions are made to further increase profits and to provide increasing stock value. And health insurance companies all have full time employees whose only job is to find a way to deny coverage (and therefore payment) for an individual’s care, which has been deemed necessary by their physician. The Insurance companies are, of course, protecting their profitability. The quality of care simply gets in the way of this mission.
So here we are at another major junction in the political arena where once again we have a big push toward national health care, only this time there is much more support than there has been in the past. The argument that only free enterprise can provide the necessary competition that will insure that the U.S. will stay on the cutting edge with their quality of healthcare doesn’t wash.
As for any progress made in the medical fields-most progress is made at our universities through their research programs, many of which are government funded. Many of these discoveries made in university studies wind up being patented by pharmaceutical companies which had little or nothing to do with the research. But it is legal for them to patent the concept, idea or new drug so it becomes that company’s intellectual property and therefore does not remain in the public domain.
The FDA has compounded the problem by championing a law stating that only a drug can cure a disease. So if any doctor or a group of doctors discover a cure for any disease that involves, say, a high protein diet with purified water accompanied by a period of rest followed by an aggressive exercise program in fresh air-the FDA might just shut them down or sue them. The quality of your care is really a major concern here, don’t you think?
Conservatives love to tout the fact that free enterprise and its intrinsic competition provide the fastest and the most reliable pathway to progress in any field. Truthfully, our healthcare has been in the hands of free enterprise for decades now and it’s an abysmal failure. The private sector has blown it. Their mission is profitability, and the quality of our health care has suffered greatly because of it.
Jim Bell was born in Missouri in 1950 and is a graduate of the University of Missouri with a degree in Creative writing/Journalism. Hespent over 20 years in the newspaper business and worked in production. He now lives in the Denver area with my wife and I run a blog called The Sensible Approach. He says: “I view myself as slightly to the right of center politically. My views are slightly conservative on the economy and foreign policy and liberal on human rights. It is my opinion that life for the average American goes smoother when there is a balance between the Democrats and Republicans in both houses of congress. Our comfort lies in the fact that a balance of power means that both parties must compromise to get anything done.”
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37 Responses to “The Key To Our Healthcare Need is “Quality””
Jim I think you're way off the mark here, although it looks like politically you and I are pretty close. More government intervention in health will mean increased access but decreased choices. Using the examples of MRIs, there would still have to be a pre-authorization by the government just as there is often pre-authorization by insurance companies. The government cannot just give carte blanche for unlimited MRIs. And while your criticisms of the FDA have some merit, the FDA is a government organization. Why do you think they will somehow improve with nationalized health care?
The only problem nationalized health care will solve is access, and even than that's questionable because there is already a shortage of primary care docs. The only way nationalized health care can control costs while expanding access is to limit testing (like MRIs), mandate cheaper medications and prioritize expensive treatments like dialysis. I don't think the US is ready for that – people seem to want everything they have now but they don't want to pay a lot for it.
And corporations looking for enough profit for shareholders above all else help with health care how, DaGoat? By having 4 times the administrative overhead of Medicaid or Medicare? By having employees whose only job is to look for excuses to kick people out of the system? By having executives who make 9 figure salaries? Corporations and their profits have nothing to do with providing good health care for a reasonable amount. They have no interest in providing that to the uninsured unless they can pull another con job like the Medicare drug benefit that winds up being designed to benefit the corporation more than the patients.
I agree with DaGoat in that the author is off the mark. It's as though he's showing how and why our healthcare system has never really been a free market system, and elaborating on how the inability for market forces to work in our current system has led to all of these problems, and then advocating as a solution that we move to further remove market forces.
I agree, of course, that our system is not based on free markets and that has led to a lot of inefficiency and high cost. But the government can't overturn the laws of supply and demand, so turning the system over to government management instead of insurers will only lead to rationing of a different sort (we currently ration according to price, while government run healthcare will necessarily ration according to some other criteria.)
Then there's the canard about research being funded by the government; basic scientific research for healthcare advances is certainly funded that way, but the private companies still have to make enormous investments to get technology and pharmaceuticals to the market. Anyone who thinks that will still happen at the same rate if we completely de-privatize healthcare is laughably naive. If you want to argue that perhaps we don't need to keep advancing at the current rate and that we need to slow that down because it's becoming unaffordable, I don't really have a problem with that- but it's the people who think that we don't need profit incentive to continue the current rate of medical progress that are either disingenuous or they've been conned.
