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Americans: Damned if We Do, Don’t

Joe noted this finding at the end of his earlier post, but I thought it deserved its own, dedicated shout out. From today’s NYT

Over all, the poll portrays a nation torn by conflicting impulses and confusion.

In one finding, 75 percent of respondents said they were concerned that the cost of their own health care would eventually go up if the government did not create a system of providing health care for all Americans. But in another finding, 77 percent said they were concerned that the cost of health care would go up if the government did create such a system.

My question: Does that reflect confusion … or clairvoyance?



94 Responses to “Americans: Damned if We Do, Don’t”

  1. GeorgeSorwell says:

    You don't have to be clairvoyant to know it keeps going up.

  2. Pete Abel says:

    George — I think the questions/answers suggest extraordinary increases — i.e., the sense that, with or without reform, no one has yet cracked the nut on mitigating out-of-control cost increases; that neither private nor public options will do much to slow down the higher-than-inflation curve.

  3. GeorgeSorwell says:

    Pete–

    You don't need to be clairvoyant to know that what we have is unsustainable.

    Here's another quote from that NYT article:

    There is overwhelming support for a bipartisan agreement on health care, and here again, Mr. Obama appears in the stronger position: 59 percent said that he was making an effort to work with Congressional Republicans, while just 33 percent said Republicans were trying to work with him on the issue.

  4. DaGoat says:

    I don't see this as particularly surprising. People know the present system isn't effective at controlling costs but also realize the government isn't very good at controlling costs either, especially if the plan entails covering tens of millions more patients.

  5. CStanley says:

    Pete, I think your last statement in your response to GS sums it up. People are definitely concerned with the status quo, but they don't believe the current proposals solve the problem.

  6. Pete Abel says:

    George — I'm not communicating well. Let me try again: I'm suggesting Americans might be “clairvoyant” because they do not believe any of the current options — to reform or not to reform — will change an unsustainable system into a sustainable one. What I'm picking up on in these apparently conflicting poll responses is a virtual (if not complete) resignation to the fear that whether or not Washington acts, the dysfunction will continue. I'm not saying I share that fear, but three-fourths of Americans apparently do share it – and they might (“clairvoyantly”) be correct. Our history is certainly not devoid of examples of Washington’s failure to fix problems, or of the persistence of problems whether or not Washington does something.

  7. JSpencer says:

    My take on the two polls is that Amercans are more confused than clairvoyant, and why wouldn't they be when so much of the reporting is political in nature rather than explanatory. Sure the information is out there, but rather than work to dig it up (time constraints, family, work, etc.) they mostly hope their trust in the party of their choice will make everything allright. Sounds like the Professor Harold Hill method to me.

  8. CStanley says:

    Our history is certainly not devoid of examples of Washington’s failure to fix problems — even when it tries.

    Precisely, Pete, and that justifiable lack of trust is what is killing this initiative.

    Two big mistakes: First, creating a comprehensive bill that promises to save money over the long haul even though the expenditures are obviously real and the savings are not quantifiable. On this, as I've said before, the political mistake is the same as the GOP made in trying to do comprehensive immigration reform. Then, the opponents said, 'Secure the border first, and then we'll talk about the rest', and on healthcare reform, the public is saying 'Show us the savings first, and then we'll talk about expanding coverage.' In both cases, it's not that theres no appetite for the latter things to happen, but there's no trust that the plans hatched in DC will address the problem that is more important to the majority of voters and which must happen for the overall plan to succeed.

    The second mistake was Obama saying things that are provably false about the bill, and some promises that are half truths or which ignore legitimate concerns. He has squandered a lot of the goodwill that he enjoyed previously, and this will definitely hurt the prospects of this key piece of legislation passing in any form that the Dems really wanted. It may harm the rest of his presidency as well, or may force him into the same position as Bill Clinton in 1994.

  9. CStanley says:

    Sure the information is out there,

    What information are you referring to, JSpencer? From the context, I assume you mean that there's information to show how the public option plan will save money and reduce costs. Can you point me to such information?

