ObamaCare - exchanges ,report your states options!

[Phatscotty]

Question: what does frer market healthcare look like? (High level question)

I don't know. Health care, in general, has never experienced the free market, not in my lifetime. My grandpa tells me stories though, about my 5 other aunts and uncles.

They just paid the doctor the money when they needed the doctor.

[Lootifer]

Question: what does frer market healthcare look like? (High level question)

I don't know. Health care, in general, has never experienced the free market, not in my lifetime. My grandpa tells me stories though, about my 5 other aunts and uncles.

They just paid the doctor the money when they needed the doctor.

The real cost of healthcare has risen significantly with time, even in a single generation (dont confuse this with the price, price is what the butchered distorted system pops out - the $8000/p.a. or whatever number gets thrown around).

This is because healthcare has become far more complex and requires more raw materials (doctors/nurses work-hours, doctors/nurses training time, more cost-intensive equipment and more cost-intensive medicine). This is ok because the results are far better, we now live longer healthier lives.

In your Grandads time you could just pay the doctor for your annual cold and occasional spained ankle; however if you tore the miniscus in you knee, sorry bucko, you were given a crutch and declared "lame". Now we dont have to put up with that, we can get surgery and fix that up; however the real cost of the fix isnt cheap, and likely to be beyond the means of 90% of the population (the surgery I had at the beginning of the year would have been in the tens of thousands of dollars order of magnitude) - hell likely even more; not many have a spare couple of thousand to spend on a treatment which in the old days we may have just put up with for the rest of our lives.

Thats where the insurance and socialised models have evolved from. Healthcare isnt cheap; however not everyone needs it. Apart from the elderly not everyone will need a horribly expensive major surgery during their normal year to year life. So insurance is just a form of socialisation under the guise of a "free market" tag - as Doom says, the real free market would be user pays.

Now in reality the true free market option would almost be unanimously rejected by the population. Only the true Libatarian stalwarts like BBS would fight for it;

The moderate libatarians would likely offer some kind of coupon type deal (I think Friedmans' education policy is one such example, though cant remember off the top of my head - not sure if it would work in Healthcare - education is cheap in comparison).

[kentington]

I don't know what system would work. All I know is that if I had to pay for the treatments of the kidney stone out of pocket, then I would have need to just die instead. It wasn't coming out on its own.

[AndyDufresne]

I don't know what system would work. All I know is that if I had to pay for the treatments of the kidney stone out of pocket, then I would have need to just die instead. It wasn't coming out on its own.

Kentington, you could have always gone to a nice low-cost private surgeon.




--Andy

[DoomYoshi]

I don't know what system would work. All I know is that if I had to pay for the treatments of the kidney stone out of pocket, then I would have need to just die instead. It wasn't coming out on its own.

The prices are only so high because of market manipulation.

[Metsfanmax]

I don't know what system would work. All I know is that if I had to pay for the treatments of the kidney stone out of pocket, then I would have need to just die instead. It wasn't coming out on its own.

Kentington, you could have always gone to a nice low-cost private surgeon.




--Andy

Who wouldn't trust this guy?

[Night Strike]

Stuff that NS may have missed- the doctor is 67 years old, so well past retirement, I doubt that healthcare reform is why he's shutting down.

But then again, we have the patient addicted to prescription strength cough syrup to think about:

"Oh, I was shocked. I guess it's due to this Obama healthcare deal," says Jean Borgmeyer, a patient of nearly 30 years.

"Unfortunately, it's sad every day, because we get reminded, dealing with the patients," Deckard says.

"Now, I have to find a doctor, and I'll never find another one like him that you can call and get a prescription for cough syrup," says Borgmeyer.

Hmm. This sounds a bit dodgy to me.

Stuff that Symmetry did miss - the primary doctor had a younger colleague who probably could have kept on the private practice and continued serving many of the primary doctor's patients after he retired if the massive regulations hadn't been dictated from above.

[Lootifer]

I don't know what system would work. All I know is that if I had to pay for the treatments of the kidney stone out of pocket, then I would have need to just die instead. It wasn't coming out on its own.

The prices are only so high because of market manipulation.

That's on partly true. And a small part at that.

The major reason removing a kidney stone costs a lot is because you need to pay for (numbers are illustrative only), say, 4 hours of two exceptionally trained individuals, 4 hours usage rental of incredibly specialised equipment, a vertible army of support staff and a cache of medical supplies and drugs that would make hunter s proud.

Yes there is some significant distortion going on in all healthcare systems around the world. But that's only a fraction of the end user costs.