And finally, while I agree that the profit incentive has perverted our medical system so that natural or holistic medical care is not even understood by our medical providers, the free market does have an answer for that. While no one is paying attention, a competing field of medicine has grown up quite nicely beside our traditional MD/pharmaceutical based industry- it's called alternative medicine.
Jim I don't pretend to have all the answers to the health care problem but if people are going to suggest alternatives they should at least be able to show how it's an improvement over the current system. In Mr. Bell's article, most of the problems he cites will not be improved by nationalized health care.
If Medicare is so well run why is it nearing bankruptcy? Medicaid is so bad that in some states it's hard to find doctors that accept it, especially specialists.
On the Medicare drug benefit, there are good and bad plans out there. Frankly unless people are on a particularly expensive medication they're better off getting their meds for 4 bucks a month at Wal-Mart or HyVee, where the capitalist system seems to be working very well in bringing down drug prices.
For all here that rely on the old saw that government cannot do a better job than private insurance, I ask you to consider three points.
1. Who has spent billions in lobbying efforts to manipulate the way Medicare and Medicaid is implemented in our country? That would be the private insurance and Big Pharma. Do you think their interests are served by the the inefficiencies that have been injected into the Federal system?
2. The pro-business voices here make the point that shortages are somehow unavoidable for health care. Doesn't it strike you that shortages are the lifeblood of profit, and corporations are created to maximize profit?
3. Why don't we privatize our drinking water? Isn't there a great profit margin in keeping some people thirsty? Health care is just as fundamental, and equallt a moral question for a society. Doing the morally correct thing is not built into the corporate philosophy, but it is part of being American.
I don't disagree with the idea that Insurance companies are hurting folks but, in the end, decisions must be made. Either by an insurance provider or a bureaucrat. If you measure health care by access, in theory we are way behind Europe and others, but that is not the case when it comes to actual access. It can take years to be seen for a simple procedure because of the prioritizing of scarce resources. When I think of the US going down that road I fear for the future. Look at England's process, where they are trying to decide whether a person's lifestyle should determine their treatment. They way the nanny's are controlling our menus, do we even doubt that people who eat fast food or smoke or whatever the boogeyman is at the time, will be denied care since they will be considered “not worth the expense?”
For all here that rely on the old saw that government cannot do a better job than private insurance, I ask you to consider three points.First, I just have to point out that I don't think it's an old saw to say that the burden of proof should be on those who propose a particular change, to defend why that change would be a net positive one.
1. Who has spent billions in lobbying efforts to manipulate the way Medicare and Medicaid is implemented in our country? That would be the private insurance and Big Pharma. Do you think their interests are served by the the inefficiencies that have been injected into the Federal system? I'm certainly not going to disagree that the private insurance and pharmaceutical industries have looked after their vested interest to the detriment of our societal need to keep costs in line. But what does that have to do with what the best fix would be? That doesn't prove one way or another whether we'd be better served by reforming the private system or nationalizing it.
2. The pro-business voices here make the point that shortages are somehow unavoidable for health care. Doesn't it strike you that shortages are the lifeblood of profit, and corporations are created to maximize profit?Yes, I think I pointed you to an article a while ago by Dave Shuler, explaining how the medical industry is run as a cartel. That strikes me as a sensible place to begin fixing the problem without nationalizing the industry. Undo the regulations which enable it to operate in that manner and see how much we can drive down prices by increasing supply.
3. Why don't we privatize our drinking water? Isn't there a great profit margin in keeping some people thirsty? Health care is just as fundamental, and equallt a moral question for a society. Doing the morally correct thing is not built into the corporate philosophy, but it is part of being American. Huh, lots to cover with that one. First, you're taking a situation which would be moving in the opposite direction- something that's now public and talking about making it privatized. Conservatives tend to look at things not in a vacuum, but in terms of the changes that are being proposed. We never start with a blank slate and decide this is going to be better if privately owned vs this is public- when debating policy you have to look at how the policy change will impact things overall.
