There are no simple solutions, but something that would improve the availability and cost of health care would be to make it more lucrative to be a doctor, nurse or health care providing organization. Hospitals, clinics etc. have to make money to survive, and if they are profitable then entrepreneurs will make more of them. More supply will decrease wait times and cost. I don't care if my doctor makes 10x or 100x as much money as me as long as he or she provides good service at a competitive price.

Any system will involve rationing, even a market system. Capital is allocated by the forces of supply and demand, instead of by the pen of a bureaucrat. People should want a free market in health care for exactly this reason.

When capital is rationed by the market, it's a morally neutral event. No one has to decide if the hip replacement goes to Mrs. Smith or Mr. Jones. These are exactly the kind of choices that Obamacare command economy bureaucrats will be forced to make.

"Granny broke her hip? She's kinda old. Maybe she doesn't get a new one. "

People used to do this anyway. In a lot of families, old people would basically just let everyone else know they had decided it ws time to die. They would refuse care and proceed to waste away. It used to be considered the dignified and unselfish thing to do. Cultures vary.

"... it's a morally neutral event." Translation: amoral. And that's one big advantage of markets; they clear all the moral wrangling out of the situation.

I never understod why people dont like the concept of amorality

Pseudonym:
The main things stopping there not being more Drs are insurance payments due to threats of malpractice lawsuits. In some states it is about half their income.
High cost of medical degree. Graduate with a half million in debt.
The AMA puts limits on the number of Drs. It is an extremely stong union. Which controls liscensing Thereby controlling the supply of medical aid. If they want Drs to get more salary, next year few graduates get liscenses.
Have a bad Dr, sorry you have to convince his friends that he is bad to get him unliscensed.

There are no limitless supplies of anything.

So there is always rationing.

In medical care, you have two choices. Leave the rationing up to "Supply and demand", and blame "The system" for things that go bad.

Or put the rationing in human hands and blame THEM when things go wrong.

What sane person would want to be involved in option #2?

Oh, rationing is fine - until it hits your grandmother.

Seriously, this is where one has to let the free market work. There are no infinite supplies, someone is going to come up short. That's life, get over it. And the free market will do a lot better job of allocation that some faceless government bureaucracy.

Okay Missus Waserstein, I've reviewed your case file, and your federally-mandated treatment for this condition consists of one shot of Big Brother gin and a steel boot to the head. Burial will be in a hole somewhere, probably. Your family receive a condolence card and your account will be debited $4.50 for the gin, $250 for the boot to the head, $3.00 for the sympathy and $0.47 for the postage. Sign here .. and here .. and here .. and here .. one more .. okay now this one, press hard, that's six copies you're making, the goldenrod on the bottom is yours .. thank you. Next!

Gog-asuares, I don't know who the fuck you are, or what your life is like, or what you do for a living or how honest you are with the IRS or what your fucking blogname means, but... I like you.

I've been in an email fight with the rest of the family (liberal + smart) all week about nationalized medicine. They're for it, but they can't reeeeeleeee say way.

I am left to guess, and these estimations do not flatter my heritage.

Why, not way. Whatever! 'Splain, you compassionate lefties, you!

I think that if there is a an insurance option that will permit people to buy basic decent care on their own and severs the tie between the nature of one's employment and the availability of reasonably-priced insurance, our society benefits. More people have decent healthcare, they are freer to change jobs and take risks, people who are ill but didn't do anything wrong can get coverage if they take a different job or work for themselves, emergency rooms will stop closing because of all of the people who come there to get treatment they can't get anywhere else... I'm sure there are others, but these are what come to mind now.

The problem is that we have a pseudo-market for health care, not a real market. Our system traps a lot of people in jobs just because they can't get coverage on their own. Doctors tend to over-test and over-treat because they get paid more that way.

I think that the public insurance plan being debated in Congress makes sense because it will push the current insurance companies to innovate and to come up with better pricing models. I don't think a public plan will be awesome. It will be like Kaiser (my current insurance company) - bureaucratic, kinda slow, but probably not terrible. It won't be like my previous sweet PPO plan where my physician was the person who took blood and basically did everything, and I got the latest and greatest of everything. People with the resources to get better won't go with it; which means that the private system won't die. But it will have to compete more effectively, or lose a fair amount of people in the middle.

Doctors tend to over-test and over-treat because they get paid more that way.

Do you have a cite for that? I'm especially interested in evidence for the words "tend", "over" and "because".

My doctor doesn't get paid extra for tests and treatments because those things are performed by a lab or by specialists in another office.

I think that the public insurance plan being debated in Congress makes sense because it will push the current insurance companies to innovate and to come up with better pricing models.

