The problem with health care is no amount of money will ever be enough.
It's one of those areas where you can spend and spend and spend and you will still be far away from satisfying the needs we have.
The Danish model that I grew up with is ok, but don't expect treatment that are even half that of a good American hospital.
Put on top of that the fact that we are "discovering" (or inventing) more and more sickness that we can then threat which people expect the hospital to take care of.
Perhaps the real trick is to tax those treatments that are extremely both important and expensive and let the insurance companies take care of the milder forms of sickness. That way if technology makes what used to be expensive treatments easy and cheap they can be pushed into the private market.
You are kind of missing the point. A public system is fine (I live in one), but I'm not using public if I can afford to go private. It's the best of both systems: if you can't afford private treatment, you are guaranteed some treatment. If you can, you pay through the nose for it, or pay for medical insurance anyway.
Nothing will change for those who are well off, but for those at the bottom it will be great.
It may be that no amount of money will ever be enough, but that money can be spent well or it can be spent badly. Doctors can prescribe an unnecessary procedure because they're paid for it or because they fear malpractice claims. Or they can prescribe an expensive drug or surgery with a high chance of saving your life. In America, we don't do a very efficient job of spending our health care dollars. In Denmark (where I'm living now), you may or may not get treatment as good as in an American hospital (you should try some of the public ones before you judge). At least you get the treatment you need regardless of your ability to pay, and without bankrupting you in the process.
Given the amounts that are spent both by public and private actors, you should qualify your statement. Clearly, vast amounts are being inefficiently spent through Medicare. The question though is that if government isn't already good at spending the money through medicare, what makes anyone think that if you give them the whole system to run, it will be any better?
There are also all the reasons cited in Krugman's post.
Then there's the fact that the U.S. spends about twice as much on health care as any other developed nation and gets results that aren't clearly better overall. Is it a coincidence that we have the largest component of private spending?
If the insurance companies aren't already good at spending money on health care, what makes anyone think that if you give them the whole system to run, it will be any better?
I think that even most private healthcare advocates suggest that we do need to ensure that those who need the care get it - and one way to do so is for governments to cover premiums in order to do it. But to suggest that we need to completely dismantle our existing system seems rather drastic as we do get some significant benefits including the level of medical innovation that the US supplies the world. Granted, if the US is subsidizing the rest of the world through inefficient spending domestically this isn't ideal either.
As for higher administrative costs, as a number cruncher and one who has worked with non profits, this number can be both juiced and reduced depending on the operational strategy that's taken. For instance, despite higher administrative expenses, medicare fraud (15+%) is thought to be considerably higher than private healthcare - so there's a trade off here between administration and waste elsewhere. I'm not saying that this is necessarily the case here but given the fraud numbers, that case does seem compelling.
I'm not fond of the US insurance industry as a whole given that it's all third party payors (ie your employer chooses your insurance, not you) which introduces all sorts of wacky results but I find it odd that they wouldn't rather give users of the system more power rather than centralizing it with governments. Again - look at the stunning er, competence with which the bail out package has been run.
I think that even most private healthcare advocates suggest that we do need to ensure that those who need the care get it - and one way to do so is for governments to cover premiums in order to do it.
Is anybody talking about a plan like that? I haven't heard anything about it, and I would think the GOP would be touting it if thats what they wanted. Most republicans I've heard either seem to be for inaction or for a health care bill that doesn't do anything for the uninsured/needy
Good points. There are a lot of funny numbers going around. As the old saying goes, there are lies, damned lies, and statistics.
Administrative percentages are lower for medicaid than for private insurance mainly because people on public insurance spend a lot more medical dollars than those covered by the private sector. Since administrative costs usually tie to recipient, you have less recipients receiving more money, driving down percentages.
Medicare is more effective than private inshurance on a treatment per incoming heal care dollar. The problem is the focus is on end of life treatment which is the most expensive. 50% of all heath care is paid for by the US Government / taxpayers the other half is a mix of out of pocket and private insurance.
