These countries all have higher quality of care than we do, so if they have lower expenditures that is either because they spend the money more wisely or because they also have lower costs.
that is incorrect - those nations have lower quality of care; most especially in terms of access. not only do Americans have higher survival rates for severe injuries and diseases (cancer, for example, is easy to compare), we have better access to preventative treatment and screenings, and we spend less time waiting for our larger and qualitatively superior healthcare resources to serve us. Even our low-income folks are in better health than (for example) comparable Canadians, and Americans are more satisfied with their healthcare than Canadians, Germans, French, the British.... In addition, by performing an overwhelming disproportionate amount of medical research and innovation, the US System actually subsidizes other nations' healthcare.
There is a reason Canadian Premiers come to the United States when they need heart surgery. They want the highest quality available.
If you have some big ideas about how to fix it without a public option or single payer, but all means, lay it out there. So far I've never heard anybody on the right with an idea that sounded like anything more than rearranging deck chairs on the titanic... Let the companies sell insurance in all the states under the same name and whatnot.
that would be a huge benefit, namely because it would remove the ability of state politicians to jack up prices in return for campaign donations. currently in many states health insurance agencies enjoy a monopolistic or guaranteed position thanks to their relationship with state governments. In my home state of Alabama, for example, Blue Cross / Blue Shield basically owns about 90+% of the market, because the state border restriction allows them to work state politicians to protect and ensure their market share. the way it works is thus:
All the doctors and providers of Idaho's plastic surgery industry get together and agree that they are an underutilized resource. Plastic surgery makes people happy, better, and increases their quality of life. What keeps people from getting plastic surgery? Well, it costs money. So, if we want to get more people to buy our product, we need to lower the cost paid by the patient.
Plastic Surgeons United organizes as a PAC and goes and talks to various important members of Idaho's state congress. They discuss the importance of plastic surgery, the importance of winning elections, the importance of having enough money to win elections, and how all of these problems can solve each other. So Idaho's congress passes a law that all insurance agencies must cover plastic surgery in every policy they sell.
Now, the Insurance Agencies aren't going to like that; it hampers them, and so Insurers of Idaho United march on up to Capital hill where Congresscritters take them out to lunch and discuss things like the importance of fine-tuning regulation, the importance of a good working relationship between regulators and regulated, the importance of having the government fine-tune regulation so as to provide particular insurance agencies with guaranteed market share, the importance of politicians who favor particular agencies with such guarantees winning elections, and the importance of therefore making sure that those politicians campaigns are well-funded.
Plastic Surgeons get more business. The handful of largest insurance agencies that are able to donate enough money to congresscritters get protected status from the state and guaranteed market share. Congresscritters get two new sources of guaranteed campaign funding. Everyone wins!
well, except for the consumers in Idaho, who are now stuck with higher insurance premiums for services they did not want. they kind of get it in the shorts. Taking away the state border restriction would take away the ability of the above-described medical triad to screw over state consumers, and would indeed lower the price of health insurance.
however, that's just
A good idea. there are plenty others. the most fundamental one is that we allow health insurance to start acting like... well, insurance. Consider, for example, your car insurance. Why do you have it? You have it in case of a wreck, in case it is totaled, in case of a catastrophic event. You wouldn't expect your auto insurance to fill up your car, or change your oil - that's not what it is for - it is there to
insure you against the
risk of catastrophic
loss. If it had to pay for gas or an oil change, you wouldn't be buying insurance, you would simply be using your insurance company as a prepay for gasoline and oil changes. Yet this is precisely what we do with health insurance. When we go to the doctor for a semi-annual; we expect insurance to at least partially cover it. Ditto for regular medicines, and so on and so forth. Consider what kind of gasoline you buy now, and what you pay for oil changes now. Would this change if you no longer had to pay for it? Of course it would - if an insurance company were paying for these things, your incentives would be to get as much out of your premium as you could, and so you would buy the most expensive gasoline, and you would get the oil change with the tire rotation and the full fluid check and top-off every time. You would consume more resources than you would otherwise, if you were paying for these services themselves. And so would everyone else. Everyone consuming more than they would otherwise will drive up demand, which, in the absence of a rapid increase in supply, will cause prices to skyrocket, and continue to do so. Exactly like what we see with healthcare.
