Healthcare Questions

Within the last two weeks, I've had the following healthcare related experiences :

1. Got a non-emergency appointment to see my HMO Primary Care Physician at 8:30AM for 2:10PM on the same day

2. Had the remnants of a split root canal tooth extracted the afternoon of the day I called the dentist.

3. Had a low priority open MRI head scan scheduled and done eight days after asking for an appointment. This was supposedly a longer than normal delay and the private MRI facility no longer needed 24 hour scheduling to meet demand.

Question #1 :

Based only on the above, am I more likely to live in Toronto or Boston?

Question #2 :

Upon leaving the MRI facility, I was given a CD that included both head images and a viewer for use on a PC. As a lay person, what interesting use can I make of this besides proving that vacuum has a texture? Although my PCP will receive an independent report, has anyone published 'MRI Scan Analysis for Dummies'?

Addendum below :

Reference

If there is any doubt community hospitals have lost their dominance over the imaging business to entrepreneurs and doctors' groups, a trip along crowded roadways near Northshore Mall in Peabody would be instructive.

MRI centers have sprung up like fast-food restaurants. Ringing the mall are a new MRI center operated by Sports Medicine North, a group of orthopedic doctors in partnership with MRI Centers of New England, a major Shields rival; the Shields MRI at Lahey Clinic Northshore, which is operated by Shields Health Care Group; and North Shore Magnetic Imaging Center, a joint venture of Beverly Hospital, Salem Hospital, and two other North Shore hospitals.

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ask the question; how long

ask the question; how long did government have its hands on the internet? and what happened to it when the free market got ahold of it and how long did that take? Its just like NASA.

This recent Cato paper

This recent Cato paper nicely outlined the various myths regarding national health insurance plans.

"People don't comparison

"People don't comparison shop when they're sick".
I do. The more is riding on my choice, the more opinions I get.
"It's hard for people to tell when their health care provider has failed them." I sure as hell know. Believe me, when you've spent most of your life as a patient, you value your choices, and you pay attention. I spend a lot of time and a lot of money in the American health care system, I will continue to do so for the rest of my life, and socialized medicine is my worst nightmare.

Brian, Don't you still have

Brian,

Don't you still have something of a comparison problem, though? The U.S. raises its average life expectancy the same way that its average income looks so much higher than the rest of the world, namely, there are huge gaps between the richest and the poorest. So of course the richest 20 states in the U.S. do well because the richest 20 states in the U.S. are far wealthier than the richest 20 European states.

The really valid comparison, though, would be to ask what the life expectancy of the average member of a particular socioeconomic class is. For the richest Americans, I suspect you'll likely find that number to be much higher than for the richest Europeans. It will probably also be true for most of the middle class. I suspect that the numbers will reverse pretty dramatically for the poorest. How do you think the life expectancy of a kid in Boston whose parents are on welfare compares to the life expectancy of a kid in London or Paris or Berlin whose folks are on the dole?

Talk of averages can be misleading since huge inequalities will tend to iron out statistically (and morally) significant differences.

Joe- If you throw together

Joe-

If you throw together the EU's stats, they are on par with the US. If you throw in all of Europe, they do worse.

If you compare the EU to a statistically valid comparison set with the US (i.e. the richest 20 states), the US kicks Euro ass. Only by comparing the richest & smallest Euro states to the entirety of the US does one get the disparities to show.

And any mention of Cuba in a discussion of statistics is an automatic disqualifier. If there is a more intellectually & intentionally dishonest regime extant in the world than Cuba, I'm hard pressed to say.

If your goal is to have

If your goal is to have people come around to your pov, you can be a bit less condescending in your tone.

When I condescend, it’s typically to try and cover up a weak argument or an attempt to end a discussion. I imagine if my argument were strong enough, I’d have no need to be condescending.

Of course, sometimes I condescend because the other guy’s an idiot.

Sooo, you're not worth bothering to respond to as you're just going to be a condescending schmuck regardless? I can live with that.

_Yes, but size is by no

_Yes, but size is by no means the only confounding variable that must be taken into account if we are trying to assess the effect of healthcare._

True, there are lots of other factors. But I don't think that those other features are what you were making fun of with your moon example. The force of that example would just about have to be that the moon fares well because it has zero population. If your main target is population size, then it's only fair to point out that the _population_ part of the question isn't really an issue.

That’s hardly fair. I see

That’s hardly fair. I see your point about size disparity, but isn’t it the case that the EU collectively is still doing better than the US in terms of infant mortality and life-expectancy? That’s probably a pretty fair comparison in terms of size, no?

Yes, but size is by no means the only confounding variable that must be taken into account if we are trying to assess the effect of healthcare.

