patrick.net

4) Ambulance chasers. America it the most litigious society on the planet. It forces doctors to order unnecessary "defensive" tests and procedures. Healthcare services are cheaper in states with tort reform such as damage caps in cases where gross negligence can not be proved.
5) Price fixing. Medicare and Medicaid set prices for services. This creates shortages or forces doctors into gaming the system by ordering unnecessary tests and procedures to make more money. If government is involved in healthcare services at all, it should only subsidize costs for the poor in an open and free market.
6) Insurance restrictions. Many states put restrictions on what products healthcare insurance companies can offer. This limits the choices of consumers and increases prices. For example, some states mandate that abortion or contraceptives be provided in all insurance plans. What if somebody would never have an abortion or it is cheaper to pay less for insurance and buy your own contraceptives? Government regulation is costly and sometimes immoral.

chanakya4773 says

Analysis : My whole analysis will be to focus on why its not a "FREE MARKET"

Divergence from free market happens primarily because GOVT comes in between consumer and services/goods provider. Generally, once the GOVT gets involved, a third party will use its lobbying power to influence the industry ( through GOVT) to its advantage as well.

The US government has made US healthcare a huge mess. But you failed to point out which countries free market health care model you would like to see implemented. There are 36 countries with government health care which on average costs half or less of what the US spends. So obviously government in and of itself isn't the problem.

Do you have some examples of your idyllic free market system working in real life somewhere or should 330 million people in the US take it on faith that it will work?

"Given that health care is not a new industry and such a broad industry, the only reason for this divergence can be that its not a "FREE MARKET". In any free market, a broad established industry's "long term" inflation is always inline with rest of the economy. "

I'll stop you right there. Health care doesn't WORK as a free market. You're barking up the wrong tree. The US tries to have a free market, but we have one of the least efficient systems in the world, and it has nothing to do with government interference. Health insurance companies were making obscene profits, and their CEOs were commanding multi million dollar salaries, at the same time rates were skyrocketing. How you can blame that on government is incomprehensible. Every country that has government run healthcare pays LESS than we do. To say otherwise is to be completely disconnected from reality.

chanakya4773 says

I think you got it all wrong. Who is saying that there was ever a free market health care system in US ?
insurance system is not a FREE MARKET.

Fine, so where are the working free markets?

JohnLaw says

Many states put restrictions on what products healthcare insurance companies can offer. This limits the choices of consumers and increases prices. For example, some states mandate that abortion or contraceptives be provided in all insurance plans. What if somebody would never have an abortion or it is cheaper to pay less for insurance and buy your own contraceptives? Government regulation is costly and sometimes immoral.

you're completely and totally wrong with all of that.

More coverage choice just makes it easier for insurance companies to offer higher-profit options, the high-deductible, low-care bullshit that is being banned by PPACA now.

As for abortion and contraception, providing those health services to people who want them is more cost-effective than paying for maternity and well-baby care.

Unless you have no women in your life you will indirectly benefit from this cost savings.

And if you have no women in your life, you are a sad person who needs to get off the internet and get a life before it's too late.

bob2356 says

There are 36 countries with government health care which on average costs half or less of what the US spends. So obviously government in and of itself isn't the problem.

I have experienced being with family and co-workers in the UK and Germany who were sick while traveling. Compared to the USA, the level of service is poor. Price fixing limits choices and produces shortages of service providers. So it may cost more in the USA, but nobody has to wait for services and you are much more likely to get well qualified, professional service providers. Costs in the USA would come down if you took the government out of the equation. Every sector that the government gets involved in experiences extreme price inflation (eg healthcare, education, housing). More government is the problem, not a solution. However, no need to worry about that now, the choice has been made. The public decided to destroy healthcare in America when it supported Obamacare.

chanakya4773 says

I still think that we can reduce costs by removing protectionism of health care industry ( #2 in my post).

I doubt that the licensing rules will change because the AMA has made their payoff to the racket.

http://www.opensecrets.org/orgs/summary.php?id=D000000068

chanakya4773 says

I think you got it all wrong. Who is saying that there was ever a free market health care system in US ?
insurance system is not a FREE MARKET.

