Where Are the Innovators in Health Care?

[Roxanne Appleby]

I hesitate to impose another political thread on our happy village (rather than stick this in isolated political blurts), but this is such a vital issue and it generates so much confusion and angst that I will. This article asks some critical questions that are usually ignored in the contentious debates over who should pay, and suggests one important explanation for why we find our health systems so frustrating.


Where Are the Innovators in Health Care?
By REGINA E. HERZLINGER
WSJ, July 19, 2007

No sector of our economy is more in need of innovation than health care, yet its many regulations handcuff entrepreneurs. A consumer-driven health-care system will unlock these shackles to bring about a much-needed entrepreneurial revolution.

Health care's $2.2 trillion of costs (17% of GDP), breaks the backs of U.S. firms that compete with companies in countries spending, at most, 12% of GDP on health care. Yet, despite this torrent of cash, more than 40 million Americans lack health insurance, mostly because they cannot afford it. Although some claim we have the world's best health-care system, where are the quality outcome metrics to back this up? Don't try that one on the loved ones of the 300,000 people killed by hospital "medical errors" in the past few years.

In almost every sector of our economy, brilliant, effective innovators have forced sluggish U.S. industries to become more productive. Sam Walton's exquisitely detailed supply chain management, coupled with his daring decision to locate Wal-Marts in rural areas, kick-started the boom in retailing, while Bill Gates, Steve Jobs and Michael Dell drove productivity in the IT sector. These entrepreneurs, and so many others, have fundamentally improved our economy by making goods and services better, cheaper and more accessible.

But can you name any innovators in our bloated, inefficient health-care system? While there is innovation in the medical technology and health-insurance sectors, when it comes to health services, the 800-pound gorilla of our system, entrepreneurs are nowhere to be found. And their absence has enabled the status quo providers to get fat and sloppy.

One analysis showed that hospital activities accounted for $400 billion of the excessive costs of U.S. health care while all too many quality measures have worsened. Patients learn -- sometimes the hard way -- to bring along an assertive, intelligent loved one to protect them during a hospital stay.

Entrepreneurs avoid health-care delivery because status quo providers, abetted by legislators and insurance companies, have made it virtually impossible for them to succeed. Unlike any other U.S. industry, consumers do not set prices, yet they provide all the money through taxes for government programs and foregone salaries for employer-provided benefits. A third party -- a government or an insurance company -- not only sets the prices but goes so far as to specify procedures and even the kinds of patients to be covered.

Lately, payers are even telling doctors how to practice medicine -- and those who follow their recipes get paid more. The recipes are devised through an innovation-killing "peer review" process. The history of medicine is filled with shameful stories of "peers" who used their powers to suppress innovations: Judah Folkman, the brilliant scientist whose anti-angiogenesis theory forms the basis for many important new cancer drugs, for example, had difficulty obtaining peer-reviewed government research funds for nearly a decade.

Third parties' lock-hold on reimbursement punishes innovators. When the Duke University Medical Center's innovative new program for people with congestive heart failure so substantially improved patients' health that hospital visits and usage plummeted, the perverse nature of the payment system meant Duke couldn't benefit from saving its patients' money -- nearly $8,000 per person. In only one year, the program had reduced costs by 40%, yielding the kind of do-good returns that would normally earn kudos from Wall Street and Main Street. But, because the third parties pay providers only for treating sick people, they penalize innovators who make people healthy.

Non-market based payment is but one of many barriers to innovation that plague the health-care industry. Insurance entrepreneurs who confront mandated benefits and "community pricing" can neither design nor price their innovations. Technology entrepreneurs must clear massive hurdles before securing the "coding" and "coverage" decisions that open the door to reimbursement. And health-service entrepreneurs must comply with tens of thousands of pages of regulations.

Time and again the regulatory status quo blocks entrepreneurship. Consider the round-the-clock coverage, offered by Washington's Dr. Garrison Bliss, that will be available to middle-class and uninsured people at a price of only $70 a month. Attempts by insurers to characterize Dr. Bliss as an insurance company -- with the attendant massive capital reserves and regulatory hurdles -- have required his small start-up to hire a full-time lobbyist. No wonder the 20 or so doctors enrolled in my class "Innovating in Health Care" at Harvard Business School are ruefully driven to earn MBAs once they realize they can innovate in medicine better as an entrepreneur than as a doctor.