[thegreekdog]

Question: what does frer market healthcare look like? (High level question)

A free market healthcare system, for me, is one in which health insurance companies exist sort of like tornado insurance companies - get it if you want, but if you don't, you should be able to pay for the storm damage or risk no storm coming.

All kidding aside, I think I would like to see a situation where medical doctors practice without many restrictions imposed by health insurance companies (e.g. if my head hurts and I want to see a headache specialist, I have to go to three different doctors). I would like to see a situation where charitable hospitals are the norm. Basically, I want to go back to the healthcare economic model of the early 20th century. I go to the doctor, I pay him $100 or whatever I feel like paying him, he checks me out, and sends me on my way. Later that day, he goes to Mary Mother of Mercy Hospital (or Beth Israel if that's your thing) and checks out some people who can't afford to pay him $100.

And the reason that details are not available for this kind of plan is that it will never happen. There are too many people invested in our current system: health insurance companies, for-profit hospitals, non-profit hospitals, doctors, nurses, malpractice insurance, attorneys, etc.

[jj3044]

A free market healthcare system, for me, is one in which health insurance companies exist sort of like tornado insurance companies - get it if you want, but if you don't, you should be able to pay for the storm damage or risk no storm coming.

The problem with this is that the Hippocratic Oath that the doctors pledge won't allow them to just walk-on-by someone who needs help. We would end up worse off because no one would pay, because the doctors would treat the patients simply because they have a conscience.

[thegreekdog]

A free market healthcare system, for me, is one in which health insurance companies exist sort of like tornado insurance companies - get it if you want, but if you don't, you should be able to pay for the storm damage or risk no storm coming.

The problem with this is that the Hippocratic Oath that the doctors pledge won't allow them to just walk-on-by someone who needs help. We would end up worse off because no one would pay, because the doctors would treat the patients simply because they have a conscience.

Why would we end up worse off?

And yes, the Hippocratic oath is very important in my free market system.

[Symmetry]

Stuff that NS may have missed- the doctor is 67 years old, so well past retirement, I doubt that healthcare reform is why he's shutting down.

But then again, we have the patient addicted to prescription strength cough syrup to think about:

"Oh, I was shocked. I guess it's due to this Obama healthcare deal," says Jean Borgmeyer, a patient of nearly 30 years.

"Unfortunately, it's sad every day, because we get reminded, dealing with the patients," Deckard says.

"Now, I have to find a doctor, and I'll never find another one like him that you can call and get a prescription for cough syrup," says Borgmeyer.

Hmm. This sounds a bit dodgy to me.

Stuff that Symmetry did miss - the primary doctor had a younger colleague who probably could have kept on the private practice and continued serving many of the primary doctor's patients after he retired if the massive regulations hadn't been dictated from above.

I didn't miss that part, it seemed kind of wishful thinking after the fact that the dude was past retirement and clearly dishing out cough syrup to addicts.65

I hope that the younger colleague sets up his own, junkie free, business.

[Phatscotty]

[kentington]

I don't know what system would work. All I know is that if I had to pay for the treatments of the kidney stone out of pocket, then I would have need to just die instead. It wasn't coming out on its own.

Kentington, you could have always gone to a nice low-cost private surgeon.




--Andy

As long as I don't catch his cold.

[kentington]

I don't know what system would work. All I know is that if I had to pay for the treatments of the kidney stone out of pocket, then I would have need to just die instead. It wasn't coming out on its own.

The prices are only so high because of market manipulation.

That's on partly true. And a small part at that.

The major reason removing a kidney stone costs a lot is because you need to pay for (numbers are illustrative only), say, 4 hours of two exceptionally trained individuals, 4 hours usage rental of incredibly specialised equipment, a vertible army of support staff and a cache of medical supplies and drugs that would make hunter s proud.

Yes there is some significant distortion going on in all healthcare systems around the world. But that's only a fraction of the end user costs.

You are right. Only there were four people who were trained in there with me. Two hospital visits and one out patient surgery building visit. I went in to the hospital and found out I had an 8mm kidney stone. They did blood work, used countless one use only items. Ultrasound, CAT scan. Had a urologist come in from his other office. He put me under and put a stent in. (Let me tell you that is one of the worst things). Then a couple of weeks later, back to the hospital for Lithotripsy, where they shoot a bunch of sound waves on your kidney and pray it doesn't do long term damage. Then you pass all of the little stones and go back to remove the stent. In my opinion this should be a costly endeavor. I would feel really bad if I only had to pay $5 for a guy to put me under and stick a tube in me and tie knots in it.

