The payment system is horrible and hides the real costs from the people purchasing. The majority of people now have no problem with a $20 copay for a doctor’s visit that actually drives 20x or 30x in real costs. Medicare actively makes the situation worse by reducing users’ costs and reducing providers’ incentives with low mandated payouts.

If people had to pay more of the real costs and insurance covered catastrophes and excessive out of pocket costs then competition in insurance and provider costs would reshape all of these cost estimates. See: auto insurance, fire insurance, and just about every other type of insurance you can buy. “Health insurance” hardly deserves to be lumped into the same market anymore.

Increasing health costs is not just the problem of the US budget, it is the problem of the US economy.

The health industry at this point is in fantasyland when it increases its share of GDP. It will not continue.

And Nemo, I posed this on a previous thread way after the post so I don’t think you saw it – you always come back to the ‘it’s a basic supply/demand issue’ – is there any universal care country you can point to that has demonstrated this in action that does have lower costs than the US? Doesn’t the UK independent panel that deems what they will and will not treat/cover act as this lever to control demand/supply of healthcare? I am just checking to see if this fits within your framing of this, because if so, it seems to work pretty well for them but we can’t do that here because it’d be a ‘death panel’ to the nth degree.

Medicare revenues have not kept up with medical costs because Medicare taxes have not increased since 1986, which is most of my adult working life. Think of how much medical costs have gone up in that time period. This is not well-known by the average American and, to my knowledge, hasn’t even been acknowledged by anyone involved in the health-care debate. Republicans and Democrats have been kicking the can down the road and now we’re finally having to deal with it.

Single-payer (Medicare for All), even with an increase in Medicare taxes, would be a LOT more cost effective for individuals. There would still be room for private insurance, because there will always be those who want private rooms if they have hospital stays. We also need to allow the importation of cheaper drugs from other countries, but with stringent testing guidelines so we don’t end up with adulterated products. Let’s be honest and have the government (using our tax dollars) provide research grants to drug companies rather than allowing them to gouge individuals for their research dollars.

We must admit the reason for the high cost of healthcare in America is a direct result of our relative affluence which has caused over-indulgence in what are historically items of complete luxury (sugars, refined grains, meats, alcohol, etc.) and an accompanied diminished demand for physical labor leading to obesity, cancers, and heart disease at an unprecedented level. Our current approach of socializing the risk does not create the required urgency or immediacy to change individual behaviors.

Can a system be devised (perhaps not this roadmap) help shift the responsibility and risk back to the individual- perhaps supplemented by increased social programs for preventative care anbd education? How do we as a nation encourage ourselves as individuals to become more involved and disciplined in our own health? Socializing the risk seems to lead to inevitable failure, or at the least a prescription to be lead by the least responsible.

It seems reasonable the market would respond with an insurance product geared to cover unforeseen medical costs that would consider an individuals behavior in establishing costs exactly as our current market prices life insurance.

There cannot be a serious discussion of fixing our fiscal situation without facing up to these points. I am disappointed that rather than finding common ground on these points and then disagreeing with his prescriptions, James turns into a Death Panel nut and demonizes Ryan. I don’t think his roadmap is the solution, but lets allow someone to admit these hard truths without being attacked.

OR, WE CAN JUST GO AHEAD AND DO EUTHANASIA ON EVERYONE ON THEIR 65TH BIRTHDAY, IF THEY’RE NOT WEALTHY.

How big is the effect? How much productivity is lost? How much wealth is sitting out, because healthy people aren’t there to generate it?

Seems to me it should be worthwhile spending some money to improve the general health and welfare of the country. No matter which way like wealth spread around, having more wealth seems like something everyone would be in favor of.

A lot of our costs could be mitigated if we dealt with the mentality of applying aggressive, advanced technological interventions to keep someone alive long after their body/mind is beyond real repair. How many people know older relatives who continued to ‘stay alive’ hooked up to machines for weeks or months, in a hospital bed, when they had no real quality of life?

Doctors are trained to keep people alive no matter what, and as long as the patient doesn’t say no and don’t have a medical directive, or their relatives won’t say no, they keep applying treatment. But who wants to say no when it’s your aunt, uncle, brother or grandmother? The problem is, most elderly patients don’t want to be ‘kept alive’ they want comfort care, a high quality of life before they die (think hospice).

I think if we confront the reality of our own mortality with dignity as opposed to fear, which could be why doctors and staff fight so hard to keep patients alive, the quality of people’s lives, and therefore care, would be much greater and yet cheaper. Patients and relatives need better counseling on end of life care, and they need education about what the quality of life likelihood is with intervention vs. comfort care depending on the circumstances and the patient.

Personally, if I ever reach the point in my life where I know I will likely die, I would rather die with a quality of life and dignity than a drawn out, lifeless existence in some nameless hospital room.

Anyway, I highly recommend the podcast, it’s informative, has a real human element, and very relative to the debate.

AS for US rationing, there’s a great deal of it with people not seeking medical care until their problems have progressed to a serious level, and rationing by corporate clerks wanting to win points for vacations by denying coverage to people.

Agreed!!! COST CONTROL. Lots of ways to do that that must be done, but ultimately at some point someone needs ration care. Yes.. RATIONED CARE. but HOW? and WHO?

Canadian systems seems just to ration care by making the care so slow to obtain… you just give up. At a radiology symposium in Montreal I learned people wait like 10 months for a CT scan and seem to just give up waiting! So Canada they ration care by delaying care and people that don’t really need it either die or give up waiting for the CT.

I’d like to see a healthcare plan entitled “RATIONED CARE” the roadmap to sustainability. That would go over like a lead balloon.

We’re just like frogs in a boiling pot of water…

Interesting analysis… but it just seems we have a NO win solution anyway you slice it.

HC spending increasing…
1) baby boomers – higher % of elderly vs. young working
2) medical innovation – more and more expensive procedures to extend life
3) Since people live longer… more opportunity to need to spend more on healthcare!

It seems unfortunate older generation didn’t think of this problem sooner and save a little more! Now the younger generation is going to be burdened by the total lack of planning of the older generation. This next generation will work their whole life in large part to pay for affordable healthcare and social security for their aging parents and all of the expensive life extending procedures which are their “right” to have paid for by affordable health insurance plans.

I wonder if this ever turns into a generational fight.