patrick.net

chanakya4773 says

and you still believe GOVT is not a problem and you are a free citizen.
this is the worst form of tyranny.

Where did anyone say that the US government wasn't one of the problems with US health care, one of many? No one said anything even close to that. Try to read more carefully. Everyone is saying that your free market idea doesn't work either. If it does then please show us where it exists. India sure isn't it.

Why is the government forcing you to do any of these things? You are free to not have health insurance, just pay the penalty, No health insurance then the subsidy doesn't matter to you. No health insurance no payment for er's for you. No health insurance no payment for litigation for you. You are free to travel to any free market hospital in the world for your care. You don't even need a doc, just use the internet. You have all the access you want to foreign doctors, just cross the border.

Why are you and john law always a matched set of comments together? Curious coincidence.

chanakya4773 says

My idea of having a free market health care system and govt run hospitals for the poor and needy will work.

WTF???? After ranting against government involvement in health care for 20 or 30 posts now you want government run hospitals? Did you log onto the wrong profile by accident?

So where does this utopian free market health care exist? Got an example? I'd love to see it. Since 93% of the hospital income in India comes from government or insurance I really don't think you can say it's a free market.

chanakya4773 says

Do you think a person living in utah will cross the border to get a doctors visit. please me more practical.

You have the option, if it's practical is a different issue. Tyranny is when the government closes the boarders so you can't leave and confiscates your paycheck to give to cigna.

chanakya4773 says

Having a charity or govt run hospital for the poor and needy atleast allows us to control the money we will be shelling out to the free loaders.
These hospitals will be with bare minimum facilities to at least not let people die on streets.

Today , the free loaders have free pass to the private sector hospital emergency rooms and they are creating havoc in the system. the better option is to remove the mandate from private sector to service them in emergency rooms and create a govt run hospital for emergency services.
these will be similar to the services we provide for homeless people.

ofcourse the hospitals will be shitty but that's what you get for free.

The total cost that we will be bearing will be far low because we won't be giving them top of the line emergency services for free at our expense which is what is happening now. instead we will be giving them bare minimum services and we will control how much to spend on it as well.

You are such a compassionate soul. How did you ever become so considerate of your fellow human beings? You talk so much about India that I guess it must be Gandhi's influence.

chanakya4773 says

Are you f** crazy. you are googling all over the place to get some crappy data. talk to someone who has lived in india and you will know how indian health care works. some useless and incomplete document from web on indian healthcare system is not enough to prove that there in no free market private health care system in india. .Its a fact that most middleclass people in india have access to fully private free market based health care system in india.majority of them are direct cash payments.ofcourse there are some shitty govt run hospitals to service the poor who are completely broke but no middleclass person will dare to go there and nobody does. The Govt does not mandate the private sector to service a person irrespective of their ability to pay.
if a person tries to go to a private hospital and demands to be treated without paying them, they will cut his balls off ;-)

So you espouse having healthcare run by charities (or government, depending on how the mood takes you) if you are poor, and there are a lot of poor in India, and in the same breath say how shitty that healthcare is. Let's just summarize your argument - if you've got the cash, you get the healthcare you oh-so-deserve. If you're poor, you can basically just fuck off and take your chances because, well, you're poor. Like I said, you're a compassionate soul.

chanakya4773 says

Its a human thing not to let people die. if you don't have that..there is a problem with you. that does not mean you allow people to use that excuse to game the system and create a huge burden. I would any day donate a small sum to help a homeless who is really desperate or help save a life. that does not mean i'll write a blank check to everyone of them ( which is what is happening now).

Thats why charity based hospitals fit the model very well because the free money that people get are based on people's compassion which serves only the really desperate for their desperate needs and thus automatically control costs. we are giving too many very expensive freebies in todays system.

Have you actually taken a look at the WHO's list of the best healthcare systems around the world and their related costs? I think you need to.

chanakya4773 says

If you are poor and you are asking somebody else to pay for you...you only get what the other person is willing to give you on compassionate grounds . whats so difficult to understand here. anything else would be called extortion. do you like to do extortion ?