Luckily there is a solution, but there is only one: consumer-driven health care. Let's take back our $2.2 trillion from the entrepreneur-suppressing status quo and allow consumers to reward those entrepreneurs who lower costs by improving health. With us in charge, not only would Duke University Medical Center have flourished, but other entrepreneurs would introduce similar cost-reducing programs for the other chronic diseases, like diabetes, and disabilities like bad backs, that account for nearly $1.8 trillion of expenses.

Until we control our own health- care system, the entrepreneurs who could reform it -- and make our lives better -- will continue to look elsewhere for opportunities. Who can blame them?

Ms. Herzlinger is a professor at Harvard Business School, a senior fellow at the Manhattan Institute and the author of "Who Killed Health Care?" (McGraw Hill, 2007).

 

[R. Richard]

The Kaiser health care system in at least California is an example of an attempt to innovate health care.

The Kaiser clinics/hospitals are clean, modern and well staffed. They provide reasonable health care at affordable rates. You get to see a doctor and if you need a specialist, Kaiser has a lot of specialists on contract and will get you a specific specialist if they don't have one. That's the good side.

You rarely see the same doctor twice. That's not too bad, if you are a man. Women like to build a relationship with a doctor, particularly in the ob/gyn area. The waiting rooms have much the same ambiance as a TB ward. The legions of the great unwashed are alive, if sick, at Kaiser. If the Kaiser doctors find something wrong with you other than what you came in to be treated for, you make another appointment to have it treated most times. That's the bad side.

 

[WRJames]

The notion that "consumers" would clean up health care if only left to their own devices is such rubbish that it boggles the imagination. It is difficult to believe that the author of the article has ever had a serious personal encounter with the medical establishment.

There is a hint, when it is mentioned that hospital patients need to bring along an aggressive and articulate protector -- but this is true for almost any significant illness. I know from personal experience that doctors do not expect their recommendations to be challenged, and that in many cases they are doing what is expedient, rather than what may be in the best interests of the patient. Medicine is a very technical specialty, and, while all of us at LIT probably have the intellectual resources to get information from the internet and argue with our doctors, that really is not true for the population at large. Easing regulation might result in better health care for a few, and worse for a majority of the population.

The simplest first step to a solution would be to replace our system of privately funded insurance and privately run HMO's with a universal system of insurance available to all. That safety net, would, in fact, ease a tremonedous burden on small business, and allow people to take more chances with their economic existence. As it is, a lot of people who would be running small businesses are working for larger organizations because they need the health insurance. And corporations are moving those jobs to third would countries to avoid paying it.

Beyond that, three of the greatest cost factors in the health industry are the high overhead of dealing with the HMOs, the overwhelming cost of liability insurance, and the obscene cost of drugs (the amount of money drug companies pour into wooing doctors with various bribes is staggering, not to mention the adds that dominate the news shows). Fixing these has little to do with consumerism, but a whole lot to do with Congress showing some small trace of backbone. The fact that nothing has been done to fix such obvious problems just shows how deeply our poltiicians are on the take from those making money from the current situation.

I have not seen Michael Moore's movie, so I don't know how deeply he delves into this. I am speaking from my own personal experience.

 

[Roxanne Appleby]

The notion that "consumers" would clean up health care if only left to their own devices is such rubbish that it boggles the imagination. It is difficult to believe that the author of the article has ever had a serious personal encounter with the medical establishment.

There is a hint, when it is mentioned that hospital patients need to bring along an aggressive and articulate protector -- but this is true for almost any significant illness. I know from personal experience that doctors do not expect their recommendations to be challenged, and that in many cases they are doing what is expedient, rather than what may be in the best interests of the patient. Medicine is a very technical specialty, and, while all of us at LIT probably have the intellectual resources to get information from the internet and argue with our doctors, that really is not true for the population at large. Easing regulation might result in better health care for a few, and worse for a majority of the population.

The simplest first step to a solution would be to replace our system of privately funded insurance and privately run HMO's with a universal system of insurance available to all. That safety net, would, in fact, ease a tremonedous burden on small business, and allow people to take more chances with their economic existence. As it is, a lot of people who would be running small businesses are working for larger organizations because they need the health insurance. And corporations are moving those jobs to third would countries to avoid paying it.

Beyond that, three of the greatest cost factors in the health industry are the high overhead of dealing with the HMOs, the overwhelming cost of liability insurance, and the obscene cost of drugs (the amount of money drug companies pour into wooing doctors with various bribes is staggering, not to mention the adds that dominate the news shows). Fixing these has little to do with consumerism, but a whole lot to do with Congress showing some small trace of backbone. The fact that nothing has been done to fix such obvious problems just shows how deeply our poltiicians are on the take from those making money from the current situation.

