quote:

ORIGINAL: freedomdwarf1

quote:

ORIGINAL: DesideriScuri
Then why hasn't anyone been able to show that? It's not like I haven't asked. So, now I'm asking you to prove that statement. Prove that it works remarkably well in driving costs down across the board.

Considering a lot of the drugs are made in the US and the services are similar...
Compare: US pricing with UK pricing.
Compare: US pricing with Canadian pricing.
Compare: US pricing for Australian pricing.
Compare: US pricing with.... any other European pricing.

quote:

Those in the US are paying 10x or more for the same products and most equipment even though the cost of transporting them overseas is shitloads more expensive than moving them around within the US.
Every element within the US system needs mega-buck malpractice insurance because they allow such huge claims to be made. Everywhere else, those payouts are bucket-loads less than the US.

quote:

quote:

ORIGINAL: DesideriScuri

quote:

If the supermarket buys direct from the farmer with an agreement to buy most (or all) of the crop at X price being lower than the market rate but still profitable, the farmer has no surplus to worry about, he still makes his money, the consumer gets the cabbage at cheaper prices and the supermaket deals with all the logistics and distribution and still makes their bit.
Sure, the farmers bitch about the volume sales and getting lower unit profits. But at the same time, a lot of hassle is removed and he has a guaranteed sale even when it's a bad year.

How does government know what price will allow some profit, though? What level of profit is acceptable?

As I keep telling you... in healthcare, it's not a business and doesn't need to make a profit.
People need to stop thinking of it as a business too.
Stop trying to put a national service into a business model - it will never fit and isn't designed to do so.

quote:

Within a single-payer system, the government control the prices and dictate what they will pay the suppliers if they want a big slice of the cake.
And this is where the unit profit and volume of scale still makes it worthwhile to the suppliers to do it and make a profit.

quote:

quote:

ORIGINAL: DesideriScuri
They don't? Under my ex's insurance, I had the option of a branded drug, or the generic version. I paid a higher co-pay for the branded drug, so I always chose the generic. Hell, I've even told my physician to write the script for the generic. WalMart started this pharmacy pricing war for many of the most common medications (non-controlled substances, IIRC). What happened after they did this? Other pharmacies made similar choices. I have 5 or 6 (not sure if Giant Eagle has a pharmacy, as I don't shop there) pharmacies within 5 minutes of my house. I have no restrictions on which one I get a Rx filled.

You are still thinking inside that little box of yours.
Start thinking of no-pay rather than co-pay and still have that same choice.

quote:

quote:

ORIGINAL: DesideriScuri
The only time you probably won't have a choice is in an emergency situation, where time is of the essence. You're going to the closest facility. You could shop for a primary physician if you want. You can shop for specialists if you want. Few do that because they aren't actually paying for themselves.

Again, you're still thinking inside that little commercial box at a local level.
In a single-payer system, there is no need to shop around.
Your physician is doing the same work for the national hospitals as he is for the private ones.
The same applies to all the specialists and their teams around them.
An emergency is an emergency - it won't matter where you go for the treatment.

• A Conservative interpretation of the US Constitution
  
• Personal Responsibility
  
• Help for the truly needy
  
• Limited Government
  
• Consumption Tax (non-profit charities and food exempt)
  

quote:

ORIGINAL: DesideriScuri
Yep, all those are lower now. Any proof that the systems drove costs down, though? That was your claim.

quote:

ORIGINAL: DesideriScuri

quote:

Those in the US are paying 10x or more for the same products and most equipment even though the cost of transporting them overseas is shitloads more expensive than moving them around within the US.
Every element within the US system needs mega-buck malpractice insurance because they allow such huge claims to be made. Everywhere else, those payouts are bucket-loads less than the US.

Some studies say malpractice insurance is only 2% of costs. That may or may not be accurate, but, even if it is, halving it would help.

quote:

ORIGINAL: DesideriScuri

quote:

As I keep telling you... in healthcare, it's not a business and doesn't need to make a profit.
People need to stop thinking of it as a business too.
Stop trying to put a national service into a business model - it will never fit and isn't designed to do so.

