Why our for profit health care system does not work!

[PeteEU]

The government shouldn't be regulating the price for any industry much less drug prices.

I agree somewhat. If the price point is set fairly then sure, but in the case of drugs it cant be. Why? Patents for one.. creating a monopoly for life giving drugs means high prices. There are many problems with no price regulation or supervision when it comes to drugs. Now that of course does not mean that government should dictate prices... we dont do that in Europe for example. What we do, do is to have common sense regulations that protect the consumer. For example a regulation that requires pharmacies and doctors to always prescribe the cheapest drug. Or the fact that, there is a regulator/watch dog that keeps an eye out for price gouging and the punishment is so harsh that no drug company would want to attempt it. Drug companies are free to set their prices as they want, but if they abuse this privilege then there is the ability to punish them. It is stuff like this, that keeps drug prices in Europe in check.. and dont come with that old bull**** right wing crap about the US subsidising the rest of the world.. simply not true.

As far as crony capitalism and governments favoring a particular company or industry over another, I am in full agreement with you that it is a problem, however we have fundamentally different views on how to fix it. I believe reducing the role of Government in an industry is the only way to remove such corruption, you see corruption and believe more government is needed (which only increases corruption, power corrupts and absolute power corrupts absolutely is a truism that many see to have forgotten)

The only reason government should get involved is due to abuses of industry or the private sector...that has always been my view. Problem in the US, is that the government has been infested by the private sector so we basically have an oligolicary and not a democracy. Reducing the role of government wont change that, because all you are doing is allowing the corporations to do what they want at the detriment of the average consumer. Look at what the GOP has been attempting to do by removing regulations on the banks.. regulations put in place because the banks almost bankrupted the US.. wonder where the GOP got that idea?

No, what has to be done is to reclaim government from the corporations and special interests and use government to protect the "little guy", aka the average citizen against abuse by powerful rich people and corporations. Only that way, will the role of government diminish because the abuses of the rich powerful corporations will be in check. The "free market" is piss poor in regulating itself and that is a fact that can be see through out history... check out the early raid road days in the UK and its free market and lack of self regulation.

Now one way of doing that.. a way that even the right wing can accept.. is to promote competition and remove as many barriers to competition that have been put in place on behest of big business. Problem is, it is the US right wing that fights (more than often) against such things.. like opening up the insurance market across the US, allowing imports of drugs from safe countries like Canada and so on and so on. Competition works, and if government is not strong enough or/and independement to secure this competition .. then you basically have the US of A of today.. a nation where many industry sectors are highly inefficient due to industry mandated "regulations" that secure their standing in the market place.. and it is only getting worse with big mergers. Telecommunication, TV/News, and many other industries are becoming more and more an one or two or maybe 3 way market, and that is a problem.

 

[independentusa]

Technological advancement increases quality and reduces costs over time. Sure, at first new technology is expensive but over time new technologies are found raising the quality and lower costs of the previous technology. Large flat screen TV's used to be incredibly expensive, now even those in the poorest of neighborhoods have them as they are more affordable.

Your problem with the cost of new technology in health care is you comparing apples to oranges when it comes to TV's and health care. New TV's come down because of the competition between manufactures.There is no real competition in health care to bring down costs. New technology often increases the cost of services. Something new comes along and all of the local providers of service will buy the equipment. this creates a situation where there is more "product" than need. Thus to pay for the equipment service providers have to jack up the cost of each unit of service to insure a profit level for the new equipment. I can tell you this is one reason for the high cost of American health care.

