Robert J. Samuelson: Can Americans stem future increases in health care spending?

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  • HaHaHaHa Othello, WA
    May 22, 2013 6:46 p.m.

    Exactly Redshirt, and another thing to consider, is the US system carries the financial burden of most of the worlds R&D. Pretty hard for them to do that with their socialized systems!

  • 2 bits Cottonwood Heights, UT
    May 22, 2013 12:42 p.m.

    Tyler D
    I can't really comment on your statement because I can't find it in any quick research. I don't know where you got that 50% MLR ratio for insurance companies before Obama Care, but let's assume it's true. What would be more interesting to me than pre-Obama statisstics would be... has that ratio changed after Obama Care (we can't know since Obama Care hasn't even fully rolled out yet). But from every indication so far insurance companies are charging even more now than they were 3-4 years ago. I know what I pay for my insurance through my employer has gone up significantly this year. Anybody else out there experienced the same this year?

    Assuming everything you said is true... what in Obama Care changes those facts? It doesn't. I can't find a singe thing in Obama Care that is intended to decrease cost. That wasn't their goal. The goal of Obama Care was to increase the number of people with health coverage... not to reduce actual costs.

    Name something in the bill that reduces what clinicians charge. Until we reduce the actual "cost/price" spending won't go down.

  • Tyler D Meridian, ID
    May 22, 2013 11:15 a.m.

    @Redshirt1701 – “There is no free market healthcare practice in the world.”

    Which raises the question “why?”

    You seem to suggest that the only answer that makes sense is some combination of people being foolish dupes and governments being evil tyrants that seek control. Seems a stretch to believe this is so far ALL developed governments around the world.

    Seems far more likely that even the most freedom loving people have asked their governments to regulate the healthcare system because it has inherent market problems (asymmetrical information, vertical demand curve when ill, etc…) that cannot be corrected otherwise. And I believe a thoughtful study of both healthcare economics and other country’s efforts to address market failures (admittedly some are better than others) bears this out (check out the documentary on Taiwan and how they created their healthcare system in the late 90’s).

    @Redshirt1701 – “The best comparison is the US prior to the 1930s and today.”

    Scientific advances and technological changes render this comparison all but meaningless…

    @2 bits

    Please research medical-loss ratios prior to Obamacare… many insurance companies were charging far in excess of cost plus reasonable profit (e.g. 50% MLR in many markets).

  • Redshirt1701 Deep Space 9, Ut
    May 22, 2013 10:18 a.m.

    To "Tyler D" actually the Swiss don't surpass us, nor are they equal. The citizens there want what we have, and the government isn't going to give it to them because it will raise the fascist insurance rates there. The Swiss, want what we have, but are being denied the healthcare that they want because the costs are unbearable by the government.

    There is no free market healthcare practice in the world. It is a socialist, communist, or fascist system. There is truly no system out there like what you want me to name. Even in the developing nations they are operating socialist healthcare programs.

    The best comparison is the US prior to the 1930s and today. Back then people were cared for and either paid for the bills themselves or else went to charity hospitals. People were cared for using the best practices of the time.

  • 2 bits Cottonwood Heights, UT
    May 22, 2013 10:08 a.m.

    If we want to affect the COST of healthcare... Laws and legislation is not the way. It has to be done by people who are willing to live more healthy lifestyles and take responsibility for their own health. Laws won't do it.

    As for the recent Obama Care legislation... it wasn't intended to lower COST of healthcare. It was intended to expand COVERAGE. If we want to reduce COST we need to start over (even IF you think legislation is the answer).

    If you want to lower COST... you also can't start by attacking the insurance companies. They only pay the bill the Hospital sends them. Insurance companies are not responsible for the cost of the care. And they can't stay in business if they don't collect enough in premiums to pay the bills. Same goes for the Government. It's impossible for them to not go bankrupt or go into more debt IF they don't collect enough in premiums and taxes to pay the doctors and hospital. It's simple economics 101. If you are in the business of paying claims... you can't charge subscribers less than it costs to pay the providers.

  • Tyler D Meridian, ID
    May 22, 2013 9:09 a.m.