_I’ve heard tell that the

_I’ve heard tell that the infant morality rate on the moon is quite low as well–nearly zero, I hear. Yet they have no healthcare whatsoever. Perhaps it follows that we should abandon the healthcare industry entirely._

That's hardly fair. I see your point about size disparity, but isn't it the case that the EU collectively is still doing better than the US in terms of infant mortality and life-expectancy? That's probably a pretty fair comparison in terms of size, no?

Qwest regarding this quote,

Qwest regarding this quote, “Maybe if I change the spelling to Canadaslavia it would upset some left wing sensibilites less, and possibly force them to examine the reality they live in.” Actually, by changing the spelling of Canada you make yourself look like a shithead and will cause people to ignore you completely. (P.S. Scott Scheule, told you so.)

Funny then, the not only do you not ignore him, but even go so far as to insult him.

Matt McIntosh, if the US has such great health care why is their life expectancy lower than Canada, Sweden, France, etc.? Why is their infant mortality higher than Canada, Sweden, France, CUBA! Personally when it comes to judging the the quality of health care I prefer statistics like these to anecdotes, and strangely, so do scientists.

I've heard tell that the infant morality rate on the moon is quite low as well--nearly zero, I hear. Yet they have no healthcare whatsoever. Perhaps it follows that we should abandon the healthcare industry entirely.

Matt McIntosh, if the US has

Matt McIntosh, if the US has such great health care why is their life expectancy lower than Canada, Sweden, France, etc.? Why is their infant mortality higher than Canada, Sweden, France, CUBA! Personally when it comes to judging the the quality of health care I prefer statistics like these to anecdotes, and strangely, so do scientists.

Qwest regarding this quote, "Maybe if I change the spelling to Canadaslavia it would upset some left wing sensibilites less, and possibly force them to examine the reality they live in." Actually, by changing the spelling of Canada you make yourself look like a shithead and will cause people to ignore you completely. (P.S. Scott Scheule, told you so.)

Brandon Berg, you fail to take into account one simple fact, people don't go comparison shopping when they're sick. Just like people don't do comparison shopping when looking for funeral parlours. Plus it's hard for the consumer to tell when their health provider has failed them. It's better for people to have access to free cancer diagnosis tools than a state of the art cancer treatment facility. But no one's going to think, "I got cancer cause I didn't get regular tests."

Tran Sient, a lot of times it has to do with population size. There's no multiple birth wing in all of Vancouver, which is the third largest city in Canada. Do you know how many multiple births there are in Vancouver? On average less than one a year. Therefor, it makes little sense to have such a facility on hand and it is more practical to contract the work out to other facilities and the nearest one happens to be in Seattle.

All, An addendum dealing

All,

An addendum dealing with MRI suppliers and politics has been added to the original post.

Regards, Don

C.S: Yes your right, i

C.S:
Yes your right, i purposefully mis-spelt Canada using the pseudo-Russo
Slavic spelling, that I myself invented.(i've tried to make the 'a' print backwards for years but cannot ) I don't think Canada is a communist country, but it CETAINLY IS a quasi-socialist country. Maybe if I change the spelling to Canadaslavia it would upset some left wing sensibilites less, and possibly force them to examine the reality they live in deeper.:smitten:

If your goal is to have

If your goal is to have people come around to your pov, you can be a bit less condescending in your tone.

When I condescend, it's typically to try and cover up a weak argument or an attempt to end a discussion. I imagine if my argument were strong enough, I'd have no need to be condescending.

Of course, sometimes I condescend because the other guy's an idiot.

That’s a statement that

That’s a statement that demonstartes mind-boggling ignorance of how markets actually work. Of course, that’s par for the course for leftists, and I hear it all the time, so I’ll just copy and paste a response I gave elsewhere.

If your goal is to have people come around to your pov, you can be a bit less condescending in your tone. The thrust of your comments, I agree with. In a market open to competition, there are incentives for profit that involve having other companies lose profit. Companies compete for profit. In a socialist system, there are no such incentives because there are no other companies.

The reason for this is

The reason for this is simple, it is more profitable to treat symptoms than it is to strive for a healthy population.

That's a statement that demonstartes mind-boggling ignorance of how markets actually work. Of course, that's par for the course for leftists, and I hear it all the time, so I'll just copy and paste a response I gave elsewhere. Enjoy!

This may be a problem, but it's not a problem specific to the profit system. In fact, government intervention in the medical system is arguably a contributing factor. If all "legitimate" doctors are doing more or less the same thing, then they all benefit if we keep getting sick. But the market doesn't work that way. Suppose you have a better idea--an idea that would make all those doctors obsolete. Sure, it's bad for them, but it's good for you--you'll make a bundle--and in a free market, they can't stop you. But this isn't a free market, and they can stop you. The AMA is a government-backed cartel, and government-backed cartels are not an inherent feature of the profit system.

