Here’s another idea for medical reform: consulate care. Let countries like Sweden, France, etc. with approved national health care systems have bigger consulates, and open them up to paying customers for medical services. For example, you could sign up for Swedish Care, and when needed you’d go to their consulate to get medical care as if you were living in Sweden.
Wow! The people here have some really good ideas. However they are not in the pits like me. Two things you have not discussed." Rule out" and" cover for" The hospital is a bee hive of people slinging about orders that are then applied to people. Then someone has to pay for it. Here is what happens at one hospital when you walk in and claim you are sick.
I have discovered that the hospital is what is known as an "idiocracy" because the operate just like the movie of the same name.
I was talking to this guy and describing what happens in the Emergency Room. A nurse asks you where you hurt. The nurse then pushes a button on a computer screen that describes you symptom. This automatically orders the "appropriate" x -ray and Lab tests for that condition. Then when the doctor sees you the tests are already done. The doctors have already decided what tests are needed. They need every test that will cover or rule out this condition. In other words if you get sent home after you are seen,the doctor and die anyway the doctor and the hospital are covered because you have had all the tests to "rule out" the condition.
Damn.my friend said.that sounds just like the movie.
As you might imagine this is expensive and they keep coming up with more tests to do. Also you might imagine that some people can't pay. Well someone pays.--you. Robin has suggested a great solution. Close all the emergency rooms and send everyone to the Swedish Embassy.Another solution is to send all these patients to the trial attorneys offices.
One thing to keep in mind is that the US government already spends about $2700 per person on health care (not just on poor people). So we could probably swing getting all the poor people signed up for e.g. French health care.
Since no one else is saying it, I'm gonna say what everyone here (or at least every non-American here) is thinking...
Why doesn't the US just copy Canda's healthcare system and get over itself? If consulate care is considered an option then isn't that a silent admission that the systems other countries came up with are simply better than America's system, so why bother with a half-assed solution?
On the other hand, it would be hilarious to see the look on your republican or libertarian neighbor when you ask him why his car was seen parked outside the Swedish consulate the other day...
Being seen at a European or Canadian consulate would become the new being seen in a gay bar or a brothel for conservatives. :-)
It is up to government who pays the ER costs, it could be the hospital customers or it could be the government itself. You don't provide any source for this claim and assume ER is the only making price difference. I guess this fits some political agenda, but truth is, there're probably real costs from excessive medical regulation, maybe even some cultural factors, otherwise bad institutions or whatever.
Consulate care would provide some competition for operation costs. I'm sure if you would have to have an operation, you'd very angry that some consulate could provide a life-saving surgery at 1/5th the cost? Or maybe those who want such but wouldn't be allowed would be angry? I don't know. You decide.
No, this wouldn't fix the screwed up incentives in US health insurance system, and I don't know why you are inclined to give an armchair economic lecture on that, because I didn't come to defend it. You could have single-payer, government-run or something else and still have consulate care.
But armchair economic analysis, especially of very complex system like health care is cheap. There're actually health economists who analyze things as a day job; are you one? The quality of armchair economic analysis is on par with armchair medical analysis, or maybe armchair physics.
And like Robin said once, disagreeing can mean disrespect. I would consider it rude to disagree with a physicist about his day job research as layman.
Ari, it ends up in the “overhead” and gets added to everything.
To a first order that the US uses insurance doesn't matter. The costs of uncompensated care have to be paid by someone, that adds to the cost of US procedures.
The problem is that insurance companies can game the system to avoid paying for those costs. Those costs don't go away, they simply get moved to other payers. There are costs to this, the costs of figuring out how to game the system and the costs of structuring the insurance reimbursement system to take advantage of it.
Now those costs are higher because they are borne by fewer payers. There is now an even greater incentive to game the system to avoid them. The more gaming there is of the system, the more incentive there is to game the system.
As long as the incremental cost to incrementally game the system is less than the cost to not game the system, the system will be gamed.
That is why health care is so expensive in the US. There are so many incentives to game the system and they are built in and developed over time so they are structural and implicit. Getting rid of them means starting over, but delaying starting over is another way to game the system so it doesn't happen.
Everything spent on gaming the system is wasted. It doesn't provide any health care, it just moves the costs of providing health care to different payers. In every health care system with multiple payers, those payers will have an incentive to game the system to shift costs to other payers. With rigid regulations, in theory that gaming can be reduced, but when the incentives to game the system remain, then those regulations will be corrupted by corrupt payers and the system will be gamed.
