• This is a political forum that is non-biased/non-partisan and treats every person's position on topics equally. This debate forum is not aligned to any political party. In today's politics, many ideas are split between and even within all the political parties. Often we find ourselves agreeing on one platform but some topics break our mold. We are here to discuss them in a civil political debate. If this is your first visit to our political forums, be sure to check out the RULES. Registering for debate politics is necessary before posting. Register today to participate - it's free!

What should be the first step to fixing healthcare in the US?

What should be fixed first?


  • Total voters
    37
Knee replacement at one hospital vs a next is sometimes different by 50000? how is this possible?

Oh, that's easy to explain: prices are established not by market interaction between the provider and the consumer, but via bargaining with insurance companies and government administrators. You have to make some things cheaper, some things more expensive, and not in a manner that makes any logical sense to an outsider observer.

And I don't mean just insurance of the patients: if the surgeons doing hip replacement at the hospital A have a great malpractice insurance, and surgeons at the hospital B a lousy one, it likely will be compensated by a much higher price of the procedure at B.
 
That way those, like you, who trust the FDA to can buy only FDA approved medicine. Those who trust others can have medicine approved by others.

"Approved"? So, you are talking about medicines approved by other regulatory agencies? That wasn't my impression.


That way, everybody should be happy.

Because the unhappy ones will disappear via natural selection, after buying drugs from quacks?
 
Oh, that's easy to explain: prices are established not by market interaction between the provider and the consumer, but via bargaining with insurance companies and government administrators. You have to make some things cheaper, some things more expensive, and not in a manner that makes any logical sense to an outsider observer.

And I don't mean just insurance of the patients: if the surgeons doing hip replacement at the hospital A have a great malpractice insurance, and surgeons at the hospital B a lousy one, it likely will be compensated by a much higher price of the procedure at B.

and thats the part that needs regulated, there is no excuse for inconsistency like that and the system cant be fixed unless theres better consistency.
If its the mal practice insurance difference then THAT should be evident on the bill, not hidden. That should be under something called facility liability or admin costs etc. Not make the knee price vary by 500% and the local anesthetic vary by 300% etc etc etc

Its no wonder its an industry so hard to try and fix when everything is a shell game and so hidden.

When these inconsistencies exist for hospitals on the same block, for the same patient, under the same insurance thats the biggest break down in the system and most things cant be solidly studied or fixed unti that is.

its horrendous
 
"Approved"? So, you are talking about medicines approved by other regulatory agencies? That wasn't my impression.

Other agencies that test and certify medicines, sure.

Because the unhappy ones will disappear via natural selection, after buying drugs from quacks?

Just like the ones who die by being denied life saving drugs by the FDA will disappear.
 
of course they dont care but this is the part that needs regulated and the rest will fall in line, its one of the areas where other countries are ahead of us.

I have no problem with Agent J knees costing 1500 and captain courtesy knees costing 10000 especial if my knee is rated for 10 years and his is rated for 25 THATS how business works.

But my knee should never be available at one hospital at 1800 and at another hospital literally in walking distance 15000. Thats complete bull**** and what needs looked at and fixed.

business is business but simply ass raping the customer (PATIENT) especially in an industry where lives are on the line is just wrong and a serious problem.

Perhaps the facility that charges the higher (inflated?) knee replacement price is also mandated to give away free care to ER patients or accepts Medicare/Medicaid patients for their extremely discounted reimbursement rates while the other does not. It is very hard to get an apples to apples comparison for different care facilities. The same lab test (e.g. INR test) can be had at rates varying by 400%, but if your "co-pay" is the same at each facility then you likely do not care at all.
 
and thats the part that needs regulated, there is no excuse for inconsistency like that and the system cant be fixed unless theres better consistency.

Regulatory fixes can do only that much in a system so complex and constantly changing. The only lasting solution is to return actual customer (patient) to the role of immediate buyer, individual or cooperative. With money in her pocket, any patient should be able to really shop the market of medical goods and services. When this becomes (once again) reality, prices will get in line and start dropping, just like they kept doing all this time in the tiny corners where real retail market had survived (Lasik or elective surgery, e.g.)