Honestly, I find this line of thinking utterly bizarre. Sure, if I'm the only game in town, I'm better off giving you a temporary solution so you'll be back for more next week. But if I'm not the only game in town, and my customers aren't completely blind, how can this strategy possibly work? Sure, I'd like to keep on milking my customers, but why would they be willing to go along with it?

There are numerous examples throughout history of entire industries shrinking dramatically or disappearing entirely when something better came along. These didn't always happen because the top firms in these industries decided it was time for a change. They usually like things as they are. Changes frequently come from outsiders who don't have vested interests in the status quo, and from consumers who like the new way better.

The only item that truly

The only item that truly amazes me is the short time it took to get your mri scheduled. I've never heard of such unless it involved an emergency.

I take it that you're here in the States, but will you tell us what sort of insurance plan this is? It sounds too good to be true.

des, I take it that you’re

des,

I take it that you’re here in the States, but will you tell us what sort of insurance plan this is? It sounds too good to be true.

It has little to do with the insurance plan, which is Harvard-Pilgrim. It is likely the competition and level of supply of independent MRI capability North of Boston that has brought down the appointment times. It is relatively common to see TV consumer ads for a specific MRI supplier as it tries to capture or create demand.

Regards, Don

C.S. -- Qwest and I actually

C.S. -- Qwest and I actually live here in the People's Republic of Canuckistan, so I think we're entitled to poke fun.

"...I am prepared to make the following bet: ten years from now, it will be objectively clear that the United States provided significantly better health care to its citizens between 1990 and 2005 than did other developed countries. From the vantage point of 2015, the policy blunder of the past fifteen years will not be that the United States spent too much on health care, but that other countries spent too little. The socialized systems, forced to ration health care because tax revenues are not sufficient to pay for state-of-the-art care, are constraining their citizens from being diagnosed and treated as well as Americans."
-- Arnold Kling

'Hmm, I wonder what the

'Hmm, I wonder what the average Canadian pays in health care.'

Hmm, I wonder what they pay in taxes. Oh wait, since there is no defense budget, its probably not that much more than the US. Hmm, I wonder why Canadians come to the US for real treatment.

So in other words youy spend

So in other words youy spend $7500 in health insurance a year. Hmm, I wonder what the average Canadian pays in health care. ... $2831.17, according to my numbers. Lets compare that to the U.S. ... $5475.73. Interesting.

To figure it out for yourself: Go here for population and GDP numbershttp://www.cia.gov/cia/publications/factbook/

Go here for Healthcare cost:

http://www.corporatism.netfirms.com/universal.htm
http://www.nchc.org/facts/cost.shtml

The reason for this is simple, it is more profitable to treat symptoms than it is to strive for a healthy population.

BTW, Scott, Qwest didn't misspell Canada, he tried to imply Canada is communist. Imagine someone bringing up Pinochet everytime a free market economy was mentioned.

I have dental insurance and

I have dental insurance and it takes me weeks to get an appointment (this is in the U.S.). This is not a defense of Canadian healthcare.

They give you the images?

They give you the images? Cool!

CSS, How much did it cost

CSS,

How much did it cost you to do this? That would really help answer your final question.

1. $15 Non-Group Insurance Co-pay.
2. $165 fee for service, no dental insurance.
3. Nothing, effectively included in the ~$625 monthly single insurance premiums.

Regards, Don

Dear C.S., Nitpicking

Dear C.S.,

Nitpicking orthographic irregularities is a fine way to give off the appearance of having an anally-embedded rod, and will cause most rational people to suggest you remove it.

Dear Qwest, Spelling Canada

Dear Qwest,

Spelling Canada with a K is a good way to look like an idiot and will cause most rational people to ignore the rest of your argument.

Dear Don,

How much did it cost you to do this? That would really help answer your final question.

Qwest, I'm pretty sure

Qwest, I'm pretty sure you're right. Though I think McGuinty has been making mumblings about allowing private clinics for certain things.

#1. Boston. I believe here

#1. Boston. I believe here in Kanadastan its illegal to run a private clinic. its against the Kanadastani health act, although in some places MRI's have bypassed this system.

Joe, True, there are lots

Joe,

True, there are lots of other factors. But I don’t think that those other features are what you were making fun of with your moon example. The force of that example would just about have to be that the moon fares well because it has zero population. If your main target is population size, then it’s only fair to point out that the population part of the question isn’t really an issue.

I was making fun of the confusion of corellation with causation generally. Since infant mortality could be expressed as a percentage as well (as it generally is, isn't it?), I don't think size of a population is a particularly relevant variable in and of itself. Moreover, the quote I was responding to was not contrasting the EU, an example you yourself inserted, with the United States, but rather France, Sweden, and Cuba.

des,

Said I: Of course, sometimes I condescend because the other guy’s an idiot.

Said you: Sooo, you’re not worth bothering to respond to as you’re just going to be a condescending schmuck regardless? I can live with that.

