Democracy - We had a good run

[Former Lord of Winterfell]

But the more likely result is that costs will simply skyrocket, because people don't want to make that trade off, and politicians do not have the will to implement the reductions.

I happen to agree with you. The majority will go apeshit if they start losing the incredibly open access they now possess, and the newly insured with go apeshit if you try to impose cost controls on their benefits too. But at least recognizing that not everyone can "win" is having a more honest debate than the "everybody wins" arguments that advocates take as their starting point.

btw, one of the other possible factors relating to overall health care expenditures in the U.S. -- noted in the AEI analysis of the WHO report linked above -- is "discretionary expenditures". I'm assuming that's for things like elective plastic surgery or other quality of life expenditures that people voluntarily pay out of pocket.

[ljkeane]

No. It really isn't.

Again, we're talking here about care being given to people who have access to it.

So again, specifically which part of that post are you disagreeing with?

And it's not hard to find numerous things such as doctors per patient or even access to CT scanners etc which the US ranks behind other countries even if you do disagree with the WHO ranking.

The point being made was that the insured in the US 'may' get the best care in the world for the significant extra cost. The point I was making is that 'may' shouldn't be acceptable for the huge costs involved. I'm struggling to see why you're having difficulty following?

[The Progressive]

But the more likely result is that costs will simply skyrocket, because people don't want to make that trade off,

Because healthcare costs aren't skyrocketing already? What a lousy argument.

and politicians do not have the will to implement the reductions.

Pay-as-you-go was passed by the Democrats. If you don't want to see politicians who won't be willing to make cuts, then don't vote for the Republicans.

But at least recognizing that not everyone can "win" is having a more honest debate than the "everybody wins" arguments that advocates take as their starting point.

I don't know who's more dishonest here, someone who make up numbers and unsubstantiate assumptions about the pharmaceutical industry while ignoring the finding from CBO that premiums for group policies would decrease with healthcare reform because it's no longer convenient................ or their opponents.

Seriously, repeating the same tired talkingpoints won't elevate their truthiness.

[Former Lord of Winterfell]

And it's not hard to find numerous things such as doctors per patient or even access to CT scanners etc which the US ranks behind other countries even if you do disagree with the WHO ranking.

You are missing the point, which is that different people in the U.S. have different levels of access. When you use average numbers, that gets overlooked.

The point being made was that the insured in the US 'may' get the best care in the world for the significant extra cost. The point I was making is that 'may' shouldn't be acceptable for the huge costs involved. I'm struggling to see why you're having difficulty following?

I said "may" because I acknowledge there is disagreement. But we hear a lot about that WHO 37th number which implies that the debate is closed. It's not -- particularly when the only WHO number that directly measures care itself has the U.S. as first. I think the clear answer is that yes, we do have the best health care for those who have insurance, but I acknowledge that others disagree, which is why I said "may".

[The Progressive]

You are missing the point, which is that different people in the U.S. have different levels of access. When you use average numbers, that gets overlooked.

By this logic, shouldn't other countries' health outcome be compared to the lowered tiers of health insurance consumers given that it's the same rate that other countries are paying for their healthcare? I can't believe that people would make this argument against "average numbers" because by comparing the average numbers, the odds are already stacked in favor of the US.

[ljkeane]

I said "may" because I acknowledge there is disagreement. But we hear a lot about that WHO 37th number which implies that the debate is closed. It's not -- particularly when the only WHO number that directly measures care itself has the U.S. as first. I think the clear answer is that yes, we do have the best health care for those who have insurance, but I acknowledge that others disagree, which is why I said "may".

That's fine and I acknowledge that in many cases the insured in the US do receive a very good level of care but there are certainly many experts who rank the level of care you would receive in countries like France etc above the US so there is certainly some debate on the subject. I don't think you can view a healthcare system where there is even some debate about it's relative quality when it without debate costs nearly twice as much as remotely cost effective.

[Former Lord of Winterfell]

Pay-as-you-go was passed by the Democrats. If you don't want to see politicians who won't be willing to make cuts, then don't vote for the Republicans.

Do you understand that "pay as you go" isn't binding on future Congress, or even this Congress? And that even your supposedly cost-conscious Democrats already voted to waive the mandatory Medicare SGR cuts for 2009, and that Congress -- regardless of party control -- has never once failed to intervene to stop those supposedly automatic cuts?

I don't know who's more dishonest here, someone who make up numbers and unsubstantiate assumptions about the pharmaceutical industry while ignoring the finding from CBO that premiums for group policies would decrease with healthcare reform because it's no longer convenient................ or their opponents.

Yeah, the basic law of supply and demand is an unsubstantiated assumption. Whatever. And yes, the CBO report is a perfectly reliable predictor of future costs, right? As I pointed out previously, this Administration was completely wrong when it predicted the effect of TARP, the effect of the stimulus (remember unemployment not going over 8%?), and the effect of the auto bailout. But like Charlie Brown, you ignore history and keep running up to that football expecting Lucy not to pull it away.

