Insurance isn't even the problem

[Morality Games]

In order of priority, the high costs of medical service in the United States result from:

By a wide margin -- Pharmaceutical companies (lack of competition due to decades spanning global monopolization by industrial-political fiat, treatment-centric research)

Bad, but not nearly as bad -- Medical service providers (hospitals intentionally over paying doctors by obfuscating reputation with talent, guilds manipulating supply and demand)

Distant Third -- Insurance companies (charge more than medical service and equipment is worth in order to make some kind of profit)

I guess people blame insurance because they're the ones who stick you with the bill.

 

[lizzie]

Well, the real problem, underlying the problems you mention, is government mandates starting in the 70's, which make comprehensive coverage mandatory, rather than catastrophic coverage, which is what we used to have for insurance back before that time. This is what eliminated competition for pharmaceuticals and medical providers, because the consumer no longer had any say in determining cost of goods and services. The consumer became a passive recipient, and doctors (and other providers) no longer needed to compete, since they had a guaranteed consumer base. The same thing happened with drugs. Since insurance pays for drugs, and the consumer does not need to be aware of his actual costs, marke-oriented price controls have no bearing. We overutilize because we don't need to do otherwise, thus the supply goes down relative to demand.

 

[Morality Games]

Well, the real problem, underlying the problems you mention, is government mandates starting in the 70's, which make comprehensive coverage mandatory, rather than catastrophic coverage, which is what we used to have for insurance back before that time. This is what eliminated competition for pharmaceuticals and medical providers, because the consumer no longer had any say in determining cost of goods and services. The consumer became a passive recipient, and doctors (and other providers) no longer needed to compete, since they had a guaranteed consumer base. The same thing happened with drugs. Since insurance pays for drugs, and the consumer does not need to be aware of his actual costs, marke-oriented price controls have no bearing. We overutilize because we don't need to do otherwise, thus the supply goes down relative to demand.

... you can pick over every detail you want to make the government responsible for whatever, but bear in mind that before the New Deal employers didn't even supply their employees with group plans they've enjoyed for decades. Roosevelt strong armed them into it. I think a bigger problem would be American companies negotiating fifteen-year licenses to manufacture and sell product with foreign governments for the exclusive right to sell the product, then sticking it to the domestic market to power this expansion while outlawing drug imports.

This obsessive determination to cherry pick data until you create the reality you want really has to stop if America is ever going to make any forward progress on its problems.

 

[lizzie]

... you can pick over every detail you want to make the government responsible for whatever, but bear in mind that before the New Deal employers didn't even supply their employees with group plans they've enjoyed for decades. Roosevelt strong armed them into it. I think a bigger problem would be American companies negotiating fifteen-year licenses to manufacture and sell product with foreign governments for the exclusive right to sell the product, then sticking it to the domestic market to power this expansion while outlawing drug imports.

This obsessive determination to cherry pick data until you create the reality you want really has to stop if America is ever going to make any forward progress on its problems.

It's not a reality that I want. It's the history of what has happened with health insurance and health care in this country, and it's why the costs have skyrocketed. The only way we are going to progress is to face the facts that we overindulge, then we expect it to be taken care of for little cost. That isn't reality. If people don't want to pay high prices for health care, then they are going to have to participate in getting the costs down by their own actions, and try to understand where their own responsibility lies for the problems we have created.

 

[Morality Games]

It's not a reality that I want. It's the history of what has happened with health insurance and health care in this country, and it's why the costs have skyrocketed. The only way we are going to progress is to face the facts that we overindulge, then we expect it to be taken care of for little cost. That isn't reality. If people don't want to pay high prices for health care, then they are going to have to participate in getting the costs down by their own actions, and try to understand where their own responsibility lies for the problems we have created.

That's not history, that's one detail out of a decades spanning history. One of many policy decisions. A detail that suggests a certain message.

History isn't that simple or convenient. It doesn't lend itself to messages in that way.