I don't see how that follows. Nowhere did I say I condescended "regardless."

Joe, Switching the problem

Joe,

Switching the problem to one of class is shifting the goalposts. The initial claim is that socialist health care provision is superior to the US because of aggregate statistics. Of course, if you get similar socioeconomic state/population units, the US comes out ahead again.

It may be interesting to compare Poor to Poor; I strongly suspect that the US will again come out ahead in an objective comparison, but that's from personal anecdote- workaday Canadians and, say, French or Germans, wait in line whilst the politically connected in Europe & Canada move to the head of the line. That's certainly not a fair situation, and I imagine that waiting for health care (preventive or otherwise) is not going to lead to good outcomes- certainly not in acute situations.
Or, of course, it may be that in general people don't need nearly as much health care as they're led to believe they do (which wouldn't surprise me), and so the rationing and waiting for health care has little negative effect on populations on a gross level. I wonder, too, how objective & standardized the statistics are; I know it is true that the US counts premature infants in its "infant mortality" while Europe does not; that right there is a major skew in the statistics. I imagine that similarly creative stat keeping in Europe may also be behind some apparent "good numbers". The opacity of health care statistical reporting is a major stumbling block (I imagine an intentional one) to accurately slicing up data comparisons between different populations (vs. politicized state-level rollups).

The level of infrastructure investment in socialist health care systems is also poor- dental equipment & technology in Germany is at least 10-15 years behind American standards, though the extra pain & suffering of German dental patients as a result of old equipment is not captured in any statistics, for example. The fact that there are more MRI machines in a large American city than all of Canada is a telling indictment, in my view. At the very least it is an opportunity cost that must be weighed against any 'potemkin statistics' trumpeted as proof that the system works.

In any case, if you have to keep chasing more finely detailed distinctions in order to get a comparison that looks good for socialist medicine, I think that itself is telling.

Brian, At the risk of

Brian,

At the risk of sounding snarky, how is it that when you shift the comparison (e.g., from U.S v. France or UK to richest 20 states vs. EU) it's to seek "statistically valid comparisons" but when I do so it's "moving the goalposts" or chasing distinctions to make my argument look good?

Out of curiosity, since I'm sure that you know more about this than I, to what extent are the many MRIs in Boston underutilized or resorted to when it's not really particularly necessary? How many hospitals and/or clinics have gone bankrupt from purchasing MRIs that really aren't being used often enough to justify having them? How are they then avoiding bankruptcy?

Here's my worry. Lots of our rich abundance of medical technology is really extra. Rather than facing the consequences of bad investments, hospitals either (a) order unnecessary tests for those who can pay, or (b) raise prices on other services to offset bad investments. Because, as others have pointed out, sick people don't do all that much comparison shopping, competition doesn't have the same effect on healthcare that it does in other sectors. (Not that it has no effect, just that it has less effect.)

So, yes, we have more stuff. And if you can afford it, you can take full advantage of that stuff and live a long time. Lots of people, however, can't afford even the basics of healthcare, let alone the neat stuff. And the more stuff we buy, the more expensive everything gets, with the result that fewer people can afford the basics.

I'm not in this field, though, so maybe this is off base. The argument above, though, is not from liberal fantasy-land, or at least it's not exclusively there. I heard something very much like it from a lot of people back when I interned at BCBS.

Joe, No snark- Its a case of

Joe,

No snark- Its a case of apples and oranges. As you said, there are socioeconomic differences that drive outcomes in health. The usual "US vs. France" comparison is comparing a rich state (France) with a much smaller and more homogenous population (socioeconomic differences) than the US, which contains 50 states of varying wealth, development, ethnicities, etc, as well as (and perhaps most importantly) a dizzying (to Euro standards) variety of authorities overseeing health care policy or lack thereof, vs. a French dirigiste model where everything is pretty tightly controlled from Paris.

THere is no meaningful statistical comparison between these two sets, IMO. California v. France, maybe (similar population & domestic product), but certainly not one where France stands alone and all the poor areas of the US are lumped in.

It is another question entirely (though subject to the same comparison restraints) to disaggregate health care outcome statistics by economic *class* (vs. geopolitical). I'd still say that if you want to look at how the poor do in France vs. somewhere in the US you'd have to compare to California or Texas, etc. A direct comparison is meaningless, IMO.

As to 'underutilization' of MRIs and various medical capital equipment goes, that risk is borne, properly in the case of MRI clinics, by the owners of the equipment & clinic and their financial backers. If they choose poorly THEY lose (I don't, and the poor do not), and since the cost is concentrated on them and their backers, they have a higher incentive to estimate correctly. If they don't, they go out of business and, most importantly, the MRI machines are sold to someone else. If there aren't enough buyers for it, the price will drop until someone buys it, either for its intended use or something else. IN any case, the regular market mechanism works to clear capital from nonproductive uses to productive ones, adjusting the price of the resource and properly aligning the incentives of the people procuring the devices to make sure they're going to a socially beneficial end.