Insurance companies should butt out and return to their natural role of providing policies for the cases of accidents or sudden serious illness. Government should limit itself to subsidies for the poor (or for everyone, as a phase, as I say in #84).
 
Last edited:
Perhaps the facility that charges the higher (inflated?) knee replacement price is also mandated to give away free care to ER patients or accepts Medicare/Medicaid patients for their extremely discounted reimbursement rates while the other does not. It is very hard to get an apples to apples comparison for different care facilities. The same lab test (e.g. INR test) can be had at rates varying by 400%, but if your "co-pay" is the same at each facility then you likely do not care at all.

doesnt really matter what the cause is regulate it, until then the system will never work and you said actually what the problem is, if you cant make apples to apples compassion how does one ever address the problems on a fiscal level?

if i owned 13 car factories and they all made the same cars using the same tools but had 13 extremely different budgets, insurances, prices for services etc etc how do I ever come up with a way to control costs that works? I cant until they all operate with in at least a close range of eachother.

If some of them give free oil changes one sunday a month then they all do it or none of them do it or they all do it once every 3 months.
If some of my factories are mandated to use Pirelli tires then they all use them

etc etc

without this control and forcing an apples to apples situation or at least a granny apple to red delicious apple im ****ed (or at least my customers are) and so is any guess at my costs and bottom line.
 
Other agencies that test and certify medicines, sure.

I wrote above that Americans should be given easier access to medicines approved in Europe, Australia and other countries with respectable regulatory bodies. That's what you mean?
 
I wrote above that Americans should be given easier access to medicines approved in Europe, Australia and other countries with respectable regulatory bodies. That's what you mean?

That's not what I meant, but that would be great too. I meant agencies along the lines of Underwriters Labs that would test and approve medicines.
 
Regulatory fixes can do only that much in a system so complex and constantly changing. The only lasting solution is to return actual customer (patient) to the role of immediate buyer, individual or cooperative. With money in her pocket, any patient should be able to really shop the market of medical goods and services. When this becomes (once again) reality, prices will get in line and start dropping, just like kept doing all this time in the tiny corners where real retail market had survived (Lasik or elective surgery, e.g.)

Insurance companies should butt out and return to their natural role of providing policies for the cases of accidents or sudden serious illness. Government should limit itself to subsidies for the poor (or for everyone, as a phase, as I say in #84).

but in my opinion its complexity shrinks majorly with regulation, other countries already do this to a degree it cant be to hard for us to figure it out.

but of course im also for the patient having the power and options too but with out regulations in a market where you must pay or die or lose a leg, they only have so much power

your example of elective is just that, ELECTIVE so the consumer/patient power is dramatically increased vs me needing a new or artificial hurt by next week or cancer meds, or knee surgery so i can walk, or my gall bladder removed so i can eat and sleep right etc

I agree i just dont think its so cut and paste for THIS market like others
 
your example of elective is just that, ELECTIVE so the consumer/patient power is dramatically increased vs me needing a new or artificial hurt by next week or cancer meds, or knee surgery so i can walk, or my gall bladder removed so i can eat and sleep right etc

That's the reason the caring dear government has left them alone, but it is not any kind of proof that the market cannot take care of necessary procedures. Medical goods and services being "inelastic" is largely a myth. They are made inelastic by the pathological setup we have. And direct price controls never work - you will just pay for them with diminished choices, quality and longer waiting periods.

Regulations are necessary of course, but they should focus on safety and efficacy (as we are discussing on this very thread).
 
That's not what I meant, but that would be great too. I meant agencies along the lines of Underwriters Labs that would test and approve medicines.

Which in turn would have to certified by the State...But yes, in theory, I have nothing again the FDA getting some competition.
 
Which in turn would have to certified by the State...But yes, in theory, I have nothing again the FDA getting some competition.

I would not require that any agency seek permission from the state to operate. That's the whole point of my suggestions.
 
I would not require that any agency seek permission from the state to operate. That's the whole point of my suggestions.