I actually support the opposite model. Public heath care funding for generic drugs / cheep new drugs and basic heath care. Private insurance for extremely expensive drugs, experimental or high risk treatments, and life support once you are brain dead.
The first 20% of heath care spending goes increasingly far. The last 20% is pure waste. The problem is people want to try and help the old live forever so medicare is a black hole that will suck this country dry. Unfortunately I don't think we are going to have a cap on spending if you have less than a 20% chance of being alive in one year.
PS: Want to make heath care cheaper pay for the first 100$ of any drug / month if and only if it has zero advertising.
"Private insurance for extremely expensive drugs, experimental or high risk treatments, and life support once you are brain dead."
But isn't this exactly the problem in the model?
Most people can't afford the high risk expensive treatments so you are basically just bankrupting them.
The expensive treatment is the treatment that we "really" need, but also that which is without reach for most of us.
By keeping the expensive treatment in the public domain as long as the private sector hasn't found a way to commodify it. So that people in general have access to it, seems to be a fair way of doing it.
If only the rich can afford treatments that are expensive you could might as well keep the old system.
It depends on what you mean by expensive. In home nursing care is horribly expensive on a benefit per dollar spent. Open heart surgery can be far cheaper relative to medical benefit.
Look at the Japan model where public money is used to drive costs down but there is a side channel for private hospital rooms, in home care, homeopathy, and other things which provide little benefit vs cost.
Basically, everyone get's the high reward treatments, but when it comes to drugs which might possibly reduce your risk for X slightly, well that's up to you.
PS: If it's cheep and does little it's still expensive relative to gain.
Comments
The problem with health care is no amount of money will ever be enough.
It's one of those areas where you can spend and spend and spend and you will still be far away from satisfying the needs we have.
The Danish model that I grew up with is ok, but don't expect treatment that are even half that of a good American hospital.
Put on top of that the fact that we are "discovering" (or inventing) more and more sickness that we can then threat which people expect the hospital to take care of.
Perhaps the real trick is to tax those treatments that are extremely both important and expensive and let the insurance companies take care of the milder forms of sickness. That way if technology makes what used to be expensive treatments easy and cheap they can be pushed into the private market.
Don't know, it's a tough nut to crack.
You are kind of missing the point. A public system is fine (I live in one), but I'm not using public if I can afford to go private. It's the best of both systems: if you can't afford private treatment, you are guaranteed some treatment. If you can, you pay through the nose for it, or pay for medical insurance anyway.
Nothing will change for those who are well off, but for those at the bottom it will be great.
It may be that no amount of money will ever be enough, but that money can be spent well or it can be spent badly. Doctors can prescribe an unnecessary procedure because they're paid for it or because they fear malpractice claims. Or they can prescribe an expensive drug or surgery with a high chance of saving your life. In America, we don't do a very efficient job of spending our health care dollars. In Denmark (where I'm living now), you may or may not get treatment as good as in an American hospital (you should try some of the public ones before you judge). At least you get the treatment you need regardless of your ability to pay, and without bankrupting you in the process.
Given the amounts that are spent both by public and private actors, you should qualify your statement. Clearly, vast amounts are being inefficiently spent through Medicare. The question though is that if government isn't already good at spending the money through medicare, what makes anyone think that if you give them the whole system to run, it will be any better?
What makes you think insurance companies spend money efficiently?
For one thing, they tend to have much higher administrative costs than publicly run health care programs. See, for example, Wikipedia's article on health care in the US: http://en.wikipedia.org/wiki/Health_care_in_the_United_State... or this blog post by Ezra Klein: http://voices.washingtonpost.com/ezra-klein/2009/07/administ...
There are also all the reasons cited in Krugman's post.
Then there's the fact that the U.S. spends about twice as much on health care as any other developed nation and gets results that aren't clearly better overall. Is it a coincidence that we have the largest component of private spending?
If the insurance companies aren't already good at spending money on health care, what makes anyone think that if you give them the whole system to run, it will be any better?
