windelina: (Firefly)
[personal profile] windelina
Paul Krugman's latest deals with healthcare:

Those of us who accuse the administration of inventing a Social Security crisis are often accused, in return, of do-nothingism, of refusing to face up to the nation's problems. I plead not guilty: America does face a real crisis -- but it's in health care, not Social Security.

Well-informed business executives agree. A recent survey of chief financial officers at major corporations found that 65 percent regard immediate action on health care costs as "very important." Only 31 percent said the same about Social Security reform.

But serious health care reform isn't on the table, and in the current political climate it probably can't be. You see, the health care crisis is ideologically inconvenient.

Let's start with some basic facts about health care.

Notice that I said "health care reform," not "Medicare reform." The rising cost of Medicare may loom large in political discussion, because it's a government program (and because it's often, wrongly, lumped together with Social Security by the crisis-mongers), but this isn't a story of runaway government spending. The costs of Medicare and of private health plans are both rising much faster than gross domestic product per capita, and at about the same rate per enrollee.

So what we're really facing is rapidly rising spending on health care generally, not just the part of health care currently paid for by taxpayers.

Rising health care spending isn't primarily the result of medical price inflation. It's primarily a response to innovation: The range of things that medicine can do keeps increasing. For example, Medicare recently started paying for implanted cardiac devices in many patients with heart trouble, now that research has shown them to be highly effective. This is good news, not bad.

So what's the problem? Why not welcome medical progress, and consider its costs money well spent? There are three answers.

First, America's traditional private health insurance system, in which workers get coverage through their employers, is unraveling. The Kaiser Family Foundation estimates that in 2004 there were at least 5 million fewer jobs with health insurance than in 2001. And health care costs have become a major burden on those businesses that continue to provide insurance coverage: General Motors now spends about $1,500 on health care for every car it produces.

Second, rising Medicare spending may be a sign of progress, but it still must be paid for -- and right now few politicians are willing to talk about the tax increases that will be needed if the program is to make medical advances available to all older Americans.

Finally, the U.S. health care system is wildly inefficient. Americans tend to believe that we have the best health care system in the world. (I've encountered members of the journalistic elite who flatly refuse to believe that France ranks much better on most measures of health care quality than the United States.) But it isn't true. We spend far more per person on health care than any other country -- 75 percent more than Canada or France -- yet rank near the bottom among industrial countries in indicators from life expectancy to infant mortality.

This last point is, in a way, good news. In the long run, medical progress may force us to make a harsh choice: If we don't want to become a society in which the rich get life-saving medical treatment and the rest of us don't, we'll have to pay much higher taxes. The vast waste in our current system means, however, that effective reform could both improve quality and cut costs, postponing the day of reckoning.

To get effective reform, however, we'll need to shed some preconceptions -- in particular, the ideologically driven belief that government is always the problem and market competition is always the solution.

The fact is that in health care, the private sector is often bloated and bureaucratic, while some government agencies -- notably the Veterans Administration system -- are lean and efficient. In health care, competition and personal choice can and do lead to higher costs and lower quality. The United States has the most privatized, competitive health system in the advanced world; it also has by far the highest costs, and close to the worst results.

Over the next few weeks I'll back up these assertions, and talk about what a workable health care reform might look like, if we can get ideology out of the way.


Hunh. Well, I've known that the US has terrible infant mortality rates for an industrialized country.
I guess we're discovering yet another area where we're not "#1".

Date: 2005-04-13 04:11 pm (UTC)
From: [identity profile]
efficiency is an issue that totally keeps coming up with arguments against socialized healthcare and it drives me frickin' nuts. because when i was living in germany i had to go to the german hospital emergency room and it was the best hospital experience of my life:

went up to a window told them what's up. sat down. 5 minutes (no exaggeration) a woman asked me into this room. she helped me fill a form out because i didn't know german. this form was one page. i didn't have jack for information, all i had was my host family's name and the town they lived in. no phone, no address. keep in mind also that i'm obviously a foreigner. so we fill out this form, it takes a few minutes but as she's doing that this other lady is prepping me for surgery, doctor comes in does the surgery, they give me a piece of paper and say come back in a few days. i go out of that room and around the counter is the pharmacy where my prescription is already filled and i'm on my way home. seriously, i the whole thing took about half an hour!

i went back three times for follow ups and every time it was the same, _no_ waits, super nice people, insane efficiency.

so that's that. compare that to experiences i've had in us military hospitals or the hcmc downtown that were agonizingly bureaucratic and inefficient makes it clear that it's not government healthcare = sucky and expensive or market competition = awesome. execution is definitely a factor.

people act like it's all impossible to do socialized healthcare and when i tell them i have experienced this impossibility they get all stupid and are just against it. why can't we do what germany did, why we can't just copy them? i really don't understand what the problem is. it seems to me some people are just irrationally clinging to some cold war pinko fear that is just silly.