[Phatscotty]

the prices of anything health related are too high because of government intervention. Everything the government touches explodes in price (tuition, real estate, school lunches, food)

On the other hand, the free market has a strong track record of lowering prices, and maximizing freedom and liberty

[Symmetry]

the prices of anything health related are too high because of government intervention. Everything the government touches explodes in price (tuition, real estate, school lunches, food)

On the other hand, the free market has a strong track record of lowering prices, and maximizing freedom and liberty

Huh, you kind of left out the evidence in that post. I'd like to look at your strong track record, if you're ok to display.

[Night Strike]

the prices of anything health related are too high because of government intervention. Everything the government touches explodes in price (tuition, real estate, school lunches, food)

On the other hand, the free market has a strong track record of lowering prices, and maximizing freedom and liberty

Huh, you kind of left out the evidence in that post. I'd like to look at your strong track record, if you're ok to display.

Doctors are required to do several different tests, even if they know the tests are unnecessary, in order to avoid being sued if something goes wrong. The government has either forced such tests to happen or allows people to sue for any reason, regardless of merit. The government doesn't let people buy insurance policies across state lines, so people are stuck buying whatever minimum coverage their state mandates instead of buying the best product for themselves (which is the basis of the free market). When the government DOES get involved in paying for medical care, they don't pay the doctors full market prices for the work, so they have to charge private purchasers more in order to make up the difference.

[Symmetry]

the prices of anything health related are too high because of government intervention. Everything the government touches explodes in price (tuition, real estate, school lunches, food)

On the other hand, the free market has a strong track record of lowering prices, and maximizing freedom and liberty

Huh, you kind of left out the evidence in that post. I'd like to look at your strong track record, if you're ok to display.

Doctors are required to do several different tests, even if they know the tests are unnecessary, in order to avoid being sued if something goes wrong. The government has either forced such tests to happen or allows people to sue for any reason, regardless of merit. The government doesn't let people buy insurance policies across state lines, so people are stuck buying whatever minimum coverage their state mandates instead of buying the best product for themselves (which is the basis of the free market). When the government DOES get involved in paying for medical care, they don't pay the doctors full market prices for the work, so they have to charge private purchasers more in order to make up the difference.

You seem to have left out the evidence I was asking for, and replaced it with a weird rant about how you think things are.

I would advise reading this

McAllen, Texas and the high cost of healthcare

It's pretty dismissive of the "fear of getting sued" argument that you propose. Indeed, it points out that medical malpractice suits are largely an irrelevant excuse.

One night, I went to dinner with six McAllen doctors. All were what you would call bread-and-butter physicians: busy, full-time, private-practice doctors who work from seven in the morning to seven at night and sometimes later, their waiting rooms teeming and their desks stacked with medical charts to review.

Some were dubious when I told them that McAllen was the country’s most expensive place for health care. I gave them the spending data from Medicare. In 1992, in the McAllen market, the average cost per Medicare enrollee was $4,891, almost exactly the national average. But since then, year after year, McAllen’s health costs have grown faster than any other market in the country, ultimately soaring by more than ten thousand dollars per person.

“Maybe the service is better here,” the cardiologist suggested. People can be seen faster and get their tests more readily, he said.

Others were skeptical. “I don’t think that explains the costs he’s talking about,” the general surgeon said.

“It’s malpractice,” a family physician who had practiced here for thirty-three years said.

“McAllen is legal hell,” the cardiologist agreed. Doctors order unnecessary tests just to protect themselves, he said. Everyone thought the lawyers here were worse than elsewhere.

That explanation puzzled me. Several years ago, Texas passed a tough malpractice law that capped pain-and-suffering awards at two hundred and fifty thousand dollars. Didn’t lawsuits go down?

“Practically to zero,” the cardiologist admitted.

“Come on,” the general surgeon finally said. “We all know these arguments are bullshit. There is overutilization here, pure and simple.” Doctors, he said, were racking up charges with extra tests, services, and procedures.

[thegreekdog]

Several years ago, Texas passed a tough malpractice law that capped pain-and-suffering awards at two hundred and fifty thousand dollars.

[Symmetry]

Several years ago, Texas passed a tough malpractice law that capped pain-and-suffering awards at two hundred and fifty thousand dollars.

I didn't write that, Atul Gawande did, and the full quote is:

Others were skeptical. “I don’t think that explains the costs he’s talking about,” the general surgeon said.

“It’s malpractice,” a family physician who had practiced here for thirty-three years said.