A free market cannot exist with a licensing system and creating barriers for foreign doctors/nurses to practice in US

I think you aren't listening to what I'm saying. I said we TRIED to have a free market system, but healthcare does not lend itself to a free market solution.

chanakya4773 says

I still think that we can reduce costs by removing protectionism of health care industry ( #2 in my post). I know the ideal solution is to get GOVT out of the industry but something is better than nothing.

Insanity. I want to see a doctor who has actual training, not some random dude who CALLS himself a doctor. I am not going to some non-licensed bozo and get butchered. If you want to do that, move to a 3rd world country.

We've got all these right-wingers screaming how much they hate Obamacare, but NONE of them ever offers a realistic alternative. Unlicensed doctors with no training - give me a fucking break.

Homeboy says

but healthcare does not lend itself to a free market solution

This makes no sense. Why do you claim this?

Homeboy says

Insanity. I want to see a doctor who has actual training, not some random dude who CALLS himself a doctor. I am not going to some non-licensed bozo and get butchered. If you want to do that, move to a 3rd world country.

In a free market you would have to take responsibility to vet the credentials of the doctors you choose. Typically there would be services created to make this easy. Furthermore, there are many services that doctors do that an RN or other medical professional could just as easily do like diagnosing the common cold, testing for strep throat, etc... If the symptoms you are experiencing are more severe then you decide what level of service is required. If you are more comfortable always seeing an MD then its your choice.

JohnLaw says

Homeboy says

but healthcare does not lend itself to a free market solution

This makes no sense. Why do you claim this?

Healthcare is like national defense. It is hard to have a true market-based solution UNLESS we accept having people dying on the street.

(I have a market-based military "solution" too, but even I do not consider it sensible.)

But I love the certification as opposed to licensing idea.

chanakya4773 says

Peter P says

Healthcare is like national defense. It is hard to have a true market-based solution UNLESS we accept having people dying on the street.

you are wrong. there will be charity based hospitals which will pop and atleast not allow people die. ofcource they won't get the royal treament that they get in private emergency rooms today. mandating private hospitals is not the solution.

I rather have a single-payer universal healthcare system with a parallel private system.

Health insurance does not make sense because of the moral hazard of self-selection. Yet we do not want to bankrupt people randomly because of illnesses and accidents.

As most people here know, Market is like God to me, and I advocate the privatization of all roads and sidewalks (seriously).

Yet healthcare is something as problematic as national defense for the market to handle.

Chana - common sense, and root cause analytics. Have you reviewed the French or German health care system?

chanakya4773 says

We can always have insurance for catastrophic medical events. insurance for doctors visit ..etc does not make sense. Insurance should be only used for events which backrupt people and nothing else because insurance is a very in-efficient system. even in single payer universal health care system, it should be the case.

Ideally, yes. Let's see how much costs can be lowered. People should not have to spend $20K on scans and tests.

BTW, one more important thing: TORT REFORM.

Peter P says

Yet healthcare is something as problematic as national defense for the market to handle.

I completely disagree. Before the 30s there wasn't even such a thing as healthcare insurance. As a matter of fact, healthcare in the USA was totally private until 1965. Nobody was dying in the streets and there were numerous private, charitable organizations that took care of the poor.

chanakya4773 says

WHEN DID WE TRY FREE MARKET SYSTEM ???
WE NEVER HAD ONE AND NEVER TRIED ONE

What the hell are you talking about? Are these government entities? No.

Unitedhealth Group
Wellpoint Inc. Group
Kaiser Foundation Group
Aetna Group
Humana Group
HCSC Group
Coventry Corp. Group
Highmark Group
Independence Blue Cross Group
Blue Shield of CA Group
Cigna Health Group
BCBS of MI Group
Health Net of California, Inc.
BCBS of NJ Group
BCBS of FL Group
Regence Group
BCBS of MA Group
Carefirst Inc. Group
Wellcare Group
HIP Ins. Group
Metropolitan Group
Unumprovident Corp. Group
Universal Amer Fin Corp. Group
Lifetime Healthcare Group
BCBS of NC Group

Your "idea" of removing all licensing requirements is utter insanity. How would there be any protection at all against "doctors" who are incompetent, scam-artists, etc? There have even been cases of doctors raping their patients, literally. I certainly would not want someone like that to still be able to practice medicine. For god's sake, you need a license to DRIVE A CAR, but you don't think people should have a license to render you unconscious and cut into your body with knives?

