Name:   MartiniMan - Subject:   Let's separate the cost and quality of care Date:   7/31/2018 10:48:40 AM

First of all, I am glad this post generated the discussion it did because once intelligent people see the actual cost of Medicare for all they begin to think twice about the folly of universal health insurance run by the government.  However, I think you need to separate the healthcare system itself from the mechanism for paying for it because they are two very different issues.  The fact of the matter is that the U.S. has the finest healthcare system in the world.  In terms of access and quality of care we are the gold standard and there's a reason why people come here from all over the world to be treated.  And there's a reason U.S. hospitals on the Canadian border have billboards in Canada advertsing that they acccept the Loonie.  Need a hip replacement?  Tough luck in Canada or the UK or pretty much any other universal health care country.  You wait six months or longer and if you are too old they just say no.  Same with a stent or bypass surgery.  Come to the U.S. and you are on the table in a matter of days....unless you are on Medicare/Medicaid/VA.....you know, the ones run by the government.

The issue we have in this country is the system for paying for our medical care.  That is, third party payers, be they insurance companies or the government, separate the consumer from the direct cost of their health care.  When you separate the consumer from the cost impacts, prices always go up beyond what they should (just look at the rise in college prices versus the rest of the economy).  I suggest you look at the cost of Lasik or CT scans, neither of which are covered by insurance.  Both of these are paid with cash and both have not only dropped in price but have greatly improved in quality because of that ugly capitalist idea, competition.  So in my view and broadly speaking, until we get the consumer closer to their health care buying decisions costs will continue to spiral, especially given all the distortions in the market caused by Obamacare.

Universal healthcare run by the government in other countries all have two things in common, rationing (lack of doctors, nurses, hospitals, bloated, inffective govt departments, etc.) and inordinately high income tax rates that stifle their economies.  Had Obama decided to tackle the real issues we faced instead of the monstrosity they foisted on us we would all be better off.  The biggest issues are how to deal with preexisting conditions, portability and providing an option for those that could not get insurance but actually wanted it (as opposed to mandating it for those that don't).  Instead we got a stupid, destructive law that is driving insurance costs out of this world.  Exactly what we predicted would happen because the govt does nothing well. 

There are also a number of other reforms that on the margins would help with the cost side of the equation.  Tort reform would help drive down costs because doctors would be less inclined to practice defensive medicine.  I can tell you as one who has an HSA account, when our doctor wants to do some tests we always quiz them as to why because we pay for them directly.  Once we hear their explanation we then decide whether to have the tests done and we often decline because they are unnecessary.  It would also be nice if we could buy healthcare insurance the way we buy all our other insurance products but that is a lot more complex change than it would appear.  But having a requirement for carriers to limit their reach due to state regulations limits competition. We see that in our business where there are only a handful of markets that can insure our employees across the country, which means less competition for our business and higher prices.  Were that barrier removed we might see more competition and lower prices for insurance.

As for drug companies, I am torn about what to do with the cost of prescriptions.  On the one hand, the prices we pay fund R&D and to the extent we artificially depress drug prices one area where they will cut costs to maintain profits is R&D (at least that's what drug companies claim although they could probably cut other costs to maintain profits but that would likely involve people losing jobs).  Again, my view is that competition will solve some of these problems but the fact is that drug companies try to recoup the cost to develop new drugs with higher prices, especially the exotic ones.  So I think the concept of artificial price controls is a bad one because it stifles innovation and competition.  But maybe there's a solution out there that would help mitigate costs for those that need but cannot afford the really pricey drugs.  That may be an area where effective legislation could help if done right (which would be a miracle given past history).

At the end of the day a majority of Americans do not want to double the federal budget and those left wingers that want to tell us how other countries do it (despite all the problems) is not very compelling.  But we shall see if the U.S. wants to follow socialist countries down this rathole where the govt takes half your income, unemployment norms are 10% or higher and your healthcare decisions are made by unelected, unaccountable bureaucrats.  If they do then we will eventually understand why the U.S. was once the world's greatest economy but we pissed it all away with ideas that have never worked and will never work.