That is one of the major savings in going to single payer health care. There is no incentive or ability to game the system and shift costs onto other payers.
a) So basically you are saying that without insurance surgery costs more in US than because of ER? If so, source please. I've seen better arguments made in favor of protectionism.
b) If the numbers Floccia is giving are right, then its still a small part of the 1-2 trillions US is spending on health care.
Sounds like a way to let US cities benefit from a medical tourism trend that's already happening: http://zgp.org/~dmarti/busi...
(The transformation of post-embargo Cuba into "Bedpan Island" will dwarf this, but it's still a way to keep the US medical industry competitive, the same way that international competition is keeping the US software industry competitive.)
35% of people in Singapore are foreigners, working migrants who are young and not necessarily covered by local insurance. So it's safe to say they're in the $2500-$3000 range for actual citizens. It's not much of a free market with 29 out of 43 hospitals being state run, most people being insured through a government scheme and the government subsidizing most of the care.
Singaporean healthcare costs about $2100 per capita on health care. ($7400 in the US) Much of this is subsidized by the government, but that hardly makes it not a free market, any more than food stamps distort the market for food. Other actions of Singapore's government may distort its healthcare system, though.
You're not getting it: even if doctors, hospital personnel, pharmaceutical reseachers and medical faculty members worked for minimum wage and all administration was handled by computers, then healthcare costs would still be much more than $1000 per capita per year (it's now $7000). Not even Singapore, the most efficient of the rich countries when it comes to healthcare comes anywhere near that $1000 mark (they're in the $2500-$3000 range I believe). Why did I choose a $1000 mark? Because that's how cheap healthcare would have to be to be both fully privately funded and affordable to people on minimum wage (since about 20% of citizens are children the insurance premium would be about $100 per adult per month). Even if the free-market was 100% effective and devoid of vultures and corruption it would not be able to lower costs to that $1000 mark. The natural resources and labor involved with modern healthcare just cannot be funded with that kind of money.
In short it is impossible to have affordable healthcare when everyone pays the same premiums because healthcare just cannot be made cheap enough to become affordable to people near minimum wage. Some form of government intervention is therefore necessary (and in case you were wondering, yes, Singapore has singlepayer healthcare). This can take the form of the government dramatically increasing minimum wage, or forcing insurance companies to cap their premiums and make wealthy clients pay more, or by using taxes fund healthcare.
By now you're probably asking "well, then why was healthcare so affordable in the 1950s and 1960s?" Here's my answer: 1) it wasn't affordable to everyone, especially in the South many people died of preventable diseases, 2) the percentage of elderly people in the population has more than doubled since those days, 3) there were no MRIs, chemotherapy, bonemarrow transplants, open-heart surgery, etc... and 4) in those days people didn't eat at KFC every day and didn't drive to the mailbox. Yes, besides these factors there is a lot of waste and corruption and some bad habits can be curtailed, but if you take those out of the equation you'll only end up at Singapore's level which is still a long way from that $1000 per capita per year.
The Kaiser Commission on Medicare and the Uninsured estimates that about 50 million uninsured Americans are responsible for about $43 billion annually in uncompensated care. To cover the costs of the uninsured, the average American family pays an additional $1,000 in the cost of their insurance.
Uncompensated care is part of the problem but only a small part.
The health care market in the US is inefficient with rampant over-regulation, rent seeking, entrance barriers and poorly thought out forced cross subsidies. On top of this, there is a disconnect between the person paying for the service and receiving the service.
Net result of all of these factors is that it is now cheaper to buy travel and free market health care outside of the US than it is to buy Health care in country.
Several commenters have brought up that part of the reason is that our health care is really health care and a buried welfare transfer. Exactly! We screwed with the market and guess what we get?
If there was an efficient, free and fair market in health care, additional provider capacity would lower prices. But there is nothing about the US health care market that is efficient, free or fair.
I don't think you understand the drivers of high cost of medical care in the US.
In the US, there is a very large cost of ER care of the uninsured. This cost does not exist anywhere else in the developed world. There is no program to pay this cost, it is “absorbed” by the health care system by charging higher prices for everything else. This is in addition to the other inefficiencies of the US health care system.
