

How to reduce healthcare costs and improve quality - pseale
http://histalk2.com/2009/11/30/readers-write-12109/

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mattmaroon
I like almost all of those, but it fails to address issue #1 which is the
employer-funded health care system (which itself is an artifact of salary
restrictions that were part of WWII rationing). Right now most people get what
appears to them to be unlimited health care at a fixed price and thus have no
incentive to strive for cost-effectiveness.

Imagine your employer said "We made a deal with Safeway. We'll take $30/mo out
of your paycheck, and you can go to Safeway and all of your groceries are
free." You'd be eating Filet Mignon washed down with a bottle of '82 Margaux
every night.

That's effectively the way our health care system works. It won't become truly
efficient until the people consuming the service are paying for it too.

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pwnstigator
Somehow, I think there's a difference between eating filet mignon and being
treated for cancer. I could eat a good steak every day, but I wouldn't want
chemotherapy unless I was pretty sure I had cancer in the first place.

Most people are just trying to get the treatment necessary to keep them at a
high level of function. Why should anyone be denied that? Almost no one goes
into a hospital and demands thousands of dollars worth of unnecessary tests
for diseases they couldn't possibly have-- and those who do are often mentally
ill hypochondriacs, given inappropriate treatment because (surprise!) health
insurers are generally shitty about MH issues.

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mattmaroon
You completely and totally missed the point.

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pwnstigator
You made an inappropriate analogy.

There are no inherent costs to the consumer in eating fine foods.

There are enormous inherent costs to medical care. Most patients want to be
treated with minimal pain, risk, and time lost, so they can get back to their
regular lives. Their incentive is already, in virtually all cases, in the
cost-minimizing direction.

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yummyfajitas
This has been shown empirically to be false. Patients will consume medicine
with no health benefits if it is free, but not if they must pay for it.

<http://www.rand.org/health/projects/hie/>

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mattmaroon
You did not miss the point.

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RyanMcGreal
1 idea to reduce healthcare costs and improve quality:

* Institute a national, single-payer health insurance program.

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yummyfajitas
This will help how? There are few economies of scale to be gained by going
national [1], and single-payer gives consumers no incentive to consume less.

[1] You save a bit of money by having the IRS collect payments, but the
billing department is not a major component of healthcare costs.

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abstractbill
It seems to be working rather well in a large number of other first-world
countries (I'm speaking from experience - I'm British, and my wife is half-
French and grew up in France. Now we live in the US where we enjoy just about
everything except for the healthcare system).

"single-payer gives consumers no incentive to consume less"

Having been fortunate enough to live in a country with a single-payer system,
I never saw the kind of over-consumption you're hinting at.

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RyanMcGreal
I live in Canada, and have to laugh at free market fundamentalists who claim
that single payer monopsonies encourage over-consumption. When it's pointed
out that Canadians actually see doctors less frequently than Americans, they
turn around and conclude that Canadians can't get access to doctors.

~~~
pwnstigator
Mouth-breathing teabagger reasoning: It's soshullism, therefore it must suck.
Also, Canada's cold and Europe can't decide on a common language, so no point
taking those people seriously.

I also find it odd that these people can focus on the comparably miniscule
problem with the Canadian and British systems, while completely ignoring the
glaring faults of ours.

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3pt14159
These 4 would lower costs the most:

\----

Tort reform. Cap every state as has been done in California and Texas.

Eliminate doctors’ malpractice costs for patients who demand free care. If the
government insists that ED docs see every patient (through EMTALA), they are
de facto government employees for those patients and should receive government
indemnification.

Give needles to addicts, along with access to treatment.

Strongly consider legalizing and decriminalizing drugs.

\----

I would also add:

Make it legal to see anyone for healthcare. If I want to have my veterinarian
cousin administer 5 stitches, then I should be allowed to.

Make it legal to OPTIONALLY sign away your right to sue.

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tptacek
If you make it legal to optionally sign away your right to sue, then everyone
will lose their right to sue, except for the few adverse venues of last resort
(public-funded hospital emergency rooms, perhaps) that won't be able to
decline services.

The same thing happens with the "let people shop interstate for insurance"
idea. If you look just a couple moves ahead into that game, you see that that
proposal is just cover for "adopt the lowest common denominator of insurance
regulation nationwide", because every rational insurance company will simply
move to Alaska or Wyoming or wherever regulations are least onerous.

The exact same thing happens in banking, which is why Charlotte is a US
banking hub.

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3pt14159
The probability of the event happening * the loss = the premium of the
surgery. That is it. If you would rather pay 1000 dollars for a surgery than
3000 then that is your business. I certainly wouldn't sign away my right to
sue when I'm under back surgery.

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johnl
Socialize the judicial portion with flat rates for doctor/hospital boo-boos
and a government panel to oversee and "punish". 3 strikes and you loose your
license, back to school. No lawyers, reduced insurance, speeder payment
processes. = Reduced rates for us.

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pwnstigator
Some good ideas, but mostly revolting. He's basically trying to preserve a
system where the wealthy get better treatment than the rest. (See items #3, 9,
14, and 15.)

 _Realize that screening doesn’t save money for society._

Um, link? Although current screening practices may be overly aggressive-- I
have no idea-- this is different from saying that screening is an
unconditional money-loser, which is what the OP strongly implies.

Notice this, as well: _Dan Field is a physician with The Permanente Medical
Group._

So, at least he discloses the pocket he's in.

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tsuraan
Yeah, the bit about name-brand drugs being only for those who an afford them
out of pocket is especially bad. Drug patents are 20 years, so the peasants
would be getting 20-year-old cancer treatments, while the select few would be
getting actual modern medicine. Besides the ethics, though, what would the
cost of modern medicines be for those few thousand who can actually afford
them? Today, plenty of middle-class people get modern drugs because their
insurance pays for it, so the cost of research, clinical trials,
manufacturing, etc is distributed among a large population. What would the
price of a pill be if only the richest of the rich could afford treatment?

