re: Why does the healthcare debate essentially revolve around like 4% of Americans?

It's not that I don't know what a risk is, it's that I find I disagree fundamentally with the notion of treating healthcare as a commodity. You mention correctly that healthcare systems that guarantee insurance (and I'll concede that the definition here is flexible) maintain solvency by denying care. Of course! This is necessary and good. We get too much bad and high-priced care.

My point was that guaranteed issue creates incentives for more cost control and denying terrible and expensive care. We need more of that.

Here's Atul Gawande who explains it much better than me:

overkill

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The 4 percent that fall into the position you described need just one family member ( or themselves) to work for a larger company and poof....or existing conditions don't matter. Total rehaul of a system for such a small group of people was dumb. He give could have paid cash for those people and it would have been better than what we got. Everyone knows the gift plan is aweful. So what solution do you propose? More government. Brilliant.

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There's no way around it. There's no healthcare system in the world that provides widespread access without government tightly regulating the market.

The point of the reform isn't just to be kind to the unfortunate few that fall in the cracks, it's that having people who are guaranteed emergency care but lack access to other care increases costs for everyone because people get more high-price ED and ICU care and less cheap primary care. Those cost increases drive healthy people out of the market, costs up and up, and onto a death spiral.

Some people advocate repealing EMTALA and wallet-biopsying every person who comes into a medical facility but this won't be politically tenable. If we're going to provide emergency/stablization level care it doesn't make sense not to provide primary/preventative care.

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I disagree fundamentally with the notion of treating healthcare as a commodity.

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No. you don't! And you prove it by turning PTs that can't pay away.

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You mention correctly that healthcare systems that guarantee insurance (and I'll concede that the definition here is flexible) maintain solvency by denying care.

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All systems that depend on OPM (other people's money) will deny care. He who pays decides what gets paid for. The construct of "the system" makes no difference.

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My point was that guaranteed issue creates incentives for more cost control and denying terrible and expensive care.

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It does no such thing. It ensures that terminal PTs get as much futile care as they demand. Providers don't care if it's effective care or not. The carrier pays either way.

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Let's try this again. Shall we?

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Gpu should add age. Our population got a lot older during that time span, while others were stable.

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No. you don't! And you prove it by turning PTs that can't pay away.

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This is a silly criticism. I practice in the system we have. I donate, volunteer, and advocate for healthcare reform that would improve access for the people who want care. I'd get paid less and I'd be more than happy to trade what I have now.

We agree on OPM, but I disagree that the construct of the system makes no difference. American healthcare guarantees high-price care to all and lower-price care to some. This is dumb.

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There's no healthcare system in the world that provides widespread access without government tightly regulating the market.

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Baloney. Lot of markets for necessities function just fine without government supply/demand regulation. See food for an example.

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Can you name a healthcare system that is sustainable without tight government regulation?

Doc, to what extent has your view on healthcare over the years influenced your views in general on markets, capitalism, etc?

You said you were once a big time conservative who liked reagan. That's obviously not the case now.

It seems, at least for you personally, through your profession you have come to have negative views of market characteristics such as prices, profits, etc.

Is this solely something you hold towards the health care field, or do you dislike capitalism overall since you became a doctor?

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This is a silly criticism. I practice in the system we have.

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Tak tsk. Such a victim of "the system". If we had single-payer, would you stop turning non-paying patients away?

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I donate, volunteer, and advocate for healthcare reform that would improve access for the people who want care.

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Your good works are honorable. But they do not change the nature of the market, nor the services you provide. You do turn people away because they can't pay. Why would you do that if it's not a commodity? Or is that you expect "someone else" to provide what you say isn't a fee-for-service commodity?

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American healthcare guarantees high-price care to all and lower-price care to some.

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Huh? It it provides high price care to all there is no "to some" left to provide lower-price care to. I'm thinking you misworded this.

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Can you name a healthcare system that is sustainable without tight government regulation?

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We used to have one here. The decline of first-party payers has precipitated our demise. Not the free market. The historical third-party payout data crossed with pricing data paints a very clear picture.

The fallacy your are constructing is that healthcare is different than any other necessity commodity or service. It's not--except the majority of consumer think they should not have to pay for their own healthcare.

If we operated a grocery store, a gas station, or anything else the same way we handle the purchase of healthcare we'd be starving, out of gas, and would have astronomical prices as well.

Ultimately the problem in our system is unchecked and unbridled demand stemming from the elimination of actually having to pay for services rendered.

That is not a legislative problem. That isn't a result of too little government regulation. It's a result of the rise of socially acceptable mooching.

The bottom line is... we cannot possibly give away billions of dollars in "free" care and distribute that expense thin enough to the remaining population at a price they are willing to pay.

If you do some digging you can find what Americans think they should pay for comprehensive medical care. Those numbers... what Americans *think* it should cost wouldn't cover their own expenses, much less the expenses of the millions of those that won't pay for their care.