  10. GeorgeSorwell says:

    CStanley–

    Ironically enough, I was going to ask you to point me to information about what's “provably false” about the bill.

    Thanks in advance.

  11. Silhouette says:

    “We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.”

    *****

    Lack of health care is disrupting domestic tranquility. Protection from and treatment for disease promotes the general Welfare of the people. The Preamble to the Constitution is the nutshelled embodiment of the forefather's intent for America. It's time for a new Amendment that reflects that intent with respect to the nation's greatest enemy that has caused the most casualties, more than any and all wars or terrorist actions combined, to citizens' lives: lack of accessible [affordable] health care.

  12. kathykattenburg says:

    … especially if the plan entails covering tens of millions more patients.

    In a way that lowers costs over the long term.

    The current system is not just “ineffective at controlling costs”; it's a disaster that has has happened and is simply unsustainable.

  13. CStanley says:

    “If you like your current plan, you will be able to keep it”

    “There are some places, like the Mayo Clinic — many of you have heard of — provides outstanding care, some of the best in the world. People fly in from everywhere to go to Mayo Clinic to get treatment. It turns out Mayo provides care much more cheaply than a lot of other health systems, even though it's better care.” (Implying that this is the model on which the proposal is based, which Mayo obviously disputes.)

    And some more from Factcheck.org:
    Obama promised once again that a health care overhaul “will be paid for.” But congressional budget experts say the bills they’ve seen so far would add hundreds of billions of dollars to the deficit over the next decade.
    He said the plan “that I put forward” would cover at least 97 percent of all Americans. Actually, the plan he campaigned on would cover far less than that, and only one of the bills now being considered in Congress would do that.
    He said the “average American family is paying thousands” as part of their premiums to cover uncompensated care for the uninsured, implying that expanded coverage will slash insurance costs. But the nonpartisan Kaiser Family Foundation puts the cost per family figure at $200.
    Obama claimed his budget “reduced federal spending over the next 10 years by $2.2 trillion” compared with where it was headed before. Not true. Even figures from his own budget experts don’t support that. The Congressional Budget Office projects a $2.7 trillion increase, not a $2.2 trillion cut.
    The president said that the United States spends $6,000 more on average than other countries on health care. Actually, U.S. per capita spending is about $2,500 more than the next highest-spending country. Obama’s figure was a White House-calculated per-family estimate.

    There are more, too, especially if you go back to his campaign promises like when he said that his plan would reduce the average family's premiums by $2000 a year, and that no one making under $250,000 a year would see their taxes go up (I include this one since inevitably the high cost of this plan is leading Congress to consider ideas like taxing employer based health benefits- a proposal Obama harshly criticized as part of McCain's plan,.)

  14. CStanley says:

    In a way that lowers costs over the long term.

    Kathy- JSpencer hasn't responded yet to my question of where the evidence is for this cost savings. Do you wish to give it a shot?

  15. Silhouette says:

    People are getting microscopic with this debate and of course this is the intent of the health insurance and pharmaceutical industries right from the get go. The last thing they want the public to do is look at the issue from a standpoint of national security. That yanks the baby right out of their hands and places it squarely in a position where we can act quickly and effectively to right the situation.

    The issue of health care is an issue of national security because the issue of unaffordable health care is breaking our system of productivity to such a degree that we are now on our knees before communist China begging for scraps and mercy because our GNP has shrunk so badly that we cannot compete effectively on the world market anymore to literally save our lives. This is because health care is sucking the system dry. Employers who cannot afford to provide it for their workers pull up stakes and funnel their profits overseas. We've been slowly bleeding from this puncture wound now for decades. The patient is getting faint, woozey, lightheaded and all because of health care issues.

    You provide a public health system and impose strict tariffs on overseas production of US goods…and close all the loopholes, you'll see some really rich folk have to tighten their belts for a short period but then suddenly their quaility of life will again rise because a nation is more productive, rich and can afford the products they sell to get rich in the first place. So essentially we're all in a huge mess because of a health-monopoly and a group of super-rich who don't want to sacrafice even five years of their highball lifestyles to reinject life into the host they've sucked off of nearly to death.

    That's the big picture that they don't want us focusing on.