So, how do we know they are qualified to do something as complex as drug testing?
 
doesnt really matter what the cause is regulate it, until then the system will never work and you said actually what the problem is, if you cant make apples to apples compassion how does one ever address the problems on a fiscal level?

if i owned 13 car factories and they all made the same cars using the same tools but had 13 extremely different budgets, insurances, prices for services etc etc how do I ever come up with a way to control costs that works? I cant until they all operate with in at least a close range of eachother.

If some of them give free oil changes one sunday a month then they all do it or none of them do it or they all do it once every 3 months.
If some of my factories are mandated to use Pirelli tires then they all use them

etc etc

without this control and forcing an apples to apples situation or at least a granny apple to red delicious apple im ****ed (or at least my customers are) and so is any guess at my costs and bottom line.

Using your car analogy, would you charge the same price for a car sold for cash up front as you would to fill out a 10 page loan application and then wait for up to two months to get your asking price reimbursed? The clinic that I use offers a 20% discount for cash payment at the time of service. They save the cost of preparing/mailing the bill(s), payment delay (or non-payment) and the need to fill out lots of insurance paperwork.
 
That's the reason the caring dear government has left them alone, but it is not any kind of proof that the market cannot take care of necessary procedures. Medical goods and services being "inelastic" is largely a myth.
1.)They are made inelastic by the pathological setup we have.
2.) And direct price controls never work - you will just pay for them with diminished choices, quality and longer waiting periods.

Regulations are necessary of course, but they should focus on safety and efficacy (as we are discussing on this very thread).

1.) i agree thats why i want more regulation
2.) i disagree has i dont want a direct control but a window just like other countries.
so the choices dont matter much to me in this field, quality is already regulated and cant go down passed that and waiting wont happen any more than it does now

but of course safety and efficiency are concerns too but again they dont matter much if i cant pay to get them used on me.


bottom line its a mess and with out cost regulation and basic conformity it can never be at its potential or even close to it
 
Using your car analogy, would you charge the same price for a car sold for cash up front as you would to fill out a 10 page loan application and then wait for up to two months to get your asking price reimbursed? The clinic that I use offers a 20% discount for cash payment at the time of service. They save the cost of preparing/mailing the bill(s), payment delay (or non-payment) and the need to fill out lots of insurance paperwork.

would depend on how well the loans are regulated and thier success (pay off rate)

but again that has no impact because i would make "cash" prices the same everywhere and "loan" prices the same every where. Easily controllable and able to be calculated or at least guesstimated.

the costs you are talking about are no more than a admin/risk line irem that can easily be accounted for.

with regulation it would never create the problem of customer A going to my shop on 1st street or my shop on 5th street and finding the price of the care different by 500%

now costumer A paying cash might find a 20% different price than customer B using a lone and that is fine.
 
Last edited:
In the same way we know that the FDA is qualified to do something as complex as drug testing.

FDA does not actually do the testing: drug companies do. FDA sets the rules and monitors the process, then decides if gathered data is sufficient.
Do you propose that the hypothetical competitor(s) should be given access to the same data, or that companies should able to choose who is overseeing them, or both?
 
FDA does not actually do the testing: drug companies do. FDA sets the rules and monitors the process, then decides if gathered data is sufficient.
Do you propose that the hypothetical competitor(s) should be given access to the same data, or that companies should able to choose who is overseeing them, or both?

That companies should be able to choose who is overseeing them (could be multiple agencies), each of which would obviously want the same sort of information currently required by the FDA.
 
There have been done some studies on how much tort reform would lower cost, and it is pretty small. If I remember right, it would be less than 1 percent. Does not make it not worth doing, but when costs are rising 2 to 3 times the rate of economic growth, there is a major problem and 1 % ain't gonna do it.

I would look with a jaundiced eye at the claim that the savings would be ~1%. It strikes me as likely that that estimate is a static estimate based solely off of the reduction in lawsuit payouts, rather than the changes in how medicine is practiced. Estimates are that as much as 25% of our healthcare spending is on purely defensive medicine, designed to avoid lawsuit rather than improve health. Slashing into that 25% by reducing the threat of suit would produce pretty significant savings, on top of freeing up medical resources.


