I'm well aware of the far left view that this health care “reform” effort, like the ClintonCare version several years ago, is anathema. If you remember Melvin Konner (“Medicine at the Crossroads” on PBS and in a book), he wrote a short book, “Dear America,” that was a polemic and more against the ClintonCare effort (he wanted single-payer back then). If you're a book reader you might want to grab that book and see what arguments he made then (against the Clinton fascistic HMO “alliance”-based health care takeover scheme, though Konner avoided saying “fascistic”) and how well they apply now (toward the ObamaCare toucher-feelier, aimlessly-cobbled-together managed-cartel fascistic health care takeover scheme). Konner detested “shoveling money into the furnaces of corporate greed” and he wanted the Canadian model for this country (“the compassion of Florence Nightengale and the efficiency of Desert Storm”).

http://www.melvinkonner.com/index.php?option=co…

So have I. Medicare is without doubt an ailing program, which is why I fear being dumped on it, and I am not rushing to accept it now that I qualify, because I could be giving up much better insurance for it, plus have to pay Medigap or carve-out supplemental insurance the total of which may well exceed what I am paying for now, for individual insurance.

The Democrats would have been far more intelligent had they (in addition to doing many other things right instread of wrong this past year) sought Medicare reform first, or at least had some idea of how to pay for their health care “reform” initiative before choosing to proceed other than taking money out of Medicare (that stupidity alone turned off the mainstream public, big time, even if it was to attack Medicare Plus Choice primarily, not the whole program).

In hindsight obviously health care should have been second after the stimulus (which wasn't done right, the first thing that spooked the mainstream more than its scary size), or even arguably tried at the same time as the stimulus (roughly in parallel during the Obama honeymoon swoon and Give-the-Dems-a-chance period). Now (with a year's legacy of failure and worse) it's going to get tough.

I don't believe the agitated crowd that says if it fails now, nothing will happen for a generation, or that whatever is passed now, is it for decades. Not true at all. The insurance companies are cutting their own throats PR-wise, their days were numbered anyway (the lefties can't see this, but it's obvious — the insurance model may end someday, and they're just desperate to stay in the game and milk it as long as they can). Even when the rate increases are for good reasons (individual markets and high risk pools being abandoned by healthier younger people as rates rise, creating a cycle of steeper price increases due to costs alone, not counting overhead and profit issues) it probably won't be too much longer before the situation simply can't continue.

Had the Dems done things right, and it's still possible given future rate increases (maybe this is being left largely alone by the Dems in the hopes that those rates do increase faster, later, leading to more reform sentiment?), not only would the public option (which I believe is still alive) and even Medicare buy-ins not be promptly rejected by most people, but (depending on how bad the insurance situatio really gets, with escalating rates, never mind profit or related scandals) people might willingly look at not only Medicare as a model but the Canadian system and lessons from other systems, including Australia-New Zealand as well as the UK and the Continent.

As it is, Medicare reform is probably essential within the next few years. Those premiums are going to jump, for example (the bogus 75% subsidized pretend-insurance “premiums” for Medicare Part B — which going to another nation's model or the Conyers bill would change).

[Those Trustees -- some of us have quoted them and tried to warn everyone for years, and years -- Social Security should begin running deficits in 2016, but that's not all that's set to happen during this decade.]

“The projected exhaustion of the HI Trust Fund within the next eight years is an urgent concern. Congressional action will be necessary to ensure uninterrupted provision of HI services to beneficiaries. Correcting the financial imbalance for the HI Trust Fund—even in the short range alone—will require substantial changes to program income and/or expenditures. [...]“

“It is expected that about one quarter of Part B enrollees will be subject to unusually large premium increases in the next two years. This occurs because it is projected that the other three-quarters of Part B enrollees will not be subject to premium increases in those years due to low projected Social Security benefit COLAs and a 'hold-harmless' provision of current law that limits premium increases to the increase in Social Security benefits.”

http://www.socialsecurity.gov/OACT/TRSUM/

You apparently want profiteers to handle your health care for life. Go for it. Show some cajones and press your party of choice to destroy Medicare and enshrine the ka-ching crowd to have a bite of every single health need you and your family ever experience.

