How SHOULD Health Care Work?

[Al_Masetti]

There are doctors even today in the United States who treat indigent people without charging them.

They don’t advertise their charitable work.

 

[jman507]

our priorities are out of whack when we think that it’s okay to make a profit off of sick people, and to sit around and watch people die if they can’t pay – it doesn’t matter how they got sick, and it doesn’t matter why they can’t pay.

lifestyle choices are a big deal, don’t get me wrong. but let’s be honest here: are meth addicts children of god? are they your brothers? if you find one vomiting up blood in the parking lot of a hospital, will you walk on by feeling proud of the good choices you’ve made?

careful. this is a trick question.

Ok, so you worry about hospitals being able to make a profit, I worry about hospitals going broke. Single payer or multiple payer, there will still be a limit on how much health coverage can be given. I’d still say Vern still had enough heart in his orginal plan to say, those who cannot get paid will still receive treatment.

I guess you could very well walk by the meth adict who is vomiting in the parking lot, and call 911, in order to have the police and EMTs arrive on the scene, since the police can help provide security if needed, and the EMTs can take the addict to the hospital to deal with the pressing medical problems, and hopefully social services can get the person in a program. It might work out well, it might not. The addict also needs to finally commit to getting better, or else no intervention will work. In the end you can help, but you might not have any idea on how to really get the addict on a path to recovery, given the addict wants to recover.

 

[Trader]

lifestyle choices are a big deal, don’t get me wrong. but let’s be honest here: are meth addicts children of god? are they your brothers? if you find one vomiting up blood in the parking lot of a hospital, will you walk on by feeling proud of the good choices you’ve made?

careful. this is a trick question.

I left this one alone because I thought it was too easy. Of course the meth addict gets treatment, and I have not heard anyone say we just let anyone die without it.

Since the manufacture, sale, and possession of meth are all criminal acts, our meth addict brother is a criminal and we have the means to get him treatment in a locked facility for his own good, and for ours. Maybe he can get a diversion program where his future job prospects are not permanently damaged by a conviction. Either way he gets treatment and some tough love that includes requirements that keep him away from the environmental factors leading to his addiction. He also gets a bill that he pays off slowly as part of his probation/parole fees.

Why would you want anything less for our brother? If you give him the message that he is not responsible for the choices he makes, you damage him as much as the illegal drugs.

 

[emily47017]

Ok, so you worry about hospitals being able to make a profit, I worry about hospitals going broke. Single payer or multiple payer, there will still be a limit on how much health coverage can be given.

i wasn’t thinking so much about hospitals as about private insurance companies, who make a profit without providing any actual health care services. as i clarified for trader, do i think service providers ought to make a good living at what they do.

i wish i knew more about the specific economics of why certain hospitals go broke and others don’t. does it have to do with the disproportionate amount of charity care that big city public hospitals have to provide? it’d be really great if we could ensure that all physicians/hospitals are getting the same reimbursement for the same services. reducing the administrative waste (31%) of a patchwork private insurance system could also help, but i really don’t know enough to make any sweeping recommendations.

tangentially, here’s an interesting study of canadian hospitals, showing that for-profit hospitals have a higher mortality rate than not-for-profit hospitals.

A systematic review and metaanalysis of studies comparing mortality rates of private for-profit and private not-for-profit hospitals

I left this one alone because I thought it was too easy.

ah, thank you. you both rightly perceived that it wasn’t a trick question after all.

we should never give up educating people about lifestyle choices that help or harm their health, and we should always be willing to help them change their behavior. we must always make sure everyone knows that their health is in their own hands.

that principle does not mean that people who make poor choices should get a different amount or quality of health care, either acute or chronic. a meth addict needs help, and giving him that help is the right thing to do. an unemployed diabetic needs help, and giving him that help is the right thing to do. your example several pages ago of the drunk with kidney failure also needs help and should be given help, though obviously we shouldn’t do anything inappropriate given his current and expected health status.

the same applies to people who’ve made bad financial decisions. i left my money in intel when i knew it was dropping like an anvil, then i sold late. now i have nothing but my dog and a borrowed car. does that mean i don’t deserve the medications that keep me alive? i hope i deserve at least as much consideration as a meth addict in a parking lot?

and you guys all do, too. none of us knows what will happen tomorrow. i hope that if any of us gets in trouble, the rest of us will be there to help.

 

[Al_Masetti]

A doctor called in to a talk show the other day, and reported that Medicare reimbursement is actually below cost for some services, to the point that some medical service providers have had to close for financial reasons.

