Good essay on healthcare issues

[rsbs]

why health insurance is different than auto insurance. The solution would seem to be to have high enough deductibles so that in a usual year, people actually do just pay their own bills and insurance is for catastrophic events. You would see the costs come down pretty fast as people are savvy consumers...much smarter than the liberals give them credit for.

Why No GOP Health Care Bill Will Ever Be Really Popular

The conventional wisdom this morning is that Republicans are suffering a colossal defeat by failing to unify behind the American Health Care Act. It’s only a colossal defeat if they let it become one. President Trump has offered a bold ultimatum: If the House doesn’t pass the American Health Care Act, he’s abandoning Obamacare. If this isn’t a bluff to win passage and he genuinely means it, it means he’s more reckless, more capricious, and more unworthy of conservative support than even his skeptics thought. A presidential declaration that repeal and replacement efforts are kaput for the remainder of his presidency would be the anti-Gorsuch, a giant vindication of his critics from the primary. He denounced Obamacare over and over again on the campaign trail. Now, in the face of predictable problems of a Republican party divided on how best to replace it, he’s willing to abandon the effort?

Different Republicans are going to have different priorities in what replaces Obamacare. The U.S. health-care system is big and complicated and has a lot of problems because it’s trying to address a lot of contrary desires. Americans want health care to be excellent, widely available, and cheap. Experience tells us we can only pick two of those qualities.

A gigantic lingering problem for any reform effort is that many members of the public have wildly unrealistic expectations about what their health care should be and how much they should pay for it, and no politician in either party has much incentive to be honest about hard truths. There’s a strong argument that the entire concept of insurance doesn’t work well for health care, compared to, say, auto insurance. The vast majority of drivers will not get in a major accident in any given year, and plenty of drivers will go years and years without an accident. Consumers are comfortable with a system where most years, they will pay in a considerable sum and get nothing from their auto insurer for that year.

Auto insurance works because a lot of people pay in and get little or nothing in return (other than peace of mind and meeting the legal requirements), but a few people pay in a little and then wreck their car, and the company can afford the costs of repairs or replacing it and make a profit on top, enough to run lots of ads with that little gecko.

Everyone needs health care eventually. And even if you’re healthy and don’t foresee health expenses in the near future, you can get hit by a bus or fall off a ladder or slice your finger with a steak knife at any time. (That’s one reason why “preventative care” rarely saves as much as the reformers hope.) Obamacare decreed that insurance should cover birth control, which is a monthly expense. Quite a few Americans take prescription drugs regularly to control chronic conditions. Significant health expenses aren’t as rare as car wrecks, meaning the insurers have to pay out more… which means they have to charge more in premiums.

The way to bring down prices in most markets is supply and demand, but that’s difficult to apply to health-care costs compared to, say, shopping for a plane ticket on Expedia. If you’re hit by a bus, you need emergency care and it’s difficult to request the ambulance take you to the less-expensive hospital. People get very attached to the doctors they know and they’ve been seeing for years — thus the importance of Obama’s pledge, “if you like your doctor, you can keep your doctor.” Pediatricians watch kids grow up. People don’t like the idea of breaking off an established care relationship and shopping around.

On paper, we can increase supply, and you’ve seen market forces improve health services not covered by insurance; LASIK surgery and plastic surgeries are the most-cited examples. But while you can increase the number of doctors in the country (and nurse practitioners, etc.) it’s difficult to increase the number of the very best doctors. Even if we somehow forced medical schools to admit more students and produce more doctors, U.S. demand for health care is only going to increase as the Baby Boomers age.

The popular argument on the Left is to declare that health care is a right, and thus shouldn’t be subject to the pressures of supply and demand. It’s a lovely thought, until you start thinking through how this would work, because all health care is the result of someone’s labor. Somebody’s got to go through college and medical school and spend all those years studying to become a doctor or nurse or specialist. Somebody’s got to research and develop the prescription medication. Somebody’s got to invent, design, and build the MRI machine, robotic surgery arm, artificial limb, etcetera. And all of those people expect to get paid, and almost everyone would agree that considering their skill, education, talent, and hard work, they deserve to be paid well.

