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Why Not Fix Medicare First?

"Nearly 30 percent of Medicare's costs could be saved without adverse health consequences," according to the President's Council of Economic Advisors. If so, Virgina Postrel wants to know, why don't we fix this before trying to make the rest of the health sector more like Medicare?

Think about this for a moment. Medicare is a huge, single-payer, government-run program. It ought to provide the perfect environment for experimentation. If more-efficient government management can slash health-care costs by addressing all these problems, why not start with Medicare? Let's see what "better management" looks like applied to Medicare before we roll it out to the rest of the country.

This is not a completely cynical suggestion. Medicare is, for instance, a logical place to start to design better electronic records systems and the incentives to use them. But you do have to wonder why a report that claims that Medicare is wasting 30 percent of its spending thinks it's making a case for making the rest of the health care system more like Medicare.

More from Mickey Kaus here.

Andy Freeman (mail):
There are also a lot of govt employees. Between Medicare, Medicaid, govt employees, the Indian Health Service, and the military, the various levels of US govt currently provide about half of all "health insurance". Their health care costs about as much as the private sector and has no better outcomes. In other words, US govt healthcare is not more effective. That makes the claim that US govt healthcare will be more effective somewhat hard to believe.

Since govt employees are fairly similar to private sector employees, demonstrating on them would go a long way toward proving that ObamaCare will be an improvement.

I say give Obama free rein wrt govt healthcare. He says that there's 25-30% savings, so let's see it. To that end, starting in 2011, the per-person budget gets cut by 5%/year for four years.

And yes, state and local govt employees are to be in the program. (Whether a state admins for the federal govt on behalf of all covered folks in said state or the fed govt administers for all covered folks is one of the decisions that Obama gets to make. However, every covered person within a state is handled the same.) The only group that gets to stay out is the VA, and Obama is free to include them.

Somewhere in there, we open it up to cost-plus govt contractors and limit their reimbursements accordingly.

If Obama is correct, this will be a huge success and the rest of the private sector will demand to join. If he's wrong, govt employees will rebel.
6.8.2009 10:31am
Just Me:
Actually, Obama has a proposal to start to do exactly that.
6.8.2009 10:53am
mcbain (mail):
Medicare is not a perfect environment for experimentation, because it serves old people. old people are sicker than the general population and largely require a different type of care.

Face it, there is going to be rationing. There is rationing right now.

The only difference is going to be that instead of rationing based on the ability to pay, there is going to be rationing based on government opinion. enjoy.
6.8.2009 10:57am
wfjag:

Medicare is, for instance, a logical place to start to design better electronic records systems and the incentives to use them.

The effects of the Dep't of Health and Human Services' HIPAA regs on transfer of med info will be to put all treatment records into electronic systems, and, to have security procedures in place to protect the privacy of the info. I keep wondering why this is being used as a justification for ObamaCare, and why it isn't challenged.

Andy Freeman write:

If Obama is correct, this will be a huge success and the rest of the private sector will demand to join. If he's wrong, govt employees will rebel.

Med. ins. for gov't employees is already provided through private insurers, who also provide med. ins. to non-gov't group plans and individual policies. For example, Anthem BC/BS is the largest gov't employees' med insurer. If it was such a "huge success" as your statement indicates is the key question -- and I agree with your assessment -- then the fact that the med. ins. insurers issuing policies to gov't employees haven't been actively seeking to extend their business into other areas appears to answer your question.
6.8.2009 10:59am
Mahan Atma (mail):
The Obama administration is trying very hard to fix Medicare, and in fact they see that as part and parcel of the health care policy they seek to advance. Insisting that they take on one piece "first" is claiming they can't walk and chew gum at the same time. Besides, it's going to take years to implement.

See the New Yorker piece on Peter Orzsag and his theories about Medicare. As far as reduced costs, he is not "assuming a can opener", he is basing that on research. It may or may not be borne out in practice, but that's what happens when you win elections -- you get to implement your policies. If they fail, you pay the price.
6.8.2009 11:01am
Mahan Atma (mail):
Oh I see, Kaus mentions Orzsag's approach.