 

[CriticalThought]

Anyone with a brain has to realize our present for profit health care system does not work and costs way too much. We pay almost twice as much per person as the next country and yet rank something like 37th in the world. We also have millions of people without insurance. I think that we do not really have a health care system. We have providers of service and providers of health care insurance. Both of these providers should be trying to provide the most health care at the least cost. Instead they try to provide the least amount of health care at the highest cost. And why can they do this, because of the lack of competition in health care in this country. When you want to buy a car you go around to several care dealers and get the most car you can afford at the least cost. NO one does that with health care. We either go to the closest doctor who provides the care we need or to one chosen by our insurance company. What we have is one of the most bloated systems which provides some of the worst outcomes in the world. Health care providers want to fully utilize the expensive equipment they buy so they over utilize high cost tests where simpler low cost tests would do as well. Drug companies raise prices a thousand fold to create huge profit levels after we give them monopoly over the drugs they create, without any controls. Our entire system is out of control and our government is doing nothing to correct the problem. Instead the very people we send to congress and the White House take millions of dollars from these drug companies, insuring nothing will be done. Now we are looking at a Medicare for all system. I am not sure it is the answer as it will create a period of time where once again the health care system will be in a huge flux. I do know that something has to be done to fix the problems before the system simply folds under its own bloated weight. Jut so you know I was part of the system for 40 years.

Our private health care system works extraordinarily well. It just doesn't work so well for the people who need affordable health care.

 

[Nap]

Your problem with the cost of new technology in health care is you comparing apples to oranges when it comes to TV's and health care. New TV's come down because of the competition between manufactures.There is no real competition in health care to bring down costs. New technology often increases the cost of services. Something new comes along and all of the local providers of service will buy the equipment. this creates a situation where there is more "product" than need. Thus to pay for the equipment service providers have to jack up the cost of each unit of service to insure a profit level for the new equipment. I can tell you this is one reason for the high cost of American health care.

I have already addressed this issue and agree that the problem in healthcare is primarily due to lack of competition caused by insurance and government.

For instance, there was a man in one of the Carolinas that wanted to open a radiology clinic that provided cheaper MRIs and Catscans but was not allowed to purchase the equipment due to regulations precisely put into place to prevent such competition. Hospitals need the revenue from up charging on items such as MRIs to recoup the money lost on providing ER services to those that can't afford it.

 

[Nap]

I agree somewhat. If the price point is set fairly then sure, but in the case of drugs it cant be. Why? Patents for one.. creating a monopoly for life giving drugs means high prices. There are many problems with no price regulation or supervision when it comes to drugs. Now that of course does not mean that government should dictate prices... we dont do that in Europe for example. What we do, do is to have common sense regulations that protect the consumer. For example a regulation that requires pharmacies and doctors to always prescribe the cheapest drug. Or the fact that, there is a regulator/watch dog that keeps an eye out for price gouging and the punishment is so harsh that no drug company would want to attempt it. Drug companies are free to set their prices as they want, but if they abuse this privilege then there is the ability to punish them. It is stuff like this, that keeps drug prices in Europe in check.. and dont come with that old bull**** right wing crap about the US subsidising the rest of the world.. simply not true.



The only reason government should get involved is due to abuses of industry or the private sector...that has always been my view. Problem in the US, is that the government has been infested by the private sector so we basically have an oligolicary and not a democracy. Reducing the role of government wont change that, because all you are doing is allowing the corporations to do what they want at the detriment of the average consumer. Look at what the GOP has been attempting to do by removing regulations on the banks.. regulations put in place because the banks almost bankrupted the US.. wonder where the GOP got that idea?

No, what has to be done is to reclaim government from the corporations and special interests and use government to protect the "little guy", aka the average citizen against abuse by powerful rich people and corporations. Only that way, will the role of government diminish because the abuses of the rich powerful corporations will be in check. The "free market" is piss poor in regulating itself and that is a fact that can be see through out history... check out the early raid road days in the UK and its free market and lack of self regulation.

Now one way of doing that.. a way that even the right wing can accept.. is to promote competition and remove as many barriers to competition that have been put in place on behest of big business. Problem is, it is the US right wing that fights (more than often) against such things.. like opening up the insurance market across the US, allowing imports of drugs from safe countries like Canada and so on and so on. Competition works, and if government is not strong enough or/and independement to secure this competition .. then you basically have the US of A of today.. a nation where many industry sectors are highly inefficient due to industry mandated "regulations" that secure their standing in the market place.. and it is only getting worse with big mergers. Telecommunication, TV/News, and many other industries are becoming more and more an one or two or maybe 3 way market, and that is a problem.

