Yesterday I spent some time with a dear old friend who, coincidentally, happens to be one of the country’s foremost health care attorneys. We had brunch at a fabulous place called the Bryn Mawr Breakfast Club, a walkable distance from here if you’re into that sort of thing. I recommend it enthusiastically. It’s a joint, something I like, and I think I’d call its cuisine “fusion”.
After exchanging pleasantries about wives (one each), kids (his), and dogs (multiples), he asked me if I’d read the House’s health care bill. I responded that I was waiting for the ink to dry and to see what the Senate would do. For him that’s his job and I suspect he’s digging into it today.
We then started to talk policy. I think that he and I are largely in agreement although I think I’m more cynical about the prospects for reform than he. I think we’re in agreement that there are more questions than “who pays”, the primary topic under discussion over the last eight years. My view is that as long as prices rise at a multiple of increase in GDP, other prices, incomes, etc. in the final analysis it doesn’t matter who pays: it will be unaffordable and the system will need to change.
Isn’t there a relationship though between the questions of “Who pays?” and “How can we constrain prices?” (at least theoretically?) I get that market forces are only barely present, but it still seems to me that the problem of government sponsored healthcare is the deep pockets of government cause price distortion.
My recollection of the debate about the ACA back in 2009-2010 was that it was claimed or at least assumed that if everyone got coverage costs would go down. We now know that to be demonstrably untrue.
What I think we can say now with some confidence is that on the hierarchy of values controlling costs is so low that costs will never be controlled as long as somebody else can be expected to pay.
The problem is that we cannot assume that somebody else will pay indefinitely. And that can happen quite suddenly.
Right. As long as we keep concentrating on “who pays,” we divide the country and solve nothing. Lowering the healthcare costs would make everyone happy, except for docs, hospitals and Pharma.
A free market would lead to price reduction, innovation, improvement in services, just as it has in retail over the last decade. Why is it that I read little discussion in this and other blogs about those free-market options that would lead to such improvement– things like demanding all healthcare prices be published on the web, that health insurance dollars be spendable in Mexico, Costa Rica and Brazil, where prices are much lower, that HSAs be encouraged in lieu of insurance, that third-party payments for all health care along with tax subsidies for such be totally discouraged?
Here’s the best healthcare plan ever of the type I alluded to as generally missing on the web altogether:
https://market-ticker.org/akcs-www?post=231949
I read little discussion in this and other blogs about those free-market options that would lead to such improvement– things like demanding all healthcare prices be published on the web, that health insurance dollars be spendable in Mexico, Costa Rica and Brazil, where prices are much lower, that HSAs be encouraged in lieu of insurance, that third-party payments for all health care along with tax subsidies for such be totally discouraged?
Those aren’t free market ideas. And as conservatives love to talk about medical tourism fron Canada to the U.S. as proof single payer systems must be bad, I find the suggestion we should be sending more Americans abroad for health care to be rather contradictory.
” I find the suggestion we should be sending more Americans abroad for health care to be rather contradictory.”
First off, nobody is sending anybody abroad. A person should have the right, however, to go abroad for health care just as he does for good food or good partying.
While going abroad to Canada for good food, partying and health care would be foolish, Mexico is an entirely different story. While the food and partying are great, the health care is better and you can get medical and dental care cheap and drugs for almost nothing without a prescription.
First off, nobody is sending anybody abroad.
No one sends Canadians abroad.
A person should have the right however, to go abroad for health care just as he does for good food or good partying.
Conservatives routinely argue that legislating in a new right is anti-free market. But here you are demanding big government step in and control the insurance industry.
While going abroad to Canada for good food, partying and health care would be foolish, Mexico is an entirely different story. While the food and partying are great, the health care is better and you can get medical and dental care cheap and drugs for almost nothing without a prescription.
Well, somehow I managed to completely screw up the editing on that last comment.
Canadians have been sent to the US for health care by their own government. It’s not a common practice but the backlogs can get very bad occasionally.
Canada’s system is good in many ways, but let’s not sugarcoat that it has many shortcomings too.
“was that it was claimed or at least assumed that if everyone got coverage costs would go down.”
Nope. It was assumed, as I have said here many times, that getting everyone covered was the first step towards controlling costs. The primary purpose of the ACA was to increase access while maintaining or improving quality.
“Canadians have been sent to the US for health care by their own government. ”
To the best of my knowledge, which is fairly good on this topic, Canadians do not get sent to the US because of backlogs. They have been sent to the US for special care that only a very few people need. Canada has decided that in some cases it is cheaper to send patients to the US rather than start their own program.
“demanding all healthcare prices be published on the web, that health insurance dollars be spendable in Mexico, Costa Rica and Brazil, where prices are much lower, that HSAs be encouraged in lieu of insurance”
1) Demanding the prices be put on the web is big government interference, not free market.
2) Nothing stops insurance companies from sending patients to Mexico, etc, except that patients don’t want to go. No one will buy that insurance. We can’t get people to cross town to save 40%. Also, just having spent hours in the OR a few nights ago trying to put back together a screwed up surgery done out of country, I can guarantee you that follow up is a problem.
3) There is no evidence that HSAs will lower costs. Go read Mark Pauly.
Steve
Oh, fiddle-dee-dee, steve. When you take the first step towards Cleveland, you get closer to Cleveland not farther away.
I think steve grossly understates the amount of rhetoric that claimed cost reductions were a primary goal and feature. Obama himself claimed that the average family would see a substantial reduction in premiums, and often boasted about projections of savings. He did usually insert some typical political weasel words like “bending the cost curve” (which I take to be steve’s point, that they knew the savings wouldn’t be immediate but would come later.)
Steve doesn’t seem to be dishonest so I’ll assume he genuinely only heard the rhetoric that he felt was accurate and disregarded the rest.
It was always obvious that insuring more people was not going to cut costs, for many reasons but not least because the supply of medical services remains fixed.
@Dave Schuler
Oh, fiddle-dee-dee, steve. When you take the first step towards Cleveland, you get closer to Cleveland not farther away.
First, not if you take the long way around.
Second, who are you to force your concept of towards on anybody? Who died and made you the boss? Some people may identify as somebody whose concept of towards does not mean that you get closer to Cleveland.
Help, help I am being triggered by a micro-aggression.
While it is possible for the path to lower costs to lead through higher costs, induction tells us that it’s unlikely.
Going to have to change my management style. We are investing about a million dollars in a new pre-op assessment and management clinic for which we will zero reimbursement. However, based upon data from UofM and a couple of other good places, we expect to save at least 5 million. (You also might want to tell those people who made the big up front investment in automation that they really lost money in the long run.) IOW, I think that there is actually a pretty strong history of people spending a lot of money up front so that they could save money in the long run.
Steve
That will only reduce costs if producers don’t capture all of the economic surplus.