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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”
“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.”
Kathy, you're right that that transaction would be cheaper. If an ER visit costs $1000, an office visit $200, you got the same result either way, and you didn't make four other office visits about problems that would have gotten better on their own, the system saves money.
But the question that needs to be answered is what happens to costs through the whole system? The cheaper you make office visits, the more people will make. How big is that effect, and does it cancel out the other savings?
A related train of questions: is it safe to assume that under a government-sponsored plan, more Americans will see doctors more often, and overall we will be consuming more doctor-hours than we are now? If so, where will these hours come from? Will the doctors we have work longer days? Will we lure more doctors from Canada or elsewhere by offering them pay raises? If so, how much will these raises add to our health care costs?
These are complex questions, and there are many more where they came from, but they're critical. Whether we end up seeing cost savings or cost increases depends on all these complex factors.
is it safe to assume that under a government-sponsored plan, more Americans will see doctors more often
Why, because it's fun to go to the doctor?
Seriously — why would Americans go to the doctor more often under a public option that emphasized preventive care? People w/o health insurance put off going to the doctor because they can't afford it. If they don't have to worry about how they are going to pay doctors' bills, why would they wait to see a doctor? And why do you think that being able to see a doctor *before* you get sick so you *don't* get sick will *increase* doctor visits?
Whether we end up seeing cost savings or cost increases depends on all these complex factors.
Obviously, no one can say for sure how much cost savings we will see under *any* plan until it's been implemented. But what we *do* know is that if we either do nothing, or if we pass a bill that does not effectively and significantly address the factors that are driving up health care costs, we will see cost increases. The system we have now is driving up costs astronomically, as we speak. I honestly don't know how anyone who claims to be concerned about “cost increases” can be in favor of scrapping the Democrats' plan (in its general outlines, since we don't actually, really, have a plan yet because of all the obstructionism) with no feasible alternative to put in its place. I don't understand how anyone who claims to be concerned about “cost increases” can complain about the Democrats “rushing” things through when we have a crisis that's been building for decades, and I don't understand the lack of a sense of urgency among people who claim to be concerned with cost increases. Anyone who can say, Hey, let's take our time, what's the rush, let's start again in the fall and “do it right” is not as concerned about cost increases as they claim to be. Either that, or they simply don't understand that every week that goes by with the status quo still in place, thousands more Americans will lose their insurance, and cost-conscious conservatives' premiums will keep on going up and up and up.
I don't *think* that's what conservatives want, but honestly, sometimes I do wonder.
Dr J–
Changing one tax law is a revision of the tax code. If you say that'll be easy, great. Someone in Congress still needs to propose it, conference it, pass it. Let me know when that happens.
You inspired me to find out more about Regina Herzlinger's ideas and I found this short piece she wrote for the Atlantic's business, yes, blog. Her ideas are interesting. There are some problems (she seems to think everyone will suddenly become a fantastic haggler over their health costs), but every solution has problems. For me, a big problem is that there is no one pushing her ideas, as a practical measure. At least, no one I could find. I had some hope you could point me toward some organization in favor of them.
I've read about Switzerland as a model. Switzerland seems unique in the industrialized world in its approach, however, and there's nothing intuitively obvious to me about its superiority. In fact, I vaguely recall reading some stuff about their ad hoc approach leading to piecemeal treatment, but I can't remember where I read it (and Google's not coughing it up). Still, all solutions have their problems, and I don't know much about the Swiss model. It could be good in a non-rainbows and non-lollipops way. If there is a serious effort behind implementing a Swiss-type model here in the US, I'd like to know more.
I provided links on this thread to a couple of the comments you've made here at TMV. (One. Two.) People can go to those links, read the threads, and decide for themselves if I've engaged in the substance of your ideas.
And, yes, I am interested in how quickly we can get some reforms, under the practical political conditions. I am especially interested in increasing the number of people who are covered by health insurance. But I understand it's a process. In that comment you linked to, in the thread to a post called “Ripples”, I also said a few things, including this, which ends by me saying, “Maybe the things you're proposing are best dealt with in the next round of reforms?”
I also said I don't live in Utopia. I don't have any interest in rainbows and lollipops. If you have something from Regina Herzlinger (or anyone else) that identifies the basic tradeoffs we're facing and proposes a path through them, please point it out. If you've shown the before and I, in my ignorance, missed it, please do it again. Links, quotes–you know how it works. Then you can bookmark it and trot it out as often as you like.