As for the OP, Rising Costs aren't so much "The Problem" as they are the chief symptom of The Problem. The chief problem with our current healthcare system is an abundance of awkward and disruptive interference. This has led to the dominance of a third-party-payment model which discourages cost-awareness and encourages over-consumption among health care consumers. Government pays for roughly half of our healthcare consumption, and of all third-party payment options, government is the one least likely to be capable or willing to nimbly find ways to impose cost awareness on those capable of sending it bills. The result is a healthcare system in which costs rapidly spiral out of control (we have a similar problem in our higher education industry). Any system which does not alter that disruption and incentivize cost-awareness among consumers for the vast majority of medical purchases will not address the chief underlying flaw of our current system, and we will continue to see costs spiral outside of the control of the citizenry and government.


Reforms which have pushed cost-awareness back onto consumers have demonstrated impressive results at lowering 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.

Medicare Part D utilized market pressure on the insurance side, and saw expenditures come in at 40% UNDER expectations - the only such government program in history to do so.

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).

Wal-Mart's low cost clinics and prescriptions save us oodles of cash. Wal-Mart reports that "half of their clinic patients report that they are uninsured" and that "if it were not for [Wal-Marts'] clinics they would haven't gotten care - or they would have gone to an emergency room".

Dr Robert Berry runs a practice just across the state border from my old hometown called PATMOS (payment at time of service). he doesn't take insurance at all - but simply posts the prices of his services. By removing the cost of dealing with mutliple insurance agencies, medicare, and medicaid, the prices he is able to list are one half to ONE THIRD of industry standard.


....And I (again) propose that we build upon the lessons of those successes by building a healthcare system that can ensure universal access to coverage while reducing costs and expenditures.
 
Last edited:
I don't know which answer to pick and here is why. Where I live it's much cheaper to buy junk food and breads, pasta etc that are white that has more sugar in it than whole grain. Vegetables, fruits, etc are very expensive. So, the first thing we need to do is make healthy food affordable. Next, kids should be having gym class every day in school. The healthier we are, the less medical bills we will have. Oh and only natural sugar, get rid of high fructose corn syrup or HFCS.
 
Yes, I mean allow people to purchase health care services from whomever they want.



Okay, we can keep the FDA, if you wish. I'd just strip them of power to prevent a drug from being put on the market. They could do the studies and publish them so people are informed. But I would still allow people to buy medicine from whomever they want.
These first 2 could only work if the AMA and FDA were replaced by various private certification companies.

Suppose 5-10 competing companies existed to certify medical professionals and/or drug safety - the competition is key here, because without it some monolithic and more easily corruptible certification company (like the FDA, really) would form.

Of course you would need to have some way of preventing a behind-the-scenes agreement between them from forming, and allowing lower standards...

But I think anti-trust/anti-monopoly laws would work there.

Give people more choices. Choices are good.
To a degree. In this case, though, I completely agree.

Limiting companies to in-state and disallowing competition across state lines is bad for any service/product, let alone medical.

I don't propose ending health insurance at all. If people want insurance, they should be allowed to buy insurance.
The problem is that some people will NOT buy insurance, and then will still be given medical care when they show up for it. This costs SOMEONE money, and most often it is the hospitals - this then drives up their costs, and thus the costs of the people who DO pay.

I could actually accept a law that required everyone to have some form of medical care insurance, but the vast number of extra limitations and stipulations in the current law (Obama Care) are what turns me off.

I mean, if it allowed someone to say "I am setting up a health care savings account", and have that count as medical care insurance.
Or if it let someone purchase high-deductible health insurance.

Frankly, that is my main issue with Obama care - it places far too many limits on what care you CAN buy.
 
Last edited:
These first 2 could only work if the AMA and FDA were replaced by various private certification companies.

Why does it even have to be private? Why not allow it to function like the Bar Exam for Lawyers? Has anyone noticed a shortage of lawyers, lately?
 
If the FDA really cared about safety, gmos would be illegal, fast food would be illegal, tobacco additives would be illegal and on and on.
 
Back
Top Bottom