Health care procedures are cheaper on a per-unit basis in Sweden because health care providers in Sweden do not have to “absorb” the cost of uninsured ER care.
Moving health care procedures from the US to Sweden doesn't cover any of the costs of uninsured ER care in the US. Those unique US costs are only covered by procedures done and paid for in the US by health care organizations with an obligation to provide ER health care to the uninsured.
In other words, fees charged in the US have a component for the actual procedure plus a component to pay for uninsured ER care. Fees charged outside the US only have a component for the actual procedure, so they appear cheaper than the US procedure. Moving the procedure off-shore, only moves the cost of the procedure off-shore. It does nothing to pay for uninsured ER care.
All moving care off-shore accomplishes is the removal of the externality of paying for uninsured ER care.
It should cost more to off-shore medical procedures because travel cost has to be included too. That off-shoring medical care is still cheaper, indicates just how badly messed up the US health care system is. It is only “cheaper” because it doesn't include the externalities of paying for US ER uninsured care. There is the issue of more middlemen in the US (insurance companies) and the rapacious profits they take and the administrative costs they incur to avoid patients with potentially high costs.
Daedaelus, most of what you wrote had nothing to do with my post so I'll just reply where it was relevant. Besides you're repeating some of what I said. It would be less confusing if you would respond in-person because I didn't come here to defend US health care system or health insurance systems.
"Why would a foreign country install medical facilities in its consulates and give away free care to US citizens? Free care that is paid for by that country’s nationals?"Obviously either the customer or US government would pay it, not the consulate state.
Again additional care is consumer surplus and win-win. This has nothing to do with insurance or ER. The point of this is to provide some care and operations at lower cost. This won't fix US health care system and insurance rent-seeking and whatnot. That is completely besides the point.
Tackling the cost side will require massive government intervention: America has a perverse system with no caps on tuition for medical schools, doctor salaries, insurance and hospital executive pay, insurance premiums and it does not collectively buy medicines while it bans the import of cheaper medicines from abroad and lets people freeride. Subsidies for poor families won't change a thing (the insurance companies will just increase their premiums). Also, Americans are just more obese than Europeans and Asians, so until that changes healthcare costs will be higher in America, no matter what clever schemes America comes up with.
Wow! The people here have some really good ideas. However they are not in the pits like me. Two things you have not discussed." Rule out" and" cover for" The hospital is a bee hive of people slinging about orders that are then applied to people. Then someone has to pay for it. Here is what happens at one hospital when you walk in and claim you are sick.
I have discovered that the hospital is what is known as an "idiocracy" because the operate just like the movie of the same name.
I was talking to this guy and describing what happens in the Emergency Room. A nurse asks you where you hurt. The nurse then pushes a button on a computer screen that describes you symptom. This automatically orders the "appropriate" x -ray and Lab tests for that condition. Then when the doctor sees you the tests are already done. The doctors have already decided what tests are needed. They need every test that will cover or rule out this condition. In other words if you get sent home after you are seen,the doctor and die anyway the doctor and the hospital are covered because you have had all the tests to "rule out" the condition.
Damn.my friend said.that sounds just like the movie.
As you might imagine this is expensive and they keep coming up with more tests to do. Also you might imagine that some people can't pay. Well someone pays.--you. Robin has suggested a great solution. Close all the emergency rooms and send everyone to the Swedish Embassy.Another solution is to send all these patients to the trial attorneys offices.
One thing to keep in mind is that the US government already spends about $2700 per person on health care (not just on poor people). So we could probably swing getting all the poor people signed up for e.g. French health care.
Since no one else is saying it, I'm gonna say what everyone here (or at least every non-American here) is thinking...
Why doesn't the US just copy Canda's healthcare system and get over itself? If consulate care is considered an option then isn't that a silent admission that the systems other countries came up with are simply better than America's system, so why bother with a half-assed solution?
On the other hand, it would be hilarious to see the look on your republican or libertarian neighbor when you ask him why his car was seen parked outside the Swedish consulate the other day...
Being seen at a European or Canadian consulate would become the new being seen in a gay bar or a brothel for conservatives. :-)
@daedalus
It is up to government who pays the ER costs, it could be the hospital customers or it could be the government itself. You don't provide any source for this claim and assume ER is the only making price difference. I guess this fits some political agenda, but truth is, there're probably real costs from excessive medical regulation, maybe even some cultural factors, otherwise bad institutions or whatever.