I think that even most private healthcare advocates suggest that we do need to ensure that those who need the care get it - and one way to do so is for governments to cover premiums in order to do it. But to suggest that we need to completely dismantle our existing system seems rather drastic as we do get some significant benefits including the level of medical innovation that the US supplies the world. Granted, if the US is subsidizing the rest of the world through inefficient spending domestically this isn't ideal either.
Just a reminder: http://www.gallup.com/poll/102934/majority-americans-satisfi... - instead of working at the people who aren't satisfied with their insurance or don't have any, we'd rather create an entirely new system from scratch?
As for higher administrative costs, as a number cruncher and one who has worked with non profits, this number can be both juiced and reduced depending on the operational strategy that's taken. For instance, despite higher administrative expenses, medicare fraud (15+%) is thought to be considerably higher than private healthcare - so there's a trade off here between administration and waste elsewhere. I'm not saying that this is necessarily the case here but given the fraud numbers, that case does seem compelling.
I'm not fond of the US insurance industry as a whole given that it's all third party payors (ie your employer chooses your insurance, not you) which introduces all sorts of wacky results but I find it odd that they wouldn't rather give users of the system more power rather than centralizing it with governments. Again - look at the stunning er, competence with which the bail out package has been run.
also fyi - http://www.washingtonpost.com/wp-dyn/content/linkset/2005/07...
update - apparently administrative costs are higher not lower for Medicare than private insurance, check this link out: http://www.heritage.org/research/healthcare/wm2505.cfm
I think that even most private healthcare advocates suggest that we do need to ensure that those who need the care get it - and one way to do so is for governments to cover premiums in order to do it.
Is anybody talking about a plan like that? I haven't heard anything about it, and I would think the GOP would be touting it if thats what they wanted. Most republicans I've heard either seem to be for inaction or for a health care bill that doesn't do anything for the uninsured/needy
Good points. There are a lot of funny numbers going around. As the old saying goes, there are lies, damned lies, and statistics.
Administrative percentages are lower for medicaid than for private insurance mainly because people on public insurance spend a lot more medical dollars than those covered by the private sector. Since administrative costs usually tie to recipient, you have less recipients receiving more money, driving down percentages.
Medicare is more effective than private inshurance on a treatment per incoming heal care dollar. The problem is the focus is on end of life treatment which is the most expensive. 50% of all heath care is paid for by the US Government / taxpayers the other half is a mix of out of pocket and private insurance.
I actually support the opposite model. Public heath care funding for generic drugs / cheep new drugs and basic heath care. Private insurance for extremely expensive drugs, experimental or high risk treatments, and life support once you are brain dead.
The first 20% of heath care spending goes increasingly far. The last 20% is pure waste. The problem is people want to try and help the old live forever so medicare is a black hole that will suck this country dry. Unfortunately I don't think we are going to have a cap on spending if you have less than a 20% chance of being alive in one year.
PS: Want to make heath care cheaper pay for the first 100$ of any drug / month if and only if it has zero advertising.
"Private insurance for extremely expensive drugs, experimental or high risk treatments, and life support once you are brain dead."
But isn't this exactly the problem in the model?
Most people can't afford the high risk expensive treatments so you are basically just bankrupting them.
The expensive treatment is the treatment that we "really" need, but also that which is without reach for most of us.
By keeping the expensive treatment in the public domain as long as the private sector hasn't found a way to commodify it. So that people in general have access to it, seems to be a fair way of doing it.
If only the rich can afford treatments that are expensive you could might as well keep the old system.
It depends on what you mean by expensive. In home nursing care is horribly expensive on a benefit per dollar spent. Open heart surgery can be far cheaper relative to medical benefit.
Look at the Japan model where public money is used to drive costs down but there is a side channel for private hospital rooms, in home care, homeopathy, and other things which provide little benefit vs cost.
Basically, everyone get's the high reward treatments, but when it comes to drugs which might possibly reduce your risk for X slightly, well that's up to you.
PS: If it's cheep and does little it's still expensive relative to gain.