Ridiculous. Yes, we have for-profit medical insurance and hospitals. They get greedy and start overcharging so they can make obscene profits. It doesn't work. Not everything can be fixed by the free market. The military, roads, environmental protection, police, firefighting, etc. are not effectively handled by the free market. Nor is healthcare.

JohnLaw says

I completely disagree. Before the 30s there wasn't even such a thing as healthcare insurance. As a matter of fact, healthcare in the USA was totally private until 1965. Nobody was dying in the streets and there were numerous private, charitable organizations that took care of the poor.

Boy the way Glen Miller played
Songs that made the hit parade.
Guys like us we had it made,
Those were the days.

And you knew who you were then,
Girls were girls and men were men,
Mister we could use a man
Like Herbert Hoover again.

Didn't need no welfare state,
Everybody pulled his weight.
Gee our old LaSalle ran great.
Those were the days.

chanakya4773 says

you are wrong. there will be charity based hospitals which will pop and atleast not allow people to die

Sure, just like magic.

chanakya4773 says

why do you have problem with certified doctors versus licensed doctors ?
you are free to go to CERTIFIED doctors who are trained according to your standards but allow other people to go to doctors who are trained differently

What the fuck are you babbling about now? You wrote that you don't think doctors should have to have a license, and I said they should. Don't confuse the issue with gibberish.

Do you honestly believe a hospital with good reputation will hire a doctor who is butchering people. Its a self correcting system. Hospital will only hire doctors who are best suited for the jobs without ruining hospitals reputation. Some third party ( like AMA) does not dictate the choice.

No, it's not a "self-correcting" system. What evidence do you have that it is?

Like I said, you are free to move to a 3rd world country if you are so intent on having incompetent doctors.

chanakya4773 says

India is one example where there is very little govt intervention and there is literally no insurance system

That's odd, I googled health insurance in India and got like 8-10 pages of companies selling health insurance in India. Could you please explain this minor discrepancy? Also I know for a fact that India has a public health care system, I've been there and talked to people involved in it. Is this also part of the free market?

India has 1 doctor for every 2000 people vs 1 per 300 in the us. The average Indian travels 77km to see a doctor. I'm not sure you could really hold this up as an example of health care US should be emulating. Care to try again?

chanakya4773 says

I am sure US was probably more free market driven in early 1900's when there was no insurance system.

Average life span was 36, would you like to go back?

Health insurance actually dates back to the civil war and became common in the 1930's. Is google not working on your computer? http://www.randomhistory.com/2009/03/31_health-insurance.html

chanakya4773 says

Homeboy says

chanakya4773 says

you are wrong. there will be charity based hospitals which will pop and atleast not allow people to die

Sure, just like magic.

Don't you read the posts before jumping in to conclusions.
Did you read the post by Johnlaw :

I completely disagree. Before the 30s there wasn't even such a thing as healthcare insurance. As a matter of fact, healthcare in the USA was totally private until 1965. Nobody was dying in the streets and there were numerous private, charitable organizations that took care of the poor.

even Ron paul said the same thing during republican primaries.

Yes, I read things and I ALSO determine if they are relevant to what I wrote. Do you? I still don't see any proof from you that the poor will magically be taken care of if the government doesn't.

Just because something was the case in the past does not mean it should be so now. Have you forgotten that we also had slavery and child labor. Did the "free market" fix that?

bob2356 says

Average life span was 36, would you like to go back?

Health insurance actually dates back to the civil war and became common in the 1930's. Is google not working on your computer? http://www.randomhistory.com/2009/03/31_health-insurance.html

Tee hee. You just got pwned, chanakya.

chanakya4773 says

We can always have insurance for catastrophic medical events. insurance for doctors visit ..etc does not make sense. Insurance should be only used for events which backrupt people and nothing else because insurance is a very in-efficient system. even in single payer universal health care system, it should be the case.

The first logical statement you've made. Health insurance should be catastrophic.