As far as "What's stopping you?", that's an obtuse response. There is a huge entrenched set of interests (insurance companies, drug companies, etc.) who are fighting tooth and nail against these changes.
6.8.2009 11:04am
Jon Roland (mail) (www):
The model for reforming at least the software used by Medicare is the VA, which uses a free, open-source package written in the MUMPS language that runs mainly on Unix servers but can run on Linux (and probably will as servers are replaced).

There is an important difference between Medicare and the VA in that the VA has its own clinics and hospitals, and thus is more like an HMO, although it does contract out some services and does reimburse private providers for things like emergency or specialized services. It seems that the 30% savings estimate largely comes from comparing Medicare to the more efficient VA system (which also gets deep discounts on the purchase of drugs and medical devices). It also offers its physicians protection from liability suits, and is itself difficult to successfully sue, so avoids much of the medical malpractice costs other providers bear.

As a VA patient myself, I have to admit the quality of care is fairly good, if sometimes a little slow. (It can respond quickly to emergency conditions.) It is not clear how well its model could be extended to the general population, because on the whole veterans make somewhat better patients, taking their meds and more responsibility for managing their own care and learning about their maladies. I can see the difference in the quality of care received between more engaged and knowledgeable VA patients and those who are more passive. As in any system, to make it work for you requires some initiative.
6.8.2009 11:11am
Joe T. Guest:

As far as "What's stopping you?", that's an obtuse response. There is a huge entrenched set of interests (insurance companies, drug companies, etc.) and the 80%+ of insured people, according to Pew polls who are happy with their own insurers who are fighting tooth and nail against these changes.


Fixed.
6.8.2009 11:16am
John Thacker (mail):
Mahan Atma:

See the New Yorker piece on Peter Orzsag and his theories about Medicare. As far as reduced costs, he is not "assuming a can opener", he is basing that on research. It may or may not be borne out in practice

...
There is a huge entrenched set of interests (insurance companies, drug companies, etc.) who are fighting tooth and nail against these changes.


Even if you concede the theoretical case for "more efficient care is possible in theory," as you note that's a long way away from politically being able to achieve it. I generally agree with the New Yorker article on the situation; however, the article provides no way politically to get to more efficient care.

I'm completely unconvinced by his arguments (see his response to Postrel) that we have to nationalize the entire health care system because otherwise the AARP will reject additional efficiencies in health care. But if the AARP will defeat his plans for just Medicare, won't the political opposition be even stronger in a nationalized plan, when it covers everyone, not just the AARP members? As Orzsag himself notes, the "entrenched interests" opposing the changes for just Medicare includes the vast majority of people covered by Medicare. Wouldn't it then follow that the vast majority of voters will oppose all the efficiencies he's trying to achieve? (Just as people opposed HMOs?)

If it's politically impossible to achieve these reduced costs in Medicare, IMO it will be politically impossible to achieve them in a nationalized system. He is "assuming a can opener," perhaps not a technical one, but a political can opener.

Even supposing that somehow care restrictions are brought in as part of some great bargain for bringing in universal health care. What are the odds that such restrictions and efficiencies won't be relaxed in the future?
6.8.2009 11:34am
ShelbyC:

Actually, Obama has a proposal to start to do exactly that.



The Obama administration is trying very hard to fix Medicare,


The suggestion isn't that we try to fix medicare, it's that we actually succeed first. That way we know if the proposals actually work. Makes alot of sense, no?
6.8.2009 11:43am
rosetta's stones:
Unfortunately for Obama, he's currently spending the political capital he'd need to push through the sort of health care proposals he seems to want... and while that spent capital may help public employee union members and a couple hundred thousand Big 3 UAW members, those groups are already part of his political coalition, and no addition to the broad coalition he'd need to push through nationalized health care. If you start off as a reactionary, you're then sorta stuck in reactionary mode, and transformation is out of reach.
6.8.2009 11:52am
John Thacker (mail):
The suggestion isn't that we try to fix medicare, it's that we actually succeed first. That way we know if the proposals actually work.


And that includes politically. It's no good to say "these reforms would work in theory, except that they're impossible politically because various interests including the AARP oppose them." If it won't work politically because the insured patients hate the reforms, then expanding the group of covered insured won't solve that problem, it'll only make it worse. Even if you get it through on a compromise, that compromise will be undone in a few years.
6.8.2009 11:54am
erp:
Let them start rationing and reforming with their core group of public sector union members including congress critters, the judiciary and the White House et al. and if it works, then move on to whole country, or if that's too hard, start with the UAW.
6.8.2009 12:24pm
geokstr (mail):

Andy Freeman:
I say give Obama free rein wrt govt healthcare. He says that there's 25-30% savings, so let's see it. To that end, starting in 2011, the per-person budget gets cut by 5%/year for four years.

