5 ms·

On point #3, while I'm sure it can be better, it is worth noting out that historically medicare has done better at cost management than private healthcare (http

by i2o 15y ago

On point #3, while I'm sure it can be better, it is worth noting out that historically medicare has done better at cost management than private healthcare (http://krugman.blogs.nytimes.com/2009/07/29/medicare-versus-insurers/ http://krugman.blogs.nytimes.com/2009/07/29/medicare-versus-...). I don't have the answer either, but health is one of those areas we know enough about yet to optimize using the same techniques you would in manufacturing, for instance. It is about investing in preventative measures as it is in reactive treatments. In Canada we face similar issues where more of our tax dollars being spent on healthcare with lesser returns. This is due in part to an ageing population, but can also be attributed to the lack of broader innovation in the delivery of care. A first step would be to encourage a more team-oriented approach where the doctor's lobby group (aka union) doesn't retain so much influence and control over policy decisions. From afar it looks like the private insurance lobby is one of the larger distractions preventing the US from getting down to the real issues of efficient and effective health practices. On the business front propping up failing business models is a tough one. There is something to be said about preventing a complete and sudden collapse. The number of unemployed would hit the system in so many other ways. What we have seen from the auto industry, as much as I disagreed with the bailouts, is reinvention and retooling. I hope they take their bailouts with a great deal of thankfulness and invest wisely. I look at the next generation of companies like Tesla Motors and hope that more auto industry giants will seek to innovate and evolve rather than focus on just getting bigger (and slower). The message I believe we all (conservative and liberal) can and should agree on is respect for the tax payer dollar. Money in government isn't free, the debt and deficit isn't free. As they plan out capital and operating expenses they need to do so with an passion towards building a better country while taking calculated measures and risks. Government's role, in my mind, isn't to innovate itself but instead to facilitate innovation by its people. It should focus on facilitating the success of the people through "just enough" regulation which means refactoring how they work on a regular basis to find the most effective means in which to operate. They need to continue to question their own purposes, not get comfortable in the security of a public sector job for life. Most importantly they need to share with their shareholders, we the people, on their progress in an open and transparent manner. I don't need fancy marketing campaigns to tell me about the good work that they do, but I don't want to see them hiding it either. One way to do this is to add a more direct measure of how tax dollars are spent. In Canada we pay a good portion of our taxes into a general revenue pool. I would like to see that eliminated in favour of a clear indication of what portion of my taxes go towards specific ministries or sectors of government. I think that next level of granularity would provide a bit more awareness that public money really belongs to the public.

twoodfin 15y ago
It's fairly widely understood (though I guess not by Professor Krugman) that Medicare offloads some of its own costs onto the private sector by the below-market rates it pays providers. He's also neglecting to make a real comparison of the services that private health care provides vs. Medicare. Sure, private insurance premiums may have risen faster than Medicare spending during the '90s, but Medicare wasn't even paying for prescription drugs (a huge cost driver) until Part D was implemented in 2006.
- dpark 15y ago
  > It's fairly widely understood (though I guess not by Professor Krugman) that Medicare offloads some of its own costs onto the private sector by the below-market rates it pays providers. This is fairly widely claimed, but it's a pretty weak claim. Doctors are not required to accept Medicare. They choose to do so. They choose to accept the rates Medicare offers. When one party offers an amount for a second party's services, and the second party accepts, they have just established the market rate for that transaction. This claim also conveniently ignores the fact that insurance companies do the same thing. Check over a medical statement from your insurance company some time. You'll see where the doctor billed $300 for "nasal deconfrabulation", your copay was $25, and the insurance paid $125. Total due: $0. > He's also neglecting to make a real comparison of the services that private health care provides vs. Medicare. Sure, private insurance premiums may have risen faster than Medicare spending during the '90s, but Medicare wasn't even paying for prescription drugs (a huge cost driver) until Part D was implemented in 2006. The status of Medicare in 2006 seems to have little relevance to Medicare today. The first question is how much Medicare spends today per client vs how much private insurance spends per client, on average. The second question is how coverage differs in these scenarios. How does Medicare compare to the average insurance policy? I don't know the real answer to these questions, but I know Medicare's coverage or lack of coverage for prescription drugs in 2006 isn't relevant.
  - seehafer 15y ago
    They choose to accept the rates Medicare offers. When one party offers an amount for a second party's services, and the second party accepts, they have just established the market rate for that transaction. Not when second party holds a monopoly on a certain patient population, as does Medicare for the elderly. The healthcare market is so distorted by government intervention that calling anything a true 'market rate' is laughable.

by i2o 15y ago

twoodfin 15y ago

It's fairly widely understood (though I guess not by Professor Krugman) that Medicare offloads some of its own costs onto the private sector by the below-market rates it pays providers. He's also neglecting to make a real comparison of the services that private health care provides vs. Medicare. Sure, private insurance premiums may have risen faster than Medicare spending during the '90s, but Medicare wasn't even paying for prescription drugs (a huge cost driver) until Part D was implemented in 2006.

dpark 15y ago
> It's fairly widely understood (though I guess not by Professor Krugman) that Medicare offloads some of its own costs onto the private sector by the below-market rates it pays providers. This is fairly widely claimed, but it's a pretty weak claim. Doctors are not required to accept Medicare. They choose to do so. They choose to accept the rates Medicare offers. When one party offers an amount for a second party's services, and the second party accepts, they have just established the market rate for that transaction. This claim also conveniently ignores the fact that insurance companies do the same thing. Check over a medical statement from your insurance company some time. You'll see where the doctor billed $300 for "nasal deconfrabulation", your copay was $25, and the insurance paid $125. Total due: $0. > He's also neglecting to make a real comparison of the services that private health care provides vs. Medicare. Sure, private insurance premiums may have risen faster than Medicare spending during the '90s, but Medicare wasn't even paying for prescription drugs (a huge cost driver) until Part D was implemented in 2006. The status of Medicare in 2006 seems to have little relevance to Medicare today. The first question is how much Medicare spends today per client vs how much private insurance spends per client, on average. The second question is how coverage differs in these scenarios. How does Medicare compare to the average insurance policy? I don't know the real answer to these questions, but I know Medicare's coverage or lack of coverage for prescription drugs in 2006 isn't relevant.
- seehafer 15y ago
  They choose to accept the rates Medicare offers. When one party offers an amount for a second party's services, and the second party accepts, they have just established the market rate for that transaction. Not when second party holds a monopoly on a certain patient population, as does Medicare for the elderly. The healthcare market is so distorted by government intervention that calling anything a true 'market rate' is laughable.