Let me guess, you're poor because that's the consequence of your past life and so you only deserve what I deem fit to hand out to you. I suspect that would be nothing in your case. I tell you what, let's go back to the days of poor houses and the like whilst we are at it.

chanakya4773 says

If a homeless guy comes to you for help ..would you like to have him "demand" money or would you like to give him whatever you thing is right on compassionate grounds ?
i know when i give him few dollars that he will be able to eat only eat very inexpensive not so great restaurant versus a steak house....but thats what i am willing to give away for free. anything wrong with that?

How about having a society that actually tries to prevent homelessness rather than just having people like you thinking they're doing the very best for them by tossing them a couple of dollars when/if the mood ever takes you?

chanakya4773 says

Bigsby says

Let me guess, you're poor because that's the consequence of your past life and so you only deserve what I deem fit to hand out to you.

well then go earn it. why do you want other people's hard earned money.
do you think they got it for free

Because not everybody is as fortunate as you so obviously seem to be. Personally, I'd much prefer to live in a society that tries to take care of every citizen's medical needs rather than one that is based on your philosophy of 'fuck you, I've got mine.'

chanakya4773 says

Bigsby says

How about having a society that actually tries to prevent homelessness

The best one known to man today : free market enterprise. If there exists something better, its definitely is not known yet.

Complete and utter bullshit.

chanakya4773 says

you need to understand something here.
there is only fixed amount of health care resources available in US. if you take something from it and give it away free to somebody. somebody else is not getting it. its called rationing. rationing should be the last resort. The focus should be to grow the pie . in this case, healthcare resources pie. one way to grow the pie is to make every person contribute money to grow the pie. that why you cannot just give freebies.

You need to understand something. The US ranks 38th on the WHO's rankings of health systems whilst spending the highest amount per capita by a long way - $2500 more (according to the OECD) than the next highest spender. This isn't an issue of money or lack thereof. It's an issue of how the country has decided to spend its money on healthcare.

chanakya4773 says

There is nothing wrong with that concept. the approach is wrong though.
Given the high cost of healthcare, there is this huge outcry that you are venting. but you failed to find out why the costs are so high. before attempting to ration it, we should try to find a better way. the better way is to focus on reducing the cost so that its available to everybody.
rationing will only make all hospitals shitty.

giving govt mandated freebies creates lot a waste because there is lot of abuse since its free. that increases cost for everybody.

Yes, there are better ways. You could simply look at what the highest ranking healthcare systems have done. And guess what, none of them have done what you are arguing for. Amazing I know, but there you go.

chanakya4773 says

you can read my original post. lets talk once you read that. we all know its
broken but rationing is not going to fix it.

actually rationing of emergency services is already happening. how is that helping you ?

I've already read all your posts. I fundamentally disagree with what you are saying as you should quite clearly be able to understand. And it's laughable that you are complaining about rationing because your argument seems to be to leave the poorest in society to their chances. Charity hospitals for very basic care if you are lucky, seemingly.

chanakya4773 says

there is bigger problem here that just following what others have done.
even though other countries can brag all they want about their system, US medical field is the most advanced and is the innovation engine of the entire world. other people piggy back on our innovation.
Once you kill this system here , there will be bigger repercussions than you can imagine. sometimes the intentions are good but the results are not.The last thing you want is stagnation in medical field innovation and lose the opportunity to save thousands of lives across the globe. most countries have chosen the non-free market approach but it does not matter since US is the innovation engine anyway.

there should be every effort to keep most part of the health care system here money making industry so that people keep innovating.
once you take away the incentive to make money , innovation will die for sure.

Kill what? There's plenty of major medical innovation that comes from Europe, for example. Having comprehensive healthcare coverage isn't the death knell for medical advancement, though your plans for medical healthcare might well be the death knell for any semblance of a civilized society.

chanakya4773 says

you didn't answer on how to prevent homelessness for good...any ideas ?

It's obviously a highly complex issue, but an entirely free market has absolutely no interest in dealing with that kind of problem, and if you don't see that, then there's little point in discussing anything with you.

chanakya4773 says

I would also be interested to know why somebody ( who is already fully burdened) should be paying for your emergency room visits?
for every free emergency room visit that happens today , there is probably some already broke family paying for it.

