I sincerely wish you were right. What I believe you are overlooking is that when the government runs health care and health insurance, we will have no one to turn to when they make decisions we disagree with. There won’t be any recourse. Now, insurance companies compete. It may be slow and cumbersome, but they provide a service that is valued, and they compete with each other to get our business or the business of our employers.

Also, there is absolutely nothing about government involvement in health care or health insurance that is going to either improve the quality of medical care or insurance, or magically create more of either: the government will not make doctors work harder or study more, nor will it incent insurance companies to be more efficient. The government is not a business; it was never designed to replace a business; it is supposed to make up the rules and infrastructure within which businesses and consumers can choose to function.

I’ve thought about this too, and my interest in understanding the impact of regulations on our economy is what drove me to get a Ph.D. in economics. I can tell you that my best educated guess is that the costs of such regulations are significantly underestimated (by a factor of 7 to 8) and the benefits are overestimated. Again, I wish it were different, but the government can’t make it better.

That’s my two cents.

Sherry
http://www.SherryJarrell.com

It is the current unregulated capitalistic private insurance companies who are actually fulfilling their worst nightmare right now. “Death to us all” – private insurance companies are literally killing patients right now by denying lifesaving care like in the case of Cigna’s denial of Natalie Sarkisyan’s care.

“It will restrict our choices” which is exactly what our private insurers are doing. I have private coverage myself as a medical professional through my hospital who employs me. I’m restricted to a list of doctors I can see and also to only 4 hospitals in the local Tampa Bay area and if I seek medical care outside of this my insurer will put a majority of the financial cost on me so if I want somewhat affordable medical care I’m forced into their restrictive measures.

“Medical decisions will be made by bureaucrats” – in the private insurance market medical decisions aren’t made by myself or my doctor but rather by bureaucrats (executives and internal business analysts) from my private insurers when they decide what is covered and what is not.

Healthcare reform would put a stop to all this and I’ve actually researched for hours on what the best way to achieve this is. Here’s my solutions – http://bit.ly/9QLV8

I don’t think your logic is flawed re:
reducing profits to insurance shareholders will not increase the amount of available resources. Reducing the practice of defensive medicine does reduce current demand — and hence increases the amount of resources which will be available for newly insured. Hence my comment…
Where is my logic flawed????

But I do think you missed my point: bare minimum -reduce the # of profit enterprises, increase the # of non-profit enterprises; reduce the number of transaction fee for service payments and the profit overhead and sales flash/bang that goes with them, increase the number of outcome based payments

I want more like Mayo Clinic which is organized something like a non-profit cooperative, with salaried docs and outcome based health care; less like Blue Cross that -based on market share operates like a profit oligopoly – a market in which control over supply and demand of a commodity is in the hands of a small number of producers etc.

The comodity is a medical fee for service transaction where more transactions = more profits to stockholders, more sales flash/bang, bigger CEO/worker wage gaps, more rapacious wallstreet financial engineers placing bets on next quarters financials -non of which has much to do with doctor/patient quality medicine.

One acknowledgement where you were correct:

We agree that in certain cases, an increase in demand can lead to mass production which can lead to lower marginal costs. Examples of this would be the decline in cost of MRI scanners, and also mass production drugs that go generic.

However that will never be the case for exotic and complex drugs with huge investment/R&D/regulatory costs — and it also can not be the case for highly skilled service providers.

Furthermore, it is now abundantly clear to eveyrone that you are far more interested in lecturing than in using facts and analysis to be pursuasive –

If you can show how a single payor system that covers 100% of all Americans can: (1)provide the same or better medical choices and services than roughly 90% of all Americans currently enjoy; (2) costs the same overall; (3) and does not redistribute wealth or income (i.e. making the top 1% of Americans pay even more than the 40% of all income taxes which they are already paying), that would be pursuasive and might even change my opinion.

And while you are at it, you might address my unanswered questions above to Steve Har and Ric H

But relying on the same tired, non-economic, moralizing does no good for you, me, or the other readers of this blog. The burden of proof is upon you — since “you believe” the status quo is unacceptable — and you can have the last word too (since you seem to covet that).

… if there is a very high demand for Avastin and — no increase in production — the cost of Avastin will rise.

I don’t agree with your analysis of the law of supply and demand. When demand increases for a product — prices will rise or fall — depending on the volume of production.

For example, if there was a high demand for Avastin and production increases the cost of Avastin should fall. However, if there is a very high demand for Avastin and no increase in the cost of Avastin will rise.

In Canada, doctors are free to opt out of the national health care system and bill privately at whatever price the market will bear. Most do not because there is not enough demand for the delivery of for-profit medicine in Canada.

What I find amazing: There is a drug called Avastin that costs about $50,000 to treat one patient with colorectal cancer. Avastin extends life by 4.7 months !!! This explains why politicians on — both sides — of the border say healthcare costs are unsustainable.

Avastin is — rationed — by the health insurer. Not all health insurance will pay for the cost of Avastin. This is true in Canada and the United States.