I have not seen Michael Moore's movie, so I don't know how deeply he delves into this. I am speaking from my own personal experience.

What the Hillaries and Michael Moores of the world won't admit is that the socialized systems are all heading for their own rendezvous with fiscal destiny, and aren't all that hot either. As Canada's Supreme Court ruled last year, a "right" to be placed on a waiting list is not health care. It's just a dishonest way of rationing, and that's what the socialized systems all amount to - rationing. Consumer driven health care says we can do better.

The economic fallacy (and a bit of elitism) in your post is essentially that most health care consumers are too dumb to know what's best for themselves on complex matters such as these, so the notion of consumer driven health care is a non starter. Here's the error: Most consumers of any product are "too dumb" to understand the nuances of its features and benefits, but a few consumers are not. Because economic decisions are made at the margin, these are the ones that drive providers to innovate and excell - if there is competition and an abence of choking regulations.

"Decisions made at the margin" means that if provider A gets 10 percent more biz than provider B, because those in the know understand that A gives better value, B will figure out out to meet or beat A. And so it goes, in an endless race to deliver superior products, services and values to consumers, most of whom don't know or care that much about the fine points. But in health care all those crucial market signals are squelched by stifling regulation and dysfunctional third party and single-payer systems - Providers A and B get paid the same whether they are superb or mediocre, and they don't care much what consumers think, or how they could make it a better value.


BTW, drugs are expensive because it costs a bloody fortune to develop them, and another bloody fortune to get them approved by a dysfunctional FDA. Here's a question everyone should think about: Do you want to innovator of the uninvented drug that will save your life someday to know that if he succeeds he will make a lot of money, or are you hoping that he will dedicate his life (as he must) and the firm that does the development will risk hundreds of millions just because they are all really good guys and gals? They might be - but if my life is at stake I'd rather pay to make sure.

 

[S-Des]

The simplest first step to a solution would be to replace our system of privately funded insurance and privately run HMO's with a universal system of insurance available to all. That safety net, would, in fact, ease a tremonedous burden on small business, and allow people to take more chances with their economic existence. As it is, a lot of people who would be running small businesses are working for larger organizations because they need the health insurance. And corporations are moving those jobs to third would countries to avoid paying it.

Beyond that, three of the greatest cost factors in the health industry are the high overhead of dealing with the HMOs, the overwhelming cost of liability insurance, and the obscene cost of drugs (the amount of money drug companies pour into wooing doctors with various bribes is staggering, not to mention the adds that dominate the news shows). Fixing these has little to do with consumerism, but a whole lot to do with Congress showing some small trace of backbone. The fact that nothing has been done to fix such obvious problems just shows how deeply our poltiicians are on the take from those making money from the current situation.

To me, the most important first step is to make it less costly for preventative medical care. You have illegal aliens & uninsured citzens who wait until they're really sick, then head down to the ER (where they know they have to be treated). This makes visiting the hospital with an emergency a complete nightmare (and since the costs don't get covered by the uninsured people, they get passed along to the rest of us). People should be able to go to a doctor or clinic for minor things, so they don't become major (and costly) things. I had an infection due to a bad tooth, and the doctor wasn't even sure I needed anything (so she gave me a general antibiotic). It was $140 visit (plus the perscription). How the hell is someone who makes $300-$400/wk after taxes going to pay that for themselves, a wife, and 2 or 3 kids? So they don't get it treated, and everything gets worse.

Guliani is talking about this, but I don't know that I trust him to actually do anything about it. I know I've heard Dems talk about it, but the ones in the Presidential race are talking about the massive overhaul they'd like to try, instead of ways to relieve pressure & cost on the system. You know you won't be hearing about limits on lawsuits (especially from Edwards ).

 

[WRJames]

What the Hillaries and Michael Moores of the world won't admit is that the socialized systems are all heading for their own rendezvous with fiscal destiny, and aren't all that hot either. As Canada's Supreme Court ruled last year, a "right" to be placed on a waiting list is not health care. It's just a dishonest way of rationing, and that's what the socialized systems all amount to - rationing. Consumer driven health care says we can do better.

Well, I never said that. My solution would be to make ACCESS to health care universal -- perhaps extend Medicare or Medicaid, or provide a floor level of HMO type health coverage.