  16. Silhouette says:

    *Silence Noteworthy*..

    lol…

  17. shannonlee says:

    The CBO reports show that there will be no cost savings. People need to stop arguing that the bill will save us money.

  18. GeorgeSorwell says:

    CStanley–

    The links to Investor's Business Daily and the Mayo Clinic blog are opinion pieces, right?

    As to FactCheck, everybody already know about the problems with CBO numbers. The current struggle to further reduce costs is ongoing.

    You haven't proved anything false.

    All you've proved is that there's controversy.

  19. CStanley says:

    The IBD piece was an opinion piece which contains facts. Do you dispute the facts, or the analysis of them?

    The Mayo piece too is opinion but the point there isn't whether that opinion is agreed upon or not- the factual error Obama made is in using Mayo as an example of what this bill does. If Mayo disputes that, aren't they ultimately the ones who would know whether or not the plan uses their own methods of cost reduction?

    Oh, and the CBO- please. I assume you also felt that the CBO numbers were faulty whenever they were used to argue against Bush policies?

  20. Silhouette says:

    Oh my yes…microanalysis necessary. Let's not look at the bigger costs of not having public-funded health care! Weigh all of the costs including those to industry..then we see a net gain on the side of public health care in spades…lol..

    No! No!…keep focusing on micro issues of public vs private! DON'T let them include larger costs to our nation in the equation at all costs!!

    lol…

  21. Dr J says:

    George, a lot of your posts come across like an eight-year-old endlessly repeating “Oh yeah? Prove it!” no matter what anyone else says.

    I'd love to see you weigh in more with your own opinions backed by your own citations

  22. Silhouette says:

    In fact, it wouldn't even surprise me if health industry bots would start a siderail argument between each other at the first hint of THE BIGGER PICTURE being exposed..lol…if an hour-long pause and hopes of thread disappearance doesn't work. Or is pointed out..lol..

    Anything but argue the bigger picture. Anything but that!

  23. CStanley says:

    Silhouette, if you want someone to respond to your arguments, they sort of have to make sense. What you wrote makes you seem like a liberal version of Archie Bunker, and trying to argue with him is rather like hitting one's head against the wall.

    On your latest bit- what macroanalysis shows that overall costs of a public system would be lower than costs of healthcare as currently funded? If your saying the costs would be shifted away from corporations and onto other payers, sure. But are there reallly enough billionaires in the country to pay for all of the healthcare needs of the entire population? The question is, do costs really go down if the govt is the payer- and no one has been able to prove that that would be the case. When the govt negotiates lower prices for the portions of care that is provided under the current public systems, the providers shift costs to private payers. What happens when there are no more private payers?

  24. Silhouette says:

    Now the bigger picture they don't want us to see “doesn't make sense”. I don't want a response from you or your fellow bots. So my feelings aren't hurt…lol..

  25. GeorgeSorwell says:

    CStanley–

    Proof is proof. Opinion is opinion.

    Name-calling is name-calling.

  26. Silhouette says:

    I'll say it again:

    They [the private insurers] can compete with Uncle Sam from now on. And if Uncle Sam is this big unwieldy expensive prospect they are saying, then why do they fight it so? Answer: they fear that competition because they factually know it will be less expensive and therefore they will have to drop their rates to compete. Bottom line is less profit for them.

    The very fact that they're fighting this proves they themselves know it to be a success in the making..

  27. CStanley says:

    Well, George, as DrJ pointed out, you could try presenting some evidence for your opinion if you think you can support the opposing view better than I supported mine.

    What name calling?

  28. CStanley says:

    And if Uncle Sam is this big unwieldy expensive prospect they are saying, then why do they fight it so?

    Um, because it's a big unwieldy expensive prospect that can legally subsidize itself at taxpayer expense, until such time as the taxpayers revolt or the funds dry up, at which point the only choice is to cap the services that are paid for.

