The New Republic

I'll be cynical until public schools are cheaper than private schools.

- cthulhu2008

May 18, 2009 at 5:26pm

Jonathan,

SOME QUESTIONS??? What do you mean by controlling costs. Lowering costs? Lowering the rate of increase? Reducing the percent of GDP spent on health care? What is the appropriate cost? What is the mechanism for determining the appropriate cost?  Finally, I assume that at a minimum when you say controlling costs you mean spending less on health care than we would if we continued spending as we do under the current system. Since this is the case, please explain what is the mechanism you envisage for controlling costs? Government more efficiently allocating resources (i.e. determining who gets what treatment or prescribing more effective treatments than our current health care providers)?  Rationing? If rationing what is the mechanism.... price or quota? These should be easy questions for you? Please respond.

- dtohmatsu

May 18, 2009 at 10:36pm

I like all the questions posed by dtohmatsu  until he gets down to suggesting the answers he wants to hear. He asks:

"<What do you mean by controlling costs. Lowering costs? Lowering the rate of increase? Reducing the percent of GDP spent on health care? What is the appropriate cost? What is the mechanism for determining the appropriate cost?  Finally, I assume that at a minimum when you say controlling costs you mean spending less on health care than we would if we continued spending as we do under the current system. Since this is the case, please explain what is the mechanism you envisage for controlling costs?"

Then he inserts his assumption that a publicly-funded "government " plan will ration care and intervene between doctor and patient.  Very sneaky, dear heart.

Let's look at cost-effective models used in single payer countries who spend half what we do.per capita and as percentage of GDP.  Cut costs for the populace and the economy by eliminating for-profit insurers and excessive pharma marketing expenses.. Prioritize care by level of medical need and urgency, not by ability to pay. Ask qualified nonpolitical boards with clinician members and researchers to decide on the merits of experimental treatments.  Do not allow an HMO to intervene between physician and patient.  Do not expect someone with chest pains to shop around for the best treatment option. Do not expect a parent with a very sick child to forego a visit to a doctor because the deductible is prohibitive.

Pay physicians fairly in keeping with their professional status. Cap fees to specialists. Reduce malpractice premiums by capping awards. Under single payer, punitive damages are levied, but future/contingent care for victims is covered.

Cut costs by removing the profit margin in hospitals. Monitor hospital performance, insist on quality control, but pay approved fees for service provided, etc. We now have rural hospitals in my stste close to shtting down because reimbursement is inadequate..

Now, would you like to go back to those questions again?

P.S  Kaiser Foundation CEO Drew Altman has sent out a good article and comparison chart on attitudes towards reform: "The Experts vs.The Public on health reform."  Go to   www.kff.org/.../051809_altman.cfm

- hmseil01

May 19, 2009 at 12:53pm

hmseil,

I think the only OECD country who as a percentage of GDP or per capita spend approximately half of what the U.S. does is Japan.  Most of the other single payer OECD country are around 75 or 80% of the U.S. level. Since I live in Japan, I can perhaps give you a perspective on how they keep health care costs down.

1) No medical treatment provided in ambulances only transportation.

2) No private or semi-private rooms in hospitals.

3) No screening for H. pilori - the major cause of stomach cancer (according to WHO) in a country that has extremely high stomach cancer mortality.

4) Joint replacements at 1/5th the per capita rates for the U.S.

5) Delayed approval of new and expensive drugs resulting in wealthy "terminal" Japanese cancer patients enjoying an 85% survival rate at the University of Texas.

6) Withholding of treatment for elderly and newborns with serious medical problems.

7) 30% co-pay except for the elderly.

8) No hospitals with 24/7 emergency rooms. They call from the ambulance to figure out which hospital is open.

I can go on and on. The problem is that there is no magic bullet for reducing costs without withholding treatment.  And on top of that you can incredible inefficiencies when you have single payer setting pricing.... I can send you another post on that if you are interested.

And I would be interested in hearing Jonathan respond to the questions.

- dtohmatsu

May 19, 2009 at 11:20pm

hemseil,

And the by the way.... I did not assert the assumption that government will ration health care. I asked whether cost reduction would be achieved by a) efficiency or b) rationing. As far as I am aware those are the only options.

- dtohmatsu

May 19, 2009 at 11:29pm