Piece 'o cake. Just cut government payments to medical providers for covered services by another 50%. Once that gets filtered down into huge increases in private insurance costs, everyone in the country will be begging for the government to take over so we can all have such low cost health care.
6.8.2009 12:58pm
Bruce Hayden (mail):
The only difference is going to be that instead of rationing based on the ability to pay, there is going to be rationing based on government opinion. enjoy.
The difference is that the former is justifiable in a capitalist society, while the later is the result of turning something that is a privilege into a right.
Piece 'o cake. Just cut government payments to medical providers for covered services by another 50%. Once that gets filtered down into huge increases in private insurance costs, everyone in the country will be begging for the government to take over so we can all have such low cost health care.
Alluding, I presume, to the fact that Medicare is already free-riding on the rest of the health care system. The problem there, of course, is that if everyone tries to free ride, then no one can.
6.8.2009 1:08pm
Bruce Hayden (mail):
Think about this for a moment. Medicare is a huge, single-payer, government-run program. It ought to provide the perfect environment for experimentation. If more-efficient government management can slash health-care costs by addressing all these problems, why not start with Medicare? Let's see what "better management" looks like applied to Medicare before we roll it out to the rest of the country.
This is, of course, a loaded suggestion for a number of reasons, including that there is already massive cross-subsidization of Medicare by the rest of us.
6.8.2009 1:11pm
Mark Buehner (mail):

As far as "What's stopping you?", that's an obtuse response. There is a huge entrenched set of interests (insurance companies, drug companies, etc.) who are fighting tooth and nail against these changes.

Ah, but clearly that won't be a problem once we double down on government spending and enroll an additional hundred million or so people.

Think about the bill of goods Obama is selling us:
1.Medicare is due to go insolvent in 2017.
2.Its estimated that 30% of medicare is wasted due to fraud alone. That's before we even discuss waste.
3.It is impossible to reform medicare because of the power special interests have over Congress.

Hence, clearly medicare is the perfect template to:
1.Radically decrease the cost of health care spending.
2.Reduce waste and fraud.
3.Return medical decisions to doctors and patients.

The question, my friends, isn't 'how stupid does Obama think we are'. The question is 'how stupid are we?'

Anybody want to note an interesting pattern? Government jumps into markets with quasi-governmental entities which instantly distort the marketplace. The market produces untenable results. Liberals call for MORE government in the market to correct it.

This is exact what Freddy and Fannie did to the housing credit markets, and its exactly Medicare has helped to do to the health markets. Medicare hasn't reduced costs AT ALL- it has shifted costs to the private system. That system is now deemed to expensive (go figure), and our answer is to radically increase the size of government in the market place.

Lets all try to remember the famous definition for insanity.
6.8.2009 1:11pm
geokstr (mail):

Bruce Hayden:

Piece 'o cake. Just cut government payments to medical providers for covered services by another 50%. Once that gets filtered down into huge increases in private insurance costs, everyone in the country will be begging for the government to take over so we can all have such low cost health care.

Alluding, I presume, to the fact that Medicare is already free-riding on the rest of the health care system. The problem there, of course, is that if everyone tries to free ride, then no one can.

Precisely. But we can't oppose the freight train to utopia on a mere technicality like that, now can we?
6.8.2009 1:21pm
The Unbeliever:
Medicare is not a perfect environment for experimentation, because it serves old people. old people are sicker than the general population and largely require a different type of care.
Actually that makes it the perfect environment for experimentations in cost reduction. It has the highest per person costs, serving the most politically untouchable demographic. It would be silly to try reducing costs for demographics with low costs already--say, for young healthy adults in their 20's--since they already exhibit fairly casual demand relationships to price and supply.

Any cost reduction plan you might propose will have to pass the "seniors test" eventually, or it's not worth the paper it's printed on. Why try out policies, rationing formulas, or price structures on any "easier" segment first, when it is just delaying the inevitable? Assuming we aren't going to kick old people off the rolls once ObamaCare goes live, their demographic's contribution to health care costs are going to need to be included in whatever master plan emerges.
6.8.2009 1:26pm
Officious Intermeddler:
Insisting that they take on one piece "first" is claiming they can't walk and chew gum at the same time.