Single payer and universal/public heath care are very different things. Public health care is not insurance in any way shape or form.

chanakya4773 says

Also, like JOHNLAW mentioned US was also mostly insurance free before 1965 so you don't have to go too far to look.

bob2356 says

Health insurance actually dates back to the civil war and became common in the 1930's. Is google not working on your computer? http://www.randomhistory.com/2009/03/31_health-insurance.html

You're not paying attention.

chanakya4773 says

India is one example where there is very little govt intervention and there is literally no insurance system.

chanakya4773 says

There are lot of private health care insurance companies in india but 90% people don't use them

These don't seem to be complimentary statements.

chanakya4773 says

When govt started subsidizing insurance is when the problem started.

What do you mean, "when government started subsidizing insurance?" When did the government start subsidizing insurance?

chanakya4773 says

What the fuck are you talking about. can you explain why it worked in the past and it won't work now ?

It DIDN'T work. Are Bob's posts not showing up on your computer?

Homeboy says

chanakya4773 says

When govt started subsidizing insurance is when the problem started.

What do you mean, "when government started subsidizing insurance?" When did the government start subsidizing insurance?

He's talking about when it became tax deductable to businesses in 1954 or so. Since he isn't a brilliant student of history he isn't aware that health care insurance exploded during WWII because of wage freezes. Health care insurance was offered instead of raises. But why let facts get in the way?

Here's your golden age of medicine before they started bothering with silly things like licensing:

Once it was easy to become a doctor. During the nineteenth century the United States saw the emergence of an estimated four hundred proprietary medical schools. Set up to offer medical degrees as part of profit-making ventures, these schools generally had low standards of instruction, poor facilities, and admitted anyone who could pay the tuition. Since the proprietary schools competed with so many other for-profit schools as well as schools affiliated with universities, they advertised incentives to get students for their programs. One school gave free trips to Europe upon graduation to any students who regularly paid fees in cash for three years. Anyone who had the money could get a medical degree and practice medicine. In many of the private proprietary schools, degrees were granted after one year of courses that consisted chiefly of listening to lectures.

http://www.encyclopedia.com/doc/1G2-3468300573.html

1900s:

Most medical schools operated primarily for the benefit of their physician-owners and lacked libraries, laboratories, or even much clinical experience for students. Hospitals were few in number, located only in the largest urban areas, and served primarily the poor. Most surgeries were still done in the home. The nation was flooded with ineffective and sometimes dangerous patent medicines sold directly to the public by charlatans. Diseases such as yellow fever, typhoid fever, tuberculosis, pellagra, and hookworm ravaged entire communities. Government support of health care initiatives was weak at best.

http://www.encyclopedia.com/doc/1G2-3468300224.html

1910s:

Unhealthy Americans

The growing emphasis on medical examinations in the 1910s revealed that most Americans had some kind of health problem. Of 3.76 million men examined for service in World War I, about 550,000 were rejected as unfit; and of the 2.7 million called into service, about 47 percent had physical impairments. In one study examining 10,000 workmen, not one was reported in perfect health. Ten percent were slightly impaired, and the other 90 percent were in varying stages of poor health: 41 percent had problems requiring minor treatment; 35 percent had conditions requiring medical supervision; 9 percent had serious physical impairments requiring systematic treatment; and 5 percent had grave problems requiring immediate medical attention. Among 5,000 citizens of Framingham, Massachusetts, examined as part of a Metropolitan Life Insurance demonstration project to control tuberculosis, 77 percent were recorded as ill with some disease; two-thirds of the defects discovered were supposedly preventable. But Americans did not see themselves as unhealthy. The physicians' examinations found twelve times as much illness as did a house-to-house survey of self-reported sickness.

http://www.encyclopedia.com/doc/1G2-3468300562.html

You want to go back to that, huh?

bob2356 says

He's talking about when it became tax deductable to businesses in 1954 or so. Since he isn't a brilliant student of history he isn't aware that health care insurance exploded during WWII because of wage freezes. Health care insurance was offered instead of raises. But why let facts get in the way?