“McAllen is legal hell,” the cardiologist agreed. Doctors order unnecessary tests just to protect themselves, he said. Everyone thought the lawyers here were worse than elsewhere.

That explanation puzzled me. Several years ago, Texas passed a tough malpractice law that capped pain-and-suffering awards at two hundred and fifty thousand dollars. Didn’t lawsuits go down?

“Practically to zero,” the cardiologist admitted.

“Come on,” the general surgeon finally said. “We all know these arguments are bullshit. There is overutilization here, pure and simple.” Doctors, he said, were racking up charges with extra tests, services, and procedures.

[thegreekdog]

Several years ago, Texas passed a tough malpractice law that capped pain-and-suffering awards at two hundred and fifty thousand dollars.

I didn't write that, Atul Gawande did, and the full quote is:

Others were skeptical. “I don’t think that explains the costs he’s talking about,” the general surgeon said.

“It’s malpractice,” a family physician who had practiced here for thirty-three years said.

“McAllen is legal hell,” the cardiologist agreed. Doctors order unnecessary tests just to protect themselves, he said. Everyone thought the lawyers here were worse than elsewhere.

That explanation puzzled me. Several years ago, Texas passed a tough malpractice law that capped pain-and-suffering awards at two hundred and fifty thousand dollars. Didn’t lawsuits go down?

“Practically to zero,” the cardiologist admitted.

“Come on,” the general surgeon finally said. “We all know these arguments are bullshit. There is overutilization here, pure and simple.” Doctors, he said, were racking up charges with extra tests, services, and procedures.

I know, I read it. Texas is not all states, nor representative of all states.

[Lootifer]

the prices of anything health related are too high because of government intervention. Everything the government touches explodes in price (tuition, real estate, school lunches, food)

On the other hand, the free market has a strong track record of lowering prices, and maximizing freedom and liberty

Shortsighted and narrow views like this is the single reason I argue with you so strongly PS (you often call it trolling). Your post looks as though you didnt read a single word I said on the previous page.

[jj3044]

Healthcare costs increased substantially, as a percentage of GDP from 1968 to 2008. Why? I'm sure the growing number of obese people and increases in the average age of our population had much to do with it. But one would think technological advancement would breed less need to spend money on healthcare. There are a number of studies showing what drives healthcare costs in the US. Such factors include increase utiliation of health insurance created by increased consumer demand (which will only increase now that we have "free" health insurance), new treatments, and more intensive diagnostic screening. Other researchers indicated that healthcare providers are rewarded for treating and testing patients rather than curing them. None of these cost factors are helped by the Affordable Care Act.

Healthcare costs increased also DUE to technological advance. 200 years ago, if you had cancer, you'd never find out and simply die. No cost. 30 years ago if you had cancer, they put you and a machine that radiates a very large part of your body and your survival chances increased tremendously, but it did cost a lot of money and the therapy also damaged healthy tissue. Of course you would now get older and... the older we get the more healthcare we need (simple math plus older people generally need more healthcare than younger people). Nowadays we have machines that can treat tumors with pinpoint precision. Higher chances of survival and less damage to healthy tissue but... exponentially more expensive as these high precision machines can cost in excess of $1 million each. The mere fact that we can now discover more and more diseases/ailments and also treat them lease to higher healthcare cost.

Speaking of people putting words in other people's mouths... I never wrote that quote above.

[Symmetry]

Several years ago, Texas passed a tough malpractice law that capped pain-and-suffering awards at two hundred and fifty thousand dollars.

I didn't write that, Atul Gawande did, and the full quote is:

Others were skeptical. “I don’t think that explains the costs he’s talking about,” the general surgeon said.

“It’s malpractice,” a family physician who had practiced here for thirty-three years said.

“McAllen is legal hell,” the cardiologist agreed. Doctors order unnecessary tests just to protect themselves, he said. Everyone thought the lawyers here were worse than elsewhere.

That explanation puzzled me. Several years ago, Texas passed a tough malpractice law that capped pain-and-suffering awards at two hundred and fifty thousand dollars. Didn’t lawsuits go down?

“Practically to zero,” the cardiologist admitted.

“Come on,” the general surgeon finally said. “We all know these arguments are bullshit. There is overutilization here, pure and simple.” Doctors, he said, were racking up charges with extra tests, services, and procedures.

I know, I read it. Texas is not all states, nor representative of all states.

It's not really about Texas, it's about the second most expensive county for healthcare in the US. Hint- lawsuits ain't the problem.