There is no reasonable basis to believe that government can walk and chew gum at the same time. I'm all out of benefit-of-the-doubt; I want a demonstration of basic competence before I let these fools nationalize a third of the economy.
6.8.2009 2:12pm
mcbain (mail):

The difference is that the former is justifiable in a capitalist society, while the later is the result of turning something that is a privilege into a right.


so you saying that we cannot trust the highly trained and selfless government officials with deciding what diseases among what populations get treated?
6.8.2009 2:20pm
mcbain (mail):

It would be silly to try reducing costs for demographics with low costs already--say, for young healthy adults in their 20's--since they already exhibit fairly casual demand relationships to price and supply.


True, but somehow I think that "experiment" in the understanding of the administration would involve hoisting a medicare style system upon people who still have their teeth.
6.8.2009 2:53pm
Thorley Winston (mail) (www):
Skimming through the CEA report that Virginia Postrel linked, several thoughts came to mind:

1) The authors point out (correctly) that the United States spends more per capita on health care than any other country but make no effort to explain any of the cost-drivers as to why that is. This seems rather important because if you want to control health care spending, you need to know what's driving it and what you could potentially end up losing (e.g. innovation) by imposing controls.

2) The authors make the claim that we're getting worse outcomes solely on the basis of life expectancy and infant mortality rates, both of which are greatly affected by factors (e.g. teenagers killed in automobile accidents or via shootings, ethnicity) are at best tangentially linked with health care (beyond a certain basic minimum) and which really don't vary that differently from other comparable population groups in other nations.

3) I was unable to find any support for the claim that they could reduce spending on Medicare by 30% without adversely affecting patient outcomes even when I read the report that they cited in the footnote which supposedly supported that claim (it doesn't). It may be true though that you could cut Medicare spending by 30 percent or greater without affecting infant mortality rates (one of their two metrics for health outcomes) if only because people on Medicare usually don't have that many new babies.
6.8.2009 3:09pm
Sarcastro (www):
The important thing is that we not let the market decide if medicare is good enough.
6.8.2009 3:16pm
Anon1111:

The important thing is that we not let the market decide if medicare is good enough.


No, the important thing is that we give people hope by trying change.
6.8.2009 3:26pm
The Unbeliever:
True, but somehow I think that "experiment" in the understanding of the administration would involve hoisting a medicare style system upon people who still have their teeth.
That's an interesting point; I suppose we have slightly different ideas about what we mean by an experiment, or what the ultimate goal would be.

If we wanted to see the effects of applying medicare rules to a population who (largely) doesn't use it, applying it to healthy people in their 20's would do it. However, I was referring to the effects of serious government intervention for the express purpose of reducing health care costs, instead of testing for some other goal like increasing quality, simplifying systems, or universal coverage.

And if we're aiming for decreasing costs, then the logical target would be the demographic with the highest cost per person. We could try to decrease costs among those 20-yr-olds, but it wouldn't really mean much; the well known lowest cost option for them is to simply opt out from coverage (which screws up insurance pools that rely on them to subsidize older participants), or to carry low premium, high deductible catastrophic coverage... and then never use it.
6.8.2009 3:53pm
Mark Buehner (mail):
50% of medicare costs are incurred in the last 6 months of its patients lives. Dying is expensive. Now who exactly wants to be the brave politician that tells families (much less the AARP) that grandma isn't getting the extra round of treament, much less the hospice care?

You want to balance the medicare books? Easy- just start sending terminal patients home to be cared for by their families. We're all supposed to pitch in Obamatopia right? Let's see how that idea flies...

Otherwise? Forget it, there is no low-hanging fruit. This is a government bureaucracy remember?
6.8.2009 4:10pm
Dan Weber (www):
although it does contract out some services and does reimburse private providers for things like emergency or specialized services

I generally favor the VHA- and MayoClinic-style health care. But I was discussing the issue with someone who did billing for a cardiology clinic that did emergency service on someone covered by VHA. The VHA said it wouldn't pay because the services weren't done in their facilities. They could appeal, but the billing person had to wait until the start of the fiscal year to try again.