Medicare is run by the Federal Government.

The most under-reported Federal agency is probably HCFA. Yet they control a lot of the fee structures.

Seems to me that before the Feds got involved, doctors routinely made house calls.

 

[vern_humphrey]

i wasn’t thinking so much about hospitals as about private insurance companies, who make a profit without providing any actual health care services.

If the insurance companies don’t provide you a service, why do you pay the premiums?

i wish i knew more about the specific economics of why certain hospitals go broke and others don’t. does it have to do with the disproportionate amount of charity care that big city public hospitals have to provide?

It does indeed. Emergency rooms are required to treat anyone who walks in – regardless of ability to pay.

In some places, people use the ER as their primary care facility, and get free treatment. As a result, some hospitals have been forced into a hard choice – go broke (and deprive everyone of health care) or close their emergency rooms.

it’d be really great if we could ensure that all physicians/hospitals are getting the same reimbursement for the same services. reducing the administrative waste (31%) of a patchwork private insurance system could also help, but i really don’t know enough to make any sweeping recommendations.

The administrative waste of government healthcare plans is twice that of private insurance.

tangentially, here’s an interesting study of canadian hospitals, showing that for-profit hospitals have a higher mortality rate than not-for-profit hospitals.

A systematic review and metaanalysis of studies comparing mortality rates of private for-profit and private not-for-profit hospitals

Note the reason!!

 

[Trader]

A doctor called in to a talk show the other day, and reported that Medicare reimbursement is actually below cost for some services, to the point that some medical service providers have had to close for financial reasons.

Medicare is run by the Federal Government.

The most under-reported Federal agency is probably HCFA. Yet they control a lot of the fee structures.

Seems to me that before the Feds got involved, doctors routinely made house calls.

I doubt we would have doctors making house calls anyway, if only because technology has changed and the doctor’s little black bag could not carry all the equipment he(or she) needs now. The doctor’s time is more valuable now and the travel time would be considered very wasteful by most of them. Nurses do make house calls now and they are nearly as well trained as doctors were 50 years ago.

Your larger point is a good one. If patients and providers were able to bargain for services in a free market, at least some would choose a more personalized kind of medicine. How can government decide what is good for 300,000,000 individual consumers better than the actual people involved?

 

[emily47017]

If the insurance companies don’t provide you a service, why do you pay the premiums?

It does indeed. Emergency rooms are required to treat anyone who walks in – regardless of ability to pay. In some places, people use the ER as their primary care facility, and get free treatment. As a result, some hospitals have been forced into a hard choice – go broke (and deprive everyone of health care) or close their emergency rooms.

The administrative waste of government healthcare plans is twice that of private insurance.

Note the reason!!

vern, it’s no fun engaging you in debate because you consistently refuse to integrate any new information.

• i said “health care services”. the guy/gal in the call center in las vegas doesn’t diagnose or treat anything; instead s/he gets paid to refuse reimbursement.
• some inner-city hospitals are going broke because the ER is the only way poor people can get any sort of medical treatment, and inner-city hospitals serve a disproportionate number of poor and indigent. yep! sure enough! single-payer would ensure that these people could get more economical general practice treatment *and *that all ERs – including those in poorer areas – would get equal reimbursement for everyone they serve.
• simply false: medicare advantage benchmarks and payments compared with average fee-for-service spending
  see also: administrative costs in US hospitals , [payments for care at private for-profit and private not-for-profit hospitals

](http://www.pnhp.org/single_payer_resources/devereaux_costs.pdf)

• noted: “Typically, investors expect a 10%–15% return on their investment. Administrative officers of private for profit institutions receive rewards for achieving or exceeding the anticipated profit margin. In addition to generating profits, private for-profit institutions must pay taxes and may contend with cost pressures associated with large reimbursement packages for senior administrators that private not-for-profit institutions do not face.”

so when they’re getting the same reimbursements for services, they’re wasting a significant portion of that money on other things, like profits for investors, huge salaries for CEOs, the greater administrative waste (see above), and, yes, taxes, which a not-for-profit hospital doesn’t have to pay.

and then there’s this: “The private for-profit hospitals employed fewer highly skilled personnel per risk-adjusted bed. The number of highly skilled personnel per hospital bed is strongly associated with hospital mortality rates, and differences in mortality between private for-profit and private not-for-profit institutions predictably decreased when investigators adjusted for staffing levels. Therefore, lower staffing levels of highly skilled personnel are probably one factor responsible for the higher risk-adjusted mortality rates in private for-profit hospitals.”

i guess you were hoping the reason better supported your arguments? sorry.