Second, there's the issue of the basic right to potable water vs. having the right to pay for bottled water. I realize it's possible to create a government run healthcare system with privatized options for the bells and whistles of healthcare, but that is an important distinction. People should have the right to appendectomies, trauma treatment after an accident, prenatal and neonatal care, vaccinations, etc etc, but I think most of us would agree that there's not an inalienable right to erections, liposuction, and cosmetic breast implants. As it seems inevitable that we're moving toward a government run healthcare system, I hope that those distinctions won't be missed, and I hope people will also acknowledge that there's a tremendous amount of gray area where decisions will have to be made. Is the latest chemo drug really a necessary treatment? Do we have a right to request the most recent innovations in screening for heart disease or cancer, or will our government decide what is 'good enough'? These decisions are already being made to a great extent by insurance companies, but currently we have the right to pay out of pocket if we don't like the decisions.
CS
1. Insurance and Big Pharma's answer to medical care is to maximize profits. HMO s were their brilliant idea, and maximizing profits by limiting service is a blatant example why they should not be in charge of the system. I believe the societal need of Americans trumps the “right” of these cartels to limit service so they may maximize profit.
2. The link you pointed me to also had a link that demonstrates that Administration is the fastest growing segment of health care while actual patient care employees grows the least. I've posted previously that my wife works at a local hospital where the current ratio of administrative staff is 40% of the total. Likewise, there are legions of suits in the Insurance trade who must be paid – and quite handsomely at that. The insurance mavens invoke preexisting conditions, and limit prenatal care not because it's good for the patient, just the bottom line. The federal government gets those who cannot afford to get help, and hospitals dump patients into taxis if they have no insurance. The cartel you spoke of is only in it for profit, not medicine. If I have to choose an Administrative body, I choose a governmental one whose purpose is service, not the almighty buck.
3. What private insurance company currently pays for erections and liposuction? Bringing up what's not covered now is no way to convince me that the government will cover these procedures later. Private or government, your money will still buy you all the cosmetic surgery you wish.
Ok. Let's not start with a blank slate.
Potable water used to be a privatized commodity. Haven't you seen any westerns where the one rancher limits access to “his” water? The government had to intervene and does so today. The Missouri River is managed by the government to maintain viable transportation levels and works with adjoining states to mitigate water usage disputes. The river has neither gone dry or overflowed for quite some time.
Some commodities are not safe in the hands of private business, it's not their nature to see this need as anything more than a way to make money. Health care can't be managed like boxed cereal. A bushel of corn costs about the same as a box of corn flakes. We can barely afford that kind of markup for cereal. Why effectuate a system that has made US health costs the highest in the world and about 9th in effectiveness?
HMO s were their brilliant idea, and maximizing profits by limiting service is a blatant example why they should not be in charge of the system. I believe the societal need of Americans trumps the “right” of these cartels to limit service so they may maximize profit.
But any entity that is charged with managing the distribution of health care resources will have to limit services according to some criteria. So your criticism of how the insurance companies have done so still doesn't explain how or why the government would be able to craft a better solution. They can't infinitely grow the supply side for medical personnel and services, so they will have to ration or alternatively allow the costs to keep rising until they're unsustainable.
And no, I wasn't saying that private insurance companies pay for the cosmetic stuff. My point was that those are the types of things that everyone agrees are not part of the 'basics'. But then I went on to give some example of the vast gray area where decisions will have to be made. How will a government system deal with those areas? If you look at VA care and Medicare now, there are already a lot of things that just get denied, so how are we not to believe that would be the case if everyone received their healthcare via government paying the bill?
Some commodities are not safe in the hands of private business, it's not their nature to see this need as anything more than a way to make money.
The point you are missing is that the government has actually created the cartel of healthcare with it's policies. I don't see why the government should allow the medical profession to limit the supply of doctors, for instance, do you? Sure, to a small degree, to keep quality high- but when was the last time a new medical school was built? There was actually a conscious decision made, supported by government policy, to restrict the number of graduates even though there were obvious arguments against that with our aging population. So that's just one small example of how getting the government OUT Of the way might help.
The article I linked to also talked about similar problems with biotech equipment facilities and the process by which they have to seek government approval.
The healthcare system will never operate perfectly as a free market system (inelastic demand, for one thing) but these are examples of the government actions which cause costs to rise- protecting the providers instead of the consumers.
CS
Your response “But any entity that is charged with managing the distribution of health care resources will have to limit services according to some criteria. So your criticism of how the insurance companies have done so still doesn't explain how or why the government would be able to craft a better solution.”
