There should be a new thread with a new rule: if you are going to ridicule someone's plan, either offer your own plan or be quiet altogether. I am not partisan, but republicans are definitely in the "no-plan" zone. ....
This one may take a beer... or three, but what the hell -- I need to keep the Miller bottlers employed.....
First question -- "Do we have a healthcare crisis?"
Next question -- "What are the elements of the crisis?"
Next question -- "What are the specific causative factors?"
Next question -- "What can we do to address these identified factors?"
It has to flow in that order. We cannot "generate" a crisis just to "generate" a need for change to fix it. We did that with the creation and adoption of Medicare, and look at how well that has worked out. Most agree that we have a problem, and a rather significant one at that. The primary party in "crisis", however, is the government payors and those who, for whatever reason, have inadequate insurance.
Assuming that we agree that there indeed are problems tantamount to a crisis, the base problems are twofold: access and cost. It is my contention that these are not mutually exclusive issues; gaining a handle on costs will improve access MUCH more than the other way around.
This is where the Dems get it wrong -- assuming their goal ever was to address the actual problems in healthcare delivery, an assumption that is suspect at best. One can be "insured" and lack access -- ask any Medicaid patient in states with poor Medicaid fee schedules if their "access" is adequate -- so "insurance" alone does not equate "access". "Cost" is an even bigger problem; the reasons for this are legion, but in order to discuss this one must understand (and acknowledge) that all of healthcare operates in an environment of relative price fixing -- with the price fixing apparatus being Medicare itself. You can think of this conceptually (rather simply) as this: Medicare sets the bar for pricing. For MC patients, this is fixed and non-negotiable. While it is true that private insurers negotiate payment rates, MC is used as the benchmark. The degree of variance from MC should be thought of as elastic bands attached to the MC bar, and is relative to the insurer and provider market in any given locale. The greater the competition on the provider side, the less the elasticity to the (+)MC fees, the greater the insurance competition the greater the elasticity to the (+)MC fee potential, and so on for the various competitive environments. Regardless, the price remains relatively fixed across the board, with the variances in the private sector being a game of minimal percentages.
As an aside, at this point I would like to point out this: in a fixed price environment, service / good consumption assumes an equal role in determining total expenditures. This is why some form of rationing must take place....
If we were able to control costs and consumption, out of pocket pay would be more affordable, insurance premiums should be more affordable, etc, but how do we get there? The degree to which savings can be realized through pricing pressures is finite; prices can only go down to the level of costs, so the savings there are inadequate to make a significant dent in the overall expenditure trends. Further, we are restricted in our capacity for increased productivity to offset price declines in medicine due to the relative inability to automate many of the necessary processes. The only way to effectively "bend the cost curve" is to restrict the volume of services. That's it. Free market forces could drive down specific sector costs quite likely, but even that will not address the structural problem that we have; our problem has not been one of
price escalation, it has been one of
increased utilization.
My solution would be based on two principles predominantly:
-allow the market to determine appropriate pricing levels
-acknowledge and accept that some degree of rationing is necessary, the degree to which will be determined by available funding and whatever list of services the risk carrying entity chooses to cover
The government really has no justifiable role in determining either of these issues.
). Anyway, good luck to everyone, and I hope you learn to have faith in our government, hopefully through this reform going better than you expect. 
).
