Health Care: Must-Read Of The Day

I can’t wait to hear Republicans explain to us how this is all Obama’s fault.

“As more people have lost jobs, many who are healthy have decided to go without health insurance or get a bare-bones, high-deductible policy, reducing the amount of premiums insurers receive.”
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Anthem Blue Cross said the same thing. Any chance of seeing actual numbers?
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It may be factual but has the feel of one of those explanations that “everyone knows” is true.

The insurance companies do not seem worried that they will have any problem doing this, I wonder why.

I am glad you gave the Main example Karen. Do you think this will affect the Senator of this state that wants to take more time to do health insurance reform?

Sorry that should be Maine.

They won’t have a chance. Obama will be lecturing us on how all of this is from 8 years of Bush.

So what exactly are the individuals getting for their money, Karen? Do you have an example of the policy you are speaking of that will “increase by 20, 25, or even 30%”? Why would the individual policies increase, and the group policies stay the same? Common sense tells me that individual buying power cannot be that much less than group buying power. At least not by 20, 25, or 30%.
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I am thinking you are talking about individual health insurance policies which you see advertised on TV or on roadside placards boasting “Cheap Health Care Insurance”, but really do not cover much of anything at all. How much of this is all about deals which the Obama Administration has made with Big Pharma? Is there drug coverage in these plans? Are they basic plans for what we use to call “Major Medical”? Major medical plans which covered up to 80% of the medical costs if hospitalized, but didn’t cover basic health care costs such as doctor’s visits and routine care. Do these plans have high deductibles and co-pays?
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While I will agree it is good to expose this, but how much of it is really hype? I think it would be a good idea to show examples of the type of “health care insurance” we are talking about and then compare it to let’s say group plan policies or Medicare/Medicaid.
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I am very dubious that this seems to come out at a very opportune time, when we are also talking about restarting the talks all over again versus going forward with the 2000+ bill already in the House and Senate. I can’t imagine if the Health Insurance companies did not like what is in the House/Senate bill, that at this time they would all of a sudden come out and say they are going to increase premiums, unless there is some motive on the part of the insurance companies to now want the bill which is in congress.
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But, I also find this report by Price Waterhouse very interesting. They say…
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“As the above charts illustrate, by 2019 the cost of single coverage is expected to increase by $1,500 more than it would under the current system and the cost of family coverage is expected to increase by $4,000 more than it would under the current system. This amounts to an additional 18 percent increase in premiums by 2019. The overall 18 percent increase is a composite of increases by market segment as follows:”

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http://www.americanhealthsolution.org/assets/Reform-Resources/AHIP-Reform-Resources/PWC-Report-on-Costs-Final.pdf
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“Average premiums for single coverage are estimated to be about $4,800 in 2010, will increase to approximately $8,200 in 2019 in the absence of reform and could increase to $9700 if these reforms become law.”

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This report was done by Price Waterhouse in October of 2009. Seems odd that we are hearing this from your source you cite above.

Pfft, whatever. My friends’ insurance went up 100%. Yep, that’s right. One hundred percent. From around $300/month to $600/month. They’re small business owners (the only two employees) with two children. Hooray, free market!

Why do we let this happen in our country?

So the solution here is to massively subsidize and require people to have insurance? Isn’t the effect of that going to be a situation where more dollars are chasing services? We’ve seen a similar thing with tuition at universities. The government massively subsidizes college education, and look what happens to prices. Also, the patent unfairness of the mandate on younger Americans, who are already facing massive student loan bills, housing costs etc. is obvious.
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Our healthcare system has a number of components. There is the healthcare delivery system, a healthcare payment system and a healthcare welfare system, a healthcare regulatory system etc. The current payment system is a complete mess, brought on by the current employer pays mechanism. Why can’t we try to fix that? I think most people agree, conceptually, that healthcare payments should be made on a pre-tax basis. We don’t need employer-based payment to retain that. Basically, as things stand now, the insurance companies are massively indirectly subsidized by the current employer-pays payment mechanism. And we’re going to expand that? Seems nuts.
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I get that starting over is very hard, but entrenching the current system seems closer to crony capitalism than real reform.
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Why can’t we do some commonsense things? How do we decouple the insurance function (i.e., for emergent medical care) from the payment of routine healthcare? Let’s take mammography for example. There is no reason, since mammography is routine, that we need insurance cos. to handle the payment for this procedure. What if, instead, women simply got a pre-tax deduction from their paycheck and it went on a credit-card type item. What would happen to the cost of mammography? Likely would go down. We could even do the same for childbirth. A woman could simply get a pre-tax advance on her medical-care credit card, to be repaid over time. My general point is that if you started putting these pre-tax dollars into people’s hands, they’d have skin in the game, and you’d see prices come down. As it stands now, insurers have motivation to keep prices down–but they also, as we see here, have the ability to pass along costs.
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Another point–how much is the cost of healthcare insurance driven by a lack of competition and “must cover” statutes? There should be one standard for must cover–and it should be set by the feds. People should not have to subsidize drug rehab, for example, especially in a mandate system.
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If we were going to start from scratch, what would an efficient and good healthcare system look like? I doubt it would be anywhere close to what is now on the table.

According to the GOP the more it cost the less people will use it and the results will be less cost, untill more people can afford it again, then we will use again, then the cost will go up again, and we start all over again.
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What did I forget? Ah yes, we need to cut taxes on the Health Insurance Companies.
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So you see it is all for our own good.

Are you really citing that PW study that was thoroughly savaged and debunked and PW pretty much apologized for?

You can criticize the system, but it is not “free market”.

Why do we let this happen to our country?
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Other increase in prices:

Bread +27%, eggs +54%, Flour +56%, Rice 36%, oil +100%, College tution +15% over 2 decades.

Guess what? All of this are areas that the government has decided to provide subsidies or other government intervention. Can’t wait to see what HC reform will bring us.

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The left still believes we can cover more people with more health care without restricting access or increasing premiums ot taxes.

In a truly market system, it’s likely that innovation in delivery systems would lower prices. For example, if women paid, out of pocket, for mammograms, do you think prices would go up or down? Skin in the game matters.

Just what I said Spob. The GOP plan don’t use it. Hell why live till I am 80, lets die at 65!.

Talk about death panels.
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Skin in the game? We are talking about life here. Get real!

“Other increase in prices:

Bread +27%, eggs +54%, Flour +56%, Rice 36%, oil +100%, College tution +15% over 2 decades.”
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Over 20 years. Compared to 15% in a single year?
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Whats that on bread little over 1%, eggs 2% flour 2% rice 3% even less if included the compounding effect.

Your argument is hog wash!

No, he’d likely keep saying what he’s been saying, how these prices have been running away from us for decades and are only going to get worse if we do nothing.
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My comment was meant to be a joke about how conservatives insist on turning everything into a childish game of finger pointing that prevents us from dealing with our problems.
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Thanks for proving my point.

Yes, oil prices shot up because of government intervention. Of course, that explains it all.

Oh I didn’t know that mslavik. Do you have a link to that statement? I would be interested in reading about it.

That expalins why every lecture Obama gives there is always a reference to “what we were handed” “eight years of past policies”, “mistakes of the past administration”.

The joke is people have quit listening.

Liberals- Still testing positive for stupid

spob:
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We won’t have a truly market system until we abolish Medicare and Medicaid, since price floors are set for 40% of the health care system through these programs (a share which will increase in the next 10 years).

It was the same group that keeps de-bunking the discoveries of the fudged global warming research

Kevn:

Yes its called restrictions on drilling and no new refineries in theis country in over 30 years.

Let me clarify. Food price increases are for one year. College tuition costs are 15% perannum for twenty years.