    Now the bigger picture they don't want us to see “doesn't make sense”. I don't want a response from you or your fellow bots. So my feelings aren't hurt…lol..
    Didn't think your feelings were hurt, I was just presenting what I think is the more accurate reason that no one responded to your earlier comment. Considering that liberal commenters here greatly outnumber the conservative ones, I don't see other liberals agreeing with you either or even addressing a lot of your remarks so I think the issue is that they're sometimes rather off the wall in reasoning.

    “Bots”…WTH?

  29. GeorgeSorwell says:

    CStanley–

    I am, in fact, currently writing a reply to Dr J.

    I think that whole finger-in-the-ears-la-la-la thing qualifies as name-calling.

  30. CStanley says:

    I think that whole finger-in-the-ears-la-la-la thing qualifies as name-calling.

    I was only trying to describe my frustration at presenting evidence to back an opinion and then having you respond by claiming that I didn't. I mean, really- are you that sensitive that your feelings were hurt? If so, I apologize. I still stand by my characterization of your reaction, and if I could think of a way to describe it without what you'd consider 'name calling', I'd do so but I can't.

    The point remains, that if you don't think someone's evidence is strong enough, then you should present your own evidence to support the opposing view or at least take apart the analysis the other person presented and show where you think the dots aren't connected properly.

    Eg….Was the IBD piece inaccurate in reporting the stipulations in the bill which will force people out of their current plans? Was Obama accurate in asserting that he's trying to implement cost savings the way Mayo does? Was he accurate in portraying the way doctors make decisions about tonsillectomies?

  31. GeorgeSorwell says:

    Dr J–

    The US spends more per capita on health care than other nations, even though we don't get more services. Most of those other countries that spend less and get more have national health plans, right?

    The Commonwealth Fund produced a study, complete with charts, that points a way to what they call a high-performance health system. There are other studies with reasonably similar conclusions.

    Not everyone likes what's being proposed. Some of that is reasonable, like Pete Able's questions about costs. Some of it is just political, like Republican Senator DeMint's expressed argument that opposition to health care reform can be used to break Obama (link will also show some of the problems DeMint's constituents face while he plays politics), and like Republican Senator Inhofe's expressed argument that opposition to health care reform will be beneficial to his party in the 2010 elections. And some of it is just plain insane, like Republican Representative Louie Gohmert claiming the health care reforms will kill senior citizens.

    As you can probably tell from my links, I don't have much trust in Republicans to solve what even you once agreed was a health care crisis in America. Meanwhile, Democrats are sweating over the CBO numbers.

    In another comment you made here, you spoke pretty eloquently about the lack of honesty in general over the subject of costs:

    If we could have such a dialog, the result might be give and take in a number of dimensions. They might involve raising taxes, or lowering expectations, or embracing more serious systemic reforms. We might even decide that our grandparents had it much worse than us in every dimension, our grandchildren will probably have it much better, and we really are going to stick them with a bunch of bills

    I personally think we should suck it up and raise taxes–in a sensible, targeted way. But I certainly understand how politically untenable that is.

    I favor the public option. But even I recognize that will cause problems. The main one I can think of doesn't get discussed much, though Kevin Drum once summed it up pretty well:

    Well, for starters, the program could be limited just to the poor. But that wouldn't make it universal since there are plenty of non-poor who don't have health insurance and can't get it through the private market.

    No, we'd have to simply offer it to anyone who was uninsured, subsidizing the poor and charging full price to everyone else. But what would happen then? Answer: employers would start dropping health coverage for their employees. Why wouldn't they, after all? Unlike the food example, where there are personal incentives against being lazy and living off the government dole, employers have no reason to hold back. As long as a decent alternative is available, their incentive is to get out of the healthcare business, hand over the money they save to their employees, and tell them to sign up for the government program. Before long, the government would be funding a huge portion of the private insurance market.

    That will never fly, of course, so we'd need rules in place to prevent companies from dropping their healthcare plans. But that would put existing companies at a disadvantage if new companies didn't also have to provide healthcare. So we'd need rules that didn't just prohibit companies from dropping healthcare, but affirmatively required them to provide healthcare. But which companies? Lots of big companies don't offer healthcare right now, so this would be a brand new mandate

    And so on and so on. The regulation required to make all interests happy is a hall of mirrors. And that lengthy quote buries the real problem: Your employer doesn't want to be in the health care business. Your employer will dump you the second he gets chance.