 

[washunut]

In order of priority, the high costs of medical service in the United States result from:

By a wide margin -- Pharmaceutical companies (lack of competition due to decades spanning global monopolization by industrial-political fiat, treatment-centric research)

Bad, but not nearly as bad -- Medical service providers (hospitals intentionally over paying doctors by obfuscating reputation with talent, guilds manipulating supply and demand)

Distant Third -- Insurance companies (charge more than medical service and equipment is worth in order to make some kind of profit)

I guess people blame insurance because they're the ones who stick you with the bill.

The biggest problem with insurance was less about cost and more about preexisting conditions and caps.

 

[joG]

In order of priority, the high costs of medical service in the United States result from:

By a wide margin -- Pharmaceutical companies (lack of competition due to decades spanning global monopolization by industrial-political fiat, treatment-centric research)

Bad, but not nearly as bad -- Medical service providers (hospitals intentionally over paying doctors by obfuscating reputation with talent, guilds manipulating supply and demand)

Distant Third -- Insurance companies (charge more than medical service and equipment is worth in order to make some kind of profit)

I guess people blame insurance because they're the ones who stick you with the bill.

Do you think it might be the costs of medical care might be do to the fact that medical care is expensive? I mean we are talking long expensive education, costly high tech and horribly cost intensive research. And think of it this way for a minute. We spend less than 10% of gdp on our health. True, it could be less like in Germany or the Uk. But remember, they use medicines developed for the (expensive) US market and are not really very good if you are insured in the private sector and no better, if you are publicly insured.

 

[KevinKohler]

Insurance is an enabler of high medical costs. Without the majority of the population being insured, no one would be able to afford those prices. And then the medical industry must then choose between not selling their services, or making it more affordable.

 

[mak2]

This is correct. Health insurance and health care providers have a synergistic relationship. Kinda like two different parasites sucking us dry, but share with each other. Doctors and hospitals came up with health insurace because they got tired of getting paid in chickens and milk.

Insurance is an enabler of high medical costs. Without the majority of the population being insured, no one would be able to afford those prices. And then the medical industry must then choose between not selling their services, or making it more affordable.

 

[ttwtt78640]

In order of priority, the high costs of medical service in the United States result from:

By a wide margin -- Pharmaceutical companies (lack of competition due to decades spanning global monopolization by industrial-political fiat, treatment-centric research)

Bad, but not nearly as bad -- Medical service providers (hospitals intentionally over paying doctors by obfuscating reputation with talent, guilds manipulating supply and demand)

Distant Third -- Insurance companies (charge more than medical service and equipment is worth in order to make some kind of profit)

I guess people blame insurance because they're the ones who stick you with the bill.

When most folks have insurance, provided by their employer or the gov't, then the actual cost of medical care is no longer important. Those that must buy their own insurance, or pay cash for their care, are a tiny minority (less than 10% of the US population).

If your auto insurance policy covered oil changes, tune-ups and worn parts replacement then those prices would increase. If your homeowners insurance policy covered periodic repainting/re-carpeting, worn out appliance repair/replacement and lawn maintenance then those prices would increase. The biggest problem is that very few actually know, much less pay for, the actual cost of their medical care.

Add to that the mandate that "emergency" care be provided "free" to those unable to pay and you get where we are today. Imagine the affect on ""emergency" auto/home repair costs if the gov't mandated that the poor had to be given "free" service, if they were unable to pay?

 

[SBu]

In order of priority, the high costs of medical service in the United States result from:

By a wide margin -- Pharmaceutical companies (lack of competition due to decades spanning global monopolization by industrial-political fiat, treatment-centric research)

Bad, but not nearly as bad -- Medical service providers (hospitals intentionally over paying doctors by obfuscating reputation with talent, guilds manipulating supply and demand)

Distant Third -- Insurance companies (charge more than medical service and equipment is worth in order to make some kind of profit)

I guess people blame insurance because they're the ones who stick you with the bill.