It’s funny that you mention this too, mslavik. Here is a direct quote from a non-partial entitiy, George Mason University in Virginia.
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“Thus, many of the measures which PricewaterhouseCoopers left out of their equations are either known to not be cost-saving, or the potential savings are still too unknown to be quantified. A detailed analysis of which measures are indeed cost-saving needs to be undertaken, and this is also proposed in the bill.

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The article from George Mason also goes on to say…
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“In fact, the bill states that the funding will be derived from increased taxation on the so-called “Cadillac” insurance plans, from fees paid by industry and from increased taxation of individuals. But these increased costs to industry will likely be passed through to consumers of private health insurance. The bill also assumes billions of dollars in savings from decreasing Medicare payments, including a 24 percent decrease in physician reimbursements. But Medicare and Medicaid already reimburse less than the actual cost of caring for a patient. Further decreases will likey lead more physicians to opt out of accepting these patients, which would will significantly decrease their access to care.”

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It is concerning that Obama made a “special deal” with Big Labor to exempt them from any taxation on so-called Cadillac Plans. So in my conclusion and that of George Mason who is in agreement, what we are seeing is perhaps an increase in the cost of premiums due to the health care bill as proposed, a hedge against the on-coming assult against the health care insurance industry. Perhaps if the bill is defeated, and it is required to be re-worked we shall not see any increase in premiums at all.
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The George Mason article continues with the following…
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“However, the criticisms must also be valid enough to stand on their own. The simple fact of being funded by private industry does not automatically invalidate the findings of a study. By the same logic, Senate and House committees are also composed of individuals whose campaigns were supported by private special interests, so the same argument could be made to invalidate conclusions drawn by our legislators. The findings of any report must always be judged on their own merits.

Second, concerns have been raised that the study focuses on four specific provisions of the bill, while ignoring the potential for cost saving of the remaining provisions. The Senate’s “America’s Healthy Future Act of 2009” does indeed contain numerous additional provisions. Those that are intended to help contain the costs of care, and therefore the cost of private health premiums, include outcomes research and linking payment to “quality of care,” promoting disease prevention and wellness, and strengthening primary care. Shouldn’t any report evaluating the cost of reform take these provisions into account?

It certainly seems to make sense that these measures would increase wellness and therefore decrease overall health care costs. However, what makes apparent intuitive sense is sometimes disputed by empirical evidence. In this case, numerous studies published in highly regarded academic journals have either failed to show cost savings, or actually showed cost increases, as a result of increased prevention and “wellness” efforts. [See sidebar] Very few specific preventive measures which have been studied have clearly demonstrated cost-effectiveness, and even fewer have been found to be cost-saving.

Thus, many of the measures which PricewaterhouseCoopers left out of their equations are either known to not be cost-saving, or the potential savings are still too unknown to be quantified. A detailed analysis of which measures are indeed cost-saving needs to be undertaken, and this is also proposed in the bill.

But if and when such cost-benefit analyses are worked out, the question arises as to whether patients are really going to be denied care which is not cost effective. Such decisions have generated political fury in Britain, a country that is acculturated to, and generally supports, nationalized medicine. Given our much stronger culture of personal choice, and given that many people will, as a consequence, demand access to care regardless of cost, public protest over “rationing” seems inevitable. In other words, it seems likely that even if such cost-effective measures are found, implementation will depend as much on politics as on medicine or economics.

The most telling criticism of PricewaterhouseCoopers’ conclusions is that the report failed to take into account the role of proposed governmental subsidies in offsetting the premium increases for Americans who wish to keep their private health insurance. PricewaterhouseCoopers itself makes note of this at the very beginning of its report. Obviously, if the question is the impact of proposed reform on the future premiums paid by Americans who maintain their private health insurance, any subsidies provided to help offset these costs are highly relevant. However, what is most relevant to consumers of health care is the impact of health reform legislation in the absence of “corrective” subsidies. The authors of the bill imply that these will be paid from the savings obtained from the increased efficiency of the system. As noted above, however, these savings are still largely theoretical and as yet unproven.

In fact, the bill states that the funding will be derived from increased taxation on the so-called “Cadillac” insurance plans, from fees paid by industry and from increased taxation of individuals. But these increased costs to industry will likely be passed through to consumers of private health insurance. The bill also assumes billions of dollars in savings from decreasing Medicare payments, including a 24 percent decrease in physician reimbursements. But Medicare and Medicaid already reimburse less than the actual cost of caring for a patient. Further decreases will likey lead more physicians to opt out of accepting these patients, which would will significantly decrease their access to care.

Another Senate bill, the “Medicare Physicians Fairness Act of 2009,” attempts to correct for this problem by repealing the cuts in physician reimbursement. Because it is introduced in a separate bill, these additional costs are not factored into the calculations of the savings expected from the health care reform bill. These subsidies would ultimately be paid for by the public. They represent funds that are redistributed among individuals, but they cancel each other out on either side of the cost-savings analysis.

A major potential source of savings is the mandated requirement that all individuals must purchase insurance. This is intended to bring down the per-person premium rate by assuring the participation of relatively healthy young people who have previously chosen to remain uninsured. However, the potential cost saving effects of such a mandate have been diminished by the Senate Finance Committee bill, which weakened the recommended mandate to the point where individuals would face paying only a few hundred dollars in fines, far less than the cost of purchasing insurance.

Under the current bill, fines for failing to purchase insurance would not begin in 2014, and they would rise to a maximum of $750 in 2017. The IRS would collect these fines through tax returns, but the bill specifically prohibits criminal penalties for failure to pay the fines. (PwC did, in fact, calculate their increases based on the mandates laid out in the plan.)

Finally, the results of the PwC study are consistent with the outcomes of several smaller-scale experiments with guaranteed-issue and community rating on a state level, which led to increased cost and decreased enrollment in private insurance. New York and Washington are two examples. In Massachusetts, coupling similar reforms with an individual mandate was not enough to prevent significant increases in insurance premiums.

All these factors argue for taking the PricewaterhouseCoopers study seriously, despite the industry sponsorship that produced a media backlash against its conclusions. All scientific and economic studies are subject to limitations which impact the strength of their conclusions. Knowledge is imperfect, assumptions must be made, estimates are used, and human behavior does not always follow the model. These caveats hold true for the studies cited by both proponents and opponents of the current legislation. However, every additional valid study should enhance our knowledge and inform our decisions.”

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Is your source perhaps Daily Kos or Media Matters, mslavik?
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I am anxiously awaiting your response.

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SZ:

So are you arguing for abolishment of Medicare and Medicaid and public option in the HC debacle?

Has he said that about the explosion in health care prices? Has he blamed that on Bush? Or is this, once again, some lie from your fevered imagination?
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As for the rest of the current mess, yes, it’s important to keep pointing out that the Republican policies of the past eight years got us into this pathetic situation because (a) that happens to be 100% true and (b) morons like you keep insisting we should do the exact same thing again.
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You all had a chance to show us what your no-regulation, tax-cuts-for-the-rich, crony-capitalism, e-coli-conservatism would bring, and guess what? We’re living in it.
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Your idiotic policies got us here, and you keep insisting the solution is more of the same, which is utterly idiotic. Don’t get mad when people point that out.

Why would the individual policies increase, and the group policies stay the same? Common sense tells me that individual buying power cannot be that much less than group buying power.
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But yet here we are. The article clearly states that many individual plans will face massive increases here shortly.
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The article doesn’t explain how they determine which policies to raise rates on, but it’s going to be a lot of policies. I’ve seen reports of AETNA projecting losses of about 600,000 members due to price increases:
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http://www.ama-assn.org/amednews/2009/11/30/bisb1130.htm
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And this isn’t the first time, apparently:
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As chronicled in a 2004 article in Health Affairs by health economist James C. Robinson, MD, PhD, Aetna completely overhauled its business between 2000 and 2003, going from 21 million members in 1999 down to 13 million in 2003, but boosting its profit margin from about 4% to higher than 7%.