Date: 2005-04-13 04:42 pm (UTC)
From: [identity profile]
It's not impossible to do socialized healthcare. It just comes with a price tag that most Americans aren't willing to pay, especially when their experience with it has been either dealing with the military medical system (great for active duty troops, sucky for dependents - at least they have their priorities straight) or with places like HCMC. Reading about systems like Canada and England doesn't make a lot of people wild about the prospect of switching to something like that either.

Date: 2005-04-13 06:25 pm (UTC)
From: [identity profile]
the us base hospital in frankfurt i went to sucked so bad. i had a serious and painful infection and barely walk in there on a saturday morning and was just in nutso pain and they told me to come back monday because it wasn't really an emergency and they didn't do surgery on weekends. this was after waiting a few hours (no exaggeration) in a waiting room with _no_ other people, then filling out twenty pages of forms and then waiting another hour just so they could tell me to come back monday. there was seriously nobody there, i don't know what was going on there but it was the stupidest hospital experience i've had. i went from there straight to the german hospital and had the best hospital experience i've had.

anyway, i think the price tag is fine especially when i think there would be all kinds of other auxillary benefits for society. i think people not having to worry about getting sick and being screwed would have a really nice general effect on society. i don't know how to prove that.

i get confused about the price tag. most of my healthcare costs go to paying towards the chance i might have a serious accident that i most likely will never have. i would prefer it if that money could go towards more preventative general care but i can't get that preventative care because i can't risk going without the insurance against catastrophy. i'd be curious to know how much insurance payments go 'unused' to get an idea of costs. like how many people paying a couple hundred bucks a month insurance for years and years never use any benefits? where does that money go? how does the total amount of insurance paid by all people in this country line up with the total cost of healthcare?

Date: 2005-04-14 12:57 am (UTC)
From: [identity profile]
i get confused about the price tag. most of my healthcare costs go to paying towards the chance i might have a serious accident that i most likely will never have. i would prefer it if that money could go towards more preventative general care but i can't get that preventative care because i can't risk going without the insurance against catastrophy. i'd be curious to know how much insurance payments go 'unused' to get an idea of costs. like how many people paying a couple hundred bucks a month insurance for years and years never use any benefits? where does that money go? how does the total amount of insurance paid by all people in this country line up with the total cost of healthcare?

That's a really good question. Most people have major medical insurance which pays 80% (or some large percentage) of the bill for doctor visits and such; some people have HMOs which do offer some preventative care and "lifecare" services intended to get you living a healthier lifestyle, but also act like major medical so long as you only see the HMO's doctor and pharmacy; some people have PPOs which are like major medical except you get a price break for using only doctors and pharmacies in their network. I don't know of too many places that offer only catastrophic insurance, which pays off if you have an extended hospital stay but doesn't cover anything else.

Date: 2005-04-14 03:15 pm (UTC)
From: [identity profile]
i'm self employed and pay my own insurance so all i can afford is the 80% thing but the deductible is so high it's basically like i'm paying out of pocket for any hospital visit. the only thing my insurance is covering is catastrophy. oh and prescription drugs too. but i'm quite healthy and never go to the doctor so my insurance is really only covering me against catastrophy. it seems so dumb. if there was socialized healthcare i would be paying for nothing but my general well being would be protected and i'd somehow feel like the money i was paying in was going towards _something_ besides insurance against an accident i'm never going to have.

Date: 2005-04-15 12:26 am (UTC)
From: [identity profile]
ISTM you might be better off with an medical savings account, but I don't know how/if that would work since you're self-employed.

Date: 2005-04-13 08:53 pm (UTC)
From: [identity profile]
That is an education issue.

I recently listened to a couple of conservative economists discussing health care on MPR. They were asked if most corporations would really be willing to accept the higher tax burden of nationalized health care.

Both of them said corporations would most likely embrace it because what they would pay in increased taxes would be a fraction of what they currently pay for employee benefits.