I agree, the problem is that more government intervention provides more incentive to the private sector which compounds the issue. We need to remove the incentive not create more of it.

 

[independentusa]

I have already addressed this issue and agree that the problem in healthcare is primarily due to lack of competition caused by insurance and government.

For instance, there was a man in one of the Carolinas that wanted to open a radiology clinic that provided cheaper MRIs and Catscans but was not allowed to purchase the equipment due to regulations precisely put into place to prevent such competition. Hospitals need the revenue from up charging on items such as MRIs to recoup the money lost on providing ER services to those that can't afford it.

Having been in the health care system for forty or more years I can tell you that we once had a system that did hold down health care costs to a certain extent. Most people today have never heard of it. It was called regional health care planning. Each state was broken down into regions and a committee was set up to oversee each region. If a health care facility wanted to change or increase services that had capital costs over a certain amount, it was I think $5,000.00, they had to prove to the committee that such a service change was necessary. Let us look at a Cat Scanner. If my facility wanted to put in place a CAT scanner or add another one, we had to show that in our service area that such a piece of equipment was necessary. If it was not, you could still buy one, but you would not be able to charge Medicare or Medicaid for the use of such equipment. This also included service changes that would entail capital costs to set up that exceeded the capital cost limit. What this did was insure that expensive equipment was used at optimal levels and that the least costly method of determining the cause of an illness was being used. So instead of having 5 or 6 CAT scanners in an area being used at 50% capacity and being used for problems that could be determined by less expensive methods we would have maybe one or two being fully utilized. When did this end, by the Reagan Administration when they said that competition would do a better job of holding down costs. That has been proven to be untrue as we can see today.

 

[Nap]

Having been in the health care system for forty or more years I can tell you that we once had a system that did hold down health care costs to a certain extent. Most people today have never heard of it. It was called regional health care planning. Each state was broken down into regions and a committee was set up to oversee each region. If a health care facility wanted to change or increase services that had capital costs over a certain amount, it was I think $5,000.00, they had to prove to the committee that such a service change was necessary. Let us look at a Cat Scanner. If my facility wanted to put in place a CAT scanner or add another one, we had to show that in our service area that such a piece of equipment was necessary. If it was not, you could still buy one, but you would not be able to charge Medicare or Medicaid for the use of such equipment. This also included service changes that would entail capital costs to set up that exceeded the capital cost limit. What this did was insure that expensive equipment was used at optimal levels and that the least costly method of determining the cause of an illness was being used. So instead of having 5 or 6 CAT scanners in an area being used at 50% capacity and being used for problems that could be determined by less expensive methods we would have maybe one or two being fully utilized. When did this end, by the Reagan Administration when they said that competition would do a better job of holding down costs. That has been proven to be untrue as we can see today.

The reason it is untrue today is because there is no competition, something that you have even stated and agree with....

 

[ataraxia]

Correct, and initially these new services are more expensive but as time goes on it becomes cheaper and cheaper. Again the Lasik eye surgery example, the laser is incredibly expensive but as the technology increases to make that laser more available prices come down.

But it seems that over time, the sum total of the technology leads to higher costs, even though the price of individual services keeps going down. The price of diagnosing and treating a cancer today, including MRI imaging, biopsy, pathology report, surgery, chemotherapy, radiation treatment, etc., etc.... is still higher than just tying a tourniquet around someone’s arm and bleeding them into a basin, like they did in the 18th century.

Advancing science and technology is the number one driver of rising healthcare costs. You are never going to have technology prices of treating serious disease be as low as just bleeding someone into a basin. No matter how much prices drop.

 

[ataraxia]

As far as dropping LASIK prices- those prices are still pretty high. And remember this procedure opened up a whole field and sector that was just not offered 20 years ago. The price of one of those lasers that perform the surgery is currently about half a about half a million dollars each. This is not including the cost of the surgeon, facilities, or technicians operating the system. No matter how low the price of LASIK eventually drops, it is still an additional cost in the system.