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(That’s from that same AMA article.)
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So losing 8 million members, over a third of its membership, is more than just cherrypicking out the “Cheap Health Care Insurance” cases.

i don’t know anyone spending half their family income on bread. in maine, that’s what health insurance will cost for a median-income household.

[T]his is just the beginning of what we can expect to see pretty much everywhere

No.

This has been going on for 20+ years. Business as usual. This is the “middle”, rather than the “beginning”, of what we can expect. The “end” is when it all blows up and no one has insurance except millionaires. And the rest of us pay cash when we need that abscessed finger removed.

Reason number 1232133 why health care reform got bogged down: even one of the most knowledgeable reporters in the country on the topic is framing the stabbing and gouging of America as a new thing instead of a long and malicious trend.

Here is a direct quote from a non-partial entitiy, George Mason University in Virginia.
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Uh, no. That’s not from “George Mason University,” that’s from Nirit Weiss, a doctor at Mt. Sinai who apparently has zero connection to George Mason University.
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http://stats.org/stories/2009/pwc_controversy_oct27_09.html

And what exactly has Obama and the Democrats in Congress done to correct it kevin, please enlighten us!
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Perhaps it is the Krugman idea to increase government spending, which now we see our debt at over 12.5TRILLION dollars. Is that it?
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Or that the value of the dollar is now being down graded, and because of that you can afford even less than you did before?
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Or that instead of pulling out of Iraq like Obama said he was going to do, we are still spending billions of dollars a day, right?
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Or instead of pulling out of Afghanistan, Obama has escalated the war there and spending many many more dollars than Bush ever did, is that the change you are talking about?
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Or that another bank bailout is in the works to the tune of another 1.2 TRILLION dollars. Imagine that, also why we had to increase the debt ceiling a few weeks ago to 14.5 TRILLION dollars.
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Now THAT is definately “change we can believe in”.

KT:

I agree. I was pointing out the undeniable fact that the government putting their mischievous hands into anything increases the cost to the point where the principles of economics is overcome by the stupidity and meddling of the government

Could this be the turning point in the health care debate? The major failure of the Obama messaging machine is that Americans still don’t feel health care reform will have any benefits for them. 2k in monthly insurance premiums is a big deal for folks in this economy.

http://www.political-buzz.com/

What exactly are we getting? I have a guaranteed issue policy from Blue Cross that is equivalent to the COBRA and employer policies that I was no longer eligible for. I have a $1000 deducible,, 20 or 40% co-inusrance charge for all care except primary care physician , depending on whether in or out of network, ditto with drug plan which I have to pay cash for and have reimbursed, and $20 co-pay for regular doctor’s visits. What does this cost me? $15978 per year for an individual, not family. The equivalent thru the emplyer, probably less than half that amount. So yes, groups have the leverage. Of course for that premium, they force the doctors to accept payments that are approx 40% of what they bill to non insured patients. That is why doctors have to hire two account clerks for each doctor in the practice. Just to make sense of the reimbursement plans of the insurers and fight the denials issued because of typos on claim forms.

And here is some more insight on the impact of individual policies on their profits:
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SHAPIRO: So if a hospital has to pay a certain amount to deliver an MRI to a patient, a hospital may charge many times that amount to one patient and far less than that amount to another. How do they decide on who pays what?

Dr. REINHARDT: It depends on the market power. If you face, as a hospital, a huge insurance company, they will bargain for a steep discount. But if you’re an uninsured, middle-class individual, you have no market power, and they will charge you often twice the price that would be charged to an insurance company.

SHAPIRO: So if I’m – sorry, so if I’m a massive insurance company, I can say I’m going to bring you 75,000 MRIs this year, you’d better charge me very little for them, whereas if I’m one uninsured person, I’ve got no bargaining power. Is that what you’re saying?

Dr. REINHARDT: That’s what it is. The insurance company will say look, we lower the price, but you can make it up on the volume, we bring you big volume, while the individual says I bring you one appendix. That’s not a volume. And so they can jack up the price and take what they want from you.

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http://www.npr.org/templates/story/story.php?storyId=113971873
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Uwe Reinhardt is a Princeton economist, BTW.

KT:

PS: We have become a nation that now depends on the federal government for how to raise our children, how to feed them, educating them, saving businesses, getting housing, getting HC insurance. Americans dismiss their responsibilities and we have the government nanny for every perceived wrong.

In all the above the government has 1) failed and 2) artificially increased the prices of each

Or that another bank bailout is in the works to the tune of another 1.2 TRILLION dollars.
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Can you prove that?

Can he prove it? Of course not.

Oh, well that explains the record profits Exxon Mobil repeatedly put up the past year.

Well right back to the name calling. Bankrupt arguments as always. After spending billions in “crony Capitalism” Obama now says follow me and I will crate/save 95,000 a month, below any recovery and we will show no job growth. Deficits growing, national debt growing. We will be the economic equivalent of Zimbabwe by 2012.

Liberals Still testing positive for stupid

Well, if you elect to spend that cash on a Skilsaw, you can get that abscessed finger removed AND save money!

Not exactly:
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http://www.bcbs.com/blueresources/mcrg/chapter2/ch2_slide_6.html

Kevin:

You are so stupid it defies description. XOM had record profits because they own properties globally and the price of oil rises because of diminished supply and high demand. They sell oil at high prices and make profits.

Maybe Obama will take over the oil companies. Another sector liberals can screw up.

Just for you Cliffy:
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“The Congressional Oversight Panel’s February oversight report, “Commercial Real Estate Losses and the Risk to Financial Stability,” expresses concern that a wave of commercial real estate loan losses over the next four years could jeopardize the stability of many banks, particularly community banks. Commercial real estate loans made over the last decade – including retail properties, office space, industrial facilities, hotels and apartments – totaling $1.4 trillion will require refinancing in 2011 through 2014.”

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http://cop.senate.gov/reports/library/report-021110-cop.cfm

Also, there was a dramatic reduction in the growth of overall health care costs in the late 1990s, but part of that was that managed care plans were really cracking down on what they would cover. (Rationing, but by the private sector.) There was a backlash, and costs resumed their upward trajectory.

Thanks, rusty.
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The implication of your first statement was that the $1.2 trillion would be going to the huge banks again, rather than the smaller banks and businesses.
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If this were an economics thread, I’d ask what your plan is to deal with that situation.
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But it’s not, so I won’t.

The chart in my earlier link was for employer-provided coverage. I’m looking for a comparable one for the individual market, but am not finding it. Help, commenters? How out of line is this kind of increase, compared with historical trends?

Blue Shield of California raised rates by at least 30% in December last year. Hope this “nonprofit” company is included in any investigation.

