Yes and they have exised for years and medicare is in the black funded by the public. The ACA is meant to regulate the private sector.
yes yes to all of this although opening up insurance across state lines would render state coverage mandates impotent anyway, as insurers would just move to the state with the fewest of them
May sound nice to you as a blanket statement, but doesn't seem to really be thought through? So you think that the quality of healthcare will improve if the monetary incentive for physicians is capped? Since when do people work better or harder when their financial incentive gets limited? And what is the alternative to it being a profit driven industry? That the government regulates and administers it? Has your experience been that government is actually more efficient than private corporations? And that government employees are more motivated than entrepreneurs (such as doctors with their own private practice)? If I am misunderstanding what you are trying to say, please elaborate. P.S.: As far as I know, the best healthcare in the USA is actually provided in the Kaiser Permanente consortium, and while the health plans and hospital foundations are not-for-profit, the Permanente Medical Groups certainly are. With a net income of $ 1.6B in 2011, I would say that Kaiser Permanente is pretty profitable, and provides some of the best care in the country, doesn't it?
Just not accurate. Medicare rates higher among customer satisfaction than private market run health care. Their costs are also lower. The govt. has been more efficient with a higher rate of customer satisfaction than private run health care.
First off, kudos to this post. I disagree with many of the solutions, but these types of policy discussions are far more interesting than the standard partisan nonsense we have here - we need more of this. I'll take your last statement first: I think the worldwide experience suggests otherwise. While we excel in top-tier health care here, much of the rest of the highly-regulated world outperforms us in outcomes at a fraction of the cost. That suggests that there are other ways to control costs effectively. That said, there are certainly areas where the free market can play a role. Prescription drug importing, for example. As is, the US subsidizes the rest of the world's drugs, which is silly. Opening markets here would drive US costs down in a lot of areas. Oddly, the free market party is the one that opposes this. Totally agree on this one. Employer-based health coverage has helped make a mess of the system and needs to be dismantled. Disagree here, and disagree with your example. Cars are highly regulated - fuel efficiency, safety standards, etc. All sorts of minimum requirements are set. Sunroofs/etc are like optional better coverage. There need to requirements on insurance because its a complicated topic and one that is hard for consumers to grasp until they actually need to use its services, which might be years after they get the plan. At that point, if they discover loopholes or coverage failures, they are screwed. The coverage requirements could certainly be lower - that's an arbitrary line - but the idea of not regulating them at all seems like a disaster in the making. This sounds good in practice, but not so much in reality. Automobiles that are sold in the US have to comply with US standards and regulations. If they want to sell in California, they have to meet California emissions standards. That's the problem with insurance. If Swiss insurer wants to sell a plan in Texas, they can - they just have to comply with Texas standards and establish a presence here (the latter is an extra step not involved for cars). Insurance across state lines is complicated because the states oppose it because they want their own standards. That said, they should work together to standardize their basic requirements as much as much as possible - that helps everyone. But more insurers doesn't equate to cheaper health care. Insurance plans are already regulated as to their profit margins - adding more of them won't change what they charge because it does nothing to actually cut the cost of health care. In fact, it might be worse for both consumers and providers. Providers have to contract out with each health care plan they accept. If you have 6 insurers in your state, that's one thing. If you have 30 across the country, that's unwieldly. If you have to contract out with 200 acros the world, that's a nightmare. So for providers, they are either going to work with only a select group of insurers or have to add costs associated with all the massive insurance network they have to deal with. For consumers, this either means higher costs or having each of their providers work with randomly different insurance companies, limiting their own choice where they can go. Agree with the defensive medicine problem, but there doesn't seem to be any evidence that these lawsuits are a substantial cost driver of insurance as a whole. And where reforms have been implemented, we've seen no effect at all. Agreed on expanding use of nurses, PAs, etc. This is one area where you can actually drive down the cost of health care. That said, many of the lesser tasks you mentioned already are done by these people. Haven't thought about it much, but I'm not opposed to this on the surface. Will never happen though due to the "don't take away my medicare!" constituency.
This is absolutely 100 percent wrong. Kenneth Arrow proved why half a century ago. Health care is different because an unregulated market can't operate efficiently - not just due to inelasticity, as you presuppose is the whole problem, but due to information asymmetry. The problem that you have is that you believe in a universal, simple dogma of "less regulation is always better no matter what!" - this just simply isn't true and no real economist would really ever agree with this being true in all possible cases. In fact, neither would you if you really had to think about it. Health care is one of those cases. This is why you won't find a single human society anywhere that doesn't incorporate some form of regulation over health care (and the ones with the least tend to be the poorest and least healthy)).