You wrote:

quote:

Within a single-payer system, the government control the prices and dictate what they will pay the suppliers if they want a big slice of the cake.
And this is where the unit profit and volume of scale still makes it worthwhile to the suppliers to do it and make a profit.

Apparently, provision of health care services, even in the UK, is still a business with profits and loss.

quote:

ORIGINAL: DesideriScuri
There are lots of options available, and I am free to choose whichever one I want. I can price shop if I so choose. So can pretty much everyone else. That people don't isn't my fault.

quote:

ORIGINAL: DesideriScuri
You are responding to things outside of the context they were written in.

You stated that the normal rules of economics don't apply. You stated in the health care industry, people can't pick and choose.

I point out that they can.

You come back with not having to in the UK. That has nothing to do with your initial claims, nor my response.

quote:

ORIGINAL: Phydeaux

Of course it costs more to run medicare advantage. You had a lot more things covered under medicare advantage than medicare. Things like hearing aids, glasses, dental.

Those accounts - which obama care gutted were actually innovative and a bloody good idea.

The premise was this: as the elderly grow older their medical bills increase. Making them less desirable to be insured by private industry. So medicare was dumped with old, sick people.

So, by offering a subsidy to insurance companies, those companies would keep people on their roles.
Prtty much win win.

Elderly liked being able to choose a plan that worked for them.
Government got to avoid sick people being dumped into medicare.
Private industry got to defray costs of sick elders.

quote:

ORIGINAL: MariaB
My question is, do you want change?
do you feel you would benefit from a different system?
do you think none insured patients deserve what they get?
do you believe every human, no matter how rich or poor, deserve the same treatment for a long term illness?
do you believe medicine should be a business that creates fat cats at other peoples expense?

quote:

ORIGINAL: freedomdwarf1

quote:

ORIGINAL: DesideriScuri
Yep, all those are lower now. Any proof that the systems drove costs down, though? That was your claim.

They always have been since inception.
That is the power of monopoly purchase.
You don't have that in the US - at least not to the same scale as others.

quote:

This is pretty much how the single-payer system works, even in Australia where they have a 50/50 system.
What happens is, they tell big pharma and others within the healthcare industry all down the line "we have the monopoly and if you want to sell your shit to us, that's what we'll pay or you aren't getting any slice of the cake".
It works remarkably well in driving costs down across the board.

quote:

Your system runs on open market principles like any other business and because they don't work together like a single-payer (closed preference) system, each one has to negotiate their own prices with limited buying power and in competition with each other.
And because people really don't have much of a choice (because they all run pretty much at a local or state level), what little competition there is doesn't bode well for a price war. It's almost as if they are in collusion to keep the prices sky high.

quote:

quote:

ORIGINAL: DesideriScuri

quote:

Those in the US are paying 10x or more for the same products and most equipment even though the cost of transporting them overseas is shitloads more expensive than moving them around within the US.
Every element within the US system needs mega-buck malpractice insurance because they allow such huge claims to be made. Everywhere else, those payouts are bucket-loads less than the US.

Some studies say malpractice insurance is only 2% of costs. That may or may not be accurate, but, even if it is, halving it would help.

Halving it would help, yes.
But when you compare identical awards (the thalidamide case comes to mind), the awards in the US were a whole magnitude and more than what was offered anywhere else.
So you should be thinking of less than 10% in awards to get anywhere close to others, not just halved.
And if the payouts weren't so big, and the lawyers fees weren't a mortgage in themselves, the cost of malpractice insurance would be a whole lot less.

quote:

quote:

ORIGINAL: DesideriScuri

quote:

As I keep telling you... in healthcare, it's not a business and doesn't need to make a profit.
People need to stop thinking of it as a business too.
Stop trying to put a national service into a business model - it will never fit and isn't designed to do so.

You wrote:

quote:

Within a single-payer system, the government control the prices and dictate what they will pay the suppliers if they want a big slice of the cake.
And this is where the unit profit and volume of scale still makes it worthwhile to the suppliers to do it and make a profit.

Apparently, provision of health care services, even in the UK, is still a business with profits and loss.

