Guaranteed Healthcare

Depends what you mean by 'just fine' I suppose, given that i'm fairly confident that if I needed an MRI there's probabaly over a dozen of them within a 25 mile radius of where I live. Try getting one in Canada and let me know how you do.

I'm not trying to create fear. I'm trying to take a one-sided presentation of a goal and ground it with reality. There is give and take. I'm not saying a single payer system wouldn't work, I'm saying that this entire website is ignoring fact based analysis on consequences of policy changes. Every critique I make is met with essentially... 'But it will be great', or 'you're just trying to make me afraid'. it's like listening to Obama... just trust me it will be great! i'd rather have some facts about what we have to give up. and you know what, sometimes facts are not friendly and nice. Why is it that when I present a thoughtful analysis, no argues my points but only argues my motives?

And please stop using the profit argument because it just doesn't hold water. EVEN if I was convinced that eliminating profit from healthcare delivery produced a net gain for everyone (and I suppose that mean all for profit hospitals are outlawed?), you have basically saved yourself money once. you have reduced the total pie. And that total pie will continue to grow at high rates just as in today, unless some other unpleasant action is taken. Pretty soon, the pie is just as big as it once was, so we've basically saved ourselves a few years or decades from insolvency. To prevent that from happening the feds would need to 1) clamp down on what they pay the doctors and hospitals 2) reduce the rate of increase in new services and technology that occur. Does anybody actually think that would not happen? That's EXACTLY what medicare does today and EXACTLY what other single payer systems do. The problem is that the government will act like it always does, which is to avoid making any hard decisions that could cost votes. The unfunded liability for Medicare and Social Security are a financial disaster, and that mess will be payed for by us because our politicians lack the courage or INCENTIVE to put a sustainable system in place that doesn't create an overwhelming tax burden like in France, for example. That is why a private solution that competes for business and involves risk and reward can outperform economically. Without some external intervention, though, some people are not brought into the system, which of course is not ideal and is the source for most of the concern at this website. i'm certainly open to hearing ideas about that. First I would ease all the restrictions that make insurers include everything under the sun in their policies, which of course makes the cost higher than it could otherwise be. Second, individuals ought to be able to band together in purchasing groups outside of an employer, or union, or whatever so that insurers can reliably rate them without assuming that only the sick will actually buy the policy, which again drives up cost. There are all sorts of ways to make this less expensive for the long term. how you address the long term rate of inflation is far more important to the sustainability than who actually finances it.

"no contribution to positive outcomes" is flatly wrong assessment of health plans. The medical management programs developed in the private industry are succesful, improve people lives, health, and happniess. They are so succesful that even Medicare starts to adopt the best practices. Look at the HEDIS scores of priviate insurers and how they have improved them over time because of their efforts to 'harass' and 'incentivize' people.

Regarding your 'facts', let's add another one. Only one can be called a world super power that uses it's wealth to advance medical knowledge to benefit of everyone else. ( This of course is waning, as complacency and dependence replace ambition and ingenuity.) And only one attracts medical students from around the globe to receive a world class education, only to have them leave and practice in another country that hasn't invested in it's own education infrastructure to the extent America has.

The major reasons why healthcare is so much more expensive in America versus other countries is because healthcare professionals are much more highly compensated, new technology is rapidly adopted, and most of the signifant research and development occurs here. how many future doctors are saying, boy i can't wait to get a fantastic medical education in France or Canada and then go start up my practice in japan? And of course we have a population that is lazier, has a worse diet, saves very little, etc. and that makes us look worse comparatively, too. All of these things are far more significant to cost than the actual profit made by owners of insurance companies. Even if you save 15-20% by cutting out profits and streamlining administration (and getting rid of all the things that insurers do better, like fight fraudulent claims), then in 2-3 years you are still back where you started because you haven't addressed the underlying inflation. Can anybody explain to me how moving to single payer will create a long term decrease in trend? It won't. Only other actions will, such as wage freezes for doctors, or more strict utilization controls, which means more of all the things that people dislike about insurers today.

You do raise an interesting point about portability of coverage and why a given carrier might not want to invest in health since that member could leave. The only real answers i have for you are:

1) much of the insured population today is actually insured by employers and the employer pays the healthcare bills (self funded), and so this is less of an issue then you state because the carrier only administers the plan. So it's on the employer to make that choice to invest in healthy outcomes programs. and that depends on how long they expect their workforce to remain. Most employers believe this provides value and have pursued it. They of course are free to dedide, however, which would not be the case if you got rid of the private industry.

2) The industry is moving in this direction. First it was easier to demonstrate ROI for things like disease management. There was an immediate return from improving compliance with pharmacy treatment or consistent monitoring of blood glucose, etc. However, insurers are increasingly trying to sell products that address the well and at risk populations rather than the currently diseased population. I.e. they are pushing for increased preventive visits, immunizations, callling people who haven't followed a certain treatment protocol, calling the doctors when there are gaps in care, or letting them know that their patient has been seeing other doctors and is being treated for other conditions there and has been to the ER three times, and all the other things that the doctors are grateful to hear about so they can address it with the patient when they otherwise might not have known...

It's not a complete solution to address the portability/short term ROI issue, but you can't just say that insurers don't invest in their members because that's mostly not true.