    @Redshirt1701 – “You realize that when you account for accidental deaths, the US ranks first in life expectancy.”

    Curious that you would point to life expectancy as a measure of our superiority, since the healthcare we provide to anyone over 65 is about as socialist as it gets.

    And if you’re going to cite the WHO you should also note that they rank the US #37 by all combined measures of healthcare performance – behind even countries like Morocco and Columbia. But we are #1 in cost, so we got that…

    But I think you’re on the right track to point to the Swiss healthcare system. They spend about 30% less per capita than we do and they either equal or surpass us by any healthcare measure, including the ones you mention.

    So why are we paying 30% more for a product that at best is only just as good?

    And you still haven’t answered my original question… just one?

  • cjf Salt Lake City, UT
    May 22, 2013 9:02 a.m.

    @one old man

    "Remove the PROFIT motive and the answer will be a resounding YES!"

    Intermountain Health Care is a not-for-profit health care organization.

  • Redshirt1701 Deep Space 9, Ut
    May 22, 2013 7:38 a.m.

    To "Tyler D" so what you are saying is that no system is perfect, and none can deliver all care to everybody. But you want to be like the other kids.

    You realize that when you account for accidental deaths, the US ranks first in life expectancy.

    Even the highly socialist WHO recognized that the US has the fastest response time to medical needs, and had the most technologically advanced equipment.

    Other studies show that in the US, the overall cancer survival rates are the highest in the world.

    The only system that comes close to the abilities of the US system is the Swiss system, and they spend nearly as much as the US does.

  • The Real Maverick Orem, UT
    May 21, 2013 8:04 p.m.

    Single payer system.

    Get rid of insurance companies altogether.

    Stop forcing corporations to pay for health care. Stop letting insurance companies rip off workers with insane copays. Get a single payer system: everyone pays and everyone receives.

    Our system has completely failed.

  • Ultra Bob Cottonwood Heights, UT
    May 21, 2013 5:12 p.m.

    We, as people, are forced to compete in a global market because businessmen, who care more for profits than the welfare of Americans, impose their will upon our government.

    If it were possible to close our borders to the outside world as far as commercial business was concerned and did allow the import or export of goods and services with other nations, our economy would be fully determined by the American standard of living. This would never, could never, happen lest we become a total democracy.

    So because of the business control of our government, we, as a people suffer all the bad effects of the world economy and few if any of the good. Business is able to buy the ingredients of goods and services a the low prices of the world and continue to sell at the prices as if made in the US.

    The other thing is that our exports are heavily supported by our government in order to compete with the foreign products and cause hatred for America by harming the foreign Businessman. Our taxes pay for that support and for the military to protect our business.

  • the old switcharoo mesa, AZ
    May 21, 2013 4:48 p.m.

    Republican farmers and businessmen let the ag business take billions in subsidies to control the price of wheat, milk and other commodities but not cancer treatment. Nope that's socialism...

  • Tyler D Meridian, ID
    May 21, 2013 3:54 p.m.

    Normally I don’t answer the red herring tactic of answering a question with a question, but in this case I’ll humor you (please know though that besides it being sophomoric, it’s kinda rude).

    Anyway… I assume by “you” you mean any player in the market, whether consumer, provider, etc., yes?

    In that case, yes, all the managed healthcare systems throughout the developed world limit some aspect of the market, although the vast majority of those limits are on what providers are allowed to charge and how product makers can advertise and incentivize doctors.

    Regarding your medications point, most European countries do far better than we do in delivering cost effective treatments including medications, but we beat them hands down in delivering costly treatments and medications (costly and effective are not synonymous).

    As to the relative merits of the various systems, Germany and Switzerland surpass ours by almost every measure (except perhaps in how rich a provider can become), but you’re right – no system is perfect.

    OK, the question’s back to you, or are you going to ask me another question? I’ll probably ignore it a 2nd time…

  • RedShirt USS Enterprise, UT
    May 21, 2013 3:25 p.m.

    To "Tyler D" can you point to a government system that doesn't limit you in some way? Most of Europe limits what medications you get, in Asia they limit your visits to doctors, and in some countries they limit what procedures are covered.