Consulate care would provide some competition for operation costs. I'm sure if you would have to have an operation, you'd very angry that some consulate could provide a life-saving surgery at 1/5th the cost? Or maybe those who want such but wouldn't be allowed would be angry? I don't know. You decide.
No, this wouldn't fix the screwed up incentives in US health insurance system, and I don't know why you are inclined to give an armchair economic lecture on that, because I didn't come to defend it. You could have single-payer, government-run or something else and still have consulate care.
But armchair economic analysis, especially of very complex system like health care is cheap. There're actually health economists who analyze things as a day job; are you one? The quality of armchair economic analysis is on par with armchair medical analysis, or maybe armchair physics.
And like Robin said once, disagreeing can mean disrespect. I would consider it rude to disagree with a physicist about his day job research as layman.
Ari, it ends up in the “overhead” and gets added to everything.
To a first order that the US uses insurance doesn't matter. The costs of uncompensated care have to be paid by someone, that adds to the cost of US procedures.
The problem is that insurance companies can game the system to avoid paying for those costs. Those costs don't go away, they simply get moved to other payers. There are costs to this, the costs of figuring out how to game the system and the costs of structuring the insurance reimbursement system to take advantage of it.
Now those costs are higher because they are borne by fewer payers. There is now an even greater incentive to game the system to avoid them. The more gaming there is of the system, the more incentive there is to game the system.
As long as the incremental cost to incrementally game the system is less than the cost to not game the system, the system will be gamed.
That is why health care is so expensive in the US. There are so many incentives to game the system and they are built in and developed over time so they are structural and implicit. Getting rid of them means starting over, but delaying starting over is another way to game the system so it doesn't happen.
Everything spent on gaming the system is wasted. It doesn't provide any health care, it just moves the costs of providing health care to different payers. In every health care system with multiple payers, those payers will have an incentive to game the system to shift costs to other payers. With rigid regulations, in theory that gaming can be reduced, but when the incentives to game the system remain, then those regulations will be corrupted by corrupt payers and the system will be gamed.
That is one of the major savings in going to single payer health care. There is no incentive or ability to game the system and shift costs onto other payers.
@daedalus
a) So basically you are saying that without insurance surgery costs more in US than because of ER? If so, source please. I've seen better arguments made in favor of protectionism.
b) If the numbers Floccia is giving are right, then its still a small part of the 1-2 trillions US is spending on health care.
Also consulates require minimal travel costs.
Sounds like a way to let US cities benefit from a medical tourism trend that's already happening: http://zgp.org/~dmarti/busi...
(The transformation of post-embargo Cuba into "Bedpan Island" will dwarf this, but it's still a way to keep the US medical industry competitive, the same way that international competition is keeping the US software industry competitive.)
@Douglas Knight
35% of people in Singapore are foreigners, working migrants who are young and not necessarily covered by local insurance. So it's safe to say they're in the $2500-$3000 range for actual citizens. It's not much of a free market with 29 out of 43 hospitals being state run, most people being insured through a government scheme and the government subsidizing most of the care.
Singaporean healthcare costs about $2100 per capita on health care. ($7400 in the US) Much of this is subsidized by the government, but that hardly makes it not a free market, any more than food stamps distort the market for food. Other actions of Singapore's government may distort its healthcare system, though.
You're not getting it: even if doctors, hospital personnel, pharmaceutical reseachers and medical faculty members worked for minimum wage and all administration was handled by computers, then healthcare costs would still be much more than $1000 per capita per year (it's now $7000). Not even Singapore, the most efficient of the rich countries when it comes to healthcare comes anywhere near that $1000 mark (they're in the $2500-$3000 range I believe). Why did I choose a $1000 mark? Because that's how cheap healthcare would have to be to be both fully privately funded and affordable to people on minimum wage (since about 20% of citizens are children the insurance premium would be about $100 per adult per month). Even if the free-market was 100% effective and devoid of vultures and corruption it would not be able to lower costs to that $1000 mark. The natural resources and labor involved with modern healthcare just cannot be funded with that kind of money.
In short it is impossible to have affordable healthcare when everyone pays the same premiums because healthcare just cannot be made cheap enough to become affordable to people near minimum wage. Some form of government intervention is therefore necessary (and in case you were wondering, yes, Singapore has singlepayer healthcare). This can take the form of the government dramatically increasing minimum wage, or forcing insurance companies to cap their premiums and make wealthy clients pay more, or by using taxes fund healthcare.