The fact that some parts do make a profit only means that those profits subsidise those areas that don't.
The difference is, the whole scenario isn't run on a business model and never has been.
Unlike insurance companies that need to build-in a profit margin and allow for worst-case scenarios, a single-payer healthcare scheme doesn't need it.

quote:

quote:

ORIGINAL: DesideriScuri
There are lots of options available, and I am free to choose whichever one I want. I can price shop if I so choose. So can pretty much everyone else. That people don't isn't my fault.

You have that option because you paid for it with a co-pay scheme.
Now imagine if you didn't have that... Do you have that same choice?
Unless you have the bucks to pay for it, you don't.

quote:

quote:

ORIGINAL: DesideriScuri
You are responding to things outside of the context they were written in.
You stated that the normal rules of economics don't apply. You stated in the health care industry, people can't pick and choose.
I point out that they can.
You come back with not having to in the UK. That has nothing to do with your initial claims, nor my response.

It has everything to do with it.
If you wanted to pick and choose your physician or hospital or its services, you need to find out what's on offer and at what price and what you are able to claim under your insurance. You also have to consider distance and costs.
As far as I know, unless you pay megabucks, you can't pick a hospital across the other side of the country that has better facilities or better physicians and still have your insurance company pay for it and the transport costs. That's what I mean by lack of choice.
The normal rules don't apply because in a single-payer system, you have the choice of everyone and everything and you don't need to consider anything - you'll get it automatically if you need it and it's available universally across the country.

• A Conservative interpretation of the US Constitution
  
• Personal Responsibility
  
• Help for the truly needy
  
• Limited Government
  
• Consumption Tax (non-profit charities and food exempt)
  

quote:

ORIGINAL: DesideriScuri
If it works well in driving costs down across the board, you should have some proof that it did that. You can't compare one country to another. You have to compare what happened in the same country. If it's driven costs down, then it's driven costs down. If it's done nothing but limit cost increases, that's not driving costs down.

quote:

ORIGINAL: DesideriScuri
People come on here and talk about the US lowering costs if we move to a national care system. Yet, no one can show where costs have been lowered by those systems. The only thing I've been able to find is comparisons showing how national care systems have had lower cost increases. While that certainly merits looking into, it's not the same as reducing costs. If the only thing that moving the US to a national care system does, is reduce cost increases, that only solves half the problem. The other half of the problem is that our costs are too fucking high now.

Can you demonstrate that moving to a national system actually reduced health care costs?

quote:

ORIGINAL: DesideriScuri
Republicans support allowing insurance companies to sell insurance across State lines.

If there is collusion, that would be against the law here, and should be pursued (this is something that might need to be looked into regarding companies that own and operate both the insurer and the provider).

quote:

ORIGINAL: DesideriScuri
Providers need to make a profit, though, don't they?

quote:

ORIGINAL: DesideriScuri
Wrong. I can walk into any of those places and purchase my prescription, even though I don't have insurance. What's really fucked up here, though, is that the "negotiated cost" when I was on insurance for the prescription I'm on was very high. That is, the cost to the insurer was, IIRC, $90/month less my $10 co-pay. The pharmacy was paid $90 for my prescription. Now, I am not on insurance. My cost for my prescription is $10/month. I'm paying the same amount.

quote:

ORIGINAL: DesideriScuri
I can't do that in any the Market for anything, though. I can do that in my local area, and should do that for anything in my local area. I can drive for < 5 minutes to get to any of 4 grocery stores. Two are right next to each in one direction, and two are next to each other in the other direction. One of each of those pairs also has non-grocery items (one is WalMart and one is a Meijers store, which is similar to a WalMart in it's setup). I get to choose where I want to shop and don't have to think up driving costs. I don't have that choice for health care, unless you broaden to sphere to 10 minutes drive.

I don't need to leave the Toledo area for anything, yet. Cleveland is about 2 hours driving distance, and Detroit is about an hour. Ann Arbor hosts University of Michigan and it's medical hospital. There is a Medical Hospital in Toledo, too. There is no shortage of specialists in Toledo that are fantastic. We might not have the bestest of the bestest, but I'm perfectly okay with that.

Even in the UK, there is a physician or specialist that is the best, and the rest aren't. Are you able to get an appt. with the best of the best as quickly as you can your local specialist?

quote:

ORIGINAL: freedomdwarf1

quote:

ORIGINAL: DesideriScuri
If it works well in driving costs down across the board, you should have some proof that it did that. You can't compare one country to another. You have to compare what happened in the same country. If it's driven costs down, then it's driven costs down. If it's done nothing but limit cost increases, that's not driving costs down.