You have said that you're a scientist, yet you seem unclear on the concept of a controlled experiment. The data you continually cite are nonexperimental–they do not control for other factors affecting life expectancy such as homicides and accidents. Do these factors matter? Absolutely:

“One big reason our life expectancy lags is that Americans have an unusual tendency to perish in homicides or accidents. We are 12 times more likely than the Japanese to be murdered and nearly twice as likely to be killed in auto wrecks.

In their 2006 book, The Business of Health, economists Robert L. Ohsfeldt and John E. Schneider set out to determine where the U.S. would rank in life span among developed nations if homicides and accidents are factored out. Their answer? First place.”

source: http://reason.com/archives/2009/08/17/whats-sca…

(The author of that article, btw, was an Obama supporter in the last election:
http://reason.com/archives/2008/10/29/whos-gett… )

The only sensible way to evaluate the performance of the US health-care system is to perform the types of studies that I cited earlier, which estimate life expectancy conditional on having contracted a particular illness. By that criterion, we have the best system in the world. Yes, we spend a lot to get the best care. And anyone who gets seriously ill is damn grateful for the opportunity to get access to the best care.

You insist on blaming high costs on private health insurance. If you looked up the US health-expenditure data over the past 60 years, you'd find that the big uptick in the series occurred after the passage of Medicare. Need I point out that private insurance has nothing to do with this fact? And yet your solution to what you call the health-spending crisis is, essentially, to extend Medicare to everyone.

There's no free lunch, despite your fervent wish that there be one. I'll close with some wisdom from the pages of the NY Times:

It’s easy to be against high costs, and it will no doubt be hard to come up with a broad health care solution. But the way to start is by acknowledging that an affluent society should devote an ever-growing share of its resources to the health of its citizens. “We have enough of the basics in life,” Mr. Cutler, the economist and author, points out. “What we really want are the time and the quality of life to enjoy them.”

http://www.nytimes.com/2006/09/27/business/27le…

I'm going to assume you're not totally provincial and ignorant and probably know or meet people from Canada, Europe, Australia and/or Asia. You KNOW they're not suffering from inadequate health care. They're happy and healthy and live longer than we do. Every OBJECTIVE, data based study shows the US faring very poorly in nearly all measurable health outcomes.

Finally, I didn't misunderstand CS's point. But that's massaging stats that are not debatable. The point is that we KNOW the fate of every dollar that goes into Medicare and that goes to an insurance company. We know far more in the public programs goes to health care (97%), and more in the insurance system to profit and the items I listed (17-33%). Can you deny what the insurance industry itself admits? Less money goes to health care. And in fact, the LESS they provide for care, the better for their profit. It's called “medical losses.”

That fact puts them at odds with our national goal of caring for our populace. Insurance companies will NEVER care as much about your health as their profit.

Other nations pay half what we do. Or less. Yet they're healthier. Those are the facts. I think Republicans also care more about the profit of their donors than about both the public health and the public purse. Their actions prove that.

The data you linked to regarding shares of GDP spent on healthcare have next to nothing to do with health insurance, since administrative cost differences between single-payer and private insurance schemes don't even begin to account for the international differences in health-care spending. Indeed, if private insurers were as effective in denying coverage to sick people as you've previously claimed, then they'd be working toward reducing our national expenditures on health care. And that would clearly not be a good outcome.

There are three distinct issues that keep getting tangled, leading to many fruitless arguments. Those issues are: 1) the ability of people with preexisting conditions to obtain insurance, and the consequent desirability of a health-care safety net; 2) the share of GDP spent on health care services of all types; and 3) the quality of health outcomes in the US vs. other countries.

As I've already shown in my prior comment, there's solid evidence that the US ranks quite highly in terms of item 3. As your data show, and as is well known, the US spends a relatively high share of its income to get the top ranking in health-care outcomes. Whether that's a problem or not depends on what better health outcomes are worth to people. That's where the heated arguments begin.

I, and many others, believe it is best to leave treatment decisions to individuals and their families. Since people rightly want to insure against huge medical bills, this decision will necessarily also involve patients' insurers, whether they be private or public. One essential difference between private insurance markets and a single-payer system is that the compensation schedules that private plans offer to physicians and hospitals must be the subject of bargaining, and must therefore be mutually acceptable. If the insurers offer too little, they cannot induce providers to join their list of providers. If they offer too much, they cannot offer competitive rates to purchasers of insurance. The skills necessary to find the right balance here are part of the administrative cost of private insurance–a cost that, to me, is worth the benefit it delivers.