So, the solution to the cost of our healthcare (and, thus, the solution to our rising expenditures) is to find a way to bring price pressure to bear on general, predictable costs while still covering catastrophic potentialities. In other words, we need to bring market pressure to bear, as currently it is kept out of the system. Fortunately for our discussion here, several have been tried, and the results of this testing have been striking:
plans that utilize market pressure have consistently demonstrated an ability to push down expenditures:
Indiana offered HSA's, which have patients save money in tax-free accounts (where it grows and remains theirs forever and ever unless theys pend it) matched with high deductible plans to it's employees. Employees began to respond to price signals, and medical costs per patient were reduced by 33% and expenditures to the state were reduced by 11%.
Safeway has instituted a program that gave financial incentives to people who engaged in healthy behavior by allowing price signals in the
insurance side of the market to work (Indiana worked on the medical side), and saw it's per-captia health care costs remain flat from 2005-2009; when most companies saw theirs jump by 38%.
Whole Foods instituted HSA's, and let's the employees choose what they want the company to fund. This institutes price pressure on the medical side (WF covers the high-deductible plan 100%), and their CEO points out that as a result Whole Foods' per-capita costs are much lower than typical insurance programs, while maintaining employee satisfaction.
Wendy's instituted HSA's, and saw the number of their employees who got preventative and annual checkup care climb even as they saw claims decrease by 14% (in one year).
but wait! all of these are small private programs. Surely none of them demonstrate the kind of effects that we would see in a massive systemic change such as in Medicare.
oh.
At the time of its enactment in 2003, the Medicare drug benefit — known as Medicare Part D — had many critics. Some said the program, which is built on consumer choice and vigorous competition among private plans, wouldn’t work, because the private plans would decline to participate without a guaranteed share of the market. Others said the beneficiaries wouldn’t sign up for the voluntary benefit, because the competitive structure would be too complex to navigate. Still others said the program would explode in costs without government-imposed price controls.
All these predictions were dead wrong. The program is now in its sixth year of operation, and it has exceeded all expectations. Some 90 percent of Medicare participants are now in secure drug coverage of some sort, and public-opinion surveys continue to show that seniors are very satisfied with the new program. Most important, the drug benefit’s costs for the first decade are coming in 42 percent below what was predicted at the time of enactment....
In early 2004, the actuaries at the Centers for Medicare & Medicaid Services (CMS) issued national health-expenditure projections indicating that total retail prescription-drug spending for the ensuing decade would reach about $3.5 trillion. In early 2010, the actuaries released new projections estimating drug spending for the same ten-year period at about $2.4 trillion, or 31 percent below the previous projection. But these projections include prescription-drug spending for both the elderly and the non-elderly. What would the numbers look like if the drop in drug spending for the elderly (about one-third of all spending) were removed from the estimates? When that is done, the drop in projected spending for everyone else is shown to be less pronounced — just about 27 percent...
Obamacare apologists are constantly arguing that changes in Medicare have the potential to influence the entire health-care market. Well, if that’s the case, it would apply to Part D as well. For instance, Part D plans have aggressively pushed generic substitution as a way to lower premiums — and they have had considerable success. Isn’t it likely that this trend among the elderly has influenced how physicians and pharmacists behave with all their patients?...
[T]he whole point of Part D’s consumer-choice structure is that it allows enrollees to migrate out of plans with high costs to those with lower costs. And, not surprisingly, that has happened every year of the program’s operation... on an “all in” basis, Part D has been a phenomenal success story, as shown in the graph below. From 2006 to 2010, per capita Part D costs across all settings have risen by an average of just 1.2 percent annually, which is well below the per capita rise in costs for the rest of Medicare.