This is my only real problem with this style of health care, and I think it's easy to deal with once we recognize it, but it's a bit troubling to hear about.
6.8.2009 4:17pm
Dan Weber (www):
The authors make the claim that we're getting worse outcomes solely on the basis of life expectancy and infant mortality rates

Sorry to have missed this, but infant mortality cannot meaningfully be compared across countries, because what one country classifies as still born because of low-birth weight, another country will classify as alive and try to resuscitate. Upon failure this will be considered mortality of an infant, while the former country never considered it a live birth.
6.8.2009 4:22pm
Nunzio:
Wouldn't it be cheaper to send the uninsured to Canada when they get sick? Problem solved.
6.8.2009 4:29pm
ShelbyC:

There is no reasonable basis to believe that government can walk and chew gum at the same time.


In this case, there is no reasonable basis to believe that government can walk or chew gum, period.
6.8.2009 4:53pm
Brian K (mail):
There are also a lot of govt employees. Between Medicare, Medicaid, govt employees, the Indian Health Service, and the military, the various levels of US govt currently provide about half of all "health insurance". Their health care costs about as much as the private sector and has no better outcomes. In other words, US govt healthcare is not more effective. That makes the claim that US govt healthcare will be more effective somewhat hard to believe. (bolding added)

assuming your statistics are true, you conclusion is the opposite of what it should be. you are ignoring the fact that the patients on the government plans are sicker than patients on private plans. if the get the same outcomes with the same amount of money on sicker patients then the government plans are much better than private plans.
6.8.2009 6:09pm
tommears (mail):
Based simply on personal experience and not on detailed reports full of government statistics I think the 30% waste figure may well be accurate.

I am personally prone to kidney stones, which always pass in a few hours. Several years ago I passed a stone while I was in Alberta on vacation. As ususal I went to the emergency room. The doctor I saw asked me why I was there, did some basic tests and concluded that based on my history, symptoms and the blood in my urine that I was having another kidney stone. He prescribed a non-narcotic pain medication and put me on an IV fluids until the stone flushed out. I was in the Canadian ER for about 2 hours. Total cost $350CDN.

About 9 months later I went to a hospital in the near my home in Georgia with another stone. That doctor ordered the same basic tests. Although he also ordered a CT Scan. When I balked at the CT scan he basically refused to provide further treatment unless the scan was completed--I agreed to the scan. The CT scan was negative but he concluded that based on my history, symptoms and the blood in my urine that I was having another kidney stone. He then prescribed the same medication as in Canada as well as the IV. I was in the US ER for 6 hours. While my out of pocket cost (deductible/copay) was similar to the Canadian episode, the total bill paid by my insurance was just over of $3,000US.

Same disease, same patient, subjectively the same level of pain and essentially the same treatment. But in the U.S. the cost was 10X higher. Something is wrong here.
6.8.2009 7:14pm
Brett Bellmore:
Based on what I've seen of the Obama administration's MO so far, I imagine his first step in 'fixing' the health care system will be to deliberately break it, as completely and irreversibly as possible, so that ever going back to what we presently have will no longer be on the table. At that point a government takeover of the whole system will appear to be the only option, and he can take his own sweet time about figuring out how to make that work, without all the carping about how we had it better before he started.

I'm keeping my passport current, in case I need medical care.
6.8.2009 9:11pm
Brett A. (mail):
As mentioned, Medicare is already serving a portion of the population that is far more prone to illness, bad health, and high medical costs than the general population, so you can't really expect it to be more cost-effective than, say, an insurance company that gets to cherry-pick people for pre-existing health conditions, then drop them once they become too much of a liability.*

What would be more sane would be to try and see if we can combine some of the public insurance programs, like Medicaid, Medicare, SCHIP, and so forth, into one "super-program" of public insurance, so we could minimize the overall bureaucracy.

*They WILL try and drop you, by the way - assuming that your coverage is good enough in any case. Just look at the recent study (which actually re-confirmed an earlier study from 2000-2002), showing that out of all bankruptcies, 60% of them were medical cost-driven, and over 75% of the people who declared had health insurance at the time when they got ill.
6.8.2009 9:18pm
Fedya (www):
Perhaps the government should try any reforms on the legal industry first: single-payer legal care, with the government deciding who can become what sort of lawyer, and setting artificially low prices on legal services. After all, the Sixth Amendment says something about lawyers; I don't think there's anything about medical care except for the bits in the 25th Amendment about finding a President medically unfit to serve.