 

[independentusa]

But it seems that over time, the sum total of the technology leads to higher costs, even though the price of individual services keeps going down. The price of diagnosing and treating a cancer today, including MRI imaging, biopsy, pathology report, surgery, chemotherapy, radiation treatment, etc., etc.... is still higher than just tying a tourniquet around someone’s arm and bleeding them into a basin, like they did in the 18th century.

Advancing science and technology is the number one driver of rising healthcare costs. You are never going to have technology prices of treating serious disease be as low as just bleeding someone into a basin. No matter how much prices drop.

Yes, the price of health care does continue to go, but it is the rate of increase that is the problem. When a company can buy the rights to a drug and then raises the price by several thousand percent, that in any other market would be considered gauging. Our government who is supposed to protect us from monopolies seems to do nothing as they receive part of the benefit from that kind of transaction through campaign donations. The problem with having the health care system for profit, is that every stage of developing and providing a new service, everyone has to add to the cost by getting their share of the profits. And without competition, there is nothing in our market system to control the rising costs plus profits when it comes to the final price.

 

[Nap]

But it seems that over time, the sum total of the technology leads to higher costs, even though the price of individual services keeps going down. The price of diagnosing and treating a cancer today, including MRI imaging, biopsy, pathology report, surgery, chemotherapy, radiation treatment, etc., etc.... is still higher than just tying a tourniquet around someone’s arm and bleeding them into a basin, like they did in the 18th century.

Advancing science and technology is the number one driver of rising healthcare costs. You are never going to have technology prices of treating serious disease be as low as just bleeding someone into a basin. No matter how much prices drop.

Yes, the sum total of technology over time is going to be the primary driver due to increased life spans and quality of care when comparing it to 18th century medicine. However, that isn't the primary driver of why prices are so high today in comparison to what they could be. For instance, the technology to build something capable of doing an MRI has gone down over time but instead of the cost for the consumer going down the prices are rising. Think about the size and price of a computer from the 70s and 80s and how we now have something with drastically more computing power in our pockets at a fraction of the cost or what they were then.

 

[Nap]

As far as dropping LASIK prices- those prices are still pretty high. And remember this procedure opened up a whole field and sector that was just not offered 20 years ago. The price of one of those lasers that perform the surgery is currently about half a about half a million dollars each. This is not including the cost of the surgeon, facilities, or technicians operating the system. No matter how low the price of LASIK eventually drops, it is still an additional cost in the system.

Correct, but that cost has come down considerably over time as technology has made it more available. Lasik was once over 10k per eye and now you can have it done for 1-3k per eye.

 

[Nap]

Yes, the price of health care does continue to go, but it is the rate of increase that is the problem. When a company can buy the rights to a drug and then raises the price by several thousand percent, that in any other market would be considered gauging. Our government who is supposed to protect us from monopolies seems to do nothing as they receive part of the benefit from that kind of transaction through campaign donations. The problem with having the health care system for profit, is that every stage of developing and providing a new service, everyone has to add to the cost by getting their share of the profits. And without competition, there is nothing in our market system to control the rising costs plus profits when it comes to the final price.

The problem with your analysis is that without the profit motive you would see drastically less innovation as there would be nothing to gain other than notoriety and that doesn't feed your family.

 

[Fruityfact]

Correct, but that cost has come down considerably over time as technology has made it more available. Lasik was once over 10k per eye and now you can have it done for 1-3k per eye.

The often sighted Lasik example is actually a counter example to the point you think you're trying to make. Lasik is an optional procedure. The healthcare that is expensive, and a monetary burden on society is not. The freemarket works great for goods that are elastic(optional eye procedures are a great example). It works terribly for inelastic goods(think life saving healthcare)

 

[Checkerboard Strangler]

Anyone with a brain has to realize our present for profit health care system does not work and costs way too much. We pay almost twice as much per person as the next country and yet rank something like 37th in the world. We also have millions of people without insurance. I think that we do not really have a health care system. We have providers of service and providers of health care insurance.

