Health insurance bill passes the house

[DGuller]

But you don't need socialized health care to provide that, and in fact, the US already fulfills that "basic requirement" of a working society.

I think you and I have different ideas of what access entails. Having to go into bankruptcy to try to save someone close from cancer (to follow DGuller's example) doesn't sound to me like access at all. That that is an actual possibility at all is simply incomprehensible to me.

Oh, bankrutpcy may even apply in a car accident.  The example with cancer has to do with not getting the treatment at all.  Hospitals can't reject people who need emergency treatment, but they're not going to administer chemotherapy in the ER.

EDIT:  Actually, car accident specifically is a bad example, because usually car insurance would cover something.  So, to be perfectly exact, substitute some other catastrophe in place of car accident.

[Iormlund]

Now that you mention it, I don't think national health plan covers traffic accidents. AFAIK those fall under either work (when in itinere) or mandatory car insurance.

[DGuller]

Now that you mention it, I don't think national health plan covers traffic accidents. AFAIK those fall under either work (when in itinere) or mandatory car insurance.

Made an edit to that effect split second before you posted it.

[Jacob]

Based on the research that I've been doing here in Europe, I'd venture that Americans tend to care a lot less about the state and its money that Europeans.  Patients talk here about not wanting to be on very expensive medications as they understand that it costs the government a lot of money.  I think, us Americans, are more likely to be give what you got, I want the best and I don't care how much it costs the state.

I don't think Europeans are that self-less.  However they've been talked out of overconsuming medical care (if indeed they have) it's not because of some sort of care for the state's resources.  If I were to guess, and it's a pure guess, I'd imagine any lowering in consumption has to do with targetted education effort including by the doctors (no, no anti-biotics for this shit etc) and more direct controls (no, you can't have 27 appointments this months, fuck off).

[Strix]

Now that you mention it, I don't think national health plan covers traffic accidents. AFAIK those fall under either work (when in itinere) or mandatory car insurance.

It actually becomes a major pain. My wife got into a car accident recently. Our health insurance provider and the car insurance company are fighting over who needs to cover the medical bills. The crux of the matter is that she either fell a sleep or blacked out while driving on her way to work. The car insurance is arguing that if she didn't fall a sleep than it's a pre-existing condition, so they won't pay for any doctors visits to help determine if it was a pre-existing condition.

[Caliga]

(no, no anti-biotics for this shit etc) and more direct controls (no, you can't have 27 appointments this months, fuck off).

It would be great if Americans could be convinced of the fact that you don't in fact need antibiotics for everything.  The same woman I earlier mentioned who was at the doctor nonstop for herself and her kids also used to demand she and her kids be prescribed things like Erythromycin whenever they had the flu.

I think doctors hit a point where they just get tired of arguing and prescribe away.

[Iormlund]

It's comforting to see that, despite all our differences, insurance companies - like chatty old people - are the same everywhere.

[Strix]

I think doctors hit a point where they just get tired of arguing and prescribe away.

I think doctors get a lot of cash to prescribe away from the big drug makers.

[Berkut]

But you don't need socialized health care to provide that, and in fact, the US already fulfills that "basic requirement" of a working society.

It doesn't always.  It does when you get into a car accident, it doesn't when you get cancer.

Of course it does. If you get cancer, you go to the hospital and get health care. The level of care you will get will vary based on what state you are in (for example, in New York you will get as good of care being dirt poor as I can get being solidly middle class), but you cannot claim that everyone in the US (barring some extreme exceptions) does not get a basic level of health care. That is simply not true.

But no matter what system you use, *some* people will certianly get more care than others - so what do you define as the "basic minimum" that the state should provide? Even in a completely socialized system the super rich get better care - so you cannot claim that the system must provide perfectly even care - that is simply not possible.

And there lies the basic problem of all of this. Nobody is willing to actually talk about costs in a sane manner. It is all about what we "must" do, with the implication that it doesn't matter what the cost is, because everyone has some inalienable right to as much health care as they want.

[Berkut]

But you don't need socialized health care to provide that, and in fact, the US already fulfills that "basic requirement" of a working society.

I think you and I have different ideas of what access entails. Having to go into bankruptcy to try to save someone close from cancer (to follow DGuller's example) doesn't sound to me like access at all. That that is an actual possibility at all is simply incomprehensible to me.

So how often does that happen, where does it happen that someone will be refused treatment outright?

And what level of care should everyone get - should everyone get the very latest, most expensive treatments for cancer, no matter their ability to pay for it?

Like I said, this isn't about "basic healthcare", it is about what amounts of healthcare everyone should get, well beyond "basic healthcare". This becomes obvious in discussions like this when it immediately becomes clear that the actual definition of "basic healthcare" is "any and all treatments available to anyone".

[Berkut]

The problem you describe most certainly is there, but I think you're focusing on the wrong part.  It's severity, not frequency, that takes a hit.  It's not that people choose to go to the doctors willy-nilly, but rather that they go along with very expensive treatmennt that no cost-benefit analysis would come close to justifying, when a treatment 50 times cheaper would work almost as well.