By now you're probably asking "well, then why was healthcare so affordable in the 1950s and 1960s?" Here's my answer: 1) it wasn't affordable to everyone, especially in the South many people died of preventable diseases, 2) the percentage of elderly people in the population has more than doubled since those days, 3) there were no MRIs, chemotherapy, bonemarrow transplants, open-heart surgery, etc... and 4) in those days people didn't eat at KFC every day and didn't drive to the mailbox. Yes, besides these factors there is a lot of waste and corruption and some bad habits can be curtailed, but if you take those out of the equation you'll only end up at Singapore's level which is still a long way from that $1000 per capita per year.
daedalus2u,
The Kaiser Commission on Medicare and the Uninsured estimates that about 50 million uninsured Americans are responsible for about $43 billion annually in uncompensated care. To cover the costs of the uninsured, the average American family pays an additional $1,000 in the cost of their insurance.
Uncompensated care is part of the problem but only a small part.
The health care market in the US is inefficient with rampant over-regulation, rent seeking, entrance barriers and poorly thought out forced cross subsidies. On top of this, there is a disconnect between the person paying for the service and receiving the service.
Net result of all of these factors is that it is now cheaper to buy travel and free market health care outside of the US than it is to buy Health care in country.
Several commenters have brought up that part of the reason is that our health care is really health care and a buried welfare transfer. Exactly! We screwed with the market and guess what we get?
If there was an efficient, free and fair market in health care, additional provider capacity would lower prices. But there is nothing about the US health care market that is efficient, free or fair.
I don't think you understand the drivers of high cost of medical care in the US.
In the US, there is a very large cost of ER care of the uninsured. This cost does not exist anywhere else in the developed world. There is no program to pay this cost, it is “absorbed” by the health care system by charging higher prices for everything else. This is in addition to the other inefficiencies of the US health care system.
Health care procedures are cheaper on a per-unit basis in Sweden because health care providers in Sweden do not have to “absorb” the cost of uninsured ER care.
Moving health care procedures from the US to Sweden doesn't cover any of the costs of uninsured ER care in the US. Those unique US costs are only covered by procedures done and paid for in the US by health care organizations with an obligation to provide ER health care to the uninsured.
In other words, fees charged in the US have a component for the actual procedure plus a component to pay for uninsured ER care. Fees charged outside the US only have a component for the actual procedure, so they appear cheaper than the US procedure. Moving the procedure off-shore, only moves the cost of the procedure off-shore. It does nothing to pay for uninsured ER care.
All moving care off-shore accomplishes is the removal of the externality of paying for uninsured ER care.
It should cost more to off-shore medical procedures because travel cost has to be included too. That off-shoring medical care is still cheaper, indicates just how badly messed up the US health care system is. It is only “cheaper” because it doesn't include the externalities of paying for US ER uninsured care. There is the issue of more middlemen in the US (insurance companies) and the rapacious profits they take and the administrative costs they incur to avoid patients with potentially high costs.
Daedaelus, most of what you wrote had nothing to do with my post so I'll just reply where it was relevant. Besides you're repeating some of what I said. It would be less confusing if you would respond in-person because I didn't come here to defend US health care system or health insurance systems.
"Why would a foreign country install medical facilities in its consulates and give away free care to US citizens? Free care that is paid for by that country’s nationals?"Obviously either the customer or US government would pay it, not the consulate state.
Again additional care is consumer surplus and win-win. This has nothing to do with insurance or ER. The point of this is to provide some care and operations at lower cost. This won't fix US health care system and insurance rent-seeking and whatnot. That is completely besides the point.
Interesting idea Robin. Since people choose this what would happen with adverse selection and the associated costs?
@Floccina
Tackling the cost side will require massive government intervention: America has a perverse system with no caps on tuition for medical schools, doctor salaries, insurance and hospital executive pay, insurance premiums and it does not collectively buy medicines while it bans the import of cheaper medicines from abroad and lets people freeride. Subsidies for poor families won't change a thing (the insurance companies will just increase their premiums). Also, Americans are just more obese than Europeans and Asians, so until that changes healthcare costs will be higher in America, no matter what clever schemes America comes up with.