Medicare's monopoly status means that it doesn't have to compete for clients. That means that its managers don't face the same consequences as private insurers do when they offer too little compensation to primary providers. Here's one example of the hidden costs behind Medicare's vaunted administrative efficiency:

“Mike Atkins of Beth Israel Deaconess Medical Center and Harvard Medical School reported that Medicare does not fully reimburse the costs of HD IL-2 (high dose Interleukin-2) for the treatment of metastatic melanoma. As a result hospitals are not offering this treatment for metastatic melanoma and research into using HD IL-2 to treat metastatic melanoma is being curtailed. Several hospitals are not providing HD IL-2 treatment for metastatic melanoma even for those who can afford to pay, out of concern for equity issues, raising an ethical question on the right to the access of care.”

source: http://www.nap.edu/openbook.php?record_id=10358…

Clearly, there are lots of people currently suffering from metastatic melanoma who don't think that “the US” is spending enough on health care right now, and they would be quite happy to raise total spending on it out of their own pockets if they could get HD IL-2 in return. I think that they should be able to do that, but the ideologues who see health care in reductive terms of “rights” and “fairness” will, if they get their way politically, will eventually turn our system into one in which no such choices are available to individuals.

But the numbers I cite are simply this: Of every dollar taken in, 97% of what goes to Medicare is spent on health care. For private insurance it's less. 83% according to the insurance industry, 70% estimated by others. So, let me ask you this. If your daughter is hospitalized, which of these do you want to pay for?

Doctors, drugs and hospital
$14 million average annual CEO salary
Lobbying the government
Support of political campaigns
Marketing campaigns
Sales expense
Underwriting expense
Palatial offices
Art and sculpture
Retreat in the Bahamas
Corporate planes and cars
“New product” development
Claims denial experts
Investment team

But, I'm a scientist. So let's do an experiment. Let's try every blend of public and private health care strategies we can think of. Let's try a 30 year experiment and see what it yields. Here are the results:
http://www.diabetesdaily.com/edelman/2009/05/06…
http://www.economicpopulist.org/files/healthexp…
http://img44.imageshack.us/img44/3470/internati…
http://graphics8.nytimes.com/images/2009/07/09/…
http://upload.wikimedia.org/wikipedia/commons/5…

Finally, here's Alan Grayson introducing a Medicare buy in for all.
http://www.youtube.com/watch?v=z_XGJHOYuxw&feat…

“Not one country on the world stage that has a free enterprise health care delivery system ranks among the top 25 nations for the quality of their citizens’ healthcare. At last measuring, the United States ranked an embarrassing 40.”

I do not know what ranking he's talking about, since no source is cited, but I'm guessing that it's based on infant mortality rates. Since Mr. Bell has decreed that we commenters can only talk about our own personal health issues, I looked for reliable data on cancer survival rates. Here's the abstract from a study issued by the National Bureau of Economic Research, which is as scholarly and apolitical a source as can be found, comparing specific health outcomes under Canada's compassionate single-payer system and the US's evil “free enterprise” system:

“Does Canada's publicly funded, single payer health care system deliver better health outcomes and distribute health resources more equitably than the multi-payer heavily private U.S. system? We show that the efficacy of health care systems cannot be usefully evaluated by comparisons of infant mortality and life expectancy. We analyze several alternative measures of health status using JCUSH (The Joint Canada/U.S. Survey of Health) and other surveys. We find a somewhat higher incidence of chronic health conditions in the U.S. than in Canada but somewhat greater U.S. access to treatment for these conditions. Moreover, a significantly higher percentage of U.S. women and men are screened for major forms of cancer. Although health status, measured in various ways is similar in both countries, mortality/incidence ratios for various cancers tend to be higher in Canada. The need to ration resources in Canada, where care is delivered “free”, ultimately leads to long waits. In the U.S., costs are more often a source of unmet needs. We also find that Canada has no more abolished the tendency for health status to improve with income than have other countries. Indeed, the health-income gradient is slightly steeper in Canada than it is in the U.S.”

http://www.nber.org/papers/w13429

What about the US vs. wise and rational Europe? We're number 1 in cancer survival, by a much wider margin than the one by which we outperform Canada:

http://www.ncpa.org/pdfs/ba596.pdf

but in many cases the sites are not inside working genes, suggesting there may be some conceptual flaw in the statistics.