The economic fallacy (and a bit of elitism) in your post is essentially that most health care consumers are too dumb to know what's best for themselves on complex matters such as these, so the notion of consumer driven health care is a non starter. Here's the error: Most consumers of any product are "too dumb" to understand the nuances of its features and benefits, but a few consumers are not. Because economic decisions are made at the margin, these are the ones that drive providers to innovate and excell - if there is competition and an abence of choking regulations.

That may be okay for weeding out the best kind of toothbrush, but the consequences of bad medical choices are more immediate and harder to reverse. If there is elitism, it is on the part of the medical professionals who try to intimidate patients with their superior education and knowledge. I know from experience dealing with a very bullying doctor who was determined to rip out my wife's thyroid on the off chance it might be malignant. Any attempt to suggest alternatives was met with complete contempt.

"Decisions made at the margin" means that if provider A gets 10 percent more biz than provider B, because those in the know understand that A gives better value, B will figure out out to meet or beat A. And so it goes, in an endless race to deliver superior products, services and values to consumers, most of whom don't know or care that much about the fine points. But in health care all those crucial market signals are squelched by stifling regulation and dysfunctional third party and single-payer systems - Providers A and B get paid the same whether they are superb or mediocre, and they don't care much what consumers think, or how they could make it a better value.

You could still allow "better" doctors to charge premium prices -- they'd probably have to be a lot better to get anyone to pay them. What is really a scandal is the way doctors are paid, and what they charge uninisured patients. For example, my wife went in for a simple, one hour, noninvasive procedure. A few weeks later, because of a mixup, we receive a bill for over six thousand dollars. This was settled by the HMO for about six hundred. There are so many standard practices like this bordering on fraud that the "real" cost of any medical procedure is almost impossible to determine.

"BTW, drugs are expensive because it costs a bloody fortune to develop them, and another bloody fortune to get them approved by a dysfunctional FDA. Here's a question everyone should think about: Do you want to innovator of the uninvented drug that will save your life someday to know that if he succeeds he will make a lot of money, or are you hoping that he will dedicate his life (as he must) and the firm that does the development will risk hundreds of millions just because they are all really good guys and gals? They might be - but if my life is at stake I'd rather pay to make sure.

Bullshit! That is pure drug company propaganda. What they don't bother to tell you is how every doctor's office has drug company representatives dropping in all the time providing little special favors -- free lunch or something, not to mention big ones like junkets. And a lot of free samples. The amount the drug industry in spending on advertising is truly obscene. Not to mention those elaborate tv ads we see every night. Cut all that out, then tell me that the money is really going for something useful.

 

[Stella_Omega]

For most of my life I have not had health insurance for my family.

AS a matter of fact, at this time we are on Medical, and for the first time, I can go to a doctor instead of a free or sliding-scale clinic. (and there have been times when I would have to make a choice between paying a clinic's fees or paying, say, my utilities bill) I wept with relief when I was judged POOR ENOUGH to qualify. You have no conception of how grateful i am for it. And what kind of terror the future holds for me-- because i will LOSE this coverage well before I am, in fact, economically capable of carrying the kind of insurance fees I will HAVE TO PAY for my family. The only solution I can see is a national plan.

Roxanne, you prate about the Free Market constantly. But, darling, for most of us-- THE MARKET IS NOT FREE. Not to the majority of people in this society.

I DO NOT have the freedom to choose, for instance, free-range chicken, guaranteed organic produce, clothing created in a socially-responsible manner. I cannot buy an electric car.

Instead I have to compromise with the reality of my economic status and the need to provide for four people (and 11 cats) and buy the cheapest meats i am able to find, the vegetables and fruits that are lowest in cost, a ten-year-old used van with sucko gas mileage, and drive it as little as possible. I buy almost every article of clothing at thrift stores (Where, I have to say, I can dress exceedingly well)

The market gives me no choice in these matters. If I could do my part to influence the market I would. But as far as I'm concerned and many of us are concerned, I am dealing with monopolies that have already made the decisions as to what i will be provided with, what my choices will be between. And you might not believe this, Roxy, but those decisions were NOT made with my well-being in mind. They were made based on two factors; LEAST COST to the provider, and EMOTIONAL APPEAL to an ignorant population. I, a would-be intelligent consumer, am powerless. Because I have to put something into my children's stomachs. And I have to get them to school and myself to work. NOW. I cannot wait for your happy future.

 

[cloudy]

For most of my life I have not had health insurance for my family.