Then perhaps you should try and understand a system such as the one the French have. Most people aren't that desperate to pick up a gun and kill a few taliban, but they understand the need for some of their dollars to go towards defense expenditure. Why can't their dollars also go towards universal healthcare? You do understand that most people wouldn't be making the choice to pay twice, and based on current US per capita expenditure, it would be highly likely that LESS of an individual's money would be going towards funding their healthcare than is the case now whilst simultaneously enabling universal coverage. That's a win-win in my book, but apparently it means something else to you.

chanakya4773 says

Bigsby says

Having comprehensive healthcare coverage isn't the death knell for medical advancement,

read this : http://www.forbes.com/2010/01/06/health-care-reform-congress-politics-opinions-contributors-whitman-raad.html

What's your point? That has nothing to do with the impact that universal healthcare might have on research. The UK has more nobel laureates per capita than the US as have a number of other countries with universal healthcare. Does that mean I can argue that universal healthcare actually advances scientific research... or could there possibly be other factors at play?

chanakya4773 says

Health care costs ...Too much GOVT is the problem.

I would argue that the problem is bad government rather than too much.

If we completely got government out of health care and let the transnational corporations run everything how they see fit, knowing that profits, not lives, are what motivates the executives of these corporations, do you honestly believe that health care prices will go down?

Don't just answer that question right away. Think about it. Think about what corporations, particularly large and powerful ones, actually do when unrestricted by law.

A very flawed analysis by the OP. No mention of high-tech medical toys, oops, I mean DEVICES, that are one of the main drivers of insane inflation of medical care costs.

That's good ol' capitalism, complete with patents that protect the inventor. How does government get in the way of that sort of private market activity? They don't, and it doesn't work. 46 million uninsured people will tell you that.

I also detect more than a sniff of class-based contempt for the less fortunate in the OP's analysis. Does your employer provide you with health care coverage? I hope so, as it's killing the rest of us barely making the monthly premiums with their double-digit yearly increases. That's good ol' capitalism as well, juice it to the captive consumer whenever possible.

No, you have backwards, we need to get the private market bloodsuckers OUT of the healthcare industry and get the administrative costs down from 15 -30 % to more like the Social Security Administration, which manages just fine with a 3% overhead.

chanakya4773 says

Are you f** crazy. you are googling all over the place to get some crappy data. talk to someone who has lived in india and you will know how indian health care works

Are you the person who has lived in India? If you are then you should have no trouble at all refuting my numbers. Sorry I don't do anecdotal. Please feel free to provide some official numbers that dispute my crappy data. Until then I will stand on my hand.

chanakya4773 says

yes , i was born and raised in India and i know the system in and out.

I know how much it costs for medical care in india. even normalizing it to US per capita income, the costs here are "ridiculous".
don't you all agree that the costs are just absolutely insane in US ?
does anybody have an answer why ? I have put four points which are possible reasons with different degrees of effect.

Well then you should have no trouble at all providing correct numbers since mine are incorrect, when can I expect to see them?

Yes the costs are ridiculous. I'm waiting to see your theoretical free market in action. India isn't anywhere close. It's cheap because it's so poor a large number of people simply don't have health care at all. Show me a comparable to the US health care system operating as a free market, I'll be glad to look.

The rest of the first world uses government public health care with better results and half the cost. So simply saying government is the problem doesn't make much sense. Corporate ownership of the political system of the US is the problem. Not just in health care either.

There are 3 very simple reasons why health care in the US is expensive. Fee for service, insurance billings for fee for service, and drug patents. If the US used capitation for general medicine and salary for specialists like everyone else then the costs would be the same as everyone else. That would also mean the enormous cost of insurance and insurance billings were eliminated. If drug companies weren't able to continually repatent existing medications, keeping generics off the market, then the cost for drugs would be a fraction of what it is now.

Government involvement magnifies these problems but is not the cause. If you actually bothered to read some of what was posted you would discover that health insurance and fee for service were common before insurance was tax deductable and well before medicare existed. You have your causation backwards. The problems were there, then government got involved and made it worse.