The criteria is exactly the key. Do you want to have health care management based on profit or medical need? If you have concerns that the government will make some arbitrary treatment call, look to the Stimulus bill Obama got passed. “Under the legislation, researchers will receive $1.1 billion to compare drugs, medical devices, surgery and other ways of treating specific conditions.”
Efficacy for the patient is a criteria I can back.
Your second post continues with “OK, but health care isn't a fixed supply as the commodities you are comparing it to (water-….”
My example was that water can be made artificially scarce, and the current private health care system fits that comparison like a glove. It regularly limits care to maximize profit at the expense patients.
CS, I'm not trying to eradicate the private sector, but its track record is abysmal. We consistently lead the world in the cost of health care, and at the same time, the US is ranked 37th, 37th in the world behind such power houses such as Costa Rica and Columbia. Now that's what I call a profit margin.
I simply don't see any track record for government management of anything which would indicate a reason for greater confidence. Just because Obama's throwing a billion dollars at it doesn't mean that this will result in good decisions being made. When government gets involved, the profit motive doesn't go away, it just shifts to the politically connected benefactors.
Sure, govt management of a simple distribution of a commodity like water is reasonably effective- you don't have the level of complexity of decisions involved there that are present in healthcare delivery. So, I still reject your analogy, it's apples to oranges.
“I simply don't see any track record for government management of anything which would indicate a reason for greater confidence.” That's because Republicans are incapable of admitting that government does anything right.
I notice that the conservative posters completely ignore this part of Jim Bell's post.
There are no cost savings that ever go anywhere except to profits for the sake of management. Nothing is ever passed to the consumer. Rates never quit increasing. I know that when I was paying for my own insurance completely I noticed that the insurance rates always went up faster than the rate of inflation for medical care. Counting on the same people who currently run health care corporations to contribute to solving our problems is worse than trusting the bankers who got us where we are in the rest of the economy. Which is of course why it's probably going to work out that way…and our problems aren't going to be solved.
If you have concerns that the government will make some arbitrary treatment call, look to the Stimulus bill Obama got passed. “Under the legislation, researchers will receive $1.1 billion to compare drugs, medical devices, surgery and other ways of treating specific conditions.”
Having dealt with these types of boards yes they are going to make some arbitrary decisions, and probably a lot of them. They will also be extremely vulnerable to lobbying and outside influence.
On your comments on hospitals throwing uninsured patients into taxis, I don't know where you're getting this stuff but that is a $50K fine per occurrence under EMTALA, and most hospitals live in deathly fear of getting fined and losing their Medicare certification.
On erections (may as well throw some sex in here), many if not most private insurance companies pay for Viagra, Cialis, etc with the usual co-pays although they do generally limit it to 6 or 8 per month. Medicaid does NOT pay for Viagra, at least here in Iowa.
At the heart of this though is CStanley's observation that any government-run health care plan must ration care, diagnostics and treatments just as much and probably more than current private insurers. This is absolutely true and why the original article's comments about insurance companies making decisions on treatments, admissions, etc makes no sense at all. All Medicare admissions right now are reviewed by Medicare (here in Iowa they are reviewed by the Iowa Foundation for Medical Care) and if they feel the admission was not warranted they will not pay the hospital and physicians. Therefore all hospitals and physicians already use current Medicare criteria when deciding on admissions.
A government-run health care system can expand access by covering the currently uninsured but it MUST control costs. Based on Medicare, VA, Medicaid and Tri-care it will not be any less restrictive than private insurance and probably will be more restrictive.
That's because Republicans are incapable of admitting that government does anything right.
Great nonanswer, Jim. Instead of choosing to give examples of what the government has managed well, you turn it around to make it an accusation on those of us who have a normal healthy skepticism.
Cs
Your point can easily be turned back to my conclusion. We currently pay the most for health care, and are ranked 37th. Why would any fiscal conservative accept such shoddy return on our invested health care dollar? Costs go up, insurance profits go up, health care provided goes down. Analogize that anyway you want, it's a bad deal that conservatives accept because its run by holy private enterprise.
As far as government run programs. I can safely say Missouri provides Internet access to our schools, libraries, and many state agencies cheaper than private companies. Checks out the EMINTS program for just one example.