It's not as though any lawyer does anything worth more than minimum wage. :-p
6.8.2009 9:52pm
Sagar:
tommears:
"Same disease, same patient, subjectively the same level of pain and essentially the same treatment. But in the U.S. the cost was 10X higher. Something is wrong here."

probably the 'defensive practice of medicine' due to the fear of lawsuits might explain the CT scans and additional expenses to definitively rule out that it was just your routine kidney stone and nothing else.

imagine the doctor sees about 100 cases such as yours and does what the Canada ER did, and 1 out of those 100 cases happened to be something else that might have been caught by a CT scan ... can you picture the US trial lawyer asking the ER doctors if there was anything they could have done to better diagnose this case?
6.8.2009 11:54pm
Jmaie (mail):
Anecdotes cut both ways.

I was suffering headaches and my doctor proscribed a CT scan. I walked to an adjoining building where, after a 20 minute wait, the procedure was done.

Depending on the Province, wait times for a CT scan in Canada (in 2007) were between 7.8 and 20 weeks.

Stats from a CBC news story I am for some reason unable to link to.



Better service, higher cost. YMMV but I prefer our system. Of course, I have private insurance, and Joe Public would not have received the same level of service in the emergency room.
6.9.2009 12:15am
LarryA (mail) (www):
But you do have to wonder why a report that claims that Medicare is wasting 30 percent of its spending thinks it's making a case for making the rest of the health care system more like Medicare.
It's like when laws banning drugs don't work you need more drug laws, and when laws banning guns don't work you need more gun laws, and when laws fixing poverty don't work you need more poverty laws, and...
And yes, state and local govt employees are to be in the program.
Never mind them. Put members of Congress on the program.
6.9.2009 12:17am
Ricardo (mail):
I was unable to find any support for the claim that they could reduce spending on Medicare by 30% without adversely affecting patient outcomes even when I read the report that they cited in the footnote which supposedly supported that claim (it doesn't).

Here's the quote from Wennberg, Fisher and Skinner (2002) (page 9):

In [1996], spending under traditional Medicare was about $138.3 billion, and per capita spending reached $4,990. If, on an age-, sex-, and race-adjusted basis, spending levels in the lowest decile were realized in all higher regions, total spending would have been just $98.2 billion, or a savings of $40 billion (28.9 percent).


It may be true though that you could cut Medicare spending by 30 percent or greater without affecting infant mortality rates (one of their two metrics for health outcomes) if only because people on Medicare usually don't have that many new babies.

If you actually read the Wennberg, Fisher and Skinner study, they do not use infant mortality rates as a measure of health outcome for Medicare patients. They use survival rates and, for some conditions, relapse rates.
6.9.2009 12:46am
Mark Buehner (mail):

What would be more sane would be to try and see if we can combine some of the public insurance programs, like Medicaid, Medicare, SCHIP, and so forth, into one "super-program" of public insurance, so we could minimize the overall bureaucracy.


Your math is faulty. Government bureaucracy size 1 + government bureaucracy size 2 does not = bureaucracy size 3. Its more like 5. Smaller is more efficient, bigger just means that many more mid level drones babysitting the lower lever drones, and it grows geometrically, not linearly.

This entire debate at its core hinges on what 'should be' compared to 'what is'.

Rationally, if Medicare is wasting 30% of its budget, we should be able to cut 30% waste and save 30% give or take. Realistically, if that were so easy to do, somebody would have thought of it years ago and been a hero. The truth is, cutting government programs, even the demonstrably broken, fraudulent, and wasteful, is extremely difficult.

If this were a private company the CEO might wave a pen and cut the waste. But its not. Medicare is said to lose 60 billion a year on fraud alone. We've pilloried some of these banks and car companies, and I guarantee you they never lost even a fraction of that on their watch. But government waste and fraud is so insipid its not even really remarked on anymore. Accept when it can be pointed to for illusory 'savings'.

So back to the point of this thread- prove it. Fix medicare and then lets talk. But that wont happen.
6.9.2009 9:42am
Andy Freeman (mail):
> Med. ins. for gov't employees is already provided through private insurers, who also provide med. ins. to non-gov't group plans and individual policies.