Thanks.
These are complex questions, and there are many more where they came from, but they're critical. Whether we end up seeing cost savings or cost increases depends on all these complex factors.
You're right – what these rose-colored glasses scenarios don't factor in is that when you improve access to care you will increase demand and therefore utilization and cost. If you make it cheaper to see a doctor people will see the doctor more often. That would counter balance or even exceed the savings from people not having to go to the ER. Of course since there is already a primary care shortage a lot of people will probably just go to the ER anyway.
The dirty secret of preventive care is it doesn't save a lot of money. It improves the length and quality of life. Yes you will catch an occasional early colon cancer by doing a bunch of colonoscopies but you will also pay for a lot of normal colonoscopies. Also by extending life you will increase the number of years people are utilizing the health care system. Don't get me wrong, I think preventive care is the way to go for many reasons but it should not be looked on as a major cost-saving feature.
What will save money is what insurance companies do and what the government is afraid to do, and that's to sometimes say no to what people want. Insurance companies regulate expensive testing and medications. You don't need an MRI because your neighbor had one. You don't need an expensive medicine for your blood pressure or reflux when there's a $4 med at Wal-mart that will work just as well. I am hearing talk about panels of doctors and experts deciding what treatments will be covered, but very little that is concrete.
I can't tell if that was a “yes” or a “no.” Are you saying that in the system we have, the uninsured spend as much time in front of doctors as they would if they had insurance?
Well, yes, we told you so. My fellow fiscal conservatives and I have been saying for month after month after month that costs are the main problem we need to solve, while everyone on the left has refused to think seriously about them. Now we're further down the road, we have a bill that doesn't address cost control, and the cost problem has become so obvious that the CBO, the public, and centrist Democrats are starting to balk at it.
So, I'm sorry you're frustrated progress on the reform has slowed, but the left's intransigence–including your personal intransigence, Kathy–is a big contributing factor.
“There are some problems (she seems to think everyone will suddenly become a fantastic haggler over their health costs), but every solution has problems.”
GreenDreams keeps making that claim too. And while it's true that few consumers in our culture haggle, haggling is not what matters.
The magic thing consumers do is shop. They analyze value for money, and if they don't think they're getting a good deal, they very quietly take their business elsewhere. Shopping is what keeps every other industry lean, efficient and responsive, and it's glaringly absent in health care.
I can't tell if that was a “yes” or a “no.” Are you saying that in the system we have, the uninsured spend as much time in front of doctors as they would if they had insurance?
Her logic is confusing. She's arguing against her own arguments.
Dr J–
There is no constituency for the reforms you want. That's a big problem if you expect anyone to think your proposed solutions are practical.
Changes to the tax code that would benefit some will damage others, like insurance companies. Those who'll be damaged will fight them, just like they're fighting right now.
Changes in price transparency that would benefit some will damage others, like insurance companies and some of those fee-for-service providers. Again, they'll fight against those changes.
You seem to be defending the current fee-for-service structure in spite of its obvious, built-in problems. The incentives are out of whack. Yet some of those fee-for-service providers will fight against changes in those incentives.
The lack of a constituency for the reforms you want seems to me like it's a big problem. And yet you continue to talk about them as if their “magic” (a word you used in the comment I'm responding to) is posed to quickly resolve the problems we have.
You're out here complaining about problems with current attempt to solve a real problem, which is fair enough. But it's also fair enough for me to point that you have no solution to this current problem, which you acknowledge is a crisis. What's your response to the crisis?
You've also complained that I won't engage in your ideas. So I wrote a long comment in an effort to engage your ideas. (Anyone can back up this thread and read it.) Your response is to cherry-pick one sentence out of that long comment and literally claim that I (and other critics) have missed the “magic” of your solutions.
Feel free to engage.
Dr J–
Also, in your discussion with Kathy, you've been complaining that the volume of provider visits will go up under the currently proposed reforms. That seems to me to be a main point of these reforms. And that's big reason why Democrats are sweating the CBO numbers. But since that is a main point of reform, won't the volume of provider visits also increase under any reforms you want?
What's your solution?
George, several times now I've seen you agree with a policy proposal (or at least agree that it sounds reasonable) that Dr. J or I puts forth but then you argue that there isn't a politician or a political party supporting that idea. But if we, as private citizens, believe that there are solutions that haven't been put on the table, or haven't been given enough attention, or have been killed by special interest lobbies- but are good, meaningful reforms, then it's up to US to help build the public support for those policies?