At the heart of this though is CStanley's observation that any government-run health care plan must ration care, diagnostics and treatments just as much and probably more than current private insurers.
Thank you for introducing some rationality, DaGoat.
And why anyone thinks this will magically happen in the best interest of the patients instead of being subject to the selfish interests of those who are making the decisions when government is involved is beyond me. All this does is add another middleman.
Hemm- I don't accept it. The system is a mess- I just don't want to see it go from bad to worse. I propose getting rid of the bad govt interventions we now have which restrict supply even more than it needs to be restricted, as a means of reducing cost and improving availability. That's not the whole solution, but a big part of it IMO (and something which invariably NEEDS to be done whether we go to nationalized system or stick with a mostly privately run one. You won't get costs down without increasing the supply side- and in fact going to universal coverage is liable to make this much worse instead of better unless we start finding more providers really quickly.)
I do reject the accuracy of a lot of those stats on ranking though, Hemm. They're highly subject to flimflammery. The mortality rate apparently is almost completely a result of violent deaths (when you adjust for that we're on par with Europe from what I understand) and then with infant mortality (another one which often gets tossed around) the issue is that most of the other countries just don't count all live births- if an infant is very premature or underweight they're automatically registered as stillborn.
Your internet example- another example of a simple commodity- no decisionmaking involved, you just have a number of schools which all get allocated the resource evenly. That's why none of these things compare to healthcare, where there are complex decisions on how to allocate.
And on your argument about the cost/benefit, Hemm- we already spend more, not just on private sector healthcare, but also on the publicly funded part. So why would we think that increasing that would yield a better return?
http://stubbornfacts.us/domestic_policy/health_…
CS
World Health Organization statistics are well known for their flimflamery.
What business is not about a commodity or a service? Private companies corner the market on Oil, silver, coffee, sugar, and I could go on and on.
The “simple” commodity of Internet service that you feel is not a fair comparison takes bids from various providers, AT&T, SBC, Lightcore, etc. and gives its clients Internet access far below the costs any school can get on its own.
Health care gets alot of its complexity because there's money in complexity.
As to the DaGoat comment about patients dropped off in skid row. It took me about three seconds to find this video on The Google
http://www.youtube.com/watch?v=-Q-yTFZUolg
The same list provided finds such as
Hospital executive arrested for allegedly using homeless people in medical fraud
Johnny Reed Jr. of Skid Row in Los Angeles said he was once offered … Skid Row residents said the ambulances arrived each morning heralded by hospital patient recruiters who offered food, …
Medicaid fraud seems to also be a small problem for Private Health care too.
Stubborn facts is not just a web site.
As to the DaGoat comment about patients dropped off in skid row. It took me about three seconds to find this video on The Google
I stand corrected although you weren't very specific with your original comment. I had it in my head you were referring to ER patients. But yeah, Kaiser Permanente is pretty bad and I think actually is a lot like nationalized health care will look like.
CS, a belief that all government programs are badly run while the private sector does virtually everything right is not healthy skepticism, it is Republican ideological BS. Nothing more. When I was my mother's legal guardian and had to deal with her affairs including Social Security and Medicaid they were better than the private insurance bureaucracy I was dealing with for myself and my mother in law. Every human institution has problems. None of us can get everything right. But neither do most of us get everything wrong. But in Republicanland the government can't do anything right and if we just leave everything to those good decent people like Bernie Madoff, Ken Lay, Andy Fastow, Jeffrey Skilling, Robert Stanford, Timothy Belden and friends, Dennis Kozlowski, Bernie Ebbers, Enron's accountants at Arthur Andersen, the geniuses behind our current fiscal crises and a seemingly never-ending list of other crooks and incompetents that populate modern business. Yes, that was just a partial list of those that have been discovered. No one really believes that there are others who didn't get caught. It also doesn't address simple incompetence or screw ups on the part of people who are otherwise competent. And since we're discussing health care there's the magic profit protector, rescission. Yet you and DaGoat would have us believe that it is the government who can't run anything.
“But yeah, Kaiser Permanente is pretty bad and I think actually is a lot like nationalized health care will look like.”
No, it's what health care in the future you push for will look like. See the comment I made concerning rescission in my previous post.
Jim, the problem is that in those private sector screwups there's also often a government component. I realize some Republicans have been apologists for that sort of government involvement, but I am not.