Have you ever heard of a man named Wendell Potter?
Potter is a former CIGNA executive who suffered a crisis of conscience after seeing a touring free clinic run by Remote Area Medical in rural Virginia:

"What he saw appalled him. Hundreds of desperate people, most without any medical insurance, descended on the clinic from out of the hills. People queued in long lines to have the most basic medical procedures carried out free of charge. Some had driven more than 200 miles from Georgia. Many were treated in the open air. Potter took pictures of patients lying on trolleys on rain-soaked pavements."

The fact is, our for profit health insurance infrastructure is designed by nature to profit by DENYING health care as much as possible, and by promoting not cures, but "symptom management" instead.

This is the main reason why I oppose privatizing the VA Health Care System, because despite its many bureaucratic issues and failings, the fact is, the VA has steadily been improving over the years and they are committed to cure and rehabilitation, and they address many veteran health issues which would not be seen as profitable in the free market medical world.

A kidney patient (like my wife, for instance) isn't profitable unless they are on dialysis. Lithotripsy surgeries are not profitable, dialysis is. It is better from a fiscal point of view for insurance to cover dialysis than it is to offer a patient multiple surgeries to correct the condition. Furthermore, dialysis patients are essentially "circling the drain" from Day One, so they die sooner.

 

[Nap]

The often sighted Lasik example is actually a counter example to the point you think you're trying to make. Lasik is an optional procedure. The healthcare that is expensive, and a monetary burden on society is not. The freemarket works great for goods that are elastic(optional eye procedures are a great example). It works terribly for inelastic goods(think life saving healthcare)

That was precisely my point that Lasik was an elective surgery which meant that it wasn't heavily regulated nor covered by insurance which is why the price has substantially dropped over the last 15 years. Life saving or not, it is still a medical procedure that requires a Doctor and more intensive than simply having an MRI done.

 

[ataraxia]

The often sighted Lasik example is actually a counter example to the point you think you're trying to make. Lasik is an optional procedure. The healthcare that is expensive, and a monetary burden on society is not. The freemarket works great for goods that are elastic(optional eye procedures are a great example). It works terribly for inelastic goods(think life saving healthcare)

Yes. For example, Lamborghini cars are expensive. They have always been expensive. I'm pretty sure they will always be expensive. It's on the free market, but I don't see their price dropping over time anytime soon. They are high quality, with a lot of meticulous attention to detail in building them. Not everyone can afford one.

Cancer treatment is also very expensive. It has to be very high quality, with a lot of meticulous attention to detail in delivering it. I don't see that changing any time soon.

But if someone can't afford a Lamborghini, that's OK. We don't cry for them. Very few of us can. Let them buy a Chevy. If not that either, they can just take their bicycle.

But if a young child gets diagnosed with high grade brain cancer and their parents are not well off enough to afford all the testing and treatment, it's a very different story, isn't it? It's much harder to just shrug it off. Without it, people are left facing situations that their most basic human dignity is crushed. They are left facing situations no human being in the modern world should have to face, no matter how poor their circumstances.

That's why healthcare is not a commodity that can be just left up to the free market like cars or watches, or even LASIK surgery or nose jobs and boob jobs.

That's why the Universal Declaration of Human Rights, spearheaded by the US in 1948, outlines what they call basic "human rights" that governments should do their best to try to uphold: food, clean water, shelter, access to healthcare, and a basic education. Remember this was written after the horrors of WWII, and was meant to avert what they saw as some of the injustices and extremes of suffering which led to such desperate and tragic times. It was the realization that without these rights being protected, regardless of their financial situation, with people having to face those inhumane circumstances, desperation was going to lead them to do some pretty crazy things.

I think we would be wise not to forget such hard-earned lessons of our forebears.

 

[ataraxia]

That was precisely my point that Lasik was an elective surgery which meant that it wasn't heavily regulated nor covered by insurance which is why the price has substantially dropped over the last 15 years. Life saving or not, it is still a medical procedure that requires a Doctor and more intensive than simply having an MRI done.