Also, in your discussion with Kathy, you've been complaining that the volume of provider visits will go up under the currently proposed reforms. That seems to me to be a main point of these reforms. And that's big reason why Democrats are sweating the CBO numbers. But since that is a main point of reform, won't the volume of provider visits also increase under any reforms you want?
George, I think the problem here is that universal coverage really does ADD cost to the system, rather than subtract it. If you're going to go after the dual (and conflicting) goals of universal coverage and cost reduction, you have to get really serious about finding ways to decrease the amount of money that we're spending on healthcare. Part of that would involve some decrease in the utilization of healthcare services per capita (logically- if more people are added to the system, to keep even the same net cost overall you have to reduce expenditures per capita.)
Obama talks about this in handwavy manner when he refers to cutting out things like unnecessary medical tests (and those unnecessary tonsillectomies performed by greedy doctors!) But he never clearly defines how his plan, or the Congressional plans, could accomplish that.
Meanwhile, all the Dem plans are ignoring a couple of ideas from the conservative side of the aisle which really do have a chance of reducing these things. First, tort reform because that cuts down on defensive practice of medicine which leads to doctors practicing CYA by leaving a paper trail of lots of tests and procedures. Second, use of HSAs which combine with high deductible health insurance plans to increase the patient's price consciousness so that medical services aren't overutilized.
And worse yet (besides ignoring these good ideas), the current plans would further reduce individuals' incentive to make healthy lifestyle choices (the one part of 'prevention' that really does save money by reducing the NEED for healthcare services.) The plans cut out these incentives by making it impossible for insurance companies to reward people with price reductions for behavioral changes like quitting smoking or losing weight.
George, there's plenty of support for these ideas. What I've been saying, what CStanley, Jazz and other folks on here have been saying, and what Republicans have actually proposed all have a great deal of overlap. Though we may pick different bits to emphasize, we're all saying “harness the market” rather than demonizing it and hoping government on its own can wish costs down. Given how much arguing you've done with us, I'm surprised you haven't noticed.
Regarding volume of visits, I didn't complain volume will go up, I just asked Kathy whether it would or not. She said no. Or yes. Or something. I agree with you, enabling more consumption of health care seems to be the whole point of universal coverage, so I was surprised at her answer.
The question matters because it's not clear to me volume *can* go up much in the short to mid term, because it takes time to train doctors or build hospitals. If we are to make room for people priced out of the market, we must start using those resources smarter, by reducing defensive medicine and the other things CStanley describes. I haven't seen anything in the current plan that could bring this about.
Just to throw this in the mix regarding volume, and overutilization as it currently exists under our system- and as it will undoubtedly worsen with some of the proposed changes…
The classic study on utilization of healthcare services as it relates to patient cost sharing was done by RAND researchers in the 70s. The summary is that when people have to actually pay something out of pocket for each time they see a doctor tend to go to the doctor less frequently than those who have no copays, yet overall there was no adverse effect on the patients' health even though one group went to the doctor less frequently. It was also true though that there were some adverse effects among poorer people when they had a copay, so obviously the rationality of the decision to spend the money or not spend the money was affected by the amount of disposable income that the person had.
Addressing overutilization by structuring insurance plans with high copays (with some mechanism to help poor people with that cost- either have it on a sliding scale or give them tax credits for HSAs, which has the advantage of still keeping them accountable for costs but not requiring them to fund this expense out of their limited or nonexistent disposable income) would put the consumer of healthcare in the position of making more rational choices about seeking medical care, and this study showed that when people consider economic costs they do tend to make rational decisions and reduce overutilization as long as they can afford to do so.
And of course, structuring insurance this way would also require a variety of options for different consumers- with more usage of HSA/HDHP where the health insurance plan has a lower premium- otherwise there's no incentive for consumers to choose this type of plan, and the only other alternative would be to mandate it.
Dr J–
I’m not sure that Republicans have proposed much of anything.
Just last week, on July 23rd, Jazz complained that the Party of No wasn’t doing anything to solve this crisis.
In the first comment to Jazz’s post, CStanley said there was a bill but even she wondered why they weren’t pushing it.
And a little further down that thread (I’d provide a direct link, but the site won’t let me do that at the moment), you’ll see me pointing out that Republicans didn’t have any problem spending recklessly on health care when it was to their political advantage.