Oh by the way -- where was I wrong in what I said about the WHO report and the ranking of the U.S. as "37th"?

[Former Lord of Winterfell]

By this logic, shouldn't other countries' health outcome be compared to the lowered tiers of health insurance consumers given that it's the same rate that other countries are paying for their healthcare?

Heh? From where did you pull that "same rate" statistic?

I can't believe that people would make this argument against "average numbers" because by comparing the average numbers, the odds are already stacked in favor of the US.

That's because you're too blinded by partisanship to understand the point I made above, which is that a dollar spent at the upper margin is going to be less efficient in terms of overall results than a dollar spent on the uninsured. You focusing on averages shows you have no understanding of the concept of elasticity of demand/supply.

[Former Lord of Winterfell]

That's fine and I acknowledge that in many cases the insured in the US do receive a very good level of care but there are certainly many experts who rank the level of care you would receive in countries like France etc above the US so there is certainly some debate on the subject. I don't think you can view a healthcare system where there is even some debate about it's relative quality when it without debate costs nearly twice as much as remotely cost effective.

Okay, let's assume there is debate and we don't know which side is correct. That means you cannot promise those folks in the U.S. who do have good insurance that they won't suffer some diminution of care. For what its worth, I've agreed that the marginal benefit of the last dollar paid on health care here in the U.S. for "top-tier" care is low. The more you push the envelope in terms of medicine and treatments, the more expensive each improvement costs. But that doesn't mean there still isn't some improvement.

[ljkeane]

That's because you're too blinded by partisanship to understand the point I made above, which is that a dollar spent at the upper margin is going to be less efficient in terms of overall results than a dollar spent on the uninsured. You focusing on averages shows you have no understanding of the concept of elasticity of demand/supply.

Elasticity of supply and demand? Come on, the main problem with privatised healthcare is almost entirely down to the inelastic demand for healthcare and if you could definitvely define the supply curve of healthcare provision in a market with the barriers to entry and collusion that it currently has then I'll be expecting to see you receive your Nobel prize in economics fairly soon.

[TrackerNeil]

You seem to be confused, my pointing out that other factors such as diet and exercise play a role in why the United State's life expectancy is rated at 38th, doesn't mean that I am in love with the current system, I also think we can do better than what has been offered in Congress as well. As to being intellectually sloppy, I will admit that am not the best writer but I am sure that I am not confusing the health of Americans and problems of health insurance. You see I understand that the real goal should be to have a healthy populace and that the financing of health care is merely a part of the means to that goal.

I agree about healthy lifestyles, and I also agree that there is a better system than the one currently dying in Congress. It's called single-payer. Unfortunately, Americans have been as foolish on this issue as possible. They want a change but not a big change. They want insurance to remain privately run but they want those private companies to concentrate not on the profit margin but on the public weal. They want more people covered but not more people going to the doctor. Not sure how you square that circle.

[Former Lord of Winterfell]

Elasticity of supply and demand? Come on, the main problem with privatised healthcare is almost entirely down to the inelastic demand for healthcare and if you could definitvely define the supply curve of healthcare provision in a market with the barriers to entry and collusion that it currently has then I'll be expecting to see you receive your Nobel prize in economics fairly soon.

The demand for health care isn't completely inelastic. I've personally participated in employer decision-making to go to cheaper plans, force use of generic-only drugs, etc.. That's anecdotal, but common sense tells us it can't be completely inelastic.

As for supply, I'd agree that drawing such a curve is impossible. But that doesn't mean it's impossible to make observations about what happens at the margins.

[The Progressive]

Do you understand that "pay as you go" isn't binding on future Congress, or even this Congress? And that even your supposedly cost-conscious Democrats already voted to waive the mandatory Medicare SGR cuts for 2009, and that Congress -- regardless of party control -- has never once failed to intervene to stop those supposedly automatic cuts?

Then either raise tax or hold them accountable. I don't see why your failure to held no-tax-and-spend-even-more Republicans responsible is an argument against fiscal restraint attempts by the Democrats.

Yeah, the basic law of supply and demand is an unsubstantiated assumption.

You focusing on averages shows you have no understanding of the concept of elasticity of demand/supply.

The fundamental problem with this argument is to assume the elasticity of healthcare consumption on the supply and demand curve.

Nothing could be farther from the truth.

Heh? From where did you pull that "same rate" statistic?

That's not really complicated. Take the per capita healthcare expenditure of other industrialized countries, compare that to health insurance plans with similar cost in the US.

I will give you an even easier challenge ...... just compare the per capita healthcare expenditure between the US and Switzerland (which among all the industrialied countries has the most privatized healthcare market after the US) and the health outcomes between the two countries.

