thegreekdog wrote:The history of health insurance is a fascinating one. Health insurance was not invented until the late 19th century and did not evolve into what we know today until the latter part of the 20th century. In any event, health insurance is a concept that begets rising costs. If a company will pay for my medical care, why would my doctor not charge as much as he/she could possibly get paid? And if the government is backing the health insurance, would not costs skyrocket?
That's the theory, but the exact opposite is happening, TGD.
And I'm not defending the Affordable Care Act at all, as you may have seen in my previous posts on the subject. Thinking I am has influenced your admittedly well-written post, and I should have been more clear about that.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.
And your response is going to be "so what, more people are insured." And my response to you is "who cares if people are getting shitty care and it's costing more and more money."
As for the US healthcare industry being "more" free market than other countries' systems and performing worse, my only response is that being less free market than France or the Netherlands does not make it free market. It's like saying Greece is less financially stable than Portugal. Health insurance is highly regulated, true. But that's not where I'm going with this. Where I'm going with this is that there is no incentive for health insurance companies to lower costs because there is no competition. There is no incentive for healthcare providers to lower costs or provide better care because the system, regulated in this fashion by the governments of the vairous states, rewards them for increasing costs. The Affordable Care Act just pours another layer of cement on the problem, making sure that it will be that much harder to provide affordable care to everyone.
One final note - Most people regularly and happily pooh-pooh the concept that anyone can get free medical care. I don't understand the pooh-poohs. From the age of 18 to the age of 25, I did not have health insurance. I regularly received what medical care I desired and for the most part was not charged anything for it. I know there are people that cannot afford health insurance or healthcare, just like I coudn't afford it when I was younger. And I know there are people with preexisting conditions who cannot get health insurance. I have no problem with the government trying to help those people (I would prefer other people help those people without government intervention, which, by the way, already happens at non-profit hospitals). I read the Affordable Care Act and various summaries on the law, and I cannot understand how anyone who can think for themselves thinks this is anything more than a boondoggle for the health insurance industry and something that will, in the long run, greatly hurt healthcare and the fiscal status of the US government to a staggering degree.
EDIT: I'll try to salvage it, however, because you put a lot of time into it.
First off, not every country pays its doctors based on # of treatments, nor must it be that way.
Exhibit 5 of this study counters some of your concerns about state-run healthcare. As I've pointed out above, healthcare spending per capita is much higher here than in other countries. You'd think that we'd be getting at least proportionately more treatments, more examinations and more everything than other countries do as a result, but the fact is utilization rates are similar across the board. The current system is inefficient and I'll display below why a free-market system is also inefficient.
It's often said that the healthcare industry needs more competition, and that removing all restrictions is the way to more competition, which inherently means lower costs apparently (hint: it doesn't).
In fact, however, we can't even assume perfect competition in the healthcare industry (or probably any industry, for that matter). Because companies are not allowed to compete across state lines, market shares for the top health insurance companies are significantly lower than those of other industries (some of the biggest companies like Aetna, UnitedHealth, Humana etc. have around 10 percent market share). But within individual states, we often see one or two companies controlling a 60%+ market share (still relatively low compared to other highly concentrated industries).
With these borders removed, it's quite obvious that these top companies would take larger shares putting the health insurance industry in the state of permanent oligopoly. And oligopoly has proven to be a pretty bad form of competition for consumers (see: cell phone service providers, the media [and not just news, but music, books, nearly everything is in the hands of 7 companies], one can also include the film industry here)