Your slide only deals with the past five years, which doesn’t address the past two decades.
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Also, the chart shows that the rate of increase has slowed, but that prices are still increasing – just not as fast as before.

i’m also having trouble finding a comparison with previous anthem premium hikes in california, but this LA times story does suggest that this year’s (which the company agreed to delay by a few months) is unusually large:
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http://articles.latimes.com/2010/feb/04/business/la-fi-insure-anthem5-2010feb05

Here are some basic facts which you can count on.
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Fact #1: Obama care will cost you more money. You will either be taxed for your health care benefit from your employer if that is the case. Or, due to the new regulations which will be enacted with this bill for covering pre-existing conditions or recission, you will pay more for your individual health care premiums. PERIOD. Mandates will not affect costs what-so-ever as has been proven in Massachusetts. People will simply opt to pay the “fine”, and no purchase insurance. They will continue to use the ERs like a doctors office, thus inflating the cost of health care overall.
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Fact #2: Drugs will continue to cost more because of the special deal which Obama made with the Drug Companies to stay out of the Health Care debate.
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Fact #3: Seniors will lose over 500 BILLION in coverage that they now enjoy so that approximately 12 million people will be covered under the new health care reform bill.
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Fact #4: Premiums will continue to rise over time at or above inflation because the health care bill does NOTHING at all to curb costs of health care or stimulate competition. Without State to State regulations, no incentive will be made on the part of insurance companies to lower costs because of competition.
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Fact #5: Because there is not a concentration on preventative medicine or to relook at how Physician’s practice, they will continue to practice “defensive medicine” out of fear of being sued. They will continue to order needless tests and procedures simply to show they did everything possible.

Obama care will cost you more money. You will either be taxed for your health care benefit from your employer if that is the case. Or, due to the new regulations which will be enacted with this bill for covering pre-existing conditions or recission, you will pay more for your individual health care premiums. PERIOD.
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Prove it.
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And are you really saying that banning recission is a bad idea?

freeinpa:

So are you arguing for abolishment of Medicare and Medicaid and public option in the HC debacle?

No, I’m merely pointing out that we can’t have a system that utilizes third-parties for payment without market-wide negotiated price controls.
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Well, we can have that system, but it won’t be here in its present form in 20 years.
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The current health care legislation entrenches this worst-of-both-worlds system, unfortunately, as spob says.

Fact #3: Seniors will lose over 500 BILLION in coverage that they now enjoy so that approximately 12 million people will be covered under the new health care reform bill.
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So why does the AARP endorse the House reform bill?
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http://www.cnn.com/2009/POLITICS/11/05/health.care/index.html
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http://www.aarp.org/makeadifference/advocacy/GovernmentWatch/HealthCare/

Being called stupid by you is a badge of honor. Go fling feces at your neighbors now.

KT:
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Here we go again:

there was a dramatic reduction in the growth of overall health care costs in the late 1990s, but part of that was that managed care plans were really cracking down on what they would cover.

Right.
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Spending went down, but prices still kept rising precipitously.
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“Cost” continues to be a funny word in the debate.
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The growth of health care costs (to insurance companies) went down because those costs were a measure of the spending on peoples’ claims that decreased.
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The growth of health care costs that were a measure of the price –how expensive paying claims is for insurers– of each unit of health care went up.
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Please, please, please can you remember to break out “cost” into its two component parts when you talk about rising or falling: “spending”, which is how much per year a family pays for expensive bread, and “price”, which is how expensive the bread actually is. Spending can go down when the family can’t afford the bread, while the price of bread can continue to go through the roof.
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Continuing to talk about “overall health care costs” as if these two components were the same causes great confusion amongst folks who try to follow what’s happening to health care in their country, KT.

So how is subsidizing insurance the right answer to the issue of increased costs? We’ve seen what that has done to tuition.
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Any solution to the problem of massive cost increases for insurance/healthcare HAS to involve the consumers feeling every dollar they use for healthcare.
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By the goofball employer-based system we’ve set up, we’ve created a payment system that is bloated and nuts. Direct payment by consumers has to be part of a solution that works.
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And think about this–the mandate forces people to subsidize this inefficient payment system. How fair is that?

Karen, I have an Assurant Health individual policy and since I purchased it in 2005 my premiums have gone up 110% including a 59% increase from last February to this February. I’m 58 and was excited by the prospect of an early Medicare buy-in. I’m guessing that’s dead?

We’ve seen what that has done to tuition.
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No we haven’t. Provide some figures, please.
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Any solution to the problem of massive cost increases for insurance/healthcare HAS to involve the consumers feeling every dollar they use for healthcare.
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What makes you think they don’t?

And what exactly has Obama and the Democrats in Congress done to correct it kevin, please enlighten us!
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You might have heard something in the news recently about “health care reform”?
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Monday’s CBO report offers the first objective analysis of the effect on premiums. An earlier study commissioned by America’s Health Insurance Plans, an industry trade group, warned that the Senate bill would dramatically increase insurance premiums, but the study’s authors at PricewaterhouseCoopers later acknowledged that they had ignored major pieces of the legislation in their calculations.
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“This report alleviates a major concern that has been raised — that insurance costs will go up across the board as a result of this legislation,” Bayh said in a statement. “This study indicates that for most Americans, the bill will have a modestly positive impact on their premium costs. For the remainder, more will see their costs go down than up.”

The CBO found that the measure would have its most dramatic impact on the individual market. Because they are not part of a workforce or other group that can pool its risk, consumers tend to pay more for policies with fewer benefits. The Senate bill would address that by establishing insurance exchanges, effectively creating risk pools. It would limit premiums based on age and medical condition, and cut costs for insurers by adding younger, healthier people to the customer base. All those provisions would lower premiums by as much as 20 percent, on average, by 2016, the CBO said.
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http://www.washingtonpost.com/wp-dyn/content/article/2009/11/30/AR2009113004391.html
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Got that? The CBO — the nonpartisan referee that Republicans have repeatedly insisted is the gold standard in this health care debate — has said that the Senate HCR bill will lower premiums by an average of 20 percent.
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That’s what Democrats have done, rusty.
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What have the Republicans done? What did they do when they controlled the White House, House and Senate during the last decade? What have they offered now?

Americans dismiss their responsibilities and we have the government nanny for every perceived wrong.
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Once again, if you want to live in a government-free paradise, please, do us all a favor and move to Somalia.

I sure wish a few politicians in Washington cared as much about the plight of the (lower) middle class as much as Karen does.

The Constant Weader at http://www.RealityChex.com

Well here are the real numbers.
From 1999 – 2009

Bread .899 – 1.39, 57% 1lb loaf
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Eggs .92 – 1.772, 70% Doz
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Flour .267 – .464, 74% 1 lb
.
Rice .502 – 7.51, 50% 1 Lb
.
Gas 1.353 – 2.671, 74% Gal

Health Insurance premiums $ 5,711- 12,689, 119% The thing is we can’t quantify the health Insurance, what has changed in the policy deductibles, coverage, number of people covered etc. It is clear though that it increases at a greater rate.

Yes, that’s dead. i’m interested in what kind of Assurant policy you have, as my brother’s decision to purchase a series of short-term policies with them turned out to be such a disaster. And then, there was this case from Colorado:
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http://www.tnr.com/blog/the-treatment/why-matters-colorado-story

Just like a defect in the design/manufacturing of an automobile, which can be an urgent and legitimate government/PUBLIC policy issue, individual health insurance policies are similarly flawed.

Individual policies will be batched by a company, say Mutual of Omaha. Over time, EVEN IF health care costs were stable, some policy holders get cancer, have heart attacks, etc. and have higher medical expenses because of genetics, accidents, old age, and so on. Because of the inevitable increasing overall use of health insurance by the batch, amplified by healthcare cost increases, premiums inexorably go up. Each year premiums are increased, healthy/insurable members change policies joining new, healthier batches of individual policy owners. The search for lower premiums increases the % of sicker, greater users left in the batch, and it is easy to see how the premiums spiral to crazy levels. This process has also been amplified by financial hard times, as explained by the PR put out by California’s Anthem Blue Cross the last few days.

What happens when the premiums cannot go higher or the group shrinks to too small a size to be profitable? Shut-down! In my state five years ago Mutual of Omaha sent to about 1000 policy owners, who were mostly ‘uninsurable,’ a letter saying that in 6 months they would have no health insurance. According to the State Insurance office, an example of a ‘legal’ breaking of contract. Be warned: you may think you have ‘insurance,’ but only within the parameters of an insurance company’s profitability. Hence, the justication and necessity for increased governmental regulations/reforms.

