Worshipping the Single-Payer God
Lee Ratner
People on this news group should know that I am a believer in
universal healthcare from previous debates on the topic and I believe
that ensuring access to universal healthcare is a legitimate role for
the federal government. Millions of other Progressive Americans agree
with me on this. Others disagree but this is not the point of the
thread. This thread is about the current rift among Progressives about
the current healthcare bill in Congress.
Many Progressives think the current bill is bad and should be
killed. Others, while not thinking it to be a great bill, believe it
should be passed as a first step to universal healthcare. I'm in the
latter group. A lot of the Progressives in the first group seem to be
firm believers in the idea that the only way to provide universal and
affordable healthcare for all Americans is in a single-payer system.
While I believe that single-payer is a good system, I realize that
there are other methods of get universal, affordable healthcare. There
is the Bismarckian system of insurance mandates, heavily regulated
insurance companies reduced to not for profit status or treated no
differently than utilities, and subsidies to help people pay for
insurance. This bill represents the first step in setting up a
Bismarckian system in the United States. Many Progressives do not seem
to like this and are hell bent on "single payer or bust" when it comes
to health care. I really want to know why? Many other countries like
the Netherlands, Germany, Switzerland, Israel, and others manage to
provide universal healthcare through the Bismarckian system.
Progressives have been trying to institute universal healthcare
through a single-payer system since the time of Theodore Roosevelt or
may be only a little latter. We have failed miserably. Maybe we should
start looking at other ways of providing universal healthcare and see
if we can succeed.
Keith F. Lynch
> Many Progressives think the current bill is bad and should be
> killed. Others, while not thinking it to be a great bill, believe
> it should be passed as a first step to universal healthcare. I'm
> in the latter group. A lot of the Progressives in the first group
> seem to be firm believers in the idea that the only way to provide
> universal and affordable healthcare for all Americans is in a
> single-payer system.
Do you think the reason it hasn't yet been passed is due to objections
from so-called progressives? I don't. I don't think there are enough
progressives to make a difference.
> While I believe that single-payer is a good system, I realize that
> there are other methods of get universal, affordable healthcare.
> There is the Bismarckian system of insurance mandates, heavily
> regulated insurance companies reduced to not for profit status or
> treated no differently than utilities, and subsidies to help people
> pay for insurance.
The problem is that medical care costs enormously more than in
Bismarck's day. If it can't be afforded out of pocket by the average
American, then sharing the cost won't help. Nor will subsidizing it,
since the subsidies can only come from the same set of people, the
American taxpayers.
The problem is simply that it costs far too much. Unless the cost
is somehow greatly reduced, neither the present system, free-market
medicine (which is not the same as the present system), mandated
insurance, nor single-payer can possibly result in every American
getting needed medical care. Nor can anything else. There simply
isn't enough money to go around.
And if the cost *is* somehow greatly reduced, the present system would
work, so there'd be no need for reforms.
I actually agree with the progressives that single-payer may be better
than mandated insurance. Though I think both are very bad choices.
Single payer will at best result in de facto death panels in which the
government has some fixed ceiling to what they're willing to pay each
year, and allocate those dollars to those treatments with the greatest
ratio of expected additional quality-of-life-years to dollars. But
mandated insurance could either bankrupt half the population or put
half the population on welfare.
Most people eligible for government benefits such as welfare, food
stamps, housing subsidies, etc., have too much pride to avail
themselves of the benefit. People prefer to think of themselves as
making the world a better place, donating to charity rather than
receiving from it, and will not accept charity or welfare unless their
circumstances are truly desperate. This is a good thing, since if
everyone accepted every available government benefit, it would crash
the economy.
If you put half the population on medical welfare, you'll not only do
immense damage to their self esteem, you'll open the floodgates to all
other benefits. If someone is accepting one subsidy, why not another,
and another, and another? It becomes a Hobbesian war of all against
all, in which everyone is out to get whatever they can, at the expense
of everyone else. People will also stop donating to voluntary
charities.
--
Keith F. Lynch - http://keithlynch.net/
Please see http://keithlynch.net/email.html before emailing me.
David Goldfarb
Keith F. Lynch <k...@KeithLynch.net> wrote:
>If you put half the population on medical welfare, you'll not only do
>immense damage to their self esteem, you'll open the floodgates to all
>other benefits. If someone is accepting one subsidy, why not another,
>and another, and another? It becomes a Hobbesian war of all against
>all, in which everyone is out to get whatever they can, at the expense
>of everyone else. People will also stop donating to voluntary
>charities.
So how does this gloomy projection compare to the reality of places
such as Canada, the United Kingdom, and France?
--
David Goldfarb |"Understanding is a three-edged sword."
gold...@ocf.berkeley.edu |
gold...@csua.berkeley.edu | -- Babylon 5, "Deathwalker"
Jette Goldie
> In article <hglr8d$65n$1...@reader1.panix.com>,
> Keith F. Lynch <k...@KeithLynch.net> wrote:
>> If you put half the population on medical welfare, you'll not only do
>> immense damage to their self esteem, you'll open the floodgates to all
>> other benefits. If someone is accepting one subsidy, why not another,
>> and another, and another? It becomes a Hobbesian war of all against
>> all, in which everyone is out to get whatever they can, at the expense
>> of everyone else. People will also stop donating to voluntary
>> charities.
>
> So how does this gloomy projection compare to the reality of places
> such as Canada, the United Kingdom, and France?
>
we're quite good at donating to charities.