Your blood can boil as much as you want it's never going to change. Doing so would also mean the huge bribes, whoops sorry expressions of free speech, going to politicians from insurance companies, pharma, and the AMA would go away. Never, never ever going to happen. So everyone is just plain old screwed. I think I'll just continue to be an expat.

chanakya4773 says

Hi Bob,

I agree with some of your statements. But both you and me are not right on the free market concept since we both don't know "exactly" how it will work.

but we could definitely start with small steps in the right direction and fix things which we all agree are broken. getting as close as possible to the free market without messing it up is one such step. there is no perfect answer here.

So you have no basis for thinking a free market would work, you just want to give it a go. Why not give a go to a system that we do know works and that we also know supplies better results at less cost? How about that for an idea?

I noticed you tossed in that old chestnut of supply constraint. I take it that waiting a little while longer is unacceptable but having 50m lacking coverage isn't. Everything has constraints. It's how you manage them for the good of the whole. If you want to go the private route and get faster care, then you aren't prevented from doing that under the universal healthcare systems.

chanakya4773 says

Bigsby says

If you want to go the private route and get faster care, then you aren't prevented from doing that under the universal healthcare systems.

The current private route will still have all the issues i highlighted in my OP.

That's the private route in the US not in the other healthcare systems. And there's nothing wrong with the universal healthcare systems as demonstrated by the WHO report.

chanakya4773 says

Bigsby says

That's the private route in the US not in the other healthcare systems.

how do you fix the private route in US ?

looks like we are looking for bandages not solutions to the real problem.

Good grief. You minimize its role and influence by adopting an effective universal healthcare system, many of which have demonstrably better results than the current US system. That leaves a minimal role for private healthcare for those who wish to take that route. How that is implemented is unimportant because EVERYONE will still be able to get good healthcare.

chanakya4773 says

Bigsby says

Good grief. You minimize its role and influence by adopting an effective universal healthcare system, many of which have demonstrably better results than the current US system. That leaves a minimal role for private healthcare for those who wish to take that route. How that is implemented is unimportant because EVERYONE will still be able to get good healthcare.

So you don't give a damn about people who might lose their life because the line is too long and the private route is unaffordable.

universal health care will only move us from worse to slightly less worse but it still won't fix the fundamental problems.

What bullshit. You are the one who doesn't give a damn about 50m uninsured people in the US. The healthcare systems of many countries are considerably better than the US system and for considerably less cost. Your suggestion of a completely free market route is utterly laughable and yet here you are talking to me about not caring about someone losing their life because the line might be too long. How many people will lose their lives under your ridiculous free market approach because they simply can't get into the line in the first place?

chanakya4773 says

When did i say that i am ok with 50m uninsured ? and when did i say the current system is free market ?
You are assuming that i am justifying the current system which i am not.
Did you even read my original post ? the whole post is about why the current system is so broke

Oh right, charities are going to come in and build a completely new healthcare system for those 50m people. Ha, ha, ha.
And no, I don't think you are justifying the current system. You have been arguing for a completely free market for healthcare, which would be even worse.

chanakya4773 says

50 million people are uninsured because they cannot "AFFORD" it.
the goal should be to reduce the cost of healthcare so that it becomes affordable to almost all of the 50 million people. There will still be small % of people who will never be able to afford healthcare..thats where the govt or charity hospitals come.

That is one of the most ridiculous things I've ever heard. On what planet do you think you are going to be able to reduce healthcare costs in the US to the point where people who can't currently afford monthly insurance premiums will suddenly be able to find the cash for even minor medical treatment let alone common invasive procedures? And what about major surgery? This isn't a small percentage of people. This will be the 50m people that currently can't afford it + the huge number of people who also don't have access to a vast pile of cash that would be needed to pay for any procedure under your bizarro free market idea. It's just a nonsense. And which is it, charity or government? And if it is government, why is it good enough for this large number of people but not good enough for everyone else? As for the idea that charitable organisations would step in, you can only shake your head in disbelief at that idea.

chanakya4773 says

The only place you will see that is in laser eye treatments. The lasik treatment prices dropped significantly over time due to this reason. its not covered in insurance and people shop for cheapest and best option.You see companies advertising the "PRICE" of the lasik in media. How many times have you seen that for regular test/scans..etc ?

