6 ms·

Whether or not the French, Canadian, German, or UK govt can do healthcare doesn't tell us anything about whether the US govt can do healthcare. What is it abou

by anamax 17y ago

Whether or not the French, Canadian, German, or UK govt can do healthcare doesn't tell us anything about whether the US govt can do healthcare. What is it about Medicare and other existing US govt healthcare that convinces folks that the US govt can do healthcare on a larger scale? That's why I make my offer. Let's give Obama free rein wrt healthcare for folks whose healthcare is already done via the US govts at any level. Not just Medicare/Medicaid (and the state programs), the IHS and other programs, but local, state, and federal employees as well. I'll even throw in companies that get more 70-80% of their revenue from govt. That's easily 40%+ of the population. Note that those folks are already under "single payer". In return for free rein, the cost per covered person is capped at today's rates for the first two years and then decreased 5%/year each year for the next four years. Since single payer advocates claim at least a 30% savings and that's just a touch over 20%, that per-person savings should be a slam dunk. To sweeten the pot, he can use the money from the per-person cut to increase the number of people covered. I'm willing to consider letting other folks/companies buy into the program for the budgeted amount. The only thing non-negotiable is the total amount spent per person. Yes, he's free to negotiate, remove import restrictions, and the like. However, he can't force people to accept the prices that he'd like to pay - he can only refuse to do biz with folks who don't charge what he'd like. And, if he removes import restrictions, that applies to everyone, not just folks under obamacare. At the end of six years, we'll know for sure whether the US govt can do healthcare. Heck - I suspect that we'll know earlier. Deal?

DennisP 17y ago
The German system is not government healthcare. Everybody has private, nonprofit insurance. Arguably they're less socialized than we are, since they have no Medicare, Medicaid, or VA. Japan is the same, with more choice than Germany: 2000 insurance companies, take your pick. What they share with France: a mandate, a national price list for services, no claim denials allowed for anything on the pricelist, no coverage denials, electronic medical records, subsidies for the poor. They do better on stats than we do, at much lower cost.
- anamax 17y ago
  > They do better on stats than we do, at much lower cost. Irrelevant because that doesn't imply that the US govt can do that. (Also irrelevant because the German and Japanese populations are very different.) That's why I proposed the experiment - let's see what the US govt can do. Many of us prefer Google to other search engines. Google's existence proves that better is possible, but it doesn't prove that Yahoo or Bing can do better than they do.
  - DennisP 17y ago
    My point is that we shouldn't exactly be relying on the U.S. government to do it. The best systems in the world are highly regulated but not actually run by governments. One of the things they do, though, is force a price list on providers, something you've taken off the table. On the other hand, the VA actually has quite a good reputation these days. That's sort of your experiment right there. Costs are holding steady despite a pretty messed-up patient population, doctors and patients like the system, they have a very good electronic medical records system (which they've opensourced, btw) and they use those records to analyze the data and use the treatments that the evidence shows are most effective. It's been widely reported that about 98,000 people a year die from avoidable medical errors, a lot of it from medication errors. Most hospitals won't talk about their error rates. The VA told everybody, then they fixed it. For example, in a VA hospital every patient has a barcoded wristband. So does every nurse, and every medicine bottle is barcoded too. Every time a nurse gives a patient a pill, she scans all three barcodes, and a computer checks to make sure the patient is getting the right medicine at the right time. Most private hospitals have little incentive to fix errors, and certainly none to report them. Reporting just gets you sued, and in a fee-for-service system, fewer errors just means less money.
    - anamax 17y ago
      > My point is that we shouldn't exactly be relying on the U.S. government to do it. The best systems in the world are highly regulated but not actually run by governments. My point is that the US govt will be doing the regulating. Note that the US govt doesn't actually provide medical services under medicare either - it just "regulates" them. I didn't say anything about what Obama could do - free rein means he gets to decide. He can go with regulation, govt hospitals, whatever. > in a fee-for-service system, fewer errors just means less money. IIRC, Medicare mandates fee-for-service. Under the terms of my deal, Obama gets to change that. My private health care doesn't work on a fee-for-service system (at least as far as doctors and medical staff are concerned). I doubt that it's the only one. Yes - it's in the US. If its existence surprises you....

by anamax 17y ago

DennisP 17y ago

The German system is not government healthcare. Everybody has private, nonprofit insurance. Arguably they're less socialized than we are, since they have no Medicare, Medicaid, or VA. Japan is the same, with more choice than Germany: 2000 insurance companies, take your pick. What they share with France: a mandate, a national price list for services, no claim denials allowed for anything on the pricelist, no coverage denials, electronic medical records, subsidies for the poor. They do better on stats than we do, at much lower cost.

anamax 17y ago
> They do better on stats than we do, at much lower cost. Irrelevant because that doesn't imply that the US govt can do that. (Also irrelevant because the German and Japanese populations are very different.) That's why I proposed the experiment - let's see what the US govt can do. Many of us prefer Google to other search engines. Google's existence proves that better is possible, but it doesn't prove that Yahoo or Bing can do better than they do.
- DennisP 17y ago
  My point is that we shouldn't exactly be relying on the U.S. government to do it. The best systems in the world are highly regulated but not actually run by governments. One of the things they do, though, is force a price list on providers, something you've taken off the table. On the other hand, the VA actually has quite a good reputation these days. That's sort of your experiment right there. Costs are holding steady despite a pretty messed-up patient population, doctors and patients like the system, they have a very good electronic medical records system (which they've opensourced, btw) and they use those records to analyze the data and use the treatments that the evidence shows are most effective. It's been widely reported that about 98,000 people a year die from avoidable medical errors, a lot of it from medication errors. Most hospitals won't talk about their error rates. The VA told everybody, then they fixed it. For example, in a VA hospital every patient has a barcoded wristband. So does every nurse, and every medicine bottle is barcoded too. Every time a nurse gives a patient a pill, she scans all three barcodes, and a computer checks to make sure the patient is getting the right medicine at the right time. Most private hospitals have little incentive to fix errors, and certainly none to report them. Reporting just gets you sued, and in a fee-for-service system, fewer errors just means less money.
  - anamax 17y ago
    > My point is that we shouldn't exactly be relying on the U.S. government to do it. The best systems in the world are highly regulated but not actually run by governments. My point is that the US govt will be doing the regulating. Note that the US govt doesn't actually provide medical services under medicare either - it just "regulates" them. I didn't say anything about what Obama could do - free rein means he gets to decide. He can go with regulation, govt hospitals, whatever. > in a fee-for-service system, fewer errors just means less money. IIRC, Medicare mandates fee-for-service. Under the terms of my deal, Obama gets to change that. My private health care doesn't work on a fee-for-service system (at least as far as doctors and medical staff are concerned). I doubt that it's the only one. Yes - it's in the US. If its existence surprises you....