When I compare govt to private sector, I'm not arguing that 'the private sector does virtually everything right', so please don't put words in my mouth. Quite the contrary, I think there are areas of great weakness in the free market system, and I think if we could ALL get past ideology we could find ways to make the government work to help correct the weaknesses instead of making them worse.
Unfortunately though when left to their own devices, politicians usually find ways to exploit the weaknesses (a point in the system where there's complexity and opacity enough to make market forces not function well is a great point for a politician to step in, announce he's going to solve the problem, and create government intervention which allows him to skim from the excess profits/)
I agree that Republicans need to refrain from the simplistic “markets good, government bad” but Democrats need to stop making the opposite assumption. In both public and private enterprise, there are opportunities for greed and corruption and we should hold our elected officials accountable for being part of the solution and not part of the problem. When you make the private sector guys out to be villains and automatically push for government programs to substitute for the private institutions, you give the politicians license to do the same as what the private sector bad actors have done.
“Jim, the problem is that in those private sector screwups there's also often a government component.”
Bull. People on your side of the debate constantly make this claim with absolutely no real proof. It's just what you have to claim to defend your ideology.
“I agree that Republicans need to refrain from the simplistic “markets good, government bad” …”
Then when will you ever do that? It's all your posts ever are until you're called on their content like I just did. Until that happens your writings are a love letter to whatever corporations do and a hate note for government. Of course you're going to deny that I'm right on this. Scream about how I'm some radical liberal…and then go back to writing the same old things that prove me right just like all of your “Oh, the government will be worse. Government agencies don't run anything right.” statements in this thread.
Jim, the reason I make statements like “the government will be worse” in this thread and others is in reaction to people like you who default to government solutions without any evidence that they can or will work. I'm simply standing by my earlier statement that those who promote change have the onus of proof on their side. You can't just describe a problem with the status quo and then insist that the only way to solve that problem is to turn it over to government management. Notice too that instead of rebutting my argument that the government would be worse, you continually put the focus on me and duck the question itself. Can you or can you not show that the arguments that DaGoat and I have raised (the need for arbitrary criteria to allocate healthcare resources, which is still going to have to be made by people who will have motives other than the best care of the patients, is necessary in a govt run system just as in an insurer based one?
I'm at work right now but will try to come back to the first part of your comment, about what I mean by 'government being often involved in private sector screwups. Just a quick one off the top of my head would be the part of the housing crisis that you're well aware of and I'm pretty sure would agree on- banking deregulation. Now, a pure free marketer would say that deregulation should be the default- but the kind of deregulation that the govt engaged in with the banks was actually a form of corporate favoritism, giving power to the behemoths instead of protecting the competitive market. I'm all for trust busting type of regulation, because allowing megacorporations to dominate a market disrupts the normal competition.
And quickly…
In the healthcare problem specifically, I've also brought up one way that the government has also intervenes in a way that keeps costs higher- by controlling supply of physicians and medical equipment. The government in that case enables a cartel- and instead of then using the problems that result from that to justify giving control to the government, we ought to think about removing the destructive government intervention that is already there (or at least modifying it, by encouraging more medical graduates, and a shift to provision of basic wellness care to physicians' assistants and nurses who can be trained more readily and inexpensively.
Nothing controls the supply of physicians more than the cost of medical school and its difficulty. Where does the government control the supply of medical equipment? Are you trying to say any regulation that governs the quality of equipment necessarily limits supply, even of approved medical devices?
No, I'm not talking about quality regulations. Here's the background on the equipment issue (3/4 of states require a Certificate of Need before a new facility can be permitted, and studies show healthcare costs are higher in those states- surprise, surprise)
And here are the facts about medical education in the US. We're still graduating the same number of physicians today that we did in 1980. We only got to that level because the govt does subsidize it- and that's an area where the govt could sensibly intervene, to increase supply. Obviously we shouldn't increase the slots to the point that we get students entering the field who aren't qualified, but there's surely a large pool of young people who could become fine doctors if given the opportunity.
Dave Shuler has a whole slew of good articles bringing up these things that no one ever addresses in the healthcare debate. My take on it is that these things need to be dealt with (esp the supply side issue) regardless of whether our system remains mostly private or becomes government run. Either way, the resources are too scarce and that keeps costs too high.
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