Currently, the Democrats are sweating the CBO numbers. Currently–I’m repeating myself here–the Republicans are pushing legislation about a birth certificate.
Further up this thread you’ll find me quoting Republican Senators Inhofe and DeMint about how they are just playing politics.
I’m perfectly willing to stipulate that you, CStanley, and Jazz are nice people who think that something should be done about this problem.
But your assertion that Republicans have actually proposed something that will solve this?
No sale, Dr J.
Dr J–
I'm not sure that Republicans have proposed much of anything.
Just last week, on July 23rd, Jazz complained that the Party of No wasn't doing anything to solve this crisis.
In the first comment to Jazz's post, CStanley said there was a bill but even she wondered why they weren't pushing it.
And a little further down that thread, you'll see me pointing out that Republicans didn't have any problem spending recklessly on health care when it was to their political advantage.
Currently, the Democrats are sweating the CBO numbers. Currently–I'm repeating myself here–the Republicans are pushing legislation about a birth certificate.
Further up this thread you'll find me quoting Republican Senators Inhofe and DeMint about how they are just playing politics.
I'm perfectly willing to stipulate that you, CStanley, and Jazz are nice people who think that something should be done about this problem.
But your assertion that Republicans have actually proposed something that will solve this?
No sale, Dr J.
George, the facts are what they are. The Republicans in fact proposed a bill along the lines I've been advocating. The Democrats in fact buried it in committee so it wouldn't distract from their own bill. Theirs doesn't do much to rein in costs, so you're right, they are having to sweat the CBO numbers.
Are you saying that in the system we have, the uninsured spend as much time in front of doctors as they would if they had insurance?
No, I'm saying they often don't go to the doctor until they are gravely ill — and at that point they don't go to a doctor's office, they go to the emergency room of the nearest hospital, where medical care is astronomically more expensive.
I'm saying that if we had a system of preventive health care in this country to which all Americans had access, regardless of ability to pay, people would not have to wait until they were gravely ill, they would see a doctor at a much earlier stage, and they would have to visit that doctor less often, not more.
Though we may pick different bits to emphasize, we're all saying “harness the market” rather than demonizing it and hoping government on its own can wish costs down.
Dr_J, what you have written above fits the famous definition for insanity, which I won't repeat because I'm sure you've heard it.
I think the problem here is that universal coverage really does ADD cost to the system, rather than subtract it.
And your support for this argument is…. what?
To be fair though, GS, the minority party almost never does push their own legislation. The way our system works, it's almost always politically savvy to give the other party enough rope to hang itself, and then let the public decide to give your party more power to actually take part in the legislative process. I've thought about my previous comment, wondering why the party leaders haven't been talking up Ryan's bill- but really if they did that now, it would create a very confusing debate on the pros and cons on their plan at the same time that the public is trying to sort out the Dems plan. I don't think there's enough oxygen in the room to debate both approaches at the same time, so it probably does make more sense to let the disenchantment with the Dems sink in first and hope to get a bigger seat at the table next year.
Now, I'm perfectly willing to concede that I wouldn't put it past the current GOP to still blow it and miss the significant groundswell of desire to fix healthcare which could translate into a more market based reform once the public sees the problems with the govt run approach. I've been one who has been frustrated for a decade or more that the GOP hasn't embraced conservative approaches to a number of problems that the public clearly does care about, from the environment to healthcare to deficits, and I'm not confident that they've gotten the message yet aside from a few of them like Ryan and Coburn and a handful of others. We'll see I guess.
The magic thing consumers do is shop. They analyze value for money, and if they don't think they're getting a good deal, they very quietly take their business elsewhere. Shopping is what keeps every other industry lean, efficient and responsive, and it's glaringly absent in health care.
Sick people are not “consumers” in the usual sense of that word, and they do not “shop” to get “value for money” when they need a doctor. They just don't. I have never, not once in my entire life, ever asked three different doctors to provide me with estimates for the cost of telling me why I'm tired all the time and have constant sore throats and muscle aches and joint pains (I don't have those symptoms, except for feeling tired all the time — those are the symptoms of Chronic Fatigue Syndrome, which I just picked at random for an example). What I did, when I had health insurance, if I didn't have a doctor already, was go through the list of doctors my insurance company would let me see, pick one near me, and make an appointment. And that's what most people do.
People simply do not “comparison shop” for doctors except in regard to professional reputation.