I'd like to believe that, but I don't see what will cause the government to do better than Kaiser. Will the government employees doing the work have higher incentives than Kaiser employees? No. Would the government insurance plan go out of business if it is not profitable, like Kaiser would? No. Will the government leverage its monopoly on force to undercut their competitors' prices? Yes.

Do you have a cite for that? I'm especially interested in evidence for the words "tend", "over" and "because"

http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=2

I'd like to believe that, but I don't see what will cause the government to do better than Kaiser

I don't expect they will do better than Kaiser. But they will provide a way for people like Amy's friend to change jobs or start businesses and keep insurance coverage.

I don't expect they will do better than Kaiser. But they will provide a way for people like Amy's friend to change jobs or start businesses and keep insurance coverage.

Spoken like someone who's never tried to get anything out of the government.

Trust me, you'll be dead before you get help.

Your naive trust of government is touching, really. It's like the trust of a five-year-old child.

Let me tell you what happens. The government undercuts the private insurers, or causes the cost of the private insurers to rise catastrophically due to over-regulation. The government ends up being the only game in town.

And they have proven in every venture they have run that they don't give a fuck.

Do you want the government that told NASA engineers to "take off your engineer hat and put on your manager hat" - which led to seven dead astronauts - running health care?

I didn't think so either.

> Let me tell you what happens.

The guy who rides a motorcycle without health insurance wants to tell us how it happens. (Sobchac!)

> makes sense because it will push
> the current insurance companies
> to innovate and to come up with
> better pricing models.

The leftazoid fantasy machine grinds ever onward! The problem, you see, is that the current insurance companies aren't generating sufficiently innovative "pricing models". (Maybe they were more innovative in the past, and maybe they'll be more innovative in the future.) So it's the models that need to be better! Get the picture? The underlying 'pricings' are solid!...

This man has a graduate degree, or claims to.

Y'know, it's plainly obvious to me that people want stuff that they don't have to pay for. It's a human nature thing. And in these generations, they tend to double down on the preciousness for medical matters... They don't even want to be asked what medical care should cost. It's easier just to get all huffy and say there's no way measure the value of something that's so darling... Especially if someone else is going to cut the check.

This is dementia, but it gets even weirder when liberals talk about it, because they have no insight about how value gets created anyway. They think anyone with a spreadsheet is just using software to tell lies: 'The money is there! The money is there! We just have to let Al Gore tell us where to send it, and then everything will be OK.'

I'm fiddy. And I'd say that odds are even that there'll be a federal takeover of American health care such that by the time of my own sunset years, the majority of effective health care will be provided by a black market. Yes; our government is that stupid.

Do you have a cite for that? I'm especially interested in evidence for the words "tend", "over" and "because"

[New Yorker article: Annals of Medicine: The Cost Conundrum]

Are you aware that, among Medicare and Medicaid recipients, McAllen has a dramatically higher incidence of diabetes and heart disease, and if you exclude those costs it is comparable to El Paso and Grand Junction, CO? This article analyzes the situation in excruciating detail.

Note too that the article you link to contains anecdotal, not statistical, evidence. Obviously it sometimes happens, but that doesn't mean that "doctors tend to over-test and over-treat because they get paid more that way."

Articles like this are written to communicate a narrative, and are therefore likely to portray the most extreme case that the writer was able to find. If McAllen, TX has the worst over-testing and over-treating then we needn't worry, because in the end it turns out that we spend the same on individuals there as we do on individuals with similar medical problems in other parts of the country.

The problem, you see, is that the current insurance companies aren't generating sufficiently innovative "pricing models".

It is part of the problem, yes. See, cause when you get insurance at work, they can't ask you anything about your health, you're just added as part of your work's pool. Generally, the bigger the number of people insured, the less it costs per person. This is because as the group gets bigger, the insurance company is better able to assume that the sample (i.e. the group at your work) matches their actuarial data and they're able to price properly. However, small groups or individuals usually get charged more, and not necessarily because they are actually a bigger risk, but because they are less easy to predict on the whole. Why the public option could work is because it dumps small groups or individuals into a big pool of people. This is something insurance companies could do, but choose not to.

> It is part of the problem, yes.

Say no more, babe! Say no more! We all grok you, totally!

It's the models!... The pricing models!

This is something insurance companies could do, but choose not to.

Actually, it's something they are forbidden by law from doing.

And the problem still remains - the "public option" (or a sufficiently large private pool) will end up trying to dictate lifestyle choices in an effort to control costs.

The difference is that the worst the insurance company can do is raise your rates or drop you. The government can throw you in prison or prevent you getting care at all.

And that's a pretty big incentive to keep the government out of it, so far as I am concerned.