???????? – was interesting, thank you for posting it….

You haven't missed the angry-villager dynamic in play here, have you? The Michael Moores of the world are aghast that the insurance companies have policies like this…beyond which treatment you need *will not be covered!* This is proof of the fundamental wickedness of the profit-minded insurance companies. How can you imagine that the government will be able to install a similar set of policies without facing a similar mob of torches and pitchforks?

That's a patently false statement.

We don't lag in cancer survival (though this study shows that there's room for improvement in the US, particularly in certain states/regions and among minorities- but even with those negative factors we still don't lag generally as compared to other countries.) We're so far from dead last, it's absurd to claim that.

I'm not aware of any stats on comparing heart disease survival except a very limited focus one involving a few countries (Scandinavian, I believe) that have lower mortality rates in the immediate aftermath of a myocardial infarction. This could well be due to differences in severity of the disease itself based on lifestyle and genetic factors, though. If you have other stats showing across the board that the US survival rates for cardiovascular disease lag behind other countries, do share.

I've already debunked the longevity claim (that disparity goes away when you factor out violent or accidental deaths, which are not related to quality of healthcare delivery in any way.)

There are definitely things we can learn from other healthcare delivery models, and there are some narrower stats where we really do lag, as this article points out. But please stick to facts instead of propaganda. We do spend a lot more, and that has to change- but your claims about massive inferiority of our results is just not borne out in fact.

CStanley, there's no disparity in what I said. Lowering costs by deciding what procedures are or aren't covered does not require a decision on each patient to pay or deny payment. Procedure A is covered, or not, for diagnosis code B. Those decisions need be made only once, not per patient. And private insurers use the codes developed by the government, just as medicare does. Hence they actually are the beneficiaries of government spending, not the victims of it. Even with the government covering the full cost of developing the rules, private insurance is much more costly.

But we're talking in circles about comparatively trivial savings. If 80% of costs are on 20% of patients, and mostly in the last few months of life, it is THERE that we must save money. That's the toughest part of the debate, but it's sexier for you to passionately defend companies while trashing government. Government paid and controlled systems outperform globally, and to deny it is just disingenuous. We pay 3X as much for care that leaves us dead last in infant mortality, cancer, heart disease, diabetes, longevity and other measurable OUTCOMES of treatment. Governments can and do perform better globally at providing health care outcomes than our profit-driven model. You can deny it all you want, but you can't provide a single example in which a profit-driven system provides better OUTCOMES, regardless of cost.

Yes- that's why I think it's a sham to claim that Medicare operates efficiently with 3% administrative costs. Those costs SHOULD be higher if they're unable to weed out fraudulent applications- then we wouldn't need the money on the back end to investigate the fraud. That's not to say I condone politicians who protect the perpetrators- it should be prosecuted and if GOP are refusing to do so they are wrong.

No, the Medicare bureaucracy is not the victim here, the American taxpayer is. And if the administrators of Medicare don't have adequate manpower and resources to prevent fraudulent claims from being paid out, then they are part of the problem.

Wouldn't the problem be the people who refuse to give them those resources? In Missouri the Republican party proposed a bill to increase penalties for patients who defrauded Medicaid. When the Democrats proposed an addition that would also go after the businesses who committed fraud the Republicans refused to do it. Ths is a perfect example of their mindset. Screw the peasants, protect the wealthy.

That's why it makes no sense when people say, “Fine, let's not adopt a nationalized UHC system but instead let people voluntarily choose coverage under a government run plan, while others can continue with their traditional coverage.” That's not a sustainable situation because as govt begins feeling the pinch of rising costs, it's plan will continue to dictate low pricing which will then be subsidized by higher negotiated payments to the private insurance companies. So that approach makes no sense at all- you're not allowing some individuals to opt out of the government run program, not really- because they're going to pay for it one way or another. As soon as this becomes apparent, everyone will begin abandoning their private plans. We might as well skip the charade and go straight to universally mandated govt run insurance.

No, the Medicare bureaucracy is not the victim here, the American taxpayer is. And if the administrators of Medicare don't have adequate manpower and resources to prevent fraudulent claims from being paid out, then they are part of the problem.

If doctors lose money on medicare patients, of course they'll want to stop taking them. That doesn't require any collusion, it's just common sense.

Granted price caps stabilize prices, but they don't drive down the supplier's costs. You can cap what a doctor can charge for a treatment, but that doesn't make his rent any lower or his malpractice insurance payments any cheaper. His staff still has to manage the same paperwork–or more–and will still expect to be paid. So he's either going to stop giving the unprofitable treatment or shift the costs around by charging more for something else.

A doctor friend of mine reports that some of his medicare patients cover only 10% of the costs of treating them. He has to charge other patients more to make up the difference. And he's not part of a cartel.

Medicare prices are always lower that what hospitals and doctors want to charge. That's why many private hospitals and practices quit taking medicare patients. The cartel is a collusion between hospitals and doctors and insurance companies, just like the oil companies and the refineries. Medicare placing a basement on prices doesn't increase prices, it attempts to stabilize them.

CS

So private hospitals committing fraud are the reason that Medicare is the problem? That's like blaming the victim for the crime, isn't it?

Then in paragraph 3 you state that there's a problem with insurance companies spending money on denying claims. You can't square that circle- if you believe that certain procedures must be denied, there has to be a cost in arbitrating when that happens.