We got our system way back in 1944.
It isn't possible to compare like-for-like when there is almost 70 years difference and the equipment and services are vastly different.
The nearest we can do is compare identical products and similar services when paid for in different countries by different systems.
That is a fair comparison and as best as you can get.
I also gave you a very typical example in another thread where a local NHS hospital was able to buy a scanner costing £22m for £8 and the local private hospital couldn't afford to buy it. That's proof positive to me that the power of the monopoly to drive down the cost is working to provide better diagnostics within the NHS than to go private.

quote:

quote:

ORIGINAL: DesideriScuri
People come on here and talk about the US lowering costs if we move to a national care system. Yet, no one can show where costs have been lowered by those systems. The only thing I've been able to find is comparisons showing how national care systems have had lower cost increases. While that certainly merits looking into, it's not the same as reducing costs. If the only thing that moving the US to a national care system does, is reduce cost increases, that only solves half the problem. The other half of the problem is that our costs are too fucking high now.
Can you demonstrate that moving to a national system actually reduced health care costs?

I have, on several ocassions, and given examples.
Scanner: costs £22m. But to our NHS hospitals, only £8m because of monopoly purchasing power.
Doctor's visit: Private £25; NHS free.
Prescriptions (per item): Private £18; NHS free.

quote:

quote:

ORIGINAL: DesideriScuri
Republicans support allowing insurance companies to sell insurance across State lines.
If there is collusion, that would be against the law here, and should be pursued (this is something that might need to be looked into regarding companies that own and operate both the insurer and the provider).

Yeah, like it's also illegal to drive whilst drunk or to smuggle drugs, or to drive with bald tires.....
They hide it all behind waffle and red tape.
Maybe republicans support alowing to sell across the state lines but they aren't in control are they.
And if it was a single market, there can't be any collusion to worry about.

quote:

quote:

ORIGINAL: DesideriScuri
Providers need to make a profit, though, don't they?

Equipment suppliers do otherwise they wouldn't be in business.
Everything else is paid for and supplied within the healthcare system itself.
And as I said, everything within healthcare doesn't have to make a profit so it's not a consideration.

quote:

quote:

ORIGINAL: DesideriScuri
Wrong. I can walk into any of those places and purchase my prescription, even though I don't have insurance. What's really fucked up here, though, is that the "negotiated cost" when I was on insurance for the prescription I'm on was very high. That is, the cost to the insurer was, IIRC, $90/month less my $10 co-pay. The pharmacy was paid $90 for my prescription. Now, I am not on insurance. My cost for my prescription is $10/month. I'm paying the same amount.

And my prescription costs are zero.
That's the same cost as any child under 18, anyone on a pension, anyone disabled, anyone on benefits, anyone on low incomes.... zero, zilch, nada, nothing... free.
The costs for those prescriptions are bourne by the tax payer and again, by power of monopoly, the NHS pays a lot less for those same drugs than a private hospital pays.
Another example: when I was caretaker of a local village hall, I had to buy cleaning fluid to clean the floors with. It cost me more for a 1 gallon container of the stuff (wholesale business price) than it cost the local hospital for a whole pallet of the same stuff!! And don't tell me the company making the stuff isn't making a profit because they'd soon go out of business if they weren't.

quote:

[

quote:

ORIGINAL: DesideriScuri
I can't do that in any the Market for anything, though. I can do that in my local area, and should do that for anything in my local area. I can drive for < 5 minutes to get to any of 4 grocery stores. Two are right next to each in one direction, and two are next to each other in the other direction. One of each of those pairs also has non-grocery items (one is WalMart and one is a Meijers store, which is similar to a WalMart in it's setup). I get to choose where I want to shop and don't have to think up driving costs. I don't have that choice for health care, unless you broaden to sphere to 10 minutes drive.
I don't need to leave the Toledo area for anything, yet. Cleveland is about 2 hours driving distance, and Detroit is about an hour. Ann Arbor hosts University of Michigan and it's medical hospital. There is a Medical Hospital in Toledo, too. There is no shortage of specialists in Toledo that are fantastic. We might not have the bestest of the bestest, but I'm perfectly okay with that.
Even in the UK, there is a physician or specialist that is the best, and the rest aren't. Are you able to get an appt. with the best of the best as quickly as you can your local specialist?