Our plan was going to rise 37% on February 1, but we made “concessions” instead. Our co-pay on ER visits went up from $150 to $1,000. Good thing I had the “fortune” to break my ankle in January instead of February.
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Our premiums are sky high already. My ER visit and surgery are going to cost me $3,000 on top of that. I feel lucky. Could have been much worse. Then again, my insurance premiums for a year are more than what my insurance company is paying for my surgery. I hate our freaking system.

restrictions on drilling and no new refineries in this country in over 30 years. -(an example of how government restrictions have caused oil prices to increase)
-freeinpa
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That’s not accurate. New refineries and oil drills won’t make much difference in the price of gas at the pump.
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Consider this government report (commissioned by Bush, conducted by his appointees) on prospective ANWR exploration.
- http://www.eia.doe.gov/oiaf/servicerpt/anwr/results.html
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Written in May ’08, the report assumed an immediate start to oil field development:
.
With respect to the world oil price impact, projected ANWR oil production constitutes between 0.4 and 1.2 percent of total world oil consumption in 2030, based on the low and high resource cases, respectively.17 Consequently, ANWR oil production is not projected to have a large impact on world oil prices. Relative to the AEO2008 reference case, ANWR oil production is projected to have its largest oil price reduction impacts as follows: a reduction in low-sulfur, light (LSL) crude oil18 prices of $0.41 per barrel (2006 dollars) in 2026 in the low oil resource case, $0.75 per barrel in 2025 in the mean oil resource case, and $1.44 per barrel in 2027 in the high oil resource case. Assuming that world oil markets continue to work as they do today, the Organization of Petroleum Exporting Countries (OPEC) could neutralize any potential price impact of ANWR oil production by reducing its oil exports by an equal amount.
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As there are 44 gallons to a barrel, this report estimates that in 17-19 years (to reach peak output) ANWR oil would lower the price of gas between less-than $0.01 and $0.033 per gallon– unless OPEC decided to lower its supply negating that change.
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Any “restrictions” by the US government have had little, if any, impact on the price of gas.
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The untapped reserves in Iraq and Afghanistan, however, are considered large enough to lower gas prices.

My general point is that if you started putting these pre-tax dollars into people’s hands, they’d have skin in the game, and you’d see prices come down.

Umm… what?
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Do you have any evidence at all that would even remotely suggest that consumers having “skin in the game” in the realm of healthcare would do anything at all to the fact that, say, our MRIs are three times as expensive as Japanese MRIs, despite them being from the same machines and done by doctors with the same level of expertise? Is your argument here that people would suddenly become angry and… what? What do you think people would do? “Vote with their wallet” and not get MRIs? People NEED healthcare to survive – this is not a commodity like oil where people can cut back and be less wasteful. They either get healthcare or they get sick and die.
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As you can see by insurance company behavior right now, getting people’s skin the game has zero effect on them. They can raise premiums practically indefinitely and still get higher profit margins because insurance companies are in the business of not actually paying for medical care. There will always be complete morons who are “satisfied with their health insurance” plans because they never had the misfortune of actually needing healthcare.

I have a PPO with $5,000 deductible with a $2600.00 annual HSA and a $3,000,000 lifetime benefit. I’ve been pretty happy with the plan except for the rate increases. The Colorado story is scary in that it makes you afraid to challenge any decision made by the company for fear of those dreaded rescission panels. Maybe the latest reports of the highest ever profits by insurance companies will wake people up.

Trifecta: That’s awful. I am so sorry. Hope you and yours stay healthy, especially our favorite Baby Commenter (who’s not such a baby any more):
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http://swampland.blogs.time.com/2007/04/20/a_new_little_commenter_enters/

red, I think you miss the point of what I am saying–an MRI’s cost isn’t really felt by the consumers. It’s simply done is reimbursed by insurance. A simple example of this phenomenon is buffets. Do you think people eat more at buffets or when the pay for each specific item?

Call me paranoid but I think that AHIP (the insurers trade group) has actually told its members to hike premiums right now. Disgruntled policyholders/voters will then tell their representatives to pass the inadequate–indeed bad–reform bill now in Congress.

The insurers want the Senate bill because the universal mandate will hand us over to them as a “captive market.”

The insurers will end up with total control over our system. We’ll have to buy their high priced, high deductible plans in the exchange. Even with subsidies the plans won’t be affordable to low- and moderate-income folks. .

And the subsidies provided by the taxpayer will line the pockets of corporate shareholders.

Let’s put our taxes to good use. Let’s insure ourselves! Pass a Medicare-for-all plan. Get rid of the unnecessary middlemen–the private insurance companies. They are siphoning off 20-30 cents of every health care dollar–and that figure is rising as I write.

What a great system. Let’s mandate it.

I don’t think it’s that conspiratorial.
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What we might be seeing is something similar to what the credit card companies did, knowing that the CARD Act of 2009 was going into effect this month, and jacking up their rates while they still could.
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My wife and I almost always carry zero balance on our cards with Citibank, had a sky-high credit limit, and we were rewarded by them moving our fee to a ridiculous 29.99% last fall.
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Just like the credit card companies, the insurance folks want to make money while they can.

That said, I’m with you on Medicare-for-all.
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Could anyone here who defends the current system inform the rest of us just what value the private insurance companies bring to the table? What benefit we have from a private insurance system over a public one like the rest of the world?
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I’m all for capitalism, but we don’t seem to be getting anything close to our money’s worth with the current system. At all.

Rusty, this isn’t unusual, and this is what reasonably healthy people will pay. Sick people can’t get a new policy. We paid $1,600 a month for two people. We each had a $2,500 deductible and we each had an aggregate out of pocket deductible of $1,500. Last year’s policy had a lifetime limit of $2 million. This year, it has been reduced to $1.5 million.
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You are incorrect. As an individual, your buying power is significantly less than as a group. Carriers usually don’t underwrite groups of over 50. All individual policies are subject to underwriting.

Incidentally, this is Blue Cross Blue Shield, not exactly a fly by nigt company.

I’d just like to take the opportunity to thank the spectacular blogger KT for her amazing level of quality engagement with commentary, by wishing her a happy Valentines Day.
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…And happy Chinese New Year!

“Yes its called restrictions on drilling and no new refineries in theis country in over 30 years.”
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How is it you feel qualified to call anyone stupid when you obviously have no comprehension of the issue? Did the government force oil companies to close their refineries? No.
..
From the Graziadio Business Report: “The number of refineries in the U.S. has decreased by about two-thirds in the last twenty years to approximately 150 plants.”
Link to full report here</a
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This is one of the key reasons that oil companies have been able to manipulate prices. The lack of new refineries is just another red herring.

“For example, if women paid, out of pocket, for mammograms, do you think prices would go up or down?”
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Women who don’t have insurance and need to pay for mammograms out of their pockets usually don’t get them.

kevin:

inform the rest of us just what value the private insurance companies bring to the table

They’re death panels, but they’re not the government, so there aren’t “government death panels” as long as private insurers are in the picture.
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There’s relatively little competition, they have anti-trust exemptions on price-fixing, insurers are essentially state-regulated utilities, but they’re not “the government.”
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Since they’re not the government, insurers will be the emotional scapegoats for the American people as the price of what insurance pays for continues to skyrocket, and they’re encouraged by HHS and Congress to increasingly deny claims that incur the bulk of federal subsidies to families under this new law.
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So they’re the “cost decreasing” element, since they’ll continue to do the rationing. People will hate whoever is rationing their insanely expensive ($8 Tylenol gelcap at the $10,000 a night hospital) care, and this bill tries to ensure that rationing stays where it is: out of the hands of people who depend on votes to get elected.
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Obviously I don’t “defend” the current system, but if this health reform legislation doesn’t pass, then we’ll at least have a shot at putting the responsibility for either lowering prices (health care providers hate it) or denying care (people hate it) squarely on the shoulders of elected representatives, instead of cementing in place the private insurers’ role in care denial, and letting high prices continue to go wild.
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But we’re probably about to seal our fate with this “reform,” because the value that private insurers bring to the table –non-government rationing and death panels to control spending on wildly expensive health care– is the value they bring to the legislative table (Senators and Representatives), not to us (people who live and die because of these decisions).