No, I'm saying they often don't go to the doctor until they are gravely ill — and at that point they don't go to a doctor's office, they go to the emergency room of the nearest hospital, where medical care is astronomically more expensive.
Except that you can't just compare that one ER visit to one visit to the GP. When the numbers have been analyzed, it turns out that the ER visits under the current system are so infrequent (and many of the nonreimbursed ones are due to trauma, not preventable illness, so we'd still be paying for those visits no matter what we do) compared to the total cost of all the preventative and minor illness visits that would happen if everyone had full coverage that it's more expensive to provide the wellness and minor illness care. There's still a moral argument to do it, but it simply doesn't save costs no matter how much you want to believe that it does.
Kathy- If patients were paying out of pocket, they would do more comparison shopping but more importantly, they'd sometimes skip going to the doctor when they really don't need to. That was the point of the RAND study I cited- that people are pretty rational when they're spending their own money but they tend to overuse things when there's no cost (or a fixed cost no matter how much they use a service.)
That's part of the waste that Obama talks about. He says that he doesn't want to ration care in a way that will make people less healthy, but he wants to cut out the overusage. The problem is that he doesn't explain how to do that (no politician will, most likely, because it involves telling people that they can have what they need but not always what they want.)
“People simply do not “comparison shop” for doctors except in regard to professional reputation.”
Yes, Kathy, that's what I said. People don't shop for value-for-money in the conventional way because they have no incentive to; it's someone else's money they're spending. That's a major structural problem with our health care system.
In the system we have, though, people do make choices and providers court them–even providers you wouldn't expect to. St. Mary's Hospital here in San Francisco has ads all over town advertising emergency room care in 30 minutes or less. Apparently even in an emergency, people make choices about going to one ER versus another. It's great to see the hospitals competing on wait times; we'd be much better off if they competed on price too.
People don't shop for value-for-money in the conventional way because they have no incentive to; it's someone else's money they're spending. That's a major structural problem with our health care system.
Someone else's money, meaning the insurance companies? So are you saying you want to eliminate insurance companies?
St. Mary's Hospital here in San Francisco has ads all over town advertising emergency room care in 30 minutes or less. Apparently even in an emergency, people make choices about going to one ER versus another.
You mean, people will go 30 miles to a hospital that promises in and out within half an hour emergency care rather than the hospital that's five miles away when they're having a heart attack?
“So are you saying you want to eliminate insurance companies?”
From non-catastrophic transactions, yes. We shouldn't be looking to health insurance to pay for routine care, any more than we look to car insurance to pay for gas.
“people will go 30 miles to a hospital that promises in and out within half an hour emergency care rather than the hospital that's five miles away when they're having a heart attack?”
I doubt St. Mary's is advertising to reach heart-attack victims, but they are apparently convinced enough people make choices like that to make it worth their while to advertise.
Kathy, you do realize that even people with health insurance sometimes use ERs for things that can't wait till the doctor's office is open but aren't as urgent as heart attacks, don't you? Things like a bad stomach virus that's dehydrating you over the weekend, or getting a bad cut stitched up?
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.
I don't think liberal commenters here greatly outnumber the conservative ones.
I think some of us who would identify as conservative or right leaning moderate or libertarian have been a bit more prolific lately but in terms of number of overall regular commenters who lean left vs. right, there's no contest. And my point to silhouette still remains- that liberal commenters don't seem to have a clue what he's talking about either because certainly no one jumps in to agree with him in most cases. He was implying that the lack of response to his comment meant that his ideological opponents didn't have a good rebuttal, and I presented a reality based alternative interpretation.
Kathy, you do realize that even people with health insurance sometimes use ERs for things that can't wait till the doctor's office is open but aren't as urgent as heart attacks, don't you? Things like a bad stomach virus that's dehydrating you over the weekend, or getting a bad cut stitched up?
Uh, yes, Christine, or like slipping on treacherous ice while walking your dog and badly hurting your knee, which is what happened to me back in November. Those are true emergencies — things that cannot be foreseen or headed off by earlier care. But let's tweak that a little. If I, a woman in late middle age, am at risk for osteoporosis but don't get a bone density scan (as indeed, I have not) because it's extremely expensive and I don't have insurance to cover it, and *then* I break my leg falling on ice, and have to go to the emergency room, that is very expensive health care that could have been headed off if I had known I had osteoporosis and could have been treated for that at an earlier stage and maybe would not even have gone out on an icy day knowing the consequences of falling could be much worse for me.