You're right that the US is, in the aggregate, an early adopter of all new medical technology, mostly because we can pay for it (rich folk first; an advantage of wealth disparity is that it tends to drive technology), and whoever buys new pays a lot more vs. someone who gets the technology slightly after the curve (see also computer technology prices). Europeans free ride off Americans' propensity to adopt new technology early (and thus pay the high up front development costs), at the price of being slightly behind the curve (or more, in the case of German dentistry, for example).

And further you are right that because of the nature of 3rd party payer, many hospitals perform defensive medicine to both justify expenditures and defend vs. malpractice suits (driving up cost & demand for health care capital) and also pass the buck along to insurers because they know corporations will foot the bill since it's on net better for them to maintain health care coverage in the old model than to try and hold the line at the provider side (they just hire fewer employees or squeeze more out of their paychecks, spreading the pain out). The dispersed nature of the costs and the concentrated benefits (to the hospitals) pretty much demands the scenario of ever-increasing health care costs.

But that has relatively little to do with the American desire to early-adopt new medical technology and everything to do with the, dare I say, socialized nature of health care funding/reimbursement.

Really, to the extent that sick people don't do cost comparison shopping is that you can't do cost comparison shopping. Doctors simply don't compete on price; you're part of a network, you show up, you pay your co-pay (unrelated to the doctor or clinic) and there you go. In any case, you dont have St. Mary's saying "our MRI rates are the best in the county; choose St. Mary's for all your MRI needs", or fill in the blank with whatever medical practice you want done, be it surgery, other imaging, physical therapy, etc. And this, again, is due to the nature of the American health insurance system that is driven by 3rd party payers insulating both consumer and producer from the true costs of health care provision (and causing higher demand that outstrips artificially boosted supply.

I can't see how making the 3rd party government will solve the innate 3rd party problem. The difference with a government provider though is that the government has even less need to care about individual outcomes, it just needs to keep problems just below a threshold that would trigger political backlash. Hence the Canadian system of long waits & intentional institutionalization of mediocre expectations.

As I intimated above, though, you're probably right in that Americans don't *need* to consume as much health care as they do (and thus drive prices up and out of reach of poor Americans in some cases; though they just rely on emergency room service, so really its the middle class (as always) that takes the real economic brunt), though I disagree that we need political command and control to ration health care, but would rather ration by price (and let the buyers face the full cost). At the very least disaggregate health care from jobs. We don't get car insurance from our companies (usually, I guess, though I suppose some company might), we shouldn't get health insurance from them either. And as car insurance doesn't pay for gas & oil changes, neither should health insurance. But that's another topic...

Wow fascinating discussion

Wow fascinating discussion here.

I want to add that part of the problem with the cost of health care in the US is its structure. Under the current plan "employers" pay for a certain regular base cost of your plan and then you are only required to pay a small deductible when you get treatment. Much like the Canadian version, the true cost of the treatment is not paid by the person receiving it at the time of the visit. Instead, the costs come from the monthly pool of funds paid in by everyone in the system. If people are getting more treatment for the doctors because they only have to pay a small co-pay, which doesn't cover the cost of their visit), then HMOs will have to raise prices of the monthly fees to cover these extra visits.
Unlike the Canadian system though, we are not discouraged from visiting the doctor's office whenever we wish or encouraged to seek out alternatives for medication. Apparently a positive to the American system, it is precisely what prevents the Canadian system from ballooning up like the American system has in recent years.

And as for whether or not people shop around when they are sick. I think it depends on how serious their illness is and how much time they have to shop around. Someone with cancer certainly has more time to shop around than someone with a flesh eating bacteria. How many times have you heard a hospital advertise how highly ranked they are at treating certain kinds of cancer, vs. how many you've heard advertise how good they are at treating necrotizing fasciitis?

I can see how care of women

I can see how care of women would cost more than men (child birth), but most HMO plans cover a spouse as well. If this is the case, married men should make less than single men and be on par with married women. Instead, I think that gap is best explained by average age differences between men and women.

I don't know if you see a pay difference between married men and single men, I would imagine there would be a gap, albeit smaller as men don't take maternity leave for pregnancies. I've never heard of statistics on that, but they would be interesting to see. I know it's more difficult to get a job if your married (although technically I think this is one of the those legally protected things); less likely to be willing to travel, do shift work, relocate, and the additional medical costs of insuring more people.

I don’t know if there would be this mass decentralized network out there without government intervention. Pre-1995 or so, the private dial-up providers only linked within their own networks and not each other’s (IE you could only access AOL stuff via AOL and Compuserve stuff via Compuserve, but not AOL stuff via Compuserve), although there was some third party access such as newsgroups, but most of that stuff was of government origin as well. However, it is hard to tell what outside networking was driven by technology and what was driven by third-party platform (the internet) popularity.