So he's saying that all healthcare problems started in the 1950s? Because this is how it was in the 1930s:

In the 1930s the biggest health concern of America was how to pay for medical needs. The national income was less than half of what it had been in 1929, and in several states as many as 40 percent of the people were on relief. Many Americans could not pay their medical bills, and visits to physicians and hospitals decreased. Before the Depression, physicians charged a fee-for-service on a sliding scale and collected their bills as best they could. They also saw some patients on a charity basis and passed the expenses along to those who could pay. Loss of medical services and reduced ability to pay meant lower incomes for physicians, too. While doctors as a group fared better than many other professions during the Depression, in many cases they also saw their incomes halved. Hospitals were in similar trouble. Beds went empty as patients could no longer afford a two-week hospitalization, which was the average in 1933. Bills were unpaid, and charitable contributions to hospital fund-raising efforts fell.

http://www.encyclopedia.com/doc/1G2-3468301278.html

Doesn't exactly sound like a utopia to me.

chanakya4773 says

What does all this have to do with licensing versus certification.
There was lot of disease before and its common knowledge...nothing rocket science. Technology and science has advanced quite a lot and improved things including health care. The aircrafts today are much safer than the once in early part of 1900s. It didn't happen because aircraft engineers were licensed versus cerified. it happened because of the progress in the field just like any other field. every field including medicine has advanced. there is no licensing in engineering but it still advanced. Do you think all the software engineers are licensed. why the heck then software field is advancing so fast ?

Did you not read the excerpt about how poor physician training was in this period of history that you seem to think was some sort of utopia that we should strive to return to? What's difficult for you to understand about that?

Software engineering is a very poor analogy to medical practice. Among many other things, if you botch a computer program, people simply won't buy it. If you botch surgery, you kill the patient. Free markets work great for some things, but not at all for others.

chanakya4773 says

how could have insurance system solved this problem ? this was a depression problem not a health industry problem.

You are turning things around. I did not claim that health insurance could solve this problem. YOU are the one claiming that a cash-for-service system would solve all problems. YOU stated that you believe the U.S. should return to whatever we were doing pre-1950s, because of your belief that it worked so well. But I have proven that it did NOT work well, hence your argument is not valid.

It is YOUR claim that government intervention is the source of all problems with the healthcare system in the US. I am simply disagreeing with your premise.

chanakya4773 says

India is one example where there is very little govt intervention and there is literally no insurance system

chanakya4773 says

The public health care system is for the poor and needy and is directly run by govt. its a very small percentage of the total hospitals that india has

Your statements. Very little government intervention. Yet 1.2 billion people are covered by the public health care system and depending on whose number you believe 35-40% use it for their health care. So 480 million people using the public health care system represents very little government intervention??? Really???

chanakya4773 says

THERE ARE NO MANDATES ON PRIVATE HOSPITALS AND DOCTORS in india. The private industry is fully free market based.

Maybe you should read a little. Try transition.usaid.gov/in/our_work/pdfs/promise_reality.pdf for a starter. I read the whole paper about 5 years ago (it was a very, very long flight). Lots of interesting tidbits about government regulations on hospitals in India. Try page 40 hospital reimbursement by source. Let's see, 41% government, 35% insurance, 17% employer, 7% other/cash. If you care to read a little further you will find the 17% employer is from government mandated health insurance coverage in certain industries and self insurance by corporations with tax and other government incentives (page 84). So 41% of reimbursements to the hospitals by the government is "a very small percentage"???

Maybe it would be best if you discarded and drew new cards. What other country would you like to point to as a free market medical system?

bob2356 says

Your statements. Very little government intervention. Yet 1.2 billion people are covered by the public health care system and depending on whose number you believe 35-40% use it for their health care. So 480 million people using the public health care system represents very little government intervention??? Really???

Well there is a difference between a roach infested motel in a crime ridden neighbourhood and Ritz Carlton in a nice neighbourhood. The former may be free-but do you want to stay there with your family.

In the US, the latter can be used by people with insurance and poor/illegals who just walk into the emergency room and get treated for free. The middle class-they can come after your assets. But the poor/illegals are judgment proof-they have no assets. So there is a difference with the mandates.

Now I understand the rationale, if you are in a car accident, or have a heart attack, the last thing you need is to be tossed aside by the emergency room, because you have no proof of insurance-you might have left proof at home. So that is a big problem. But hospitals do run up a big tab and the rest of us pay for it.

However I read somewhere that India is giving free generic prescritpon drugs to all of its 1.2 billion citizens, don't know if the law passed yet.

Bottom line is that the 51% found that they can use the government as a means of extortion. For now, they think that all of their needs can be achieved by this and life will be better as a government serf. We shall see.