    And in doing so, your employer will derive a competitive advantage. Which is a benefit the CBO doesn't score. Because the government will be on the hook for all that insurance that all those employers dump off their financial books. Just like the government is on the hook for road construction and maintenance, which is something that everyone benefits from. Health care is just another infrastructure problem, in my opinion.

    We're running a huge deficit. That worries me. I'm as cynical as anyone. But I'd vote for the guy who wants to raise taxes to pay the deficit down. I'd vote for the guy who is ready for the honest conversation about costs and benefits. I'd vote for the guy who wants to solve real problems, and then I'd hold that guy accountable. If only everyone was ready for that kind of honesty!

    Democrats are sweating the problems.

    Republicans are sponsoring legislation about a birth certificate.

    I'm for solving as much of this problem now, while serious people are running things.

    (This was kind of a rush job, so sorry if there are grammatical errors or the links don't all work.)

  32. GeorgeSorwell says:

    God almighty, CStanley, I've been arguing with you here for five years. You should know better than anyone that I'm not sensitive about that kind of thing. Call me what you like.

    But don't pretend differently.

  33. CStanley says:

    @George- I wasn't pretending, I honestly was surprised that you'd consider that an example of name calling. It was just a way of expressing that you didn't really address my arguments, and actually claimed I didn't make them at all.

    Anyway, am I correct in saying that your response to DrJ admits that people WILL in fact lose the coverage they currently have from their employers in many cases? And if so, isn't that an admission that I was right on at least one of the points where I said Obama isn't being truthful?

    Gotta go out for a while but I'll check back later.

  34. Kastanj says:

    Rationing, having someone else decide what you can get for the money you've paid, strange bureaucrats making decisions over your head, not being able to choose your own doctor… That's what the US has today.

    The employer limits physician alternatives, an opting out and getting your own doctor is very costly. There may be increased costs for some middle-class families, but in the new system they will not be struck with sudden huge costs that really destabilize their lives. A few hundred dollars more in taxes per year (not for all middle-class households, but let us be honest and state that some middle-class families will pay more) or risk getting bankrupted by a sudden whammy, costing all taxpayers more money in the end and consuming less.

    The current system is a relic from a time of wage freezes, when employers had to attract employees some other way. I thought America was about meritocracy, state-of-the-art and adaptation, not ideological abused-spouse syndrome. Every disaster “Obamacare” would supposedly bring is already available in the status quo.

  35. GeorgeSorwell says:

    CStanley asks:

    Anyway, am I correct in saying that your response to DrJ admits that people WILL in fact lose the coverage they currently have from their employers in many cases?

    No. No. No.

    Go back and read the quote from Kevin Drum. It's about how they have to write legislation that PREVENTS current employers from dropping their employees.

    Sorry to shout, but you're not the only one who gets frustrated, CStanley.

  36. CStanley says:

    GS- As I said, I'm on my way out the door and probably skimmed too quickly- I'll take another look later.

    Surely though you can at least see why people who currently have employer based insurance that they're satisfied with are concerned, and how many people don't feel reassured by some of the provisions of the bill?

  37. GeorgeSorwell says:

    CStanley–

    Certainly some people don't feel reassured by some provisions of the bill.

    Why should they, if they're being told Obama wants to kill them?

  38. lurxst says:

    [b]The president said that the United States spends $6,000 more on average than other countries on health care. Actually, U.S. per capita spending is about $2,500 more than the next highest-spending country. Obama’s figure was a White House-calculated per-family estimate. [/b]

    CS, the $6,000 figure jibes better with the data I've found, do you have a source for the $2,500 figures? Thanks!

  39. Dr J says:

    George, thanks, tons of substance there.

    Just to comment briefly on the Commonwealth paper, I'd characterize it as more a bunch of nice sounding ideas than a credible policy recommendation.

