I'm hoping this won't devolve into a discussion of the Affordable Healthcare Act (so-called "Obamacare"). Let's do that under a more specific topic.

Rather let's discuss the current system in America, what's wrong with it and what's right, whether it needs fixing, and how to fix it. Non-Americans are encouraged to chime in.

Here's my take:

1) There is no healthcare system on a national level beyond Medicare and Medicaid. Any other systems are local to some degree or other.

2) Pretty much everyone who doesn't have their head up their hind end can see that the current way of handling healthcare is not sustainable. within a decade or two, assuming costs continue to rise, healthcare will become unaffordable for most Americans.

3) Healthcare isn't a normal market where competition functions to lower cost. Yes, insurance companies exclude certain high-risk, high-cost people in an effort to maximize their profits and keep their rates down. However, that doesn't work because for the excluded people the local ER becomes the primary care provider. Somebody has to pay for this care, so it's passed along to the people who are insured through their insurance company. This is one reason why hospital Tylenol can cost $25. The marketplace actually RAISES costs.

4) Do you think it's ethical to throw 30+ million under the healthcare bus in order to keep rates low for those with insurance, especially considering that it  ends up (as explained in the 3rd point) making costs higher anyway.

5) 30+ million people need affordable healthcare, and indigents need free healthcare. Is it so bad to have socialized healthcare for them, especially if it will function to bring costs down for the rest?

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We could require funerals for aborted fetuses, I suppose. :))

Lot of ground has been covered, but a couple other points.

Healthcare is best viewed from a national top down level instead of the individual bottom up view. Private insurance schemes measure the risks and costs for the individual, nationalized health care measure for the whole nation. Epidemiology provide answers of which ailments and their prevalence can be expected and the costs associated with treating these are known. Together they can form a fairly coherent picture of what healthcare will cost the nation and provide opportunities for prioritization and thus reduce overall healthcare related costs in a much better way than through insurance (both voluntary and mandated).

Healthcare is generally subject to Baumol's disease and it is doubtful that it can be comprehensively technologically revolutionized. Lets say a doctor or nurse can see 20 patients per day today, which is probably the same it was in 1960 and probably the same it will be in 2060. However, the salaries and wages must follow the average wage growth in the private sector, otherwise the health care profession will not be able to compete for employees. Without central planning of costs they tend to spiral, which is exactly what is happening in the US where health care cost as percentage of GDP is the highest in the world.

I can go on a while with a host of issues insurance based private health care creates compared to nationalized systems. Safe to say, no serious mainstream economist would recommend such a system. It is generally considered to be part of what's often termed 'natural government markets' due to market failure along with education, law & order, military, infrastructure, street lights, fire houses, lighthouses, etc.

There are a lot of economies available in a single-payer system not easily available in the patchwork quilt system we have in the U.S. now. For example, when people go to a national clinic in Taiwan, after the diagnosis the clinic will know what the treatment will cost, and can tell the patient, even before the treatment begins (unless it's a life-threatening emergency, of course). Also, information about the patient's diagnosis, treatment, drugs prescribed, prognosis, etc., go into a national database there, making it nearly impossible for someone wanting to scam some oxycodone by presenting the same symptoms to 10 different doctors. The typical doctor's office is disconnected from any such database and probably has a data capture and control system inferior to the one at the local supermarket.

While Republicans and conservatives tout the virtues of the current system, it's hard to find a serious economist who thinks it's anything but insane and in need of a fix from top to bottom. We won't have a fix even for those who have health insurance but see costs rising precipitously without getting everybody in the pool one way or another.

The insurance companies try to keep the cost low by excluding high risks and people with expensive-to-treat preexisting conditions. But the cost of the uninsured is unavoidable since the people they cover end up in the hospitals where the indigent go, raising costs and fees for those who can pay, or their care ends up being paid for by tax dollars.

Now, for some, it seems like the answer is to give people whatever care they can pay for and throw the rest under the healthcare bus. Thank you Ayn Rand.

why is it assumed the cost of healthcare is directly related to the demand? are you entirely sure about that? i keep reading that statement and cant get past it. working with the medical device manufacturing field...its hard to believe that statement to be a solid assumption to build an opinion on. so when you go to the ER for the lazy un-preventative care...of a shattered tibia, do you believe the cost the hospital charged you for bone screws and/or a tibia trauma plate was directly related to demand and cost of those items?

Because supply side has 7-8 years of education and twice that of experience. Try demand-side your way into chemo therapy without having cancer.

so the entire healthcare system of a nation is entirely comprised of doctors and nurses and their healing. thanks.

Not quite my statement. I was giving an example, the knowledge and power gap between supplier and customer, of why the health care market isn't quite the same as bread and butter. In fact, there are many special considerations and it's so multifaceted that it has spawned it's own field of economics.

The last time I visited a doctor, he charged me $10 per minute for 12 minutes (I timed him) - at 20 patients per day, that's only 4 hours. Sorry, but at that rate, I'm thinking that except for Wednesday, when we all know they all play golf, their days are longer than that.

That wasn't exactly the crux of my argument you attacked there. Lets say 100 patients per day then, the conclusion still stands; there is little/no difference from 50 years ago and presumably 50 years in the future.

@Arcus - I wasn't really trying to attack your argument, just saying that cutting doctors' fees to something more realistic would affect luxury car dealerships and high-end real estate agents more than anyone else.

The doctor I saw may not have been typical, he may have had us on the clinic's equivalent of a Lazy Susan, "move 'em up and head 'em out" plan. In order to minimize my need to return, I tried telling him of three minor problems I had - he discussed only one, telling me we'd visit the others on future appointments, thus assuring himself future income.

Any medical treatment I need, which is rare, I can get from VA, at either no cost to me, or a minimal co-pay. I have one, consistent healthcare provider, who is not a doctor, but who is more knowledgeable about medicine than any actual doctor I've ever met, and if the need arises, which it hasn't, he has the option of a consultation with the primary physician in charge of the clinic, which seems to be a working arrangement for all concerned.

One thing the Republicans seem right about is that the cost of litigation is a contributor to the cost of American healthcare. Medicine, while not actually an art, isn't actually a science, either. It's a very well-paid trade. A lot of guesswork is involved. A guess that doesn't pan out isn't a mistake and doesn't automatically deserve a payout of anywhere from $10's of thousands of dollars to millions. Shit happens. Even when some neglect is involved, paying large damage awards just adds to the cost of healthcare for everyone.

Should an act of sheer negligence go unpunished? Of course not, but perhaps there should be a cap on the amount of damages. Perhaps such suits should automatically go to expert panels to ascertain blame and issue awards based on a cold examination of the facts rather than the heartstrings of a jury. The payouts could be based on standardized guideline to introduce some degree of consistency to the awards system.

If a doctor's treatment strategy fails simply due to unforseeable conditions or other bad luck, why should the burden be born by the doctor and his insurance provider and, through them, the rest of us?

Another way to lower costs is to pay doctors for results achieved rather than services rendered. Some doctors "churn the account" with needless tests and treatments, with setting up future office visits for no good reason other than to be able to charge the client for the visit. Instead, how about paying the doctor for improving a client's blood glucose numbers, for lowering their blood pressure, for eliminating their cancer?

U r right on cap on litigation but u have to understand that docs order those tests to ward off litigation


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