Building the MRI by the engineers, and reading the results by radiologists, is pretty meticulous, intensive, and high stakes work. These are pretty high tech devices. And think about the stakes of missing a tiny subtle area of cancer in the brain in the corner of one of the films- or perhaps worse yet, calling a funny-looking area cancer when it's really not.

 

[independentusa]

The problem with your analysis is that without the profit motive you would see drastically less innovation as there would be nothing to gain other than notoriety and that doesn't feed your family.

In a cost benefit analysis, the cost of the profit motive far out weighs the benefits. And do you really think that companies won't continue to do R&D< I don't. To stay in business they may have to do more rather than less.they can not just produce a new product and live for years off of their ability to overprice thei product.

 

[Checkerboard Strangler]

That was precisely my point that Lasik was an elective surgery which meant that it wasn't heavily regulated nor covered by insurance which is why the price has substantially dropped over the last 15 years. Life saving or not, it is still a medical procedure that requires a Doctor and more intensive than simply having an MRI done.

Sorry but you can't just hide behind a statement like "lifesaving or not" because it IS "or not" and by that I mean, it is accounted for differently and sold differently, and paid for differently. Every aspect of elective surgery is different.

You cannot "deregulate" cardiac bypass surgery" the way you deregulate Lasik.

 

[Checkerboard Strangler]

Yes. For example, Lamborghini cars are expensive. They have always been expensive. I'm pretty sure they will always be expensive. It's on the free market, but I don't see their price dropping over time anytime soon. They are high quality, with a lot of meticulous attention to detail in building them. Not everyone can afford one.

Cancer treatment is also very expensive. It has to be very high quality, with a lot of meticulous attention to detail in delivering it. I don't see that changing any time soon.

But if someone can't afford a Lamborghini, that's OK. We don't cry for them. Very few of us can. Let them buy a Chevy. If not that either, they can just take their bicycle.

We are currently paying Lambo prices for Chevy grade drugs, services and care.

 

[imagep]

We have two major issues driving up healthcare costs, insurance and government. Like you stated, when you have no competition due to not being able to compare prices you are going to get inflated prices.

Also, if you look at the industries with the highest rising costs (healthcare, housing, education) it is typically going to be those that are more regulated. When a free market is allowed to work outside of government intervention, quality goes up and costs come down. For instance, Lasik eye surgery is an elective surgery thus it is not heavily regulated and insurances don't cover it forcing the consumers to shop around for it should they choose to have it done. In the last 15 years the prices have plummeted from 10k per eye to 1-3k per eye and as long as the government stays out of it then it will continue to drop as the technology becomes cheaper and more accessible as with every other industry.

I've been saying that for years, but even self proclaimed libertarians often don't agree that less insurance is the answer. Our population has been brain washed into believing that the only way they can pay for health care is through insurance, and most people believe that insurance saves them money.

The perfect example of this is the fact that health insurance is often referred to has "health care" (ie "I get my healthcare from the government" says someone who is on medicare or medicaid), they don't get healthcare from the government, they get health insurance from the government.

 

[imagep]

The government can't run a healthcare system that serves 9 million people. How the hell is it going to run a system that serves 350 million?

Thats why I don't support socialized health care. However, I do support socialized health insurance.

 

[Checkerboard Strangler]

I've been saying that for years, but even self proclaimed libertarians often don't agree that less insurance is the answer. Our population has been brain washed into believing that the only way they can pay for health care is through insurance, and most people believe that insurance saves them money.

The perfect example of this is the fact that health insurance is often referred to has "health care" (ie "I get my healthcare from the government" says someone who is on medicare or medicaid), they don't get healthcare from the government, they get health insurance from the government.

Of course that didn't stop political apologist Frank Luntz from crafting the slogan "government takeover of health care", did it?

 

[Fruityfact]

That was precisely my point that Lasik was an elective surgery which meant that it wasn't heavily regulated nor covered by insurance which is why the price has substantially dropped over the last 15 years. Life saving or not, it is still a medical procedure that requires a Doctor and more intensive than simply having an MRI done.

*Whoosh*