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View Diary: The last battle for single-payer (67 comments)

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  •  As you point out (26+ / 0-)

    Insurance companies suck the life out of our health care system in many ways.  It's not simply the higher overhead costs and profit margin of the insurance companies that burden the current system.  

    My primary care physician's office, in order to manage the complexities of billing numerous insurance companies, each having their own coding and diagnostic protocols, spends approximately 35% of their gross revenue in their efforts to bill and collect for their services.  Additionally, many hours are spent each week on the phone with practitioners arguing with insurance company minions about what is medically necessary for proper diagnosis and treatment of their patients.  

    Stipulating a minimum "medical loss ratio" is a help, but it does noting to address escalating costs of procedures and medications or the enormous waste of time and energy practitioners have to suffer to get paid for their work or to argue what's in the best interests of their patients with insurance company lackeys.

    It has always seemed strange to me...The things we admire in men, kindness and generosity, openness, honesty, understanding and feeling, are the concomitants of failure in our system. - John Steinbeck, Cannery Row

    by ovals49 on Sat Sep 01, 2012 at 01:41:42 AM PDT

    •  There are some promising signs (14+ / 0-)

      from state-level plans. The issues with pharmaceuticals (which the ACA basically ignored) are being dealt with in the Vermont and California plans. Mass bulk purchases of drugs and durable medical equipment drive down costs, and basically attempt to deflate the pharmaceutical bubble built on the borders of the Untied States.

      Medical spending is a case where you can truly identify waste in all its forms. It is amazing that in the United States, so much has produced so little. Healthcare is unaffordable for a very good reason- no serious effort has been undertaken to negotiate drug rates and buy in bulk. No effort has been taken to deal with insurance using Medicare as a checking account. No effort has been taken to even produce a competitive private market, if we're still going with bad ideas.

      "I know not with what weapons World War III will be fought, but World War IV will be fought with sticks and stones." -Albert Einstein

      by Kazmarov on Sat Sep 01, 2012 at 02:03:01 AM PDT

      [ Parent ]

      •  That last can't be done (5+ / 0-)

        What kind of economic basics does a "free market" require?  Things like elasticity of demand, low barriers to entry, the ability to comparison shop for price.  So what's the "elasticity of demand" for medical care when you're having a heart attack?  How do you comparison shop for prices when you've been hit by a truck?  Can anyone just hang out a shingle and start practicing medicine, or are there high costs--high barriers to entry--to participating in the field?  

        Those are the ground level fundamentals that a "free market" requires, and as I have just shown, exactly none of them can be made to apply to medical care.

        Ever get the feeling you've been cheated?

        by ActivistGuy on Sat Sep 01, 2012 at 10:25:52 AM PDT

        [ Parent ]

        •  The other basic failure (1+ / 0-)
          Recommended by:

          is lack of expertise.  Almost by definition you are looking for an expert in a field you don't understand.

          Start with the fact you are a poor judge of the expert's ability, and add to that the institutional barriers to getting data about the physicians.   What public quality measures can you get, even when you have time to choose?  

          We have some proof of this fact.  The justification for increasing copayments and sharing premium costs is that it makes the patient a more careful consumer of healthcare.  This would, by the magic hand of the free market, lower utilization and reduce overall costs.  This particular drum was being pounded pretty hard as far back as 1985, when I worked in health data analysis.  

          So far, implementing cost sharing for the last thirty years has accomplished... cost sharing.

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