I don't know much about computers and what sort of technological reasons there would be for it being easier to allow have access to a providers network, but it seems that there would be an advantage to for dial-up providers to allow you to access other networks as well, at least that seems to be the trend. Anyone can get AIM now, where it used to just be people with AOL, cell phone companies are starting to share towers. It seems like cooperation of this type evolves on the market.

At the very least

At the very least disaggregate health care from jobs. We don’t get car insurance from our companies (usually, I guess, though I suppose some company might), we shouldn’t get health insurance from them either. And as car insurance doesn’t pay for gas & oil changes, neither should health insurance.

Ya know, I disgree. I think that HR departments have an advantage when it comes to negotiating with companies for contracts like this. I think that you could end up with a per-employee net benefit with such a contract negotiation of healthcare than you would with an individual trying to negotiate their own healthcare.

Thea, I think we're pretty

Thea, I think we're pretty much on the same page, I'm just a little more hesitant to say that employers paying for health care is a problem.

Also, I wanted to comment about how you said "I attribute companies providing medical insurance as the main reason there is a pay gap between men and women, and why it is more difficult both for older people to get and keep jobs than it was a few years ago." That's a pretty interesting thought. I think it definitely explains why older people have a hard time finding work, but I don't think it explains why there's a difference between men and women pay-wise. I can see how care of women would cost more than men (child birth), but most HMO plans cover a spouse as well. If this is the case, married men should make less than single men and be on par with married women. Instead, I think that gap is best explained by average age differences between men and women.

I think many things, such as barbed wire and the internet, would have been developed without government intervention and research;

I agree, it is interesting to think about though. I don't know if there would be this mass decentralized network out there without government intervention. Pre-1995 or so, the private dial-up providers only linked within their own networks and not each other's (IE you could only access AOL stuff via AOL and Compuserve stuff via Compuserve, but not AOL stuff via Compuserve), although there was some third party access such as newsgroups, but most of that stuff was of government origin as well. However, it is hard to tell what outside networking was driven by technology and what was driven by third-party platform (the internet) popularity.

David, The problems of 3rd

David,

The problems of 3rd party payer (and the disparity in power that dependence for health care insurance gives to employers) outweighs any negotiation advantage a company might have.

Indeed, there is nothing particular to a company that cannot be done by a disaggregated insurance company or insurance provider (HMO, benevolent society, etc). When health care is tied to work, salaries go down and the social cost of unemployment goes up, as well as the individual cost. The long run effect is that companies see their health care costs skyrocket as a consequence. Its a bad deal all around.

David, If you are saying

David,
If you are saying that HR departments can negotiate better contracts due to large size of subscribers, there is nothing stopping people from pooling together on their own to do the same - a "union" for health care of sorts. Any voluntary organization can use size as an advantage in negotiations.

Brian, I don't necessarily

Brian,

I don't necessarily mean with a system like we have now. If an employer paid for major medical health insurance while also helping with medical accounts (sort of like what they do with my 401K) you could on the one hand, have employers negotiating better prices for their employees while at the same time allowing employees to see the full cost of their doctor visits.

Of course, I'm sure we agree that the best solution would be to let the market sort it all out.

Johnathan, If you are saying

Johnathan,

If you are saying that HR departments can negotiate better contracts due to large size of subscribers, there is nothing stopping people from pooling together on their own to do the same - a “union” for health care of sorts. Any voluntary organization can use size as an advantage in negotiations.

The thought had crossed my mind, although which is cheaper: forming a brand new union or using the existing union you have (AKA your employer). Many credit unions are based around a common employer and operate competitively with commercial banks.

I'm not saying that employers should be forced to provide healthcare because of this advantage, just that employees might look more favorably upon employers who offer it for this reason.

Dave- I agree that it could,

Dave-

I agree that it could, but I think that without a period of wage caps, it wouldn't have formed so unilaterally and we would be in much less of a mess today. I know that I would prefer a higher salary and increased privacy to medical coverage, and I think others would also.

Just because a system arose from government intervention, doesn't in my mind mean that it couldn't
have arisen on the free market, it just sends up a red flag in my mind to look at it more closely. I think many things, such as barbed wire and the internet, would have been developed without government intervention and research; other things, like to drug war and social security, probably wouldn't have.

I was just saying that I think that the massive third payer system that we have today, a system so omnipresent it leads some people to actually claim that all Americans have a right to someone else paying for at least part of their medical care, falls into the later category for the other reasons I mentioned.

I’m skeptical of any

I’m skeptical of any system that didn’t arise due to market forces rather than government intervention.

Ironic that you're posting on the internet then :razz:

All I'm saying is that it may very well arise given market forces because employers have an advantage of "bulk" when it comes ot negotiation with some service providers. Given that different people have different health needs though, it may not make sense to lump everyone into the same plan, but still some employer involvement might arise given market forces.