    Tell me what government system out there provides the most modern techniques and medications, and can respond to needs as quickly as the US's fascist system?

    Point out what system is perfect and delivers everything to everybody.

    Tell me of just one.

  • Tyler D Meridian, ID
    May 21, 2013 2:27 p.m.

    @RedShirt – “We can curb the cost of healthcare, but a large portion of it will require the government giving up its current idea of a fascist healthcare system.”

    Can you point to a purely free market healthcare delivery system in the developed world? Can you point to a free market healthcare system in the developing world that does more than dole out bandaids and folk medicine to all but the wealthy elite of that country?

    If the healthcare market functions just like the market for toasters, with all the same supply & demand dynamics subject to the same sorts of competitive pressures, surely we can find one example in the world where modern medicine delivered through a purely free market has created this Randian utopia of shiny, happy (and healthy) people.

    Just one…

  • 10CC Bountiful, UT
    May 21, 2013 1:39 p.m.

    Whether we like it or not, we're in a global economy, and healthcare costs are a sizable detriment to our being able to compete, globally. A few years ago GM moved quite a few manufacturing jobs north of the border to Canada because healthcare costs were making their US product uncompetitive.

    Reform is already underway in healthcare as providers realize they're too expensive for American workers, whose wages are in decline from before the Great Recession.

    When the nursing shortage was with us, some nurses were making $75,000-$80,000 a year. Those days are long gone. Nurses can now expect to make upwards of $40,000-$45,000 a year.

    Robotics and technology will reduce the need for physicians, which will mean their salaries will drop, over all.

    As more & more US workers become under wage pressure from globalization and technology, healthcare costs will need to come down further, in spite of stress levels - and associated health issues - increasing.

    There will be wailing and gnashing of teeth by MDs, but studies of those who have high Medicare patient loads indicates there are more cost savings to be found.

  • one old man Ogden, UT
    May 21, 2013 1:08 p.m.

    Remove the PROFIT motive and the answer will be a resounding YES!

  • HS Fan Salt Lake City, UT
    May 21, 2013 12:23 p.m.

    Yes we can. They do it in Canada and the rest of western world and some day Americans will wonder why we turned over our health care to corporations and Wall Street.

  • RedShirt USS Enterprise, UT
    May 21, 2013 12:09 p.m.

    We can curb the cost of healthcare, but a large portion of it will require the government giving up its current idea of a fascist healthcare system. According to various studies, up to 50% of the cost of insurance is due directly to government mandates. Get rid of most or all of the mandates and you will instantly save money.

    Next, put a leash on the lawyers that like to sue for malpractice. The malpractice insurance costs so much that not enough doctors will go into some specialties, this too drives up the cost.

    There are so many ways to cut costs, but it involves things that the lawyer/politicians will never approve.

  • skeptic Phoenix, AZ
    May 21, 2013 9:31 a.m.

    How is it that other developed nations, and some of the under developed, have successful national health care but USA, the wealthiest nation in the world can't make it work. Is it due to corporate greed and privileged citizen selfishness .

  • Hutterite American Fork, UT
    May 21, 2013 9:00 a.m.

    We can do it if we stop considering health care like any other consumer commodity but rather something we all do or will require, and therefore must provide by and for all. We must also eliminate the insurance companies who's motive is to maximize profits by reducing the amount of care they pay for, and hospitals who's goal is to maximize profits by getting as much out of the insurance companies that they can. All this in context of a patient (consumer) who is in a vulnerable position when they require health care and in no way able to make good decisions on its' provision on their own. It's a broken system.

  • Ultra Bob Cottonwood Heights, UT
    May 21, 2013 8:22 a.m.

    Can Americans stem future increases in health care spending?
    It all depends on the kind of world we are able to create for ourselves.

    If we allow ourselves to be like cattle to our keepers and accept their care and feeding according to their purposes, costs of health care will surely rise to equal the money we have left from other life necessities. Freedom will become limited to mere life itself.

    If we decide that human beings should be allowed to actually pursue the concept of liberty and happiness, we may relegate health care to it’s proper place as a common necessity like clean air, water and security. But to do so requires that we wrest control from the would-be-keepers and remove the profit motive from human frailty.