I don't think that the price tag for most Americans would be all that difficult to swallow.

Date: 2005-04-14 12:46 am (UTC)
From: [identity profile]
Sure, the corporations would be all for it. What about smaller businesses and sole proprietors? Would they be equally willing? Charlie Wilson to the contrary, what's good for GM isn't necessarily good for America, or even the other players in the auto industry.

One of my major concerns about nationalized health care (aside from a complete lack of faith in the Feds' ability to do a good job with it) is that it doesn't really solve the problem I mentioned in my other comment - people will still run to the doctor for every sniffle and sore throat. Doctors will still practice defensive medicine, and nobody will have any incentive to exercise any discipline in health care spending since it's all paid for by the government.

I wasn't in favor of W's prescription boondoggle, and this is just the same deal squared, cubed, and served up to everyone. Even forcing those who are deliberately uninsured into he program isn't going to be enough to feed this beast, I'm afraid.

Date: 2005-04-15 03:14 pm (UTC)
From: [identity profile]
Sure, the corporations would be all for it. What about smaller businesses and sole proprietors? Would they be equally willing?

Actually they discussed that as well. One of the biggest issues small business owners have is health care costs. The costs are so high they can't afford to carry it but most employees want it. It is one of the main reasons so many small businesses are failing right now (according to the economists on this program).

Again, a national health care program would take considerable burden off these companies and allow them to be more competitive.

The other issue is the fact people are reluctant to start new businesses because it means they will not be able to afford health insurance. They felt that the health care cost crisis in the US is currently the largest problem for small business. The health care crisis is crippling entrepreneurship in our country.

Date: 2005-04-16 02:49 am (UTC)
From: [identity profile]
It would also work if small businesses could get a group rate through NFIB or some similar organization, but part of the problem is that different states have different mandates for coverage which makes it impractical to offer a "one size fits all" national plan with high deductibles complemented by an MSA. Those mandates also drive up the cost of the insurance: you may not want to pay for mental health or substance abuse coverage, but here in MN insurers can't sell you a policy without them, and you wind up paying more than you might have otherwise.

So the bottom line is that we have a health insurance system left over from the 1940s wage & price freeze laws, complicated with dozens of state mandates. I don't see how adding more government regulations and bureaucracy is going to solve either of these problems, unless you think the Feds are going to peel back coverage to the bare essentials.

Date: 2005-04-13 04:39 pm (UTC)
From: [identity profile]
OMGWTFBBQ??? Krugman writing a column that I can agree with? It's a sign of the End Times!

Seriously, the health care system is pretty badly screwed up, and I think a lot of it is because most health insurance isn't really health insurance, it's more like prepaid care. So people tend to go running to the doctor for every sore throat and sniffle, which drives up the cost...and there's no good way to comparison shop between doctors and clinics, at least not yet, which is another thing that drives up costs. Don't even get me started on Medicare.

One thing I notice he doesn't mention about the VA: a lot of the efficiency he touts has come from the current administration closing down a lot of VA hospitals (many of which were providing horrible care) and having a lot of veterans dealt with on an outpatient basis or through home health care.

Date: 2005-04-13 05:24 pm (UTC)
From: [identity profile]
Actually the efficiency so to speak, is because we have no fucking money in our budget. I have been working at the VAMC in Mpls for 14 years. The staff here try our damnest to take care of our veterans. Some VAMC's do suck but that is not the case in MN.

The sad thing, is that we have to charge patient's outside insurance plans and charge higher co-payments because of the budget issues.....

Date: 2005-04-13 07:37 pm (UTC)
From: [identity profile]
I'm not sure what to think of VAs. I know that some provide very good care, but I've also heard some horror stories. I talk to cancer patients from all over the country all day long, and I've noticed some trends among those who rely on the VA for their care. Many of them complain that they can never see their doctors and such, but then, people complain about other hospitals too. The thing that scares me is that some of these people seem to be getting highly inadequate care and don't even realize that it isn't like that everywhere else. I spoke to one man who was diagnosed with lung cancer and told to come back for a checkup in 6 months. They didn't offer him any treatment, nor did they explain to him that there was no treatment available for him. It's like they were putting him out of sight and out of mind. That's just one example.

I realize I'm hearing it from the patient's point of view and I know there are good VA hospitals. There also seem to be some pretty terrible ones, though. This likely stems from the budget cuts. I find it funny that the author touts the efficiency of the VA, but it looks like efficiency for some is achieved by forsaking care for many others.