Lisa, in the 'minds' of the

Lisa, in the 'minds' of the Canadian voter and the socialist cult that tells them what to think(cbc), yes, thats exactly what they want. They don't care how bad it gets, as long as we're all the same. That is the overarching idiot feature/mantra of the Kanadian(ooppps sorry CS) health care peoples union of workers and patriots.

_Why? Cause pharmaceutical

_Why? Cause pharmaceutical companies spend a busload of cash on lobby groups / political contributions. This is the main reason prescription drugs are so much cheaper here._

Isn't this overlooking a more obvious answer? Prescription drugs are more expensive in the U.S. because pharmaceutical companies, like any other business, charge however much the market will bear. So far, Americans (generally speaking) are willing to pay very high prices for drugs (whether that payment comes from 3rd party payers or their own privately-funded insurance).

It seems to me that deregulation wouldn't, all by itself, magically lower prices. As long as I can charge $80/pill and find enough people to buy it, I'm not going to lower my price to $40/pill just because it suddenly costs less to produce it. Unless something else also changes, I'm going to charge $80 and pocket the difference. I might think about lowering prices some to capture more buyers at the margins; much will turn on how many buyers there are at the margins. But there is only so much room to create new demand for drugs. When Pepsi gets cheaper, I might well drink more of it; I won't double my Lipitor dose just because the price suddenly went down.

We can go round and round

We can go round and round about whose infant mortality and life expectancy stats are better, but so what? If life expectancy and infant mortality really are better in countries with socialized medicine, does that mean we have to have it, regardless of its effect on individuals? Like I said, socialized medicine is my worst nightmare. I fear what it would do to my health and my life a lot more than I fear any medical bills I could rack up under the current system, flawed as it is. But since I'm just one individual, do my health and well-being have to be sacrificed so we can have the system that produces the best collective results? Or is this acceptable because a system in which I am less healthy and have less choices, but everyone else does too, is more just?

"The long run effect is that

"The long run effect is that companies see their health care costs skyrocket as a consequence. Its a bad deal all around." - Brian W. Doss

You ain't kidding! I recently read that GM spends $1500 on health insurance, PER CAR.

That actually ties into the current top story, (SUMMARY: Real waged dropped by 0.2% last year but overall compensation went up.) Health costs in the state are increasing dramatically and businesses are paying the brunt of that. So while compensation is going up, it is not the result of workers getting more but merely the cost of the old is going up. That's bad news no matter how some people might spin it.

Couple of other points:

1.) A lot of people responded to my stats about infant mortality and life expectancy. But all of them are logically suspect.
i) Comparing it to the moon? If your only argument is that sad, why bother? BTW, 0/0 does not necessarily equal 0.
ii.) Size matters! 'Comparing the U.S. verses any other nation that beats it doesn't count cause the US is bigger!' Interesting claim, any proof to back that up? Prove a bigger nation will have more infant deaths on a per population basis. Japan has a larger population than Germany yet Germany has a higher rate of Infant mortality. Germany has a Larger population than Canada, yet Canada has a higher infant mortality.
iii) 'The EU and the United States are about the same size and have the same infant mortality.' EU has roughly 100 million more people but the US has an Infant Mortality rate that is 22% higher.
iv) 'There are socio-economic pressures in the US that push up the infant mortality rate.' Oh yeah? Name them. And if you even mention the more than 40 million people who are uninsured, you are proving my point.

2,) "If you are saying that HR departments can negotiate better contracts due to large size of subscribers, there is nothing stopping people from pooling together on their own to do the same - a “union” for health care of sorts. Any voluntary organization can use size as an advantage in negotiations." - Jonathan Wilde

We have that in Canada, it's called the government. In the United States the government is prohibited from using its size to negotiate a better deal. Why? Cause pharmaceutical companies spend a busload of cash on lobby groups / political contributions. This is the main reason prescription drugs are so much cheaper here.

Joe- Here’s my worry. Lots

Joe-

Here’s my worry. Lots of our rich abundance of medical technology is really extra. Rather than facing the consequences of bad investments, hospitals either (a) order unnecessary tests for those who can pay, or (b) raise prices on other services to offset bad investments... Lots of people, however, can’t afford even the basics of healthcare,... And the more stuff we buy, the more expensive everything gets, with the result that fewer people can afford the basics.

I agree that this is a problem, but I think it would be better solved with deregulation rather than increasing the government's grip on medical care.

All the things you are describing above seem to be the result of the AMA (and to a lesser extent the 3rd payer system, the FDA, and other countries free-riding off US R&D.)

Demand for healthcare would be a lot more elastic for a given firm and basic healthcare would be a lot cheaper if the supply weren't so restricted.