Avastin is also — rationed — by ability to pay. When health insurance does not cover the $50,000 cost of Avastin, rationing is determined by personal ability to pay. This is true for Americans and Canadians.

You say: “Americans who think Canada is the role model should move to Canada.” These Americans are exercising their — democratic right — to support health care reform in the United States. It goes without saying, you have the democratic right to fight this reform.

You believe that the free-market is the instrument for achieving those defining American values as expressed in the Declaration of Independence:

“the enjoyment of life and liberty, with the means of acquiring and possessing property, and pursuing and obtaining happiness and safety.

Other Americans would disagree that the free-market is the — only — instrument for achieving these defining American values. That’s called democracy.

What is truly amazing is that you think this is truly amazing. If you happen to live in one of the provinces where this treatment is not covered, what happens then???

Your comparison with 173 million Americans is a rhetorical device that is irrelevant, as the correct way to analyze this is comparing the 57% number with the % of Americans who CHOOSE to have insurance coverage.

I can show you reams of studies that prove survival rates for X, Y, or Z are better in the USA than elsewhere; and I’m sure you can dig up studies showing the opposite.

The bottom line is that whatever your good intentions, the law of supply and demand is a law. If you increase demand (unviversal care) and set price (single payor or limiting choice), you get either shortages or rationing. Americans who want more care for less money are unrealistic; Americans who are willing to have less care for all are pragmatic. Americans who think Canada is the role model should move to Canada.

At least 57% of the Canadian population has health insurance that will cover the $50,000 cost of Avastin treatment. And we spend 10% of GDP on health care.

The United States is not even close by a long shot.

You ask about access to Avastin in Canada for the treatment of colorectal cancer. Canada comes way-way-way ahead of the United States on this one.

Here are some facts:

- According to a study published in the New England Journal of Medicine, Avastin extended life by — 4.7 months — at a cost of about $50,000. See here.
- Avastin is covered by universal health care in at least five provinces in Canada (British Columbia, Ontario, Quebec, Newfoundland-Labrador, and Saskatchewan) representing 57% of the total population. See here and here.
- This means 57% of Canadians have health insurance that will pay for the cost of Avastin treatment.
- For American health care to equal this, it means 173 million Americans have health insurance that would pay for the cost of Avastin treatment.

Truly amazing. 57% of the Canadian population has health insurance that will pay for the $50,000 cost of Avastin treatment. The United States is not even close by a long shot.

In a comment above you asked about access to Avastin in Canada for the treatment of colorectal cancer. Canada comes way-way-way ahead of the United States on this one.

Here are some facts:

- According to a study published in the New England Journal of Medicine, Avastin extended life by — 4.7 months — at a cost of about $50,000. See here.
- Avastin is covered by universal health care in at least five provinces in Canada (British Columbia, Ontario, Quebec, Newfoundland-Labrador, and Saskatchewan) representing 57% of the total population. See here and here.
- This means 57% of Canadians have health insurance that will pay for the cost of Avastin treatment.
- For American health care to equal this, it means 173 million Americans have health insurance that would pay for the cost of Avastin treatment.

Truly amazing. 57% of the Canadian population has health insurance that will pay for the cost of Avastin. The United States is not even close by a long shot.

I am not finger pointing at anyone. My finger is firmly planted in my ear ;)

Being serious for a moment: in a successful difficult negotiation among parties with conflicting interests, a good settlement is one where EVERY party is unhappy.
Please correct me if I’m wrong, but the Tort Bar, managed to escape any sort of caps or limits in the current bill…and actually strengthened their hand.

It also seems to me that the pundits focus on the headline cost of malpractice insurance and litigation settlements (which are substantial). A more insidious cost is the waste of resources for tests and procedures which are prescribed because of “defensive medicine.” It’s difficult to quantify this — but if we are adding 40+ million more consumers of health care to the system, we need to address where the incremental medical resources will come from. (Forget about $$, I’m talking about doctors, nurses, cat scans etc etc etc)

Steve Har: reducing profits to insurance shareholders will not increase the amount of available resources. Reducing the practice of defensive medicine does reduce current demand — and hence increases the amount of resources which will be available for newly insured. Hence my comment…

Where is my logic flawed????

your own Churchill was more than unhappy with the Versailles treaty considering it doing more harm than good but that is no excuse whatsoever. Besides the Nazis got to power at exactly the moment when Germany was about to wriggle out of the economic stranglehold.

- just as well one may point to the fact that at least in my reading (Mrs. Dalloway, Howard’s End, Doris Lessing) the Shell-Shocked of WW1 were treated with respect in England while in Germany they were subject of verbal ridicule “Kriegszitterer” (war tremblers)

For weeks now I am on the look-out for a German translation for “trench-foot”. To date I have only the technical term Wikipedia uses in its translation of the condition. No word suitable for common usage is known to me.

From all that I conclude that there was a general lack of decent behaviour dominating the society long before they rooted for the Nazis of which the abominable disregard if not sniggering of the plight of the war wounded was only one indicator.

That’s why I am always very glad to read that the “Anglos” still write about their soldiers in respectful ways.