Date: 2005-04-13 08:20 pm (UTC)
From: [identity profile]
I am a service connected veteran who gets her care at the VA. I get really good care but it takes forever to get appointments in some specialty areas ie eye clinic, ortho etc cause we don't have enough staff, facilties and time to see the HUGE demand of patients! Sending them out to outside care costs A LOT!!

Date: 2005-04-14 12:52 am (UTC)
From: [identity profile]
I've always thought part of the problem with the VA was mission creep...taking care of service-connected disabilities, combat veterans and retirees I'm all in favor of, but as the rules are now, I'm entitled to care at the VA even though I only served ~4 years on active duty and 11 more in the Guard and Reserve, none of it in a combat zone. I don't feel entitled to anything from the VA, and yet under the rules I -and a lot of others with even less time in service- am allowed to go and get care there. That's just not right. It diverts resources from those who (imao) earned it the hard way.

Date: 2005-04-14 12:48 pm (UTC)
From: [identity profile]
Due to some wonderful *coughs* people in Congress, we had to change elibity rules, thus all the new 13,000 new enrollees. Plus, in the five state area, we are the ONLY VA with specialized services like eye clinic. Now, we have to get the patient's apt within a certain amount of time........I am not sure how the hell we are going to do that?

Date: 2005-04-15 12:20 am (UTC)
From: [identity profile]
I'm thinking that's going to depend on who makes the rules on patient priority. Worst first? Combat veterans before retirees before just plain veterans? People who can't pay before those who can afford to seek treatment elsewhere? No matter how you slice it, somebody's going to get pissed off.

Date: 2005-04-15 12:51 pm (UTC)
From: [identity profile]
Actually with the new elibility rules ie 50% SC veterans MUST be seen within 30 days of request etc, etc, is where we are really getting overwhelmed....

Date: 2005-04-14 02:10 am (UTC)
From: [identity profile]
When anybody discusses health care in america I am always surprised with the one thing that they don't mention.

A very big reason heath care is so expensive is also because americans are so fucking unhealthy. We are fat and lazy. Nobody exercises. And the majority of shit thinly disguised as food that we do put in our bodies are toxic.

So I think for anybody who wants free health care, here is a solution (and free). Why don't we all put down the Doritos, stop going to fast food joints and start exercising for 45 minutes a day and try to prevent poor heatlh. After all, if we all started getting healthy, health care costs would go down.

No I know it's a pipe dream to think we as americans want to assume any personal responsability regarding our own health. But when one is 60 and looks back on their life and sees that they ate like shit, barely did any form of exercise. Don't be shocked if you're broke, in a wheel chair looped up on a ton of drugs with a few months to live.

Now... where did I put my remote control, because there is no way I am getting up from the couch to change the channel. :)

Date: 2005-04-15 12:25 am (UTC)
From: [identity profile]
It does get brought up, but it's something that neither the insurance companies or the government can realistically do anything about. It may well be illegal in some states to charge overweight/obese people higher premiums than people who are in good condition; I really don't know but wouldn't be surprised.

Come to think of it, between diabetes and its side effects and the increased strain on the heart, obesity tends to kill people off pretty early. There's a reason you don't see too many old fat people around, and it's not because they keep them locked up in the nursing homes.

Date: 2005-04-15 12:59 am (UTC)
From: [identity profile]
My mom, 5 of my uncles and my grandma all have/had diabetes. majority of them were/are overweight as well. and the majority of either lived or are still living healthy lives.

My main point is that there a things the government shouldn't be completely responsible for. there are a ton of ways that people can help themselves in living a longer healthy life. I know not every disease is preventable. But a large amount is. We need to take the initiative to start eating healthier, exercising, not smoke, ect.

I just don't believe are taxes should go to say a life long smoker who now has developed lung cancer. Or a person who drove drunk and got in to an accident and became paralyzed. Why should my tax dollar go to pay for their health care when their condition is self inflicted?

I am all for helping the helpless. I just think the ones that can help themselves do so instead of acting like they can't.

Date: 2005-04-15 01:31 am (UTC)
From: [identity profile]
I agree with you...although most smokers are already paying higher life and health insurance premiums than the rest of us, since they tend to be sicker and die earlier. There are exceptions to the rule, of course.


Date: 2006-09-29 05:58 pm (UTC)
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