You, Lizzie, and Ttwtt* are all correct. Many factors leading to where we are today. Cronyism among corporations and government along with cronyism among corporations along with legislation that mandates things that are unaffordable during bouts of aging population. You rightly point out the factors leading to high cost of health care, they have pointed out some things that led to this scenario.

We all see that there are a lot of other factors besides insurance that lead to high health care and that addressing mostly just that issue is at least not very effective and at most possibly harmful. Healthcare reform sounds really good, but not when it involves just one component, thought up and passed by only one party, and passively implemented it probably isn't going to turn out good.

 

[lizzie]

We all see that there are a lot of other factors besides insurance that lead to high health care and that addressing mostly just that issue is at least not very effective and at most possibly harmful. Healthcare reform sounds really good, but not when it involves just one component, thought up and passed by only one party, and passively implemented it probably isn't going to turn out good.

The issue I take with the op, is that is essentially ignores the role that the populace plays in the problem, as if we are just passive ignoramuses who are getting screwed by Big Pharma, Big Medical, and Big Insurance companies. The population has responded to the changes in health care mandates by overutilizing, and running to the doctor for every little sniffle, or taking psychoactive drugs to deal with life as it is. WE are one of the reasons health care costs have skyrocketed, because WE expect great health care for little to no cost. If we had to bear the costs of drugs and doctor's office visits out of our own collective pockets, we would think twice about the money we are spending.

 

[mak2]

Health care is so expensive because in the US medicine is not evidnce based practice, it is profit based. Everything else is a distraction.

The issue I take with the op, is that is essentially ignores the role that the populace plays in the problem, as if we are just passive ignoramuses who are getting screwed by Big Pharma, Big Medical, and Big Insurance companies. The population has responded to the changes in health care mandates by overutilizing, and running to the doctor for every little sniffle, or taking psychoactive drugs to deal with life as it is. WE are one of the reasons health care costs have skyrocketed, because WE expect great health care for little to no cost. If we had to bear the costs of drugs and doctor's office visits out of our own collective pockets, we would think twice about the money we are spending.

 

[SBu]

The issue I take with the op, is that is essentially ignores the role that the populace plays in the problem, as if we are just passive ignoramuses who are getting screwed by Big Pharma, Big Medical, and Big Insurance companies. The population has responded to the changes in health care mandates by overutilizing, and running to the doctor for every little sniffle, or taking psychoactive drugs to deal with life as it is. WE are one of the reasons health care costs have skyrocketed, because WE expect great health care for little to no cost. If we had to bear the costs of drugs and doctor's office visits out of our own collective pockets, we think twice about the money we are spending.

Sure, but unnecessary drug use and procedures skyrockets in a single payer system or systems where insurance covers vast majority of drugs. France has a huge problem with prescription drugs because of their medical system. It is so highly touted by liberals, but they overlook the obvious effects of providing free universal health care which is extremely high taxes (locking the poor and middle classes into their economic class), and a population heavily reliant (addicted) on pain killers, sleep aids, and other mind numbing medications.

France: Prescription pills

Apparently, despite their love of fine wine, the French don’t binge drink like the Brits because they hate hangovers. They do, however, seem to like their tranquilizers, which has led commentators to suggest that the nation may have a surplus of prescription-happy practitioners. It’s undeniable that France has more pharmacies per person than any other European country—23,271 for about 60 million people, almost double the number in the United Kingdom (which has a similar population). France almost topples the US problem with prescription medication abuse by consuming 78 tranquilizers and antidepressants per 1,000 people.

The 10 Most Wasted Countries | Alternet

I guess my point is that, yes, America has problems with prescription drugs, but it is a problem that is shared by every country that has them, and usually worse in countries where they are cheaper (if not free). Also, MG is correct in identifying what essentially boils down to high prices for R&D which leads to great drugs and great medical tools/machines and the cronyism that results in us paying more for these things off the shelve than other countries that buy them (which is a factor, a major one, but certainly not the only one).

Like I said before, everyone is a little correct about what ails our system, and most people are correct that the ACA doesn't really address the problems.