[The Progressive]

The demand for health care isn't completely inelastic. I've personally participated in employer decision-making to go to cheaper plans, force use of generic-only drugs, etc.. That's anecdotal, but common sense tells us it can't be completely inelastic.

As for supply, I'd agree that drawing such a curve is impossible. But that doesn't mean it's impossible to make observations about what happens at the margins.

Amazingly, none of that has managed to reduce the cost of healthcare, which clearly demonstrated the inelasticity healthcare expenditures. However, what those measures actually do is shifting a higher burden of the cost onto the employees, either through increased premiums or out of pocket costs.

[ljkeane]

The demand for health care isn't completely inelastic. I've personally participated in employer decision-making to go to cheaper plans, force use of generic-only drugs, etc.. That's anecdotal, but common sense tells us it can't be completely inelastic.

Fair enough, but it's sufficiently inelastic in many circumstances that it makes little difference and that raises concerns about a purely privatised healthcare system.

As for supply, I'd agree that drawing such a curve is impossible. But that doesn't mean it's impossible to make observations about what happens at the margins.

But what constitutes 'the margins' and the factors that go in to determining the marginal cost to the consumer are certainly debateable.

[Former Lord of Winterfell]

Then either raise tax or hold them accountable. I don't see why your failure to held no-tax-and-spend-even-more Republicans responsible is an argument against fiscal restraint attempts by the Democrats.

It was the Democratic controlled Congress and President Obama who did it in 2009, and President Clinton before that. I'm not saying one party is better than the other on this, so quit making it partisan. It's just reality. What's amazing about this, though, is that you see no irony in claiming that the exact same people who voted to eliminate the automatic cuts for Medicare can be trusted not to waive these cuts.

That's not really complicated. Take the per capita healthcare expenditure of other industrialized countries, compare that to health insurance plans with similar cost in the US.

Which you didn't do. You just made it up. And even then, it still wouldn't tell you squat because you still wouldn't be able to tell from that comparison whether the care actually received was equal.

I will give you an even easier challenge ...... just compare the per capita healthcare expenditure between the US and Switzerland (which among all the industrialied countries has the most privatized healthcare market after the US) and the health outcomes between the two countries.

Which would prove nothing for all the reasons outlined about, which I'm not repeating. But Exhibit A is the WHO report and related analysis above. First in access, first in adjusted life expectancy.

[Former Lord of Winterfell]

Fair enough, but it's sufficiently inelastic in many circumstances that it makes little difference and that raises concerns about a purely privatised healthcare system.

At this point in the curve, it's pretty inelastic. I don't think that can last indefinitely, though.

But what constitutes 'the margins' and the factors that go in to determining the marginal cost to the consumer are certainly debateable.

I'd agree with that. But just to give you an example of what I mean, take any number of recent drugs whose patents were effectively extended by some marginal improvements. I'd guess that the money spent for those marginal improvements probably could produce a greater health-care benefit if spent on those who had no insurance. But admittedly, that's a supposition. There's probably data out there to back that up, but I don't care enough to dig for it.

Thanks for the good discussion, by the way.

[The Progressive]

It was the Democratic controlled Congress and President Obama who did it in 2009, and President Clinton before that. I'm not saying one party is better than the other on this, so quit making it partisan. It's just reality. What's amazing about this, though, is that you see no irony in claiming that the exact same people who voted to eliminate the automatic cuts for Medicare can be trusted not to waive these cuts.

Because the proposed Medicare Advisory Panel has much more teeth this time. A fact which you conveniently has managed to ignore every time Triskele brought it up.

First in access, first in adjusted life expectancy.

Actually, none of the above. Congressional report indicated that research comparing the quality of care has not found the United States to be superior overall. Nor does the U.S. population have substantially better access

to health care resources, even putting aside the issue of the uninsured.

http://assets.opencrs.com/rpts/RL34175_20070917.pdf

[Former Lord of Winterfell]

Because the proposed Medicare Advisory Panel has much more teeth this time.

Let's just stop there. Please explain exactly how the "teeth" are any greater.

[The Progressive]

Let's just stop there. Please explain exactly how the "teeth" are any greater.

The Independent Payment Advisory Council which would have the authority to make recommendations to the President on annual Medicare payment rates and other reforms. The President could either approve or disapprove the recommendations, and Congress could intervene within a 30-day period if it disagreed.

Any reductions by the board would be in addition to the $400 billion to $500 billion savings in provider payments already included in the healthcare reform legislation

http://www.healthleadersmedia.com/content/LED-244848/Medical-Groups-Charge-Proposed-Medicare-Payment-Panel-Could-Restrict-Patient-Access##

The list of organizations opposing this Advisory Council is revealing enough. Also, you think that Congress could pull itself together fast enough in 30 days to mount an effective opposition?