Seems to me that before the Feds got involved, doctors routinely made house calls.

funny you should mention house calls. there’s a private company in france, SOS medicins, that makes 24 hour house calls and is reimbursed for their services by the government single-payer system.

By focusing on rapidity and quality, SOS MÉDECINS FRANCE contributes strongly to the patients’ well-being and to a economical management of healthcare costs.
http://www.sosmedecins-france.fr/images/t6.gifBased on their experience with emergency services, doctors working for SOS Médecins rarely send patients to hospitals. SOS Médecins is financially independent. It does not receive any governmental subsidy but its usefulness to the general public is a guarantee of cohesion, efficiency and responsibility.

 

[vern_humphrey]

vern, it’s no fun engaging you in debate because you consistently refuse to integrate any new information.

• i said “health care services”. the guy/gal in the call center in las vegas doesn’t diagnose or treat anything; instead s/he gets paid to refuse reimbursement.

The hospital dietician, the janitor, the billing clerk, the maintenance man and the scrub-room nurse don’t provide any “health services” either – but they are all part of the system.

So my point is a valid one – if insurance provides you nothing of value, why pay the premium?

• some inner-city hospitals are going broke because the ER is the only way poor people can get any sort of medical treatment, and inner-city hospitals serve a disproportionate number of poor and indigent.

Due to a very unwise government law that assumes all hospitals have a magic money pot in the back room that magically refills itself overnight – and hence we require the hospital to pay for ER care.

yep! sure enough! single-payer would ensure that these people could get more economical general practice treatment *and *that all ERs – including those in poorer areas – would get equal reimbursement for everyone they serve.

And how would a “single-payer” system do that? It would be simply another insurance company – with all the bureacuracy and inefficiency you deplore, along with the same cost-cutting pressures.

But there would be a difference – the consumer would have no control. He couldn’t say, “I’ll take my business elsewhere” because there would be no “elsewhere.”

• simply false: medicare advantage benchmarks and payments compared with average fee-for-service spending
  see also: administrative costs in US hospitals , [payments for care at private for-profit and private not-for-profit hospitals

](http://www.pnhp.org/single_payer_resources/devereaux_costs.pdf)

I see you fell into the trap – the government requires many medical facilities to charge private pay patients more than Medicare patients. If they charge less, they are accused of “Medicare fraud”

• noted: “Typically, investors expect a 10%–15% return on their investment. Administrative officers of private for profit institutions receive rewards for achieving or exceeding the anticipated profit margin. In addition to generating profits, private for-profit institutions must pay taxes and may contend with cost pressures associated with large reimbursement packages for senior administrators that private not-for-profit institutions do not face.”

Why is it wrong for investors to want a profit?

so when they’re getting the same reimbursements for services, they’re wasting a significant portion of that money on other things, like profits for investors,

Remember, no profits, no investors.

huge salaries for CEOs, the greater administrative waste (see above), and, yes, taxes, which a not-for-profit hospital doesn’t have to pay.

So why aren’t not-for-profit hospitals taking over the universe?

and then there’s this: “The private for-profit hospitals employed fewer highly skilled personnel per risk-adjusted bed. The number of highly skilled personnel per hospital bed is strongly associated with hospital mortality rates, and differences in mortality between private for-profit and private not-for-profit institutions predictably decreased when investigators adjusted for staffing levels. Therefore, lower staffing levels of highly skilled personnel are probably one factor responsible for the higher risk-adjusted mortality rates in private for-profit hospitals.”

Interesting – I note they don’t directly measure mortality. They just measure “number of highly skilled personnel per hospital bed” and tell us this is “strongly associated with hospital mortality rates.”

i guess you were hoping the reason better supported your arguments? sorry.

What argument of mine is not supported here?

As I said, a government run health system would have all the efficiency of the Post Office and all the compassion of the IRS.

If you don’t believe it, do a web search on the problems with Veteran’s Administration health care!!

 

[emily47017]

And how would a “single-payer” system do that?

your other favorite debate tactic: when stumped, redirect to square one. i’m not wasting my time with this one. the PHNP proposal is here, information about financing is here, a shorter and more accessible piece about the financial advantages of single-payer is here, and the FAQ is here. the whole shebang can be found at www.pnhp.org.

the rest of your post is the same old strawmen you’ve been using all along, and i’m not wasting my time with them, either.

 

[vern_humphrey]

your other favorite debate tactic: when stumped, redirect to square one. i’m not wasting my time with this one.

