Perhaps we spend spend more on healthcare because we deem it appropriate; perhaps we assign greater value to interventions, etc.
Perhaps you are correct. The point is that if we could waste money on a smaller scale, comparable to what other countries in similar economic situations waste, we would have more than enough to cover everyone that has no insurance, which would go a long way toward breaking the spiral of more uninsured--->higher costs for the rest--->more uninsured...
Perhaps we have no idea what an appropriate level of consumption -- or pricing -- is because we operate in a fixed price environment and the consumer has been removed from the economic pain associated with consumption.
We do not operate in a fixed price environment. Medicare places no mandate on provider participation in the program or what providers can charge for services to private parties. It just sets the reimbursement rate it will pay to providers that choose to accept Medicare. Insurance companies use medicare prices in quoting their own simply because it is a convenient benchmark. If you think otherwise, please explain the mechanism by which the setting of Medicare reimbursement determines private insurance reimbursements.
1. U.S. healthcare operates in a price fixed environment (despite any misconceptions that you may have to the contrary). MC sets the bar; private insurance "negotiations" is a game of percentages at best.
See above
2. (quality of healthcare services) =/= (quality of health). If you do not understand this, I doubt anyone here can help you. If you do understand this, you are being intentionally deceiving.
Yes, many other factors, social, cultural, etc. contribute to our quality of health. Our baseline care costs are likely higher than many of the countries I use as examples because we eat lousy diets and exercise less, among other factors. But this does not change the fact that inefficiencies in our payment model inflate our costs a great deal, and that there are plenty of models out there that have proven to be less administratively wasteful. Single payer is not a magic bullet solution to all of the problems in our health care system, nor is any other payment model. Defensive medicine, unaligned interests inherent in the FFS model, and fraud are largely separate issues that also need to be addressed. But according to most analyses that I have seen, and supported by many case studies from the experience of other countries, single payer would take care of a great deal of administrative waste and provide coverage to our uninsured at a total cost less than what we pay now. That is a pretty good deal.
3. The only way to contain costs in our current FFS system is to somehow restrict the volume of services provided. This can be accomplished either through an authoritarian restriction of services (commonly referred to as rationing) or decreasing the need for services (via societal changes, transforming into a healthier populace, etc).
I've responded to this exact point many times already, so I won't repeat myself, except to say that there are plenty of savings available before we cut a single service. However, you are correct, we have plenty of waste in health care delivery as well, and we do need to find a rational way to cut back on wasteful services. Most people I've read point to the FFS system itself as the culprit, but that is a separate, hugely complicated issue that none of us have time to debate.
Changing from the FFS model to one of the competing "managed care" models only shifts the party of authority or the rationing body.
You can change FFS without single payer, and that is something well worth looking at. Billing methods are really a separate issue from who is paying. No one that I have ever heard of in the US has ever really adopted a billing method other than FFS. Even HMOs billed for individual services. It's a difficult problem to construct a non-FFS system that incentivizes quality care over volume. But I am much less familiar with this area than with payment models.
My main beef is with people that reject rational government interventions like single payer under the banner of preserving free-market competition with little more than an intuitive (and usually wrong) understanding of the allocative mechanisms that they champion. Minimally regulated competition is very often, in fact usually, the best allocative system because it does produce efficient outcomes. But even when there is perfect competition, a range of efficient outcomes are possible, and the exact outcome reached may not be the most socially desireable. Regulatory guidance is appropriate to steer the market to the outcome that best meets our moral ideals.
In health care, the situation is totally different. Health care services are not like DVD players, where we would be comfortable if our neighbors down the street had to do without one if they cannot afford it. We have made a decision as a society that we will not deny people necessary health care, but we have chosen an incredibly irrational way to provide it to those who cannot pay for it directly themselves - we send them to the highest cost facilities available often after whatever problem they have has progressed to the point where treatment is more difficult and expensive. Furthermore, even among those of us who pay for our own care, oligopolies in the insurance industry have pricing power that works to our disadvntage. And most people do not have the expertise to judge accurately the value of a particular insurance contract (or health care service for that matter). For these and other reasons, our economic theories about efficient allocation are just not applicable. There is ample evidence that a rationally contructed payment system that relies on human judgement rather than imperfect competition between insurers saves a lot of money, and eliminates some of the most undesireable aspects of our current system, like denial of coverage based on preexisting conditions, and price discrimination where those who buy on the individual market are likely to pay more for less coverage.
On another note, chess, I commend you. Attacking the data on which my claims of administrative savings are based is a valid way to argue against single payer. I haven't had time to read your link, but I will.
For now, as much as I am enjoying this debate, I have a test next week so this post will have to be my definitive statement for the moment. If this thread is still at it next weekend I'll happily rejoin.
That really is correct. What's more, I am convinced by past hx, more current hx, current events, as well as considering sheer numbers for a population like ours that this whole HR agenda is a BIG LOSE ALL the way around. Too bad some number will not be convinced until it is too too late.