Yes, I know how they're served today. My point is that they should be the test subjects for ObamaCare. They're largely identical to private sector employees.

If ObamaCare is supposed to be good enough for the rest of us, it's surely good enough for them.
6.9.2009 1:46pm
Dan Weber (www):
They WILL try and drop you, by the way - assuming that your coverage is good enough in any case. Just look at the recent study (which actually re-confirmed an earlier study from 2000-2002), showing that out of all bankruptcies, 60% of them were medical cost-driven, and over 75% of the people who declared had health insurance at the time when they got ill.

They might try and drop me if I get sick, but that doesn't necessarily follow from your statistics. I could have good $5 million coverage, but when we're talking about the class of medical procedures that bankrupt people, $5 million might get burned through fast.

State laws generally stop people from being dropped or having their rates hiked (cite here, although this site doesn't quote the state laws that would apply), unless they're hiking the rates on everybody in that pool. I'm sure that this protection is imperfect and companies slowly find ways around them, and we should address those faults.

probably the 'defensive practice of medicine' due to the fear of lawsuits might explain the CT scans and additional expenses to definitively rule out that it was just your routine kidney stone and nothing else.
I don't push much weight in malpractice reform, but one protection doctors should get is the ability to demonstrate up-front "here is the research that shows that test/procedure X does not improve health on patients like this one" and have the case tossed out. If the patient really wants the test/procedure, they can ask this doctor or another, but the doctor isn't under an obligation to rule out everything.
6.9.2009 2:41pm
grendel (mail):
"Depending on the Province, wait times for a CT scan in Canada (in 2007) were between 7.8 and 20 weeks.

Stats from a CBC news story I am for some reason unable to link to.

Better service, higher cost. YMMV but I prefer our system. Of course, I have private insurance, and Joe Public would not have received the same level of service in the emergency room."

Here's my two cents - from an American who relocated to Canada just over three years ago.

You are comparing apples to oranges in your CT scan comparison. If you go to an emergency room, and your genuinely needs a CT to make a diagnosis, you will get one right away.

If you need a CT scan as part of the diagnosis or treatment of a non-life threatening chronic condition or elective surgery, you will wait.

Having lived under both systems I prefer the Canadian one - and that despite having had good private insurance in the States before I came up here. The Canadian health care system is not perfect, but it is pretty good, and generally better than the US system, as is borne out by almost all objective indicia -- life expectancy, infant mortality, heart attack survival rates, you name it.
6.9.2009 4:20pm
ohwilleke:
Medicare is also a logical way to achieve "creeping single payer." For example, by allowing early retirees to buy in, by allowing small businesses to buy in, and by allowing Medicaid beneficiaries and VA health benefit beneficiaries to choose Medicare options.

The largest share of the health care costs not already in Medicare, on a per person basis, are in the 55-64 age bracket, and transferring their costs to Medicare lowers health insurance premiums for everyone else.

Another way Medicare could be expanded would be with a Medicare Part E in the tradition of the Medicare Part D prescription drug benefit. A Part E might cover pregnancy and child birth care, or trauma care, or some other type of coverage that has particularly high uninsured care rates that threaten provider solvency.
6.9.2009 4:22pm
Pippin:
"Fix" Medicare? LOL
6.9.2009 7:05pm
Mark Buehner (mail):

transferring their costs to Medicare lowers health insurance premiums for everyone else.


Sigh... this is just the kind of nonsense that gets us where we are. Medicare doesn't pay market rates for care, because they don't have to. This means providers up the costs to everyone else to make up for it. Adding huge additional dollars to medicare doesn't magically reduce the overall cost of healthcare, certainly not for the remainder in private care. Instead the balance the government wont pay for gets transferred to the remaining private plans (the young and healthy) who quickly do some math and finally realize they are getting bent over via this ponzie scheme and tricked into paying for vastly more expensive and comprehensive insurance than they actually require. But fortunately (for some) they learn this just in time for our government to make the scheme mandatory. Good news everyone!
6.10.2009 2:58am
ohwilleke:
My assumption was the expanding Medicare would be financed with tax dollars. There may be some price shifting slide back, but I'm certainly not making a free lunch argument. I'm making a shifting the toughest cases to the public sector with tax funding lowers private health insurance premiums argument.
6.10.2009 2:29pm

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