And my point to silhouette still remains- that liberal commenters don't seem to have a clue what he's talking about either because certainly no one jumps in to agree with him in most cases.
I thought Silhouette was a woman, but I'm not sure why I think that, and I could be wrong.
And the reason I (speaking for myself) don't rush in to agree with Sil on health care is not because I don't agree with her. It's because I don't quite know how to talk to her on issues we seem to be alilgned on, since on one specific issue (marriage equality), she is so homophobic. There's a disconnect there that I don't understand, and I just prefer to handle it by not engaging with her at all.
From non-catastrophic transactions, yes. We shouldn't be looking to health insurance to pay for routine care, any more than we look to car insurance to pay for gas.
So you are saying that gas is to car crashes as a yearly checkup is to stage 3 cancer?
If patients were paying out of pocket, they would do more comparison shopping but more importantly, they'd sometimes skip going to the doctor when they really don't need to.
Christine, that is what's happening now, but “need to” becomes defined by ability to pay if you don't have comprehensive health insurance that pays for preventive care. That's why you see people in the ER for pneumonia or severe bronchitis after having ignored a persistent cough or a cold that lingered for too long.
Kathy- I was responding to your comment about heart attack victims not taking the time to comparison shop for an ER…just saying that there are a number of conditions that would put you in the position of needing an ER but having time to go to one with a shorter wait time.
Have you read any of my comments which explained the RAND study on usage variations based on copays, Kathy? I've addressed all of that, and what I think would optimize people's ability to seek care when they really need it without capriciously using healthcare services for things that would get better without a doctor visit or prescription meds.
I doubt St. Mary's is advertising to reach heart-attack victims, but they are apparently convinced enough people make choices like that to make it worth their while to advertise.
Let me ask you this: What kind of health care needs could be addressed in 30 minutes or less — from the time you walk in the door to the time you walk out the door?
Dr_J–
Throw me a bone.
A link to the bill?
Tell me how it's going to solve the problem without increasing costs. Show me how it gets us to the Swiss model you support. Explain how it addresses the issues that matter to you.
You've struck me as being more Libertarian than Republican, so I'm surprised you're claiming them.
It's okay with me if all you really want to do is bash Democrats. But why pretend anything about the Republicans' interest in solution? These threads are full of people who do the first without doing the second.
As to the question of volume, I'm concerned by the things you said. How close are we to capacity? Do you have any numbers on that?
This problem of trained personnel been acknowledged for years. In the medium-sized city where I live, they've doubled the size of nursing school classes. Several nursing homes are training their own practical nurses. There's a medical school that's increased its enrollment by 50%. One of the other local colleges started a Physicians' Assistant program five or six years ago.
Maybe one of the problems is that it takes so long to train a doctor. I understand the reason why it takes so long, but–and I'm just spitballing here–maybe some of the things doctors do could be handled by technicians? Maybe they could teach people to read X-rays–again, just spitballing–in two years? Even if it took four years, that would be faster.
Is it really that bad?
Um, I assumed that ad meant no more than a 30 minute wait time. Having been to ERs for dehydration, as I mentioned as an example earlier, I had to wait for four hours as they triaged other patients through. I can understand that, but if a hospital is able to find efficiencies or increase staffing or whatever to get you seen more quickly even when you're not about to die, I for one would opt for that hospital over another when I had the chance.
Christine,
I had not seen your prior references to the RAND study. I have now. After reading the study, these quotes are representative of the conclusions that stand out for me.
I might also add that, if I was mocked (not by you) for referring to a poll from a month ago that showed support for government-run health care, then what is to be said about relying on a study that is over 30 years old?
CStanley–
I appreciate your admissions about the Republican strategy. I also appreciate your frustrations about their strategy.
Since you've been talking up that Ryan bill, I wonder if you've got a link to it. (I know you posted something last week, but it kept returning an error message when I tried to open it.) I'd also like to know how it goes about making functional changes without raising costs. I'm pretty sure Republicans think cost concerns are just for Democrats.
I think you are correct in your sense, not widely shared on your side, that Republicans are missing a significant opportunity to push alternative approaches on this and other issues. It seems to me that they are replaying the Harry Reid strategy of doing nothing but waiting for the other guy to lose the next election. If Harry Reid had spent 2007 and 2008 laying some foundation, health care reform (this is, of course, just my opinion) would already have passed in 2009.