    Paying for results rather than treatments sound terrific, as does letting you keep your current insurance and doctors. But once you get into the “how” questions, those two goals are sharply at odds. Virtually every insurance policy, hospital, doctor, and contract in the industry is geared around fee-for-service. How do you get all that machinery to re-orient around fee-for-value? And to the extent you manage, how can you expect existing arrangements to survive?

    The conventional meaning of an exchange is a clearinghouse where commodities are bought and sold. That doesn't seem to be what Commonwealth proposes, so what do they really mean by the word? The way they describe it has a whiff of simply a big government-run industry, where private entities are so tightly constrained they aren't really private in anything but name.

  40. ChrisWWW says:

    I'm a little late to this party but I want to throw a few things out there:

    * None of the bills in Congress are Obama's
    * The different plans under negotiation each have their own pros/cons and price tag

    Truth is, other countries provide better care, that's universally available, for substantially less than we pay now. The trouble is how do we replicate that here in America. It's possible, but we need to push Congress and the President in that direction.

    As it stands, defenders of the status quo/insurance industry shills (both Republican and Democratic) are scaring Americans about reform. They're insisting it will be too expensive and it will cut benefits. So they are pushing to water down the proposed health plans. They won't mention that the status quo is also too expensive and will eventually lead to a cut in benefits and more Americans with no insurance at all. What we need is stronger reform with the power to actually change the costs of health care long term.

  41. casualobserver says:

    @@What we need is stronger reform with the power to actually change the costs of health care long term.

    OK, I'll bite. Here are my top ten reasons healthcare costs are escalating in the United States. As I said yesterday, unless “public option” can possibly shift some back end ER into front end preventitive, there is not one single solitary thing “public option/single-payor/government sponsored can or will do to make any bit of difference in these cost escalation factors.

    Note my list does not have “insurance company profits” on it because in my view these are nominal dollars compared to the others listed.

    However, if you think you have a more accurate list of the primary cost escalators, post that and explain which ones Demcare legislation will reduce.

    1. Nobody shops for value.
    2. Medical innovations are usually more expensive, not less.
    3. Health care is a “luxury good”.
    4. We don't pay for what we consume.
    5. Baumol's disease.
    6. The old.
    7. The uninsured.
    8. The fat and lazy.
    9. Because death is sometimes the low-cost option
    10. Malpractice/defensive medicine.

    Public option is a transfer payment mechanism, pure and simple, it will not reduce costs in any but one (maybe) way.

  42. GeorgeSorwell says:

    Dr J–

    I often ask you for the sources of your ideas because I'm interested in what you say. I agree with your complaints about the absence of price transparency. But I don't really have much sense of where you're coming from. If there's a report like the Commonwealth Fund report that ballparks it for you, please provide a link.

    For that matter, feel free to explain it in your own words like I did.

    As for re-orienting the machinery, if there weren't huge problems there wouldn't be such an overwhelming need for reform. You once provided a link to a long New Yorker article about health care delivery in McAllen, Texas. Having a payment structure around fee-for-service causes an obvious problem: Performing more services earns providers more fees. The incentives are out of whack. That's a pretty big problem, in my opinion.

    And as for the Commonwealth report, anyone could nitpick it. (Including me.) As a practical blueprint, it has a lot of political problems. But I think it's a reasonable outline for useful reform.

  43. GeorgeSorwell says:

    Casualobserver–

    I think that's a fantastic list.

    I might move Baumol up to number one. What you're calling “Nobody Shops for Value”, I'd probably call “Lack of Price Transparency”. And today's somewhat expensive innovation is tomorrow's simple, effective solution, so I think in a more rational system innovation ends up paying for itself.

    And I think you're kidding yourself about #4. Somebody pays. Every time. That's just the way it is. And that's a huge part of the problem.

    As for #9, burial in potter's field is probably cheaper than a ride in an ambulance. I'm pretty sure you're making a different point, but I'm not quite sure what it is.

    I gather you think there is no solution. Fair enough.

  44. CStanley says:

    Lurxst- those figures were part of the Factcheck.org stuff on Obama's healthcare townhall statements. You should be able to find their sources at the link.

  45. GeorgeSorwell says:

    Lurxst–

    Thanks for pointing the problems with FactCheck as a source of checkable facts.