Also, Medicare also denies claims, but it relies on the administrative staff of the physicians offices to deal with this- so the idea that their administrative costs are so low is mostly smoke and mirrors.

And finally, I don't know how you can seriously claim that Medicare prevents fraud. This article about a bust last year in Houston estimates that the annual national cost of fraudulent Medicare payouts is $11 billion.

The problem is not that the cats in the health care industry are too fat, it's that there are too many of them. Too many clerks pushing paperwork that should have been computerized a decade ago, too many administrators jumping through government-held regulatory hoops, too many doctors doing needless tests, too many lawyers trying to squeeze blood out of other people's turnips.

That's the supply side. On the demand side we're blessed with millions of people stridently demanding that other people pay their doctors' bills. They're eager to demonize insurance companies for not paying enough bills enthusiastically enough, no matter what their contract says. And they certainly don't want to hear about cost controls that might enable them to pay the bills themselves.

This is one broken system.

healthcare costs are up for many reasons, not the least of which is that we use increasingly sophisticated end of life procedures and treat previously fatal conditions. The solution to higher costs is not to continue to reward insurance companies, nor is it some kind of abstract “controlling costs” or “increasing efficiency”. Some gains can be made by increasing prevention and allowing medications to be purchased on the global market. But let's face it, the hard fact is that in order to lower costs substantially, we need to limit the amount we are willing to spend on hopeless cases.

And we need to kick profit out of healthcare. Insurance companies do the opposite of what we pay them to do, which is to pay medical bills. A huge part of their payroll is in claims DENIAL departments, while Medicare pays nothing to deny claims. The cost of actually preventing fraud (which Medicare does) is much less than nitpicking every single claim in an attempt not to pay it.

But let me play conservative for a moment (though you all know better). LET THE MARKET DECIDE. I hereby offer to pay my share of the added cost of including me in Medicare. If they'll sell it to me, I'll buy it. Let the insurance companies compete with that. If they can't, they don't deserve to be in business. Here's another proposal. When insurers come begging for a government bailout, buy them. That's how businesses raise money in the private sector. By selling stock.

I believe he will support me on the statement that US healthcare costs have spiraled out of control most largely due to the costs of defensive medicine.

How that falls at the feet of insurance companies is patently counterintuitive……..after all, aren't they the ones constantly denying treatments??

If the government sets the price at something “reasonable and customary,” an efficient provider who might have charged less than that will naturally raise their prices and pocket the difference as profit. Lo, costs go up.

On the other hand, if the mandated price is too low, providers won't get more efficient, they'll stop providing that service. If you require them to keep providing it, they still won't get more efficient. They'll skimp on quality, or they'll shift the costs somewhere else.

“Private enterprise in a free market, not so much.”

Well, duh. Health care is the most heavily regulated industry we have.

I agree.

The problem with health care debates is that one must always start with the political positions commonly held. If we can agree that both sides have ideas that can be incorporated to create the best solution instead of the politically appealing solution, headway could begin.

This may well be my biggest concern. The moneyed interests distort the political debate so that no solution is ever found. I believe that may be their very intention. If nothing changes, they guarantee their profits and the politicians guarantee their PAC money.

I believe that both government and business must modify their efforts or the U S will certainly go bankrupt. Rhetoric has to be the first casualty of the health care crisis.

Of course- but it oughtn't intervene in the wrong direction, to make costs go up by protecting the profiteering that comes from the cartel situation.

I don't think the 'cartel' can be completely broken, but it could certainly be managed more effectively by increasing the supply of treating professionals (more medical school graduates as well as a loosening of restrictions on what can be done by PAs and nurses for wellness care) and by changing the rules for CONs for new medtech facilities (currently anyone who wants to open a new imaging center, for instance, has to prove need as well as proving that they will have no regional competition- gee, that's a great way to keep costs down, eh?)

It's certainly not the total answer, but I'd suggest that these are going to be important things to address regardless of whether our system remains mostly privatized or we go to a single payer or UHC system. In fact, if this side of things isn't addressed, the supply issue is likely to be far worse when we dump a whole lot of new patients into the system; primary care is already underserved and that's the very part of our healthcare system that's going to see drastic increases in demand with UHC.

Dr_J also mentioned the costs of practicing protective medicine (doing extra testing is the physician form of CYA, and it's very costly), so that's another area where the govt needs to get out of the way more (an example of govt intervention that works to drive costs UP, not down as we need.)

One final note is that really, even without changing a thing we could all affect costs if we price shop as though we're paying directly. I realize that's not going to happen on a scale that would bring overall costs down, but really it's a shame that we've reached this point simply because we're like the guy on an expense account who eats steak every night because he can.

No, I am not a “righty”. I am dyed in the wool libertarian.

I'll even let you smoke pot, marry a member of the same sex and allow you to believe you evolved from a frog. Just don't send me any of your bills.

So when government medicare sets the price it will pay for a particular service, this increases cost how?

Insurance ultimately doesn't care how much something costs, they just pass it on along with a nice profit increase. The health care cartel functions like oil producers and refineries. Oil sets the price, and the refineries just add their part. There is no competition here, nor is their any in health care. Collusion for a common profit? Of course.
Private enterprise in a free market, not so much.