I’m so glad to live in Canada. Healthcare is paid by taxes and I don’t pay half of my revenue in taxes. I am a health care manager and make a decent salary.

You were spewing this same crap the other day but you never answered this question:
..
Rusty — So finding $500 Billion in cuts in Medicare is wrong, right? Then why do Repubs want to cut $650 Billion out of Medicare before they finish dismantling and privatizing it? Feel free to explain that one.
..
Link to Krugman’s analysis here</a

Of course, so many of you (Rusty) miss the solution:
Single Payer
Law of Large Numbers
Risk Spread
Everyone covered
Saves money: cheaper premiums, preventitive care, more efficiency, quality care

My point was that health care costs and insurance increases have been way out in front of inflation since a long time ago. Long enough, in fact, that there was a big attempt to try to fix the system in 1994 (16 years ago). One of the other comments makes me think of an interesting point:
While insurance premiums have only risen 8% or 10% a year or something like that over this time, how much have insurance “costs” gone up (i.e. the co-pays and explosion of deductibles and the bribes to doctors so they’ll only prescribe the newest and most expensive drug, not to mention that many businesses who used to provide insurance coverage as benefits now charge their employees significant sums for this “benefit”)?

It would be interesting to find a policy from 20 years ago, with small deductibles and co-pays and figure out what that policy would cost today.

Basically the whole idea of insurance coverage and what we expect out of it has been defined down, which meant that insurers were hiding the true cost of the decline.

I think I would be rather correct to think that the cost of health insurance has been rising 15% or more for 2 decades.

Oh Canada. Many Americans, contrary to some notorious cranks, love you. And, your health care plan is envied by some of us.

diecash, don’t bother. Rusty said he wanted the Dems to keep going and pass this reform because he claimed that it would amount to historic losses by Dems in the next election.
I asked him why, if that was the case, he wasn’t helping us Dems call our Reps and Senators to get the bill passed.
He was afraid to answer, and I daresay he hasn’t called any Dems a la Operation Chaos.
http://en.wikipedia.org/wiki/The_Rush_Limbaugh_Show#Operation_Chaos
I imagine the reason he is not helping to pass this bill even though his claim was it would usher in the era of Ayn Rand and old bitter male white supremacy is that he might not believe his own hype.

The fact is that the GOP did everything they could to kill health care reform in the 90′s and then did nothing, absolutely NOTHING to tackle the problem while they were in charge. NOTHING.

So I don’t want to hear how this is somehow the democrat’s fault. And for those of you fools defending Bush, he certainly didn’t make this one of his priorities either. The price of his little pet war, Iraq, would have paid for HCR several times over.

If you guys have something constructive to add, do so, or else shut up. And quit babbling about “tort reform.”

We passed it in Texas and it’s done nothing to improve health care in the state.

And yet they’re fighting against a bill that would increase the size and depth of that pool. Funny that.

I’m ready to see these grifters run out of business.

I used to work for a Canadian oilfield services company a few years back. Every so often the co. would have a town hall meeting where we could ask questions of the CEO.
I wrote in a question once that was along these lines:

Us Americans keep hearing about how terrible your health care system is up North. I know down here that our health care benefit package is really great (although I live in Wyoming and have to travel to Colorado to see a provider on our plan). Paying for insurance down here is also a lot better deal for your company than all those corporate taxes you pay in Canada. What can us Americans brothers and sisters here at [company name] do to help you get out from under your poor health care systems yoke?

The CEO, who was a conservative and right-winger (total global warming denier), responded with something like “Is this a joke? Your health care system is the one that cost us a ton of money and makes it so our Human Resources department is as big as the Field Team.”
I got some terse e-mails over that, though not as many as I thought I would.

Everytime I see one of these stories (rates being raised for individual plans) I’m just reminded that I am trapped in borgland.

Forget about starting my own business – I flat out can’t afford it or take the risk of doing without insurance. What a freaking clusterf*ck this country has become.

lizziefromcanada:
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Recently, a rather noticeable buzz was generated in our news media down here in the States when Danny “Millions” Williams, Premier of Newfoundland & Labrador, traveled to an unnamed location Stateside (we’re unsure of the reason for this) for what the Deputy Premier described as “heart surgery” that seemingly wasn’t available in the entire nation of Canada.
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Can you tell us if this episode is the indictment of the quality of the Canadian health care system that rightist politicians and media stars have assured the American people that it represents?

“Few leaders in American history have been as blessed with the ironic opportunity of crisis as has been Barack Obama. This last year could have been written into the history books with an entirely different script, and one which would have massively benefitted the country, the Democratic Party and Barack Obama. Yet, because he is so very much not a man of his time, just the opposite occurred. Clinton got away with being a nothingburger during fat times. Obama is foolishly trying it during a moment of multiple simultaneous national and international crises, and he is failing miserably. As he should be, with such a shamefully tepid agenda.”

David Michael Green

stuartzechman:

Danny Williams was told to get care outside of NewFoundland because that province could not give him the kind of care he needed (NFL is a small province). He could have gone to any other provinces in Canada, like any other Canadian and his province would have paid for his care.

However, he did not and, even though questions were asked, we don’t know why. A lot of questions asked, no answers.

You have to consider that Williams is a conservative politician.

P.S. If I have made mistakes in my English, please oblige, I am a French-speaking Canadian. We always excuse ourselves!

stuartzechman:

I forgot to say. If the treatment is only available outside Canada, it is still paid for.

I am going to venture a guess that Rusty is already a Medicare beneficiary. So, when he stops carping about the lousy bill that Obama’s attempt to compromise with his republicans to get any movement toward reform produced, will he tell us all when he will be dropping Medicare to pick up one of those $1800+ a month private insurance plans?

I don’t live in Canada, but I can see it from my house, and I can tell you they have a far better system for providing health care going on there than we do in the states. They aren’t clogging the border crossings to get health care here and, their taxes don’t begin to match what we have to pay in insurance premiums.

It’s time we all had Medicare! Phase it in over a decade, but just do it!

KT you probably know that Kaiser Family Foundation is a source for health coverage data…but here’s a link to their July 2009 about affordability for middle class families. http://www.kff.org/healthreform/upload/7951.pdf

vhttp://truecostblog.com/2009/08/09/countries-with-universal-healthcare-by-date/
32 of 33 developed nations have universal health care. Guess what country does not?
Above is a link to all 32 countries, the date they adopted universal health care, beginning in 1912. Also, the site has an overview of the types and success of their plans.
Those of you that feel only the free enterpise system (an oxymoron) works efficiently, offers the most economical and quality care need to explain that to the citizens of those 33 countries with universal health care. Ask if the citizens, businesses, and governments if they would like to change to our system.
Is it so hard for some Americans to admit other countries have a better plan? Is it pure selfish xenophobia that keeps us stuck in a failing system? Or is it the I’ve got mine the heck with you mentality?