But Lasik is a perfect example of ADDING to health care inflation. You didn't do the math. You don't seem to grasp the cost PER lasik has gone down, the cost OF lasik has skyrocketed. Some insurance does cover lasik.

First there was no lasik so it cost nothing, then lasik was new and expensive and few people got it so cost almost nothing, now lasik is very popular and there are something like a million a year at 4k a pop. So lasik is adding 4 billion a year of pure inflation to health care spending that didn't exist in 1991 (actually about 2000). Multiply that out by all the new procedures and treatments in the last 40 years and I would think you have answered a big part of your own question about medical inflation.

BTW, your 1991 number isn't valid anyway. From 1991 to 1998 lasik was limited clinical trials with experimental lasers. I know this because my girl friend at the time had lasik and they made a really big deal about it being experimental. The first production laser for lasik was 1999 so you really need to compare price points after that. Makes for a more dramatic chart, but try to stick with apples vs apples. As Mark Twain said "There are three kinds of lies. Lies, damn lies, and statistics".

So how many tests/scans did you research the cost history of that you know the price hasn't gone down on any of them?

If the govt. was completely out of health care any medical procedure cost would not be more than a dozen eggs & the quality of care would surpass perfection. Go Free Enterprise!

bob2356 says

the first world uses government public health care

OK, yes we need expanded public health, because government provides most of the high risk care already. Government provide MediCare, MedicAid, and VA health services. So the government takes the highest risk patients, and leaves the cream for private health insurance.

Health care in United States is run by, and for the very rich.

The break down in our system starts with education. To be a doctor is extremely expensive here. The cost of education is in the area of $500K to start. In India there are more, and better educated doctors. Do all of the doctors in India pay for that education?

Last, but not least we look at being a doctor, or the medical industry as a path to wealth. Drug companies, medical devices, patents, procedures, and copyright are all sure fired ways to make a million. Isn't that a little sick when you think about it?

All those innovations for profit rather than a greater good is the root of the problem we have here.

chanakya4773 says

You don't seem to grasp that inflation = cost PER LASIK (not of all the money we are spending on all the LASIK's)

I am surprised that you have been debating about medical inflation on this board for so many months and you don't even know the concept of inflation

You are correct, I meant to talk about costs, not inflation. Mental error.

Yes I know how medical inflation is calculated by BLS. I don't agree with it, even BLS admits it's inaccurate. They only track out of pocket expenses net of reimbursements but not employee provided health care. Out of pocket is far higher than what insurance companies pay and very few people pay out of pocket. I do agree with the BLS that coming up with a true number would be impossible. It's more than ordinary inflation (which doesn't include housing and energy) but no one knows how much.

So where is the money going? Doctors real net income has been falling for 20 years. Insurance profits are way up, Drug company profits are way up. Hospital profits are way, way up.

So what is your actual solution other than saying we need a free market? Very nice, it's like saying we need world peace. Should we make insurance illegal? Nationalize the drug companies and hospitals? What would be an actual plan to create this utopia? I'm still waiting for you to point out a working example of free market health care to emulate. India certainly ain't it.

David Losh says

In India there are more, and better educated doctors. Do all of the doctors in India pay for that education?

Could you provide proof doctors are better educated in India? That should be interesting to read.

I don't know much about medical education in India, but I do know that eastern european medical schools have been flooded with students from india the last 10-15 years, so it can't be all be sweetness and light.

bob2356 says

I do know that eastern european medical schools have been flooded with students from india the last 10-15 years, so it can't be all be sweetness and light.

Transferrable credits might be a reason.

http://www.foreignpolicy.com/articles/2010/06/11/countries_without_doctors

bob2356 says

Could you provide proof doctors are better educated in India?

Here in the United States we have an academic way of educating our doctors, when in most Third World countries doctors do hands on traing, including cleaning bed pans.

The need is so great, in most countries, for medical care, health care, that every one is required to help.

In my opinion, it makes for better doctors.

Did I phrase that better?

David Losh says

Here in the United States we have an academic way of educating our doctors, when in most Third World countries doctors do hands on traing, including cleaning bed pans.