I don't think that fairly characterizes my point - it is not at all exclusive to frequency, it includes exactly what you are talking about. They are not at all exclusive.

And it manifests itself in other ways, even beyond people consuming too much health care. It manifests itself in costs as well - why does an MRI, a technology that has been around for decades, still cost $1500? Because there is no incentive for it to cost less, since nobody can get a competitive advantage by ruthlessly driving down the cost, since the basic cost/benefit market mechanism is non-existant.

Nobody care what their MRI costs, and nobody shops around for a cheaper MRI, since they are not paying for it anyway.

How do you solve this problem with socialized medicine? The obvious answer is that the state must demand it to be cheaper, but how is the state competent to decide what *ought to be* cheaper, and what is actually reasonably worth its high price?

I don't know what the answer is - what I do think though is that we are looking at the health care debate from the wrong side. We talk about how much the public option would cost, but it is all bullshit, since we have no real idea what the fair market value of health care actually is, since the market is so grossly distorted right now.

I suspect that we could all afford a lot more health care if the market actually priced the costs in some kind of sane manner. Right now the costs of routine coverage is grossly out of whack though,  because the market has so many influences that create fucked up pricing mechanisms, and the net effect is that we keep paying more and more and more and more for the same amount of service, with the increases going to a growing health care market that isn't growing in services or quality, but simply growing in bureaucracy.

[Iormlund]

There are a number of fields where a market approach simply doesn't make sense. Energy, education, food, security, safety, infrastructure ... health care is just one of them.

Where the market works wonders is in anything you don't actually need.

[DGuller]

The problem you describe most certainly is there, but I think you're focusing on the wrong part.  It's severity, not frequency, that takes a hit.  It's not that people choose to go to the doctors willy-nilly, but rather that they go along with very expensive treatmennt that no cost-benefit analysis would come close to justifying, when a treatment 50 times cheaper would work almost as well.

I don't think that fairly characterizes my point - it is not at all exclusive to frequency, it includes exactly what you are talking about. They are not at all exclusive.

And it manifests itself in other ways, even beyond people consuming too much health care. It manifests itself in costs as well - why does an MRI, a technology that has been around for decades, still cost $1500? Because there is no incentive for it to cost less, since nobody can get a competitive advantage by ruthlessly driving down the cost, since the basic cost/benefit market mechanism is non-existant.

Nobody care what their MRI costs, and nobody shops around for a cheaper MRI, since they are not paying for it anyway.

How do you solve this problem with socialized medicine? The obvious answer is that the state must demand it to be cheaper, but how is the state competent to decide what *ought to be* cheaper, and what is actually reasonably worth its high price?

I don't know what the answer is - what I do think though is that we are looking at the health care debate from the wrong side. We talk about how much the public option would cost, but it is all bullshit, since we have no real idea what the fair market value of health care actually is, since the market is so grossly distorted right now.

I suspect that we could all afford a lot more health care if the market actually priced the costs in some kind of sane manner. Right now the costs of routine coverage is grossly out of whack though,  because the market has so many influences that create fucked up pricing mechanisms, and the net effect is that we keep paying more and more and more and more for the same amount of service, with the increases going to a growing health care market that isn't growing in services or quality, but simply growing in bureaucracy.

You do make a good point about costs.  Like no-underwriting/no-mandate combination, we've got another highly perverse system with socialized demand and free-market supply.

You can't control it with a free market without getting rid of insurance, and that's just an intolerably bad thing in itself. 

What you can have is some kind of health score for each patient, as well as a real primary care physician who's in charge of all referals for his patients.  Then you reward primary care physicians for improvements in the health score of his patients, while deducting for use of resources. 

Ideally that would ensure that everything primary care physician does or gives referral to is cost-effective.  It would also ensure that the person with the real economic incentives is also the person with the actual skills and knowledge to make good trade-off decisions (the patient is certainly in no way qualified to decide whether the $1500 MRI is worth it).

[Ed Anger]

(no, no anti-biotics for this shit etc) and more direct controls (no, you can't have 27 appointments this months, fuck off).

It would be great if Americans could be convinced of the fact that you don't in fact need antibiotics for everything.  The same woman I earlier mentioned who was at the doctor nonstop for herself and her kids also used to demand she and her kids be prescribed things like Erythromycin whenever they had the flu.

I think doctors hit a point where they just get tired of arguing and prescribe away.

Look, if I'm going to drag myself to the doctor, I'm getting some drugs.

[Fate]

What you can have is some kind of health score for each patient, as well as a real primary care physician who's in charge of all referals for his patients.  Then you reward primary care physicians for improvements in the health score of his patients, while deducting for use of resources. 

Why would physicians put up with historically "low H score yielders"? (whoever they may be, but likely the poor and minorities)