AS a matter of fact, at this time we are on Medical, and for the first time, I can go to a doctor instead of a free or sliding-scale clinic. (and there have been times when I would have to make a choice between paying a clinic's fees or paying, say, my utilities bill) I wept with relief when I was judged POOR ENOUGH to qualify. You have no conception of how grateful i am for it. And what kind of terror the future holds for me-- because i will LOSE this coverage well before I am, in fact, economically capable of carrying the kind of insurance fees I will HAVE TO PAY for my family. The only solution I can see is a national plan.

Roxanne, you prate about the Free Market constantly. But, darling, for most of us-- THE MARKET IS NOT FREE. Not to the majority of people in this society.

I DO NOT have the freedom to choose, for instance, free-range chicken, guaranteed organic produce, clothing created in a socially-responsible manner. I cannot buy an electric car.

Instead I have to compromise with the reality of my economic status and the need to provide for four people (and 11 cats) and buy the cheapest meats i am able to find, the vegetables and fruits that are lowest in cost, a ten-year-old used van with sucko gas mileage, and drive it as little as possible. I buy almost every article of clothing at thrift stores (Where, I have to say, I can dress exceedingly well)

The market gives me no choice in these matters. If I could do my part to influence the market I would. But as far as I'm concerned and many of us are concerned, I am dealing with monopolies that have already made the decisions as to what i will be provided with, what my choices will be between. And you might not believe this, Roxy, but those decisions were NOT made with my well-being in mind. They were made based on two factors; LEAST COST to the provider, and EMOTIONAL APPEAL to an ignorant population. I, a would-be intelligent consumer, am powerless. Because I have to put something into my children's stomachs. And I have to get them to school and myself to work. NOW. I cannot wait for your happy future.

Eloquent, and very true.

Rox: you are so elitest, and so fucking insensitive.

 

[Roxanne Appleby]

You may be surprised by what I view as a "happy future" in health care.

I do believe that health care must be consumer-driven for the reasons the OP article describes. With several reforms in that direction it becomes possible to provide every person in the country with a health insurance voucher that will cover all expenses above $2,500 year. Here's how:

First, we need to repeal the restrictive state licensure and scope of practice regulations that masquerade as consumer protection but actually only protect the provider cartels from competition. This would allow someone like Lucky (with perhaps enough extra training to acheive nurse practitioner status) to open an urgent care clinic that could treat all the various nicks and bruises encountered in daily life (like falling off 5 gallon buckets, or nasty cuts that require a dozen stitches and antibiotics). The cost would be be a fraction of what emergency rooms cost, manned as they are by highly trained MDs who aren't needed for 90 percent of the stuff that rolls through the doors. Naturally our Lucky would have the training to recognize the stuff that she can't handle and would refer it on.

Second, allow binding waivers of liability so you could only sue Lucky for screwing up the thing you paid her to do - sew up the 12 stitches and prescribe the right antibiotic, for example, instead of a bunch of crap that some shyster thinks of afterwards that she should have done. Oh, and Nurse Lucky would only need to charge you around $40 or so for that service, because this reform and the previous one lets her operate her clinic in the most efficient manner possible (think Wal-mart vs. Rodeo Drive boutique.)

Third, every adult over age 21 would be required to buy insurance with a $2,500 deductable. Because everyone buys, including young people who don't get sick much, the costs of those who do get very ill are "socialized," and there's enough left over that the money those healthy youngsters contribute grows sufficiently to cover their own old age costs. And, because of the high deductable and everyone paying in, the cost of this insurance would only be around $4,000.

Fourth, there would be universal community rating - every person pays the same. No "prior conditions," etc. This is impossible without the universal insurance mandate because the incentive is for individuals to "free ride" by waiting until they get sick to buy insurance (in which case it's not insurance but welfare). The only things the $4,000 policy would not cover would be extraordinary end of life expenses - if you wanted you could pay more to get insurance for those, but most people would decide it's not worth it. There would be some variation in the available policies, but not much. The policies would cover children as well as their parents - in the aggregate kids are a very small portion of total health care costs.

Fifth - and here is where you will be surprised - the government would pay for those $4,000 insurance policies for every person. Not just the poor - everyone. No more employer-provided health insurance, Medicare or Medicaid.

Essentially, this plan socializes the cost of health care, but leaves the provision of in to the private sector, and removes the constraints on innovation described in the OP. It is a win-win for every member of our society. I'm sure all those who imagine some socialist paradise will find 100 quibbles over this scheme, but there's no free lunch, including in the single payer plans. This one is sustainable, and the incentives are all in the direction of making it more cost effective and patient-friendly. That is not the case in the government-run systems.