The need is so great, in most countries, for medical care, health care, that every one is required to help.

In my opinion, it makes for better doctors.

Did I phrase that better?

Better phrased but not true, Medical training is pretty much the same around the world. Almost everyone uses the same curriculum, The only difference is the US does a 4 year bachelor degree then 4 year medical school. Almost everyone else uses the British system of 6 years medical school right after high school. The US system has 2 years classroom, 2 years clinical, with a 3 year residency. The British system is 2-4 years of classroom then 2-4 years of clinical usually with a 1 year internship, although many systems use the 6th year of medical school as internship. Any specialist training is in addition to that. No one would waste expensive highly trained peoples time cleaning bedpans. Even the poorest third world country has nurses. Here's a pretty good summary from wikipedia. http://en.wikipedia.org/wiki/Medical_school

Have you ever actually travelled in the third world?

David Losh says

Transferrable credits might be a reason.

http://www.foreignpolicy.com/articles/2010/06/11/countries_without_doctors

Did you actually read it? I couldn't it's subscription only. The only part I could read says the US has 13 doctors per 1000 people which is totally fiction. The true number is 2.5 which is slightly below average for the oecd, but the US has more gp's per 1000 people than the oecd average and a better ratio of gp's to specialists than the oecd average. If the rest of the article is that bad I really don't want to bother thank you. Sounds more like a political hack piece than anything worthwhile.

bob2356 says

Here's a pretty good summary from wikipedia.

Here's wiki link that shows the number of doctors from India in 2005. http://en.wikipedia.org/wiki/American_Association_of_Physicians_of_Indian_Origin As I understand it the per cent has gone up.

bob2356 says

Medical training is pretty much the same around the world.

Here in the United States it cost $500K to be a doctor, or there abouts, from what I understand.

That's a lot of student debt unless mom, and dad pay for schooling. To get into Harvard you need to have the very best of everything which in my opinion means wealth.

In other parts of the world the cost is less, $100K in India, and the requirements to get in, and get out of medical school require testing, aptitude, and ability.

David Losh says

Here in the United States it cost $500K to be a doctor, or there abouts, from what I understand.

That's just not true. Plenty of people go to state schools and state medical schools. My wife went to medical school at umdnj at 14k a year and umdnj is currently 25k a year. My sister in law went to medical school at Texas Tech in Lubbock (I think) for something like 6k a year and I don't think they charge a lot more now. She did undergrad at UT Galveston for something ridiculous like $70 a credit. That's like 13k for all four years. You can spend 500k if you want, but you can spend a lot less also. Most people spend in the 200-300k range with undergrad, which is still a hell of a lot. Here, this is a list of every med school in the countries tuition. http://medical-schools.findthebest.com/ the vast majority are 20-40k a year tuition plus living expenses.

Curiosity overwhelmed me on this subject so I emailed a friend who graduated medical school in India and did residency in the US. He says that there are only 2500 slots a year in India state medical schools with 250,000 applicants and getting in is very corrupt. He went to a very good private medical school in Mumbai (apparently there are more than a few sketchy private medical schools) at a cost of 55k usd per year for 6 years. That's serious scratch in India even for a well off family like his.

Sumit also said that of the 30k or so med school graduates a year in India something like 3/4's go overseas because there are no residency slots or jobs after residency. So India is producing 7k domestic doctors a year for a country of 1 billion people. The US has around 20k med school grads a year for a country with 1/3 the population and they all stay here. No wonder India has only 1 doctor for every 2500 people.

David Losh says

Here in the United States it cost $500K to be a doctor, or there abouts, from what I understand.

cost of undergraduate + about 200-300K in medical school tuition + living costs.

Other factors not considered here is the loss of earning potential since it can take 7-12 years of training before you can actually start working and earning money.

Meccos says

about 200-300K in medical school tuition

bob2356 says

Most people spend in the 200-300k range with undergrad

OK, let's agree on $200K to $300K for medical school.

If the reports are true we have high medical costs because we have a lack of doctors, which also seems to be refuted here, then the government would be dollars ahead by granting a $1 Billion a year to medical students.