re: Facts on Health Care

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onmymedicalgrind

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[PM]Derailed for PM. What's going these days? Are you still in residency? And how are you enjoying the PAC NW? Good to see you back on here. [/PM]

Yea, pretty much most days suck, just different degradations of suckage. Im told it will pay off......umm I'll keep u posted on that

I do miss laughing at the typical PBer though, I cant lie.

Thanks for your thoughtful, well-informed responses. A couple of points:

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I have never met someone that chose to get cancer, have a genetic heart condition, or get hit by a bus. The basic premise alone is problematic, which frames health care mostly as a choice and talks about problems mainly through that prism. Which very often it is not. You do not get to choose your genetics or when you become the victim of an accident. Get to chose that you were born in an area where a factory polluted the air and gave you health problems but the systems that be were unable to adequately deliver compensation to cover the costs.

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My takeaway from his post was not to treat EVERY medical condition as 'mostly a choice', but to differentiate between those pre-determined by genetics or birth environment and those that are directly caused (or at least exacerbated) by personal behaviors - in his example, Type II diabetics continuing to act against medical advice and make dietary and lifestyle choices that effectively counteract their treatments shouldn't be covered at the same cost as Type I diabetics who were born with the disease. And two of your examples (getting cancer and getting hit by a bus) are still low-probability events that are greatly influenced by individual behavior, i.e. choosing to smoke knowing the increased risk of lung cancer, or playing Pokemon Go during rush hour traffic in a major city.

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The author cherry picks the entry level prices from a primary physician only business in Michigan. while ignoring the entire dynamic of how pricing in healthcare(or any market) works(and the fact the website markets their cheapest price and clouds the rest). Prices are largely dependent on local market dynamics and the monopoly power in an area. There is this under current that I guess by some magic, if we get rid of most insurance and government spending on healthcare and force all care providers to provide care at the same rates, with no downward control pressures like other countries, that magically rural Alaska will be able to charge the same price for care as one place in Michigan, or that all prices will look like that cherry picked price list.

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The larger point the author makes is that most medical providers are not required to indicate their charges at all - unlike pretty much every other business in the US. And that while it's highly likely that the price for a particular service or medication will be significantly higher in Alaska than in Michigan, the objection is that the charge for the identical service or drug will vary widely at the SAME practice in each state, based entirely on who is providing payment. Subjecting health providers to the same consumer protection requirements as, say, auto mechanics, should be the cornerstone of any real healthcare reform proposal.

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Just because a person's probability to get any one type of disease is low, the combined probability of any sort of catastrophe or health problem is much higher. Furthermore, for the vast majority of health issues, a person can not predict what he will or will not acquire.

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I can confidently predict at least two things with 100 certainty: at some point, I will die (p=1.0). And as a male, I will never give birth (p=0.0). It would be just as ridiculous for a healthcare policy to insure me, as an individual, against either possibility. The US health care system as presently constituted seems to ignore both realities (how many trillions of taxpayer dollars have been spent on Medicare expenses for people who will die anyway, even with the treatments? And what percentage of my premium goes for birth control, pre-natal care, and labor and delivery coverage that I will never need?)

In the end, I imagine that the Feds will have to take over the entire high-risk pool side of the equation, at a great cost - perhaps creating a 'public option' for pre-existing conditions. However, opening the rest of the market up to legitimate competition, and allowing healthy individuals to seek lower priced options (like paying out of pocket for routine services, and covering low-priority events with inexpensive catastrophic coverage, similar to the old 'major medical' policies outlawed by the ACA) seems like the best way forward.

One final question - if you've spent any additional time on the author's site, you will note that he has been pointing out what he believes is an unsustainable rise in Federal outlays for healthcare for many years. If you haven't looked beyond the link in the OP, here's a nice collection of his previous posts on the subject.

My question is this: do you disagree with his assessment that failure to radically lower the percentage of Federal and state budgets devoted to healthcare (mostly Medicare/Medicaid) will ultimately result in economic and political collapse? And if so, what is the basis of your belief that we will somehow be able to outrun the math absent significant, politically unpopular changes?