I didn't invent this - it's described by Charles Murray in his "In Our Hands: A Plan to End the Welfare State."

 

[cloudy]

Third, every adult over age 21 would be required to buy insurance with a $2,500 deductable. Because everyone buys, including young people who don't get sick much, the costs of those who do get very ill are "socialized," and there's enough left over that the money those healthy youngsters contribute grows sufficiently to cover their own old age costs. And, because of the high deductable and everyone paying in, the cost of this insurance would only be around $4,000.

oh, sure, that'll work.

Everyone can pay $4,000/person per year for insurance. Is the sky blue in the world where you live, Rox?

 

[Stella_Omega]

Four grand apiece. In my family that will be eight grand a year that I must come up with for myself and my husband.
oh, and another 2,500 for either of us that actually needs medical attention. So I am looking at eleven grand a year-- for the adults. My income in a good year-- and there haven't been many lately-- is around thirty-five. I have to pay rent. In Los Angeles, that is 24,000 a year median, yes-- two grand a month.

Gawrsh! Why those two expenses put together-- make thirty-five thousand dollars exactly!

ETA;

Fifth - and here is where you will be surprised - the government would pay for those $4,000 insurance policies for every person. Not just the poor - everyone. No more employer-provided health insurance, Medicare or Medicaid.

Why do you say "Should be required to buy" and then turn around and say that the government pays for it?????
Isn't that exactly what we've ALL BEEN SAYING?????

 

[WRJames]

We take it for granted the everyone has a right to a basic education. EVERYONE. That may have been controversial at some point in our history. But we take it for granted now. And that does not prevent private schools from providing a "better" education, or home schoolers from opting out -- our enough other variations that we still feel like a free society. Why can't we figure this out for health care?

Stella -- my editor lives on the margin -- but she lives in Toronto. Health care is not an issue for her. She is able to crazed things like start up a small publishing house without the worry that if something goes wrong with her health, if she has a minor accident -- it's all over.

Down the street from me some of our friends live in a beautiful, beautiful house. A dream house. Except it was not their dream -- the man who buiilt it, an architect and builder, fell off a roof building someone else's dream -- and lost everything, because he could not afford insurance.

The current system is killing creativity and entrepreneurship. It is, literally, bad for business.

 

[jomar]

Fifth - and here is where you will be surprised - the government would pay for those $4,000 insurance policies for every person. Not just the poor - everyone. No more employer-provided health insurance, Medicare or Medicaid.


...but there's no free lunch...

Does Mr. Murray say how the government will foot the bill? Increased payroll taxes perhaps?

 

[cloudy]

Does Mr. Murray say how the government will foot the bill? Increased payroll taxes perhaps?

probably by cutting all the welfare programs, like HUD, foodstamps, etc. It certainly won't be taken away from the rich folks.

 

[jomar]

probably by cutting all the welfare programs, like HUD, foodstamps, etc. It certainly won't be taken away from the rich folks.

Something would have to shift, that's for sure. And you're right - the politicos will make sure the rich don't suffer, even though they'd also get free health insurance under the plan.

 

[Stella_Omega]

We take it for granted the everyone has a right to a basic education. EVERYONE. That may have been controversial at some point in our history. But we take it for granted now. And that does not prevent private schools from providing a "better" education, or home schoolers from opting out -- our enough other variations that we still feel like a free society. Why can't we figure this out for health care?

Stella -- my editor lives on the margin -- but she lives in Toronto. Health care is not an issue for her. She is able to crazed things like start up a small publishing house without the worry that if something goes wrong with her health, if she has a minor accident -- it's all over.

Down the street from me some of our friends live in a beautiful, beautiful house. A dream house. Except it was not their dream -- the man who buiilt it, an architect and builder, fell off a roof building someone else's dream -- and lost everything, because he could not afford insurance.

The current system is killing creativity and entrepreneurship. It is, literally, bad for business.

YEp, a great deal of my probolem stems from the fact that I work for myself.

So does my sister-- she is at the point now where she should hire one more person (besides herself) but she cannot do it because she can't pay health insurance-- not for herself, either. She can't afford to move that step forward.

 

[Vermilion]

So what do you all think of the UK National Health Service?

We may bitch and moan about it, especially in terms of waiting lists and dental practices, but when it comes down to it if I get ill or have an accident I know I will be taken care of. Simple as.