  46. kathykattenburg says:

    JSpencer hasn't responded yet to my question of where the evidence is for this cost savings. Do you wish to give it a shot?

    If I can go to the doctor when I'm sick or don't feel well, instead of waiting until my condition is so bad that I have to go to the emergency room, that saves all Americans money.

    If I can get regular preventive check-ups, potentially life-threatening diseases and medical conditions can be diagnosed, or find out I'm at risk, before the problem is so severe that I have to go to the emergency room or have really expensive life-saving treatment. That saves all Americans money.

    If I do not have to rely for my health care on a private, for-profit insurance company that spends millions of dollars a year on lobbyists to make sure any public health care option is killed and never enacted, and in general to make sure all health-related legislation is written so that my profits are not adversely affected, even if that means shafting the people who need health care, then administrative costs that are built in to the cost of private health insurance policies will not exist, and that will save all Americans a lot of money.

    This is just for starters — just what I could come up with myself, from my own self-education, reading, listening, native intelligence, and common sense.

    Which means you could have come up with these answers, too.

  47. lurxst says:

    I think casualobserver's list is a good place to look at what our expectations are for a good law and fiscally effective system.

    1. Nobody shops for value.
    I think HSA users are an example of who is more prone to shop for value, but its true that much medicine seems to come from a “how much can you pay?” tradition. This might also concern #5. Baumol's.

    2. Medical innovations are usually more expensive, not less. I agree here. But insurance companies don't make the innovations in anything except cost control. Much R&D is performed by teaching hospitals, universities and in the field outside of big pharma or health plan initatives.

    3. Health care is a “luxury good”.
    This is closely tied with 7 and 8. Some of the innovations and changes in nations with national health systems have a lot to do with a overall public health. People do get hopeless about the costs of healthcare and their lives are affected accordingly. Without access to regular care, and I'm not referencing the usual talking point of “You can always get care, look an Emergency Room!” but instead I mean a culture that rewards good health and people can easily get regular checkups, teeth fixed, major medical problems addressed early. Then they can have a shot at contributing as a taxpayer and are less likely to end up a public charge at much weightier costs. There will always be some outliers but overall you look at Mortality rate data and those NHS nations have a longer lived, healthier populace. I wish I knew more about the history of other national health plans, in terms of how long this took, 2 generations, 3?, to see the slow change. Right now a regular workers costs (me for example) are so prohibitive that many are forced onto public plans after they go broke from lack of work while healing and massive copays and deductibles. You can burn through $8,000 of your HSA money in a blink. When that happens many end up on public systems. And to imagine a low wage earner being able to easily save up $8,000 each year..its gets pretty hopeless. So best to just adopt an attitude of detached concern about that ugly mole or that bad cut you got over the weekend.

    4. We don't pay for what we consume. I think george nailed it. Someone always pays.

    5. Baumol's disease. Getting adequate medical services into some areas of the country and communities is amazingly difficult, so there will have to be some attention given to the different costs. So far the health insurance biz only partially address this, the feds are already hip deep in subsidizing these services.

    6. The old. I think end of life care is a real area to debate and look for the best options. Even with better overall health outcomes, people still have to die eventually.

    7. The uninsured.
    8. The fat and lazy.
    9. Because death is sometimes the low-cost option
    10. Malpractice/defensive medicine. I think there should always be some way to file grievances and address real malpractice. Could there be a national malpractice indemnity pool?

    Thanks for the list, good talking points.

  48. kathykattenburg says:

    The CBO reports show that there will be no cost savings. People need to stop arguing that the bill will save us money.

    This statement is almost a parody of itself.

  49. JSpencer says:

    “What information are you referring to, JSpencer? From the context, I assume you mean that there's information to show how the public option plan will save money and reduce costs.” – CStanley

    Just getting back here, sorry bout the delay – lots of running around today. I think you may have misunderstood the context. As I said: “…when so much of the reporting is political in nature rather than explanatory.” I was referring to reporting in general. Good information is available on most any subject (including healthcare) but if people wait for the MSM to give them worthwhile info, they might be waiting a long time.

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