When you get personal lie that, you forfeit the argument

the PHNP proposal is here, information about financing is here, a shorter and more accessible piece about the financial advantages of single-payer is here, and the FAQ is here. the whole shebang can be found at www.pnhp.org.

I’m well aware of what the PNHP proposal is.
You still haven’t answered the question – how would the single payer system do away with people swamping emergency rooms? How would it make medical care** less** costly?

Or to put it another way, how would allowing the practice of uising expensive medical resources with no consequences to the user to spread make things better?

the rest of your post is the same old strawmen you’ve been using all along, and i’m not wasting my time with them, either.

When you resort to unchristian remarks like that, you forfeit the argument.

 

[emily47017]

when a *person *intentionally and repeatedly derails honest debate, it’s not unchristian to call him on it, is it? or maybe all these years i’ve been misreading christ’s debates with the pharisees.

 

[vern_humphrey]

when a *person *intentionally and repeatedly derails honest debate, it’s not unchristian to call him on it, is it?

What is unchristian is to use an accusation like the above.

or maybe all these years i’ve been misreading christ’s debates with the pharisees.

Before one can use Christ as a metaphor for oneself, one must be truly Christ-like.

 

[Man]

OK Vern,

The problem with subsidized insurance is that it inflates costs across the board. Whenever the government meddles in the price, everyone takes action to maximize profit. Thus, if I had an 80/20 split, I would upgrade my insurance. The insurance company would respond by raising the rate, and the doctors would raise their rates as well. Hey, it’s their tax money too!

That’s the status quo, and its all but impossible to avoid.

The key would be placing the income cap for the sliding scale low enough. Even then, however, you could have greatly increased demand (not necessarily bad) that increases costs. And, some people still wouldn’t buy it.

 

[Holly3278]

In my opinion, health care should be free for everyone and especially so for the poor.

 

[vern_humphrey]

OK Vern,

The problem with subsidized insurance is that it inflates costs across the board. Whenever the government meddles in the price, everyone takes action to maximize profit. Thus, if I had an 80/20 split, I would upgrade my insurance. The insurance company would respond by raising the rate, and the doctors would raise their rates as well. Hey, it’s their tax money too!

That’s the status quo, and its all but impossible to avoid.

The key would be placing the income cap for the sliding scale low enough. Even then, however, you could have greatly increased demand (not necessarily bad) that increases costs. And, some people still wouldn’t buy it.

Actually, since you pay your own way with MSAs and spend your own money (except in the rare event you reach the catestrophic deductable) the incentive is not to spend more than you need – since you save all you do not spend.

Those who cannot save enough (and we base that on their income tax returns) are only partially subsidized – they always spend some of their own money, and any unspent part of their own money, they save.

 

[vern_humphrey]

In my opinion, health care should be free for everyone and especially so for the poor.

If everyone gets health care for free, who pays for it?

After all, you wouldn’t go to work every day at a job that paid nothing – and neither will doctors and nurses. So who will pay them?

 

[Trader]

In my opinion, health care should be free for everyone and especially so for the poor.

By that same reasoning, shouldn’t food, clothing, and shelter also be free for everone?

How about education, entertainment, and transportation?

Are you wealthy enough to support everyone for their every need and want? Who besides you would do any work at all when everything was provided for free?

 

[Al_Masetti]

How would the free health care be provided?

How would it be “metered out”, so that some folks didn’t go there every day as a place to hang out … for every ache and pain … and the folks who need an MRI right now, really get it right away.

Would some bureaucrat in an office someplace decide who gets what? How would that differ from what we have now? Are you familiar with HFCA by any chance?

Who would decide how many MRI machines would be installed in each city?
Would doctors work 40 hours a week? Would they be government civil service employees? What if not enough people wanted to work in the medical profession? Would people be drafted? Would some people be forced against their wills to clean bed pans or clean up the various disgusting body fluids and things? Would some people be forced to do surgery? Or donate blood?

If there weren’t enough people to do the work, then would there be waiting lines?

How would that free health care work?*

 

[emily47017]

By that same reasoning, shouldn’t food, clothing, and shelter also be free for everone?

How about education, entertainment, and transportation?

Are you wealthy enough to support everyone for their every need and want? Who besides you would do any work at all when everything was provided for free?

the public school system is free education for all; those who support school vouchers also support free or near-free private education for all.

the very poor get free food from the USDA: foodstamps.

in a patchwork sort of way, there are programs that help with housing… these are not as well funded or well managed as they really should be, but it’s something.

the very poor are also often able to get free clothing from community organizations, though that’s not currently subsidised by the government.