But could it work on such a large scale as America? Would it work if it was administrated state-wide or would economies of scale (is that the right term???) mean that states with big cities in them like New York and Washington where there are more people with higher salaries would have better health care than poorer states with a higher percentage of old people (like Florida or Arizona???)

x
V

 

[Stella_Omega]

So what do you all think of the UK National Health Service?

We may bitch and moan about it, especially in terms of waiting lists and dental practices, but when it comes down to it if I get ill or have an accident I know I will be taken care of. Simple as.

But could it work on such a large scale as America? Would it work if it was administrated state-wide or would economies of scale (is that the right term???) mean that states with big cities in them like New York and Washington where there are more people with higher salaries would have better health care than poorer states with a higher percentage of old people (like Florida or Arizona???)

x
V

When I was working in London back in '79, I had to get two wisdom teeth removed, and my IUD replaced.

Each time, the practitioner was horribly apologetic that I had to pay-- I think it was seven pounds or so. I could afford it.

 

[amicus]

Gadzooks! I almost always read posts by Roxanne. for my own selfish reasons.

A self proclaimed Libertarian, Ms. Appleby advocates 'forcing' each person to pay X amount of dollars, matched by X amount of dollars, also confiscated by government from each wage earning citizen to fund a health care system.

Sighs...

Last year, in late spring, my daughter, her husband and their three children invited me out to dinner with the family to celebrate a birthday. They gave the birthday girl a choice of where to go; because of 'Mud Pies', she chose, ah, I think it is called Red Robin.

The place was noisy and very busy and the little girl wanted to explore and use the bathroom, so I headed out with her telling my daughter I would just have a hamburger and a coffee.

I saw the bill later as we were finishing up; well over a hundred dollars and my hamburger and coffee and she added Fries that we all shared, my portion came to about $13.00, for a goddamned hamburger, fries and a coffee.

Later that summer, just last year, I ventured up to Oregon and my two sons and one's girl friend rented a house to live in, about a grand a month plus utilities, and we were doing yardwork when the girl said she was hungry.

I offered to make a run and asked what they all wanted.

I came back with eight hamburgers and two fries, total bill, under $10.00, Whopper Jr's, I think they are called, I don't do hamburger joints much.

When personal computers first came out, I paid $1600.00 for an NEC 64K machine, gads...my digital watch has more computing power than that little computer did.

The same with the Apollo 8, moon mission, total computer power aboard was less than my digital camera.

Two things I mean to imply by those anecdotal's; we have choices in what we purchase, in a free market place, and secondly progress and innovation through competition always works.

There could be and should be a medical clinic system as proliferate as McDonald's or Burger King, almost on every corner, each offering their services in a free market without regulation.

Someone in this thread, without shame no less, referred to Mandatory, forced public education as a benefit that is taken for granted in our times. Unfortunately, like National Health Care plans in Europe and Canada, which don't work, and don't supply quality medical care, the school system here doesn't work either, is perhaps the worst in the world.

There is an old saw about a man giving up freedom for security and finding that having lost freedom, he had no security at all and was dependent upon his benefactor.

I too, would like to see a medical care system that is efficient and economical for all at the least possible cost; everyone would, I think.

We, the world at large, could have such a system if only we can ever be smart enough to turn it over to free enterprise, get the greedy hands of government out of it and pursue our own individual dreams.

It will happen, sooner or later, I promise you. When the command/socialist schemes fail, as by definition they will, you will be surprised at the efficacy of individual free people making decisions in their own self interest.

Always the Optimist....Amicus in incurable romantic...

 

[jomar]

I couldn't imagine not having insurance. I'd probably would have had to declare bankruptcy if not. I also work for myself and at times carried a low premium, high deductible plan - catastrophe insurance. When my wife went back to work we were able to be covered under her company plan (which is when the big needs arose).

I wonder how the govt plan would pay providers, and what they get paid in the UK. Managed care was supposed to fix things in the US, but some folks got rich off of denying services and reducing providers reimbursement (still are). So docs had to see more people to maintain income (which includes overhead, not just their take home). See too many people and quality of care suffers, and the dominoes continue to fall. In the meantime, costs are still spiraling up.

 

[jomar]

I too, would like to see a medical care system that is efficient and economical for all at the least possible cost; everyone would, I think.

We, the world at large, could have such a system if only we can ever be smart enough to turn it over to free enterprise, get the greedy hands of government out of it and pursue our own individual dreams.