If it's needed, yes, we can.
Imagine Walmart or MacD's being a hospital franchise... same sort of stuff available anywhere to the same standards (generally) across the country. When they buy a product, do you think they pay the same $'s than your local corner shop or supermarket?? No they don't; nowhere near the same.
When I was hauling fish fillets for MacD's, they were paying less per box of fillet'o'fish (250 portions) than it costs me to buy a small fries. Think about it.
Example: toy made in China costs $25 to buy as a single retail item. Corner store buys it from their local wholesaler for $18; wholesaler buys from their distributor for $10. Distributor buys it direct from China by the container load for $3 each.
Walmart buys direct from China, not by the container load but by a whole shipload at a time and probably only pays $0.30cents each for that same toy. Even if it costs them $5 per item (on average) to get it distributed across the US to all of their many stores, they can still afford to sell retail at $9 each and beat the wholesale price.
The chinese manufacturer is laughing all the way to the bank because he pays $1 a week in wages and gets those toys rolling off the production line at 5 cents each.
The same principal applies to a single-payer healthcare system. They have the power to negotiate a much lower price for everything - equpiment, services, staff, even building contracts. Whatever they save in monopoly and bulk-buy purchasing power means the less they have to take out of the general pot of taxes and more they have to spend on other related things (like better equipment, more nurses, newer buildings etc).
Economies of scale means everything is cheaper. When those costs are factored into the national healthcare budget, that's what they take into consideration. This is also why our tax rate for N.I is only 8.6% - I hate to think what it might be if they didn't have that buying power.
This is why our doctors are only paid $150K-$250K in salaries. It's a reasonable livable wage and if they want more they do private work.
It also means the budget has a known expenditure for salaries. Less guesswork, no contingency needed, a known quantity.
Maybe "profits" isn't the right word to convey what I mean and leading to commercial confusion - perhaps a lower budget deficit or a lower tax burden or just simply lower costs would be more accurate.

• A Conservative interpretation of the US Constitution
  
• Personal Responsibility
  
• Help for the truly needy
  
• Limited Government
  
• Consumption Tax (non-profit charities and food exempt)
  

quote:

ORIGINAL: MariaB
@DesideriScuri How do you know that prices in the US wouldn't still be as high as they are?
It makes no difference what the internal billing costs are. As a user of a universal health care system, you don't pay a bill, you don't see a bill. You just pay your tax's.
NHI is averaged out over everyone. If every other country that have this system in place can do it at a reasonable cost, then why can't the US?

quote:

@DesideriScuri Why does anyone have private insurance in the UK? Most private insurance is purchased by companies for employees. It ensures a fast service and is seen as a bonus by those employees. I have used both private hospitals and NHS hospitals in the UK. Private when I need to get an appointment at a very specific time and date and NHS when I'm happy to take the appointment they give me. Private medical care definitely has its benefits but not always. Recently I needed to see a surgeon and only had a 2 week window to get that appointment. My appointment to see him under the NHS came through quicker than the private appointment. Its nice to have the choice but its nice to know you will get good and thorough treatment regardless.

quote:

@DesideriScuri There are no private entities that supply the health care system? The medical device manufacturers are nationalized? All the suppliers are nationalized? Why do they sell stuff to the private hospitals at a higher cost than they do the national hospitals, then?
Most medical device manufacturers are not nationalized. My ex husband worked for a private manufacturer that supplied hospitals with CT scanners. Large machines such as CT scanners are made to order.
We can hypothesize about prices but if any company gets a large, regular and reliable order it can cut its costs and as there are far more NHS hospitals than there are private ones, the NHS hospitals can simply demand a better deal.

quote:

@DesideriScuri What would happen if the NHS couldn't find a Dr. willing to work for less than $300k?
A qualified doctor in the UK earns on average £100,000 a year. Substantially more for a consultant specialist. Any GP demanding a much higher salary would be told to look for work elsewhere. Any doctor knows his potential earnings before he starts medical school. Why would he suddenly demand more than his considered worth. Lets also keep in mind that British and French doctors spend their lives saving not only the rich but the poor as well. They never have to turn anyone away because their patients insurers are kicking up a fuss. I should of thought that our doctors get far more job satisfaction than their American cousins.