If the treatment is only available outside Canada, it is still paid for.
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Gah! God damn it, Canada, stop doing health care better than us all the god damned time!
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(j/k)

towan: You are so right. Having lived for a number of years in a town on the Canadian border, I witnessed what they came to America to purchase. It wasn’t health care.
When pubs were not open on Sunday, they came to the US. Bars on US side flourished.
When porn shops were still illegal in Canada, US border towns boomed with porn shops.
When the monetary exchange makes it cheaper to shop in the US than Canada, border grocery stores and other shops proliferate.
Never has there been a boom in health clinics on the American side of the border. NADA. NONE.
In fact, many Americans go to Canada for cheaper drugs and other care. The town I lived in was rural. HMOs and PPO plans were nonexistant. All that was available was the highest priced indemnity plans. If you had a preexisting condition, forget any coverage. Canada was a refuge.

lizziefromcanada:
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Merci, très beaucoup.
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Thanks so much for responding, your English is perfectly adequate for setting the record straight.

stuartzechman:

I don’t know if you have seen this :

“The United States spends more on medical care per person than any country, yet life expectancy is shorter than in most other developed nations and many developing ones. Lack of health insurance is a factor in life span and contributes to an estimated 45,000 deaths a year. Why the high cost? The U.S. has a fee-for-service system—paying medical providers piecemeal for appointments, surgery, and the like. That can lead to unneeded treatment that doesn’t reliably improve a patient’s health. Says Gerard Anderson, a professor at Johns Hopkins Bloomberg School of Public Health who studies health insurance worldwide, “More care does not necessarily mean better care.” —Michelle Andrews ”

http://blogs.ngm.com/blog_central/2009/12/the-cost-of-care.html

Enlarge the graphic.

Kevin:
“Once again, if you want to live in a government-free paradise, please, do us all a favor and move to Somalia.”

The depth and nuance of your responses no doubt put you at the head of your Romper Room class.

==
Besides wait a few months, Obama and the liberals are turning this country into Somalia

diecash1:
How is it you feel qualified to call anyone stupid when you obviously have no comprehension of the issue?

Because liberals like you and Kevin make it easy
==
“.Did the government force oil companies to close their refineries? No.”

By gun point no but every environmental change or permitting cost billions to the oil companies. Unlike governments who “invest”, companies calculate a return on investment because their shareholders demand it. When the cost and time frame exceed the companies hurdle rates they cancel the project or sell the asset.

And how do I feel qualified to call you stupid in this matter. I worked as a chemical engineer for 10 yrs at an oil company performing synthetic fuels research

==
And its amazing that one of you quotes a government report “commissioned by Bush”. Check the history of these reports from the government. Oil was never to reach $100/bbl. And they make assumptions on oil reserves from the Saudis, the swing producer for OPEC, without a single oil field audit. The largest oil field the Saudi’s has which is 16% of the supposed world wide reserves started pumping out water a year or so ago. It put in a language even you could understand, the field is running dry.

Getting a report from the government saying their actions did not increase prices is a truthful as Obama saying his spending is not causing a deficit.
==

From the Graziadio Business Report-”Because of reduced capacity and increasing demand, U.S. refineries are operating at 96 percent capacity”
==
So something that runs at nearly full capacity is a red herring for higher gasoline prices? And when these refineries go offline or have problems the smaller capacity with high demand has NO impact on prices? Seriously read an economics book.
==
–

SZ

“market-wide negotiated price controls.”

Isn’t this a practice they have tried in Medicare and it has failed. When left to the devices of the government this will lead to political corruption and massive fraud.

Seems to me that somewhere in all of that schooling you would have learned some reading comprehension but apparently not.
..
The “red herring” was your throwaway line about there being no new refineries built in the last 30 years. The fact that there were no new refineries built is a red herring due to the fact that this did not limit refining capacity. It was the plan of industry to eliminate refineries in order to better manage their capacity and to allow then to manipulate prices of refined products more easily. As such, 2/3s of refineries were closed and capacity was expanded at existing refineries.
..
Of course refineries operating at 95-100% of capacity has an effect on the prices of refined products; any problem becomes magnified and distorts the price. Where exactly did I say otherwise?

lizziefromcanada:

I don’t know if you have seen this.

I have.
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The first part is data, which is, at this point, indisputable.
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We, the United States, spend the most, twice as much as every other OECD nation.
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The second part is not data, it is analysis, and it is incomplete.
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Fee-for-service is only one of the factors that leads to the high cost of US health care. The other factor is price.
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I don’t know if you have seen this piece comparing the price of health care units (drugs, procedures, physician visits, etc.) between the United States and other first world countries (link to the Washington Post )
.
In it, US physician visit fees range up to $151 vs Germany’s $22, US CT imaging scans range up to $1800 vs Germany’s $319, and US drug prices (such as for Lipitor) range from as high as $334 vs Germany’s $48.
.
Canada’s health care prices are also radically less expensive, with physician visit fees range up to $151 vs Canada’s $30, US CT imaging scans range up to $1800 vs Canada’s range up to $530, and US drug prices (such as for Lipitor) range from as high as $334 vs Canada’s $30.
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Download the pack of pdf charts.
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Yes, Gerard Anderson says “More care does not necessarily mean better care,” and that is undeniably true, but doesn’t speak to the relative importance of fee-for-service in raising costs. It is obviously true that less care does not necessarily mean less costly care, either.
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Differences in fee-per-service vs comprehensive treatment payment schedules may account for much of the difference between the highest and average costing locales in the United States, but not between the United States and other OECD countries.
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Ezra Klein refutes that simplistic claim this way:

There is a simple explanation for why American health care costs so much more than health care in any other country: because we pay so much more for each unit of care. As Halvorson explained, and academics and consultancies have repeatedly confirmed, if you leave everything else the same — the volume of procedures, the days we spend in the hospital, the number of surgeries we need — but plug in the prices Canadians pay, our health-care spending falls by about 50 percent.
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In other countries, governments set the rates that will be paid for different treatments and drugs, even when private insurers are doing the actual purchasing. In our country, the government doesn’t set those rates for private insurers, which is why the prices paid by Medicare, as you’ll see on some of these graphs, are much lower than those paid by private insurers.
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The health-care reform debate has done a good job avoiding the subject of prices. The argument over the Medicare-attached public plan was, in a way that most people didn’t understand, an argument about prices, but it quickly became an argument about a public option without a pricing dimension, and never really looked back. The administration has been very interested in the finding that some states are better at providing cost-effective care than other states, but not in the finding that some countries are better at purchasing care than other countries.

The acceptance of the “fee-for-service explains everything” theory by a consensus of media outlets is an interesting phenomenon in the US health care debate. Ezra Klein uses a weirdly passive construction “The health-care reform debate has done a good job avoiding the subject of prices,” as if the was a conscious actor named “the debate” who found it much easier to talk about unnecessary care than about extremely expensive prices.
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When employed by someone like Ezra Klein, that kind of phrasing usually means “The press corps aren’t doing a very good job of explaining the problem, because they’re exclusively focused on how political actors’ proposals define the problem to be solved.”
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Michelle Andrews’ casual “Why the high cost? The U.S. has a fee-for-service system” is part of that problem we have talking about health care in the United States, unfortunately.
.
Thanks for reading this, lizziefromcanada. Believe me, I’ve read Michelle Andrews’ contribution many, many times. Thanks for providing another opportunity to discuss “fee-for-service explains everything” vs “fee-for-service doesn’t explain $1800 CT scans in a country with more machines per capita than almost every other country –the United States.”

I am going to venture a guess that Rusty is already a Medicare beneficiary.
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As a businessman, not as a recipient. I think that, in a previous thread some time back, he let this information escape. He’s making money off of the services.