With the exception of Medicaid, Medicare and maybe some others I'm not aware of, it's my understanding that insurance companies are part of the free market. They're 'for profit' companies, as are most medical practices. I'm certainly not educated in the area, but I think much of the federal and state laws about insurance deal with accessibility and who can treat what.

 

[amicus]

With the exception of Medicaid, Medicare and maybe some others I'm not aware of, it's my understanding that insurance companies are part of the free market. They're 'for profit' companies, as are most medical practices. I'm certainly not educated in the area, but I think much of the federal and state laws about insurance deal with accessibility and who can treat what.

~~~

Jomar...I am not an expert in such things, nor do I claim to have special knowledge. I usually try to skate by with the moral and ethical side of a discussion and leave it to others to provide the details.

Governments and Unions, pretty much the same thing, long ago insisted on health insurance for employees. For a while it didn't matter much as the numbers of insured were few. Then we started discovering health providers and insurance companies doing their thing of charging ten dollars for an aspirin and outrageous fees for minor services.

That of course led to more restrictions and regulations and more government employees to manage and administrate the new laws; which meant more employees to provide health insurance for.

Pharmaceutical companies entered into the fray by soliciting health care providers to provide 'their' drug of choice and the advertising wars started and continue to this day...who cares, "insurance" pays the bill, the health care recipient never even, in most cases, sees the bill.

It is a classic 'labor' scenario: limit the number of providers in the medical field, keep the price high and the supply beneath the demand.

It got to a point where the working class could not afford medical care without government assistance. Enter Medicare and Medicaid and a hundred other programs meant to alleviate health provider costs to the middle and lower class.

Throw in the aspect of single mothers requiring specialized care in terms of children and pregnancy and the total inability of the working or welfare mother to make ends meet.

It is a sticky problem and very complex and has been with us since the 1960's.

I am appalled at the number of people who want to solve the problems with the end result of affordable care, but the means, socialism, destroying the fabric of a free, or almost free, society.

I can easily understand the working poor who want and need relief now if not yesterday and that they are willing to accept any plan that will provide the care.

If you left it up to government to supply inexpensive hamburgers to the masses, it would be run like the postal service or public education, poorly. If you leave it up to government to run health care, because it deals with sickness and life and death, the results will be tragic.

Not a good scenario to me.


amicus...

 

[Stella_Omega]

Originally Posted by amicus
I too, would like to see a medical care system that is efficient and economical for all at the least possible cost; everyone would, I think.

We, the world at large, could have such a system if only we can ever be smart enough to turn it over to free enterprise, get the greedy hands of government out of it and pursue our own individual dreams.

Ahhh hahahahahaha! Right, none of those insurance companies are in the least greedy, are they!

*snicker* snickersnicker snork giggle gigglegigglesnicker snorksnuckHYUCK hah har har har ooooHOOOHHHH ha ha ha ha Hee hee hee hee hee hee hee hee hee... whOO! Heh. Heh heh. Heh heh hee hee hee hEEEE har har har! Haw haw snickersnicklegigglesnork hur hur huh hyUUUCK haw haw haw! huh... Snicker... snicker haw haw haw hee hee heheheheheeee heee HEEE hee hee hee HAW HAW HAW HAW hur hur fuff uff whuh haw haw... heh heh...heh .... Damn, I needed that laugh, thanks.

 

[amicus]

Wow, Stella...like Madonna said to Tom Hanks in "League of their Own"...."That was a goooooood pee..."


That was a goooooooood laugh....grins...and to think I was responsible.

ami

 

[jomar]

It is a classic 'labor' scenario: limit the number of providers in the medical field, keep the price high and the supply beneath the demand.

It got to a point where the working class could not afford medical care without government assistance. Enter Medicare and Medicaid and a hundred other programs meant to alleviate health provider costs to the middle and lower class.



amicus...

Yikes! Joke was almost on me. I got to reading your post and thinking of a response and almost burned dinner!

Anyway, seems to me it's an incredibly complex situation, Amicus - multiple interlocking and interdependent industries with their own agendas. Not a simple supply chain like building a computer or TV.

I'm not sure if you mean 'labor' scenario for the pharm companies or the insurance companies. If the insurance companies then they are the for profit companies acting it out. They limit and deny services, restrict provider pools (e.g., in network panels), etc. I'm not defending govt run programs such as Medicaid, just saying the free market is already in play in the insurance industry and nobody is satisfied with it.



Careful with your back when you guffaw, Stella.