David-

Ya know, I disagree. I think that HR departments have an advantage when it comes to negotiating with companies for contracts like this. I think that you could end up with a per-employee net benefit with such a contract negotiation of healthcare than you would with an individual trying to negotiate their own healthcare.

I have two main problems with 3rd payer system:

1. I'm skeptical of any system that didn't arise due to market forces rather than government intervention. It's possible, as others have commented that some companies would offer health insurance on the free market, but because you do have quite a deal of choice in the amount of healthcare you consume in many cases, it's a difficult thing to 'insure'.

2. It bureaucratizes (I'm not sure that's a word, but I'm going to pretend) both the medical industry and employment. I'm not sure of the actual number, and I don't want to make one up, but the amount that medical facilities spend on bureaucratic overhead because of 3rd payer systems is ridiculous. I attribute companies providing medical insurance as the main reason there is a pay gap between men and women, and why it is more difficult both for older people to get and keep jobs than it was a few years ago.

I know that I for one, would much rather work for a company that didn't provide health insurance if it meant I received a larger salary. Really even if it just meant I didn't have to go in for a physical and get blood drawn, I'd probably be happy.

C.S.-

We have that in Canada, it’s called the government. In the United States the government is prohibited from using its size to negotiate a better deal.

Governments don't negotiate
better deals. I was trying to think of some sort of condition to put on that, but I really can't think of any. Even if
the government had the best intentions, without prices and voluntary exchange, it's just not possible to allocate resources properly. The government really only has two modes of operation; woeful inefficiency and theft.

If you look at something like public transportation (at least in St. Louis, I can't really speak to anywhere else), money is just poured into a program that flounders about hopelessly, or in the best case scenario provides a service at a much higher cost than the market would. These cases are clearly not a good deal.

If you look at something like interstate or airport expansion, the government seizes private property and pays whatever a government provided appraisal determines to be "fair". These cases are clearly not a negotiation.

It seems surely there should be more than anecdotally examples that don't fit either of these scenarios, but I really can't think of any.

What is the basis for your assumption, that the government would be more effective at negotiating
(I guess I assumed your use of this word implied consent of the vendor, if it doesn't I do concedes the government is very good at theft.) than a firm or even an individual would be in a free market?

Why? Cause pharmaceutical companies spend a busload of cash on lobby groups / political contributions. This is the main reason prescription drugs are so much cheaper here.

Actually, I think that the reason prescription drugs are so much cheaper in places other than the US is the FDA.

I work at a pharmaceutical plant, and I've talked to people at work about this quite a bit; I really know very little about the pharmaceutical regulating bodies of other countries, so anyone feel free to correct me, but it seems that the FDA requires jumping through many more hoops to sell pharmaceuticals than are required in other countries.

The FDA is a lot stricter about drugs coming into the US that were manufactured in other countries than similar government agencies of other countries. (I think this is also why pharmaceuticals have outsourced manufacturing jobs a great deal less than many other industries.) A co-worker told me that all the material produced at our facilities in China and Europe, will not be allowed to be sold in the US by the FDA.

Another guy I know had a friend in R&D that developed a process that eliminated the need for two steps in the production of a pretty high volume product. It was estimated that implementing the change would save tens of million dollars a year. However, because the change was significant enough, the FDA would have to review it to see if modifications needed to be made to the DMF. With all the customer notification, and all the customers needed to notify the FDA of the change in raw material (We make active pharmaceutical ingredients that we ship to other facilities or sell to other companies to put into dosage form.), and the risk of needing to refile the DMF, it was decided that it was not worth it. The actual drug would have had the exact same chemical composition, given product made both ways it would not be possible to determine which was which, but the FDA red tape was still enough to keep the new process from even moving to lab scale.

Again, I don't know about regulatory agencies of other countries, but between the costs incurred for FDA compliance and the delay in new product release due to the FDA while generic versions of the drug are being made abroad, pharmaceutical companies in the US have a lot of costs to recoup.

Brandon Berg; Yes, it is

Brandon Berg;
Yes, it is against the Canada health act , in some way, to send a patient an accurate 'dummy invoice' to inform them how much they cost me or you. I'm sure someone trolling along can give me a good government employee type reason why that SHOULD be so. :mad:

David Peterson: No one here

David Peterson:
No one here is discouraged from visiting a doctors office. My father has run a clinic for over 30 years and actively encourages people to look after themselves better and to reduce clinic and hospital visits. to no avail. its 'free' and they will go to someone else until they hear what they want to hear. he figures 50% of the people who come into his office should not even be there and with a $10 or $20 fee per visit they would vanish. He tried to implement a 'dummy invoice' policy so the patient would see what it cost 'somebody' but the gov't disallowed it.:mad:

No one here is discouraged

No one here is discouraged from visiting a doctors office.

My mistake, I thought you were limited in your visits and often had to wait 'till your regularly scheduled visit to see the doctor.