• A Conservative interpretation of the US Constitution
  
• Personal Responsibility
  
• Help for the truly needy
  
• Limited Government
  
• Consumption Tax (non-profit charities and food exempt)
  

quote:

ORIGINAL: Yachtie

It's no point at all within context, which apparently you also do not comprehend.

quote:

ORIGINAL: MariaB

The American health care system is so distant from anything I recognize.

The British NHS haven’t exactly had an easy time of it. It’s been long painful journey.
Even now, if I want to make an appointment with my doctor in the UK, I will be asked if its an emergency and if it isn’t, I will be told in no uncertain terms that there are no available appointments for two weeks and to phone back in two weeks. When I phone back Ill be told the same thing!! When I eventually do get to see my general practitioner, I will of sat in a waiting room for a good hour (over the scheduled time) and if I’m lucky, Ill get to see my GP for five minutes.

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ORIGINAL: TheHeretic

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ORIGINAL: GotSteel

*shrug* for some reason the "poor people should die on the emergency room curb" view of health care just doesn't poll very well.

And who besides Ed Shulz thinks anyone actually holds such a position?

I thought you might be better than a bullshit strawman artist, GotSteel. You disappoint me.

quote:

ORIGINAL: DesideriScuri

Wrong. I can walk into any of those places and purchase my prescription, even though I don't have insurance. What's really fucked up here, though, is that the "negotiated cost" when I was on insurance for the prescription I'm on was very high. That is, the cost to the insurer was, IIRC, $90/month less my $10 co-pay. The pharmacy was paid $90 for my prescription. Now, I am not on insurance. My cost for my prescription is $10/month. I'm paying the same amount.

quote:

ORIGINAL: graceadieu

We're talking about why the founding fathers didn't specify health care as part of promoting the general welfare. My response is that that's because people didn't use much healthcare in those days, or spend much on it, which I feel is rather a good point, sorry.

quote:

ORIGINAL: graceadieu

quote:

ORIGINAL: MariaB

The American health care system is so distant from anything I recognize.

The British NHS haven’t exactly had an easy time of it. It’s been long painful journey.
Even now, if I want to make an appointment with my doctor in the UK, I will be asked if its an emergency and if it isn’t, I will be told in no uncertain terms that there are no available appointments for two weeks and to phone back in two weeks. When I phone back Ill be told the same thing!! When I eventually do get to see my general practitioner, I will of sat in a waiting room for a good hour (over the scheduled time) and if I’m lucky, Ill get to see my GP for five minutes.

That actually sounds just like the American health care system.

I had to get an MRI last week for a sports injury. It took me 3 weeks to get an appointment, and I still had to wait for half an hour past the appointment time. I went in to the orthopedist today for the results (inconclusive), and after seeing me for 5-10 minutes he told me that I should get a cortisone shot to dull the pain, but they couldn't do it today and I have to come back for that in a week or two. Which he could've told me 3 weeks ago! And of course, I have to pay every time I go in or get any tests.

quote:

ORIGINAL: DesideriScuri
You don't get it. Why does insurance cost so much here? Um, because the individual costs of services and procedures is so high. If those costs dropped across the board, insurance costs would drop across the board.

quote:

ORIGINAL: DesideriScuri
The Federal government is already spending around 10% GDP in health care costs. That covers about a third of the US Citizenry. UK's NI is 8.6% (according to freedomdwarf). No one can show that care costs drop by moving to a national care system. If care costs don't drop, whether the Federal government is footing the bill or it's split private/public, we're still going to be spending a shit ton more than anyone else.

quote:

ORIGINAL: DesideriScuri
So, NHS isn't actually meeting all the demands of the marketplace, then.

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ORIGINAL: DesideriScuri
Did your ex's employer make a profit?

quote:

ORIGINAL: DesideriScuri

quote:

@DesideriScuri What would happen if the NHS couldn't find a Dr. willing to work for less than $300k?

Thanks for ignoring the question completely.