I'm not aware of any attempt to find out if “non-working” genes (ones without a start code) really are as unused as they assume. This may suggest that they have a purpose that isn't properly understood yet.

This post was mentioned on Twitter by TMV: Getting Rid of Health Insurance Would Improve Healthcare Quality: While The five largest health Insurance compani… http://bit.ly/9pExvt...

Our future probably will be without the insurance model (as well as employee health benefits — nobody wants “job lock” or any other constraint on portability) is likely to be either the Medicare-Medicaid model (which eliminates the employer-based problem as well as much, but not all, of the insurance model) or the VA model (taking over infrastruture and employing providers directly in order to control future cost growth).

If (when) we do this, we will exchange one intermediary (the insurance industry) for another (Uncle Sam).

There are a number of other discrepencies too that skew things (like the fact that part of the admin cost to private insurers is state taxation which Medicare doesn't face, and the fact that some Medicare overhead shows up in other part of the federal budget and isn't accounted for in the lower estimates that you cite), but it looks to me like the biggest factor is that Medicare's claims per person are so much higher than the average claims of private insurers and that makes the percentage of admin costs look relatively low.

Why does that matter? Because it means that you can't assume that expanding a Medicare type program to more people (that is, younger, healthier people than the current enrollees) is going to result in cost savings. Quite the contrary, since on a per person basis the admin expenditures of Medicare are higher.

Here's a source for this info…and yes, Heritage is a right wing ideological source, but you still have to show me where they're factually incorrect if that's what you think.

(the insurance model)

http://www.nytimes.com/2010/03/11/health/resear…

An informative link. Thank you.

The two essential features of our change that are the object of radical reform are a) the insurance model for pre-paid comprehensive health care; and b) having insurance as an employee benefit. Ending these would be radical reform but welcomed by many.

Mr. Bell (and readers here), you might want to start here for review — a timely piece in the Economist.

“Ending the health insurance model”

http://www.economist.com/blogs/democracyinameri…

We may approach this from different core perspectives. I am neither a tax cutter nor a philosophical small government advocate. My focus is more on efficient government and relatively balanced budgets, while eliminating the unnecessary expenditures that muck up our fiscal system. The raw dollars are not so much the issue, my view, as the bang for the buck and the resources to pay.

If the federal government came out tomorrow and said they were going to retract unnecessary foreign military presence in Europe, Asia and the Pacific, and use the savings to construct 100 nuclear power plants while providing policy opportunities to encourage private capital formation for a transition to plug-in electric transportation, I would not much argue the combination of a necessary and useful goal combined with a fiscally sound approach.

Likewise, a single payer health care system combined with agressive systemic cost cutting could, if done properly, significantly lower individual and business costs for healthcare. If systemic costs were effectively lowered, the payroll tax necessary to support single-payer would be less than current premium costs. The fly in the ointment, of course, is that government is currently so disfunctional that the idea of a clean, well run, no political pork, system for anything seems a stretch of credibility.

Eliminating MANDATORY, employer-provided health care would indeed drastically reduce medical costs. It was that set of actions by Congress that jump-started the huge increase in the cost of health care, noting else. That is so often ignored in the HCR debate, that the evil big insurance companies are in reality a government created problem in the first place.

Well, actually the biggest jumps in health came later, so there must be other factors…but certainly the uncoupling of insurance and employment would be simple to do (either phase out the deductibility for the employer or add a neutralizing tax deduction for the individual purchaser) and would help increase competition in the health insurance market (as well as allowing for portability of a plan from job to job, or during a period of unemployment, without having to use COBRA.)

$12.2 billion is, sad to say, drop-in-the-bucket stuff compared to the overall cost of healthcare in America

Excellent point tidbits. Contrast that $12.2 billion in profits with the $1 trillion dollar increase in costs over ten years the CBO estimates HCR will cost the US. That is a mind-boggling average of $100 billion dollars a year.

On a slightly separate but related rant, it is absolutely amazing to me how as a county in the one year since Obama was elected we have gone from being shocked at programs that cost hundreds of billions to blithely accepting $1 trillion dollar spending as is it was nothing.

I think, unfortunately, it is almost because to many people $800 billion sounds worse than $1 trillion, because 800 is bigger than 1.