You made a claim about about fairness to the minority party. I agree they cannot move any legislation forward. But I expect you to concede the willingness of Republicans to push legislation about a birth certificate and about the Gates case. Republicans are perfectly willing to push legislation that really matters to them. I don't see how anyone can deny it.
It's possible they can block health care reform. If so, maybe they'll break Obama and win big in 2010. But I don't think so. I could be wrong, of course, but I don't think Republicans really understand what hit them in 2008.
Republicans have forgotten about the war. They've forgotten how Katrina administered a coup de grace to the notion of Republican competence.
They've also forgotten about their own reckless expansion of Medicare during the Bush Administration and they've forgotten about their own financial industry bailout.
I don't love everything the Democrats have done. But government spending is the conventional wisdom response to recessions (so much so that even Bush and Cheney pushed it through at the end of their own term in office). And Democrats are sweating the CBO numbers while the Party of No strokes the prejudices of the birthers and claims the proposed health care reforms will kill seniors.
While I respect what the Democrats are doing to solve problems, it also seems inevitable that Obama is going to lose me over the wars.
If that happens, am I really supposed to vote for the party of Glenn Beck? You can't beat something with nothing.
CStanley–
As I've said here and on other threads, I think there's a crisis and I'm in favor of doing something soon that gives more people insurance coverage.
Soon. Soon. You know?
I think Dr J has said a bunch of interesting things. You may have noticed that I am putting up links to some things he supports in an effort to explain them. I think his complaint about lack of price transparency being a problem is 100% correct. (If you went to Walmart and they didn't have prices on their stuff, you'd go across the street to Target; on the other hand, you don't show up at Walmart in an ambulance.)
I have even agreed with you about some things. You may, for example, have noticed that I am rather more concerned about price than some of the other people on my side. I'm also not a big one for talk of universal human rights and such.
That's because it's obvious to me that these reforms would save money.
If your boss didn't have to pay for your insurance, he'd have more money to invest in new equipment, new software, and other improvements–plus he could buy that Mercedes he's always wanted. He might even have enough left over to give you a raise, CStanley. (You deserve one, right?)
Think of emergency rooms that charge a million individuals with a billion dollars, aggregated, in costs. What if, instead, they accepted $800 million because they are no longer saddled with the expenses of patients who can't pay. The economy just saved $200 million! And a bunch of those patients still have money in their pockets that they can spend on books or plasma tv's or beer. Maybe they'd even pay down their credit cards a little. (I can dream, right?)
The problem is the government is still on the hook for your health insurance and all those emergency room visits. Those expenses get included in the CBO score. (And fair enough–I'm for being honest about the costs as well as the benefits.) But the money saved by your boss and by all those people with broken arms doesn't get included in the CBO score. Plus, the guy who didn't break his arm didn't save any money at all.
Dr J has also been known to say we're not honest about what we pay for and what we get. Holy Moly, do I ever agree with that!!
I think this round of reforms, the round that (I hope) gets people covered by health insurance, won't and shouldn't be the end. I've told Dr J that some of his ideas would make a good basis for the next round of reforms. But if there's nobody working for them now, then they're not going to happen now, and the problems that now exist haven't gone away.
I'm willing to accept half a loaf to get some portion of the crisis solved now.
George, I'd say lack of price transparency is more of a symptom of the bigger problem: nobody cares what the price is. If they did, we'd have price transparency because people would demand it.
And the reason they don't care is because they're spending Somebody Else's Money. Get them spending their own money for most transactions, and price transparency will become the norm within a few years.
Advances in health care will make it more expensive, the more is adopted and then expected.
Meanwhile, we are an aging society. I've said many times, just wait another 10-20+ years…
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.
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.”
In a general sense, this is a continuation of the behavior of the Dems to rush bad legislation that they simply have outdone themselves in attempting with their latest issue, here, health care.
Specifically, the deliberate avoidance initially of addressing the costs and how to pay for them, and then engaging in falsehood about costs (in addition to other facts about what they were trying to do) was what has primarily generated public concern about and opposition to this failed effort.
In this case, the Dems rushed to pass anything with “health care” stamped on it, rushed to the point of neglecting fundamental concerns with this (costs and payment), and even managed to fracture itself (the Dem contingent) while appearing this time momentarily to be almost as dysfunctional as the Republicans currently are commonly seen. (But compounded with dishonesty and poor appeals to the public, too.)