Sure Medicare rates highly with CUSTOMERS because they pay very little and there isn't currently a major choice limitation associated with it. (Although if you ask Medicare patients they will all tell you that they hear more and more doctors telling them no new Medicare patients) However, Medicare reimbursement rates are brutal for doctors. Blue Cross Blue Shield, the largest insurance carrier in the state, has battled major hospital chains and almost lost them by trying to get their rates down to Medicare level.
I don't normally agree with Sam, but I do here. Healthcare can't operate on a free market basis. It is literally impossible for consumers to be informed enough about medicine to be able to make the best decisions, unless you think it's smart to make healthcare choices solely based on "cheapest provider gets to do my surgery." On top of that, if you have a stroke, heart attack, car accident, etc. you don't get to price shop. There ARE market solutions to some parts of the cost problem, but turning healthcare into a complete free market isn't one of them.
bmd: on your last point about Medicare, I think that also brings up questions what you intend with pre-existing conditions and regulation of insurance rates. Your no-regulation solution seems to suggest that there would be a lot of uninsurable people, with no proposed solution. Old people are almost always going to be money losers, so without Medicare, they would be unable to get any insurance - either being priced out of it or just flat out denied by insurers. There's no way to make money on a 90 year old because of end-of-life costs.
Medicare customers could use private insurance as well. I've heard that medicare and reimbursements could be a problem, but I don't have the insight to it. The fact that they could get their rates lower than insurance is a reason why I like the idea of making Medicare for all. I think a Single Payer system would be great for our nation. Even with the problems with medicare I think it's superior to most private run plans. Either way it shows that the govt. can run a health care program as well if not better than private insurance companies, which is the point I mostly disagreed with.
Medicare rate levels for all doctors would drive many out of the industry and/or dilute the quality of care for the non-wealthy by turning all doctors that cater to the general public into complete turnstiles. They are seriously low. The government doesn't actually run Medicare either. The only advantage Medicare has over private insurance is lower reimbursement rates to providers, which they only accomplish through market share. Government (and insurance companies) only have two ways to attack the exploding costs of health care: rationing of care and cutting reimbursement rates. Neither of those options are actually good long term for the American consumer. Or non-American consumers honestly. The only reason European countries and Australia and Canada get to benefit from lower costs for pharmaceuticals and health devices is because the American consumers pay through the nose for them and subsidize the rest of the world. Edit: By the way, yes, Medicare customers get to purchase private insurance through the form of supp policies, advantage plans OR if they still work through a group policy. They have locked benefits though, so it's not really a marketplace.
Well we had the same old tired market place ideas. that have failed and are largely talking points to keep the status quo. Here's another plan that could take care of our wasteful health care scheme. It involves buying out the insurance companies with tax payer money, getting a fabulous return on our investment by eliminating the horrible waste in such a large part of the economy. For those worried about the hundreds of thousands or insurance company clerks, marketers etc. who would not be needed they could be retrained and even hired by the government. Hopefully some of the top MBA types have some skills that could help them do some small business start ups though that may be doubtful. http://jacobinmag.com/2013/12/the-backroom-deal-that-couldve-led-to-single-payer/ ********** US private insurance, whether for-profit or otherwise, may well be the most wasteful bureaucracy in human history, making the old Gosplan office look like a scrappy startup by comparison. Estimates of pure administrative waste range anywhere from 0.75 percent to 2.6 percent of total US economic output. Extrapolating again from the biggest four for-profit insurers, in 2008, the industry as a whole claimed to spend 18.5 percent of the premiums it collected on things other than payments to providers. (The other 81.5% that is spent paying for actual care is known as medical loss ratio. Keeping this ratio down is a health insurer CEO’s top priority.) Medicare, by contrast, spends just 2 percent. The difference amounts to $130 billion, to which we must add the compliance costs the private insurers impose on health care providers — $28 billion, according to Health Affairs. The costs incurred by consumers are difficult to measure, although very real to anyone who’s spent an afternoon on the phone with a health insurance rep. So, to recap, nationalization of the health insurance industry in 2009 would have cost no more (and almost certainly a lot less) than $240 billion The savings in waste resulting from replacing the health insurance racket with an extension of Medicare would have resulted in no less than $158 billion a year. That’s an annualized return on investment of 66 percent. The entire operation would have paid for itself in less than 18 months, and after that, an eternity of administrative efficiency for free. And, of course, happy shareholders.