--
Jette Goldie
jette....@gmail.com
http://www.flickr.com/photos/wolfette/
http://www.jette.pwp.blueyonder.co.uk/
http://wolfette.livejournal.com/
("reply to" is spamblocked - use the email addy in sig)
T Guy
> The problem is simply that it costs far too much. Unless the cost
> is somehow greatly reduced, neither the present system, free-market
> medicine (which is not the same as the present system), mandated
> insurance, nor single-payer can possibly result in every American
> getting needed medical care. Nor can anything else. There simply
> isn't enough money to go around.
>
> And if the cost *is* somehow greatly reduced, the present system would
> work, so there'd be no need for reforms.
(T Guy):
Unless you pick one particular way of reducing cost: omit the cost of
insirance companies and possibly drug companies making profits from
the health industry.
T Guy
Paul Ciszek
In article <078b22cb-27ef-470b...@b2g2000yqi.googlegroups.com>,
The enormous difference between what the uninsured pay and what
insurance companies pay for the same care indicates just how much
costs could be cut without changing anything. In a discussion in
another newsgroup long ago, someone found an example of a uninsured
patients being billed $200 just to start an IV, while insurers were
billed $15. Same hospital, same nurses starting the IV, etc.
--
Please reply to: | "Any sufficiently advanced incompetence is
pciszek at panix dot com | indistinguishable from malice."
Autoreply is disabled |
David Friedman
<078b22cb-27ef-470b...@b2g2000yqi.googlegroups.com>,
T Guy <Tim.B...@redbridge.gov.uk> wrote:
What are the total profits of insurance companies and drug companies,
and how do they compare to total health care spending in the U.S? I
would be surprised if they represented a significant fraction, but I
don't actually know. Presumably you do know, since without that
information you can't have any basis for what you just posted--so tell
us.
--
http://www.daviddfriedman.com/
http://daviddfriedman.blogspot.com/
Author of _Future Imperfect: Technology and Freedom in an Uncertain World_
David V. Loewe, Jr
<dd...@daviddfriedman.nopsam.com> wrote:
> T Guy <Tim.B...@redbridge.gov.uk> wrote:
>> ("Keith F. Lynch" <k...@KeithLynch.net> ):
>>
>> > The problem is simply that it costs far too much. �Unless the cost
>> > is somehow greatly reduced, neither the present system, free-market
>> > medicine (which is not the same as the present system), mandated
>> > insurance, nor single-payer can possibly result in every American
>> > getting needed medical care. �Nor can anything else. �There simply
>> > isn't enough money to go around.
>> >
>> > And if the cost *is* somehow greatly reduced, the present system would
>> > work, so there'd be no need for reforms.
>>
>> (T Guy):
>>
>> Unless you pick one particular way of reducing cost: omit the cost of
>> insirance companies and possibly drug companies making profits from
>> the health industry.
>
>What are the total profits of insurance companies and drug companies,
>and how do they compare to total health care spending in the U.S? I
>would be surprised if they represented a significant fraction, but I
>don't actually know. Presumably you do know, since without that
>information you can't have any basis for what you just posted--so tell
>us.
Profit margin, not quite what you're looking for, for the health
insurance industry is around 3.3%.
http://1.bp.blogspot.com/_otfwl2zc6Qc/SoMLoWBKM4I/AAAAAAAAK4g/wKdZyg5LxQ0/s1600-h/profits.bmp
--
"Are you hiding somewhere behind those eyes?"
Ira Davies and John Oates
Michael Benveniste
<dd...@daviddfriedman.nopsam.com> wrote:
>What are the total profits of insurance companies and drug companies,
>and how do they compare to total health care spending in the U.S?
In 2007, the top 12 drug companies made just under 79 billion dollars
in profits (Source: Fortune Global 500). According to a lobbying
group, http://healthcareforamericanow.org/, the top 10 health insurers
made 12.8 billion dollars. (I presume that's a more relevant number
than for all forms of insurance.)
Healthcare expenditurs in 2007 in the U.S., according the Health and
Human Services, were $2.2 trillion.
--
Mike Benveniste -- m...@murkyether.com (Clarification Required)
Don't succumb to the false authority of a tool or model. There
is no substitute for thinking.
Keith F. Lynch
> In 2007, the top 12 drug companies made just under 79 billion
> dollars in profits (Source: Fortune Global 500). According to a
> lobbying group, http://healthcareforamericanow.org/, the top 10
> health insurers made 12.8 billion dollars. (I presume that's a
> more relevant number than for all forms of insurance.)
> Healthcare expenditurs in 2007 in the U.S., according the Health and
> Human Services, were $2.2 trillion.
Thanks. So drug companies and insurance companies account for about
four percent of total medical costs. That's obviously not why medical
care is so expensive.
Keith F. Lynch
> The enormous difference between what the uninsured pay and what
> insurance companies pay for the same care indicates just how much
> costs could be cut without changing anything. In a discussion in
> another newsgroup long ago, someone found an example of a uninsured
> patients being billed $200 just to start an IV, while insurers were
> billed $15. Same hospital, same nurses starting the IV, etc.
Did the hospital have any explanation for the discrepancy?
I'd refuse to pay the $200, as that's completely ridiculous. Even $15
is very steep for something that takes less than a minute. If I ever
need an IV, I'll start it myself.
Keith F. Lynch
> Keith F. Lynch <k...@KeithLynch.net> wrote:
>> If you put half the population on medical welfare, you'll not only
>> do immense damage to their self esteem, you'll open the floodgates
>> to all other benefits. If someone is