Oregon JC:
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It’s not a “tepid agenda.”
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It’s radical and a continuation of what was attempted with some reasonable success (in terms of its enactment, not its value to ordinary people) in the 1990s.
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NAFTA wasn’t “tepid,” it was significant. DMCA wasn’t “tepid,” it was a crushing blow against all of the little individual enemies of the partnership. Gramm-Leach-Bliley wasn’t “tepid,” it literally destroyed the financial regulatory framework of the New Deal.
.
TARP isn’t “tepid,” it’s extreme. HCR isn’t “tepid,” it’s a giant step in an ideological direction.
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We are in the unenviable position of needing to somehow defeat the radical center without empowering the radical right, in order for things to stay as bad as they are.
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We are, as it’s said in policy-speak, supremely f*cked, JC.

Yes, of course, SZ, but Green was speaking of the public-serving agenda. In that case, I’d say tepid was an overstatement.

I guess I’m of the opinion that using “hot” vs “tepid” plays into the (dishonest) rhetorical strategy of the center, which seeks to frame its goals as “moderate,” when the opposite is the case.
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Not only is “tepid” an understatement, it’s just plain wrong. New Democrats’ solutions (the Feds finance hedge funds’ secret purchases of Citi’s balance sheet crap –stock in long defaulted mortgages– at inflated prices) are terrible for people (no Cramdown).

diecash1

Maybe you need to get off your arrogant high horse. My use of the term “red Herring” was in response to you post with it. It was not my throw away line.
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“The fact that there were no new refineries built is a red herring due to the fact that this did not limit refining capacity”

So demand grows but there is no new capacity but htis doesn’t limit refining capacity?

You are too stupud to breed.,

Damn you are ignorant. Like I said, reading is fundamental. Your throwaway line was specifically this: “Yes its called restrictions on drilling and no new refineries in theis country in over 30 years.” I then pointed out that it was a red herring. No new refineries has nothing to do with anything; it was the plan of the oil companies to reduce the number of facilities and better match available refining capacity in order to maximize profits and the effect of refineries upon the markets for their products. Read it s-l-o-w-l-y this time and maybe you’ll understand it.
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As per usual, you piss and moan while insulting others. Calling you a moron is a serious insult to morons everywhere.

freeinpa

When left to the devices of the government this will lead to political corruption and massive fraud.

That’s your ideology talking, not the facts.
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The rest of the wealthy world doesn’t seem to have a problem doing it, why should we?
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Are we like the Democratic Republic of the Congo, a cultural kleptocracy?
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I agree with you that Medicare (and especially Medicaid) pricing is rife with apparent corruption, and is nowhere close to being as rational or transparent as every other country (Medicaid rebates are a big loser for everyone except health care profiteers), but why does it have to be this way?
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It’s not that “government is always bad, so we get ripped off,” otherwise the Germans would be ripping of the Germans, the French would be ripping off the French, the Japanese would be ripping off the Japanese, the Swiss would be ripping off the Swiss, and (given the Italians’ propensity for this kind of scandal) the Italians would be ripping off Italians, but it just doesn’t happen that way in the rest of the OECD world.
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These are some of the same governments that were gaming the Iraq Oil for Food program, so I’m not suggesting that they’re saints. The fact is, though, that their citizens demand not to be ripped off by their health care system pricing, and so they’re not. Maybe it’s because the Germans can just take a train ride over to Switzerland or Italy and they see what prices are, where we don’t have that much general knowledge about what goes on in other countries.
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Who knows? The fact is, though that somehow these other countries can do it, so the question is: why can’t we?
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It can’t be that Americans are somehow more disloyal or immoral than other people, that’s crazy. So why would we be incapable of having the same relatively corruption-free scheduling of health care prices that other countries have?
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Why is our government always going to give us corruption and massive fraud? What do you think is especially wrong with Americans or our country?

We don’t need government to set anything what we need is for the hospitals to quit charging so much.. however it’s the fault of the American people who THINK going to a hospital is like a day at the spa private rooms, with a view, cable, internet etc.. all this is nice but it does cost not to mention the drug companies who charge top dollar and want you on as many drugs as possible.. come on folks you don’t want to share a room with even one person and want all the luxuries of home you have to pay for them.. your hard pressed to even find a hospital that has semi private rooms anymore.. and IF the hospital knows you have insurance they make sure they keep you until your insurance won’t pay anymore.. but the government isn’t doing a thing about the two ends that make the insurance companies have to raise their rates, the hospitals and drug companies who by the way make sure their investors make MORE than the insurance companies..

SZ, thanks for the response. My copy & paste and disjointed response were all I was capable of this a.m. What you and Lovely Bride will discover someday if blessed by a child, is that coherent thought is a precious rarity. Even in conversation, let alone trying to type/process info/think critically. What happens when the digital and diaper data streams are both flowing.

It is not just individual policies. I had an Anthem Medicare Advantage plan (California) whose monthly premium went from $00.00 to $78 per month as of Jan. 1, 2010. As my only income is Soc. Sec., I had to change to another plan that I could afford which gives me signiicantly less coverage.

baja: The first year I had Medicare Advantage with Health Net my premium was $30 a month, next year $50, last year $101, and this year $119. I keep the Advantage plan because of the high medicare deductibles if you are hospitalized. The deductibles and copays also increased. I switched to another company and my monthly premium is $95 a month.
Medicare Advantage is subsidized by the government but still is unable to control their costs.
People like me who are retired and have medicare need to let it be known that we want universal health care. It can’t be all about us.

freeinpa- Thanks for explaining your position. Basically, you feel that 1) the government “interventions” and “restrictions” are irrational “environmental” and “permitting” requirements; 2) the government’s reports are wrong- due to poor information, incompetence or bias.
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1) Governors and Senators are desperate to have oil companies in their State—they’ll work around zones and fees. And you can’t argue that there are no legitimate ecological (lakes, drinking water, contaminated soil, etc) pitfalls with oil drilling/refining- if you want to do so, be specific and include links. Further, the last admin was notorious for allowing business to dictate environmental policy. The restrictions don’t appear very restrictive.
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And who are these liberals that have steered policy? “(O)ver 30 years” ago there was a change in US oil and energy policy. Reagan and Congress decided not to continue Carter’s domestic oil and alternative energy (nuclear, wind, solar [he had panels on the WH], bio-fuel) initiatives. Hundreds of domestic rigs and refineries closed by choice as the Administration and the oil industry got all kissy-face with Saudi Arabia and embraced cheap foreign oil (they even hired Saddam). It was not an imposition. They built the infrastructure, placed the apparatus and included the military to make it happen. It’s hypocritical for republicans, now, after a massive US taxpayer and industry investment in foreign oil, to complain that liberals are stopping domestic oil. The oil industry does not want domestic oil, they want Iraqi and Afghani oil—it was the path they chose “over 30 years” ago.
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2) If the government is making assumptions (due to a lack of audits or otherwise), then you’re making assumptions too. Why are your assumptions better than the Dept. of Energy’s? Would ANWR produce more than “0.4 and 1.2 percent of total world oil consumption in 2030″? Specifics please. And if the report suffers from bias, it would have showed ANWR to be more impactful than it really is, not less.
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Big picture: “drill baby drill” is more campaign slogan than policy. Any new domestic sites will take almost 20 years to be productive and all available info suggests that we won’t produce enough oil to counter OPEC’s ability to manipulate global supply and price. Our best hope is to develop an alternative transportation fuel.

spob,

I think you have hit on a very good point. We need consumer based health care and not a system where the insurance is purchased by the employer. In my local newspaper, a gentleman from a “libertarian” organization suggested a way to may health care much more efficient and affordable for all . . . . . And I agree simply subsidizing the current system is pure madness . . . . . . . .
Now, since I have agreed with you, I am going to throw at you that snowball from Hell. LOL