When you declare something is a right, it means it cannot be denied, particularly due to an inability to pay. Which means someone else, i.e., the government is in charge of payment.

Put aside the exorbitant cost of having the government pay for everyone’s health care for a moment. You could argue the “government pays” system is close to what we have with Medicaid… except a lot of doctors find Medicaid payments to be way below fair market value, “around 50 to 85 cents on the dollar of the actual cost of medical care.” Many doctors say that they’re still willing to take the personal financial loss that comes from treating Medicaid patients, up until the point that they can’t afford it. As of 2015, only 67 percent of doctors take Medicaid, and only 45 percent of doctors take new patients on Medicaid. Even the illustrious Mayo Clinic announced it is going prioritize non-Medicaid and non-Medicare patients.

The Democratic solution? Introduce laws forcing doctors to accept Medicaid payments. Some gratitude for the caring profession, huh? Making health care a “right” means that doctors are forced to work for reimbursement set by the government. It reduces them to tools of the state.

But this hasn’t sunk in with much of the general public. They still believe that there’s some system out there where they can get the very best care, choose any doctor they like, see any specialist they prefer, and pay little or nothing for it. And until that perception is dispelled, any health-care reform proposal will be greeted as a disappointment.

[Canuck_2]

One thing the article forgot to mention is the option of moving to a single payer (would that be similar to your present medicare/medicaid?) Which would get rid of the costs of workers in insurance and book keeping for hospitals and doctors AND the profit that the insurance companies taken out.

The resulting savings would keep costs down for doctors AND the single payer and the reduced payments would net out to be the same for the medical care givers.

[rsbs]

the essay, from National Review, leaves out single payer for the same reason I would not mention it....it's a fantasy that "single payer" would accomplish anything worthwhile.

You can have a system that tells doctors and hospitals how much to charge, etc. but there is nothing that makes them work for those rates. The best system is to have free market reforms lead to a better product at a lower price, like in virtually every other field. That is accomplished by having people know what the charges are, and what their responsibilities are.

Just got a letter from Children's Hospital here in Minnesota that they are no longer accepting BCBS Medicaid rates for patients....the rates are too low for them to operate and pass the losses on to other paying custormers.

A good example of what I just stated.

[bruce MN]

7 1/2 years of trying culminated in this one that The President and The Speaker just pulled off the docket. Just in the last hour.

As for now, ACA stands. There does need to be something better.  Will be interesting to see if there is something cobbled together that can survive through to a floor vote before the '18 primary season. That's not all that far off.

Not that was ever to be believed but so much for "something great.  Cheaper and better that covers everybody.".  Now watch Bannon and Trump go to work to turn Ryan into a hybrid of Boehner, Weiner and Cantor.  They are going to use this to the max in the "tear down the administrative state"  campaign. Will be interesting to see how they frame it.

[AllenJwi]

Just let it collapse. When the money is gone so is this crap.

[r3020]

We have single payer. It's called VA. There many vets die on a waiting list waiting to get onto the waiting list. Then the administrators receive huge bonuses for excellent work.

[r3020]

Now you defend Ryan when for weeks you have said his bill is worse than what we now have? They should have voted on the bill. Killed it dead. Then started new with a market based approach.

[WCMO]

VA is more like single provider, or national health care, it is what "socialized medicine" would look like.

Medicare is single payer for the elderly.

[jennys_mn]

You're a big shot Republican, 20. Why didn't they call you and ask for your input?

Or maybe, they wouldn't be able to handle the backlash of millions of Americans all of a sudden without insurance - and more calling for the do over of our last election.

Time to repeal and replace our so called president.

Tick Tock.....BONG!!!!

Jen

[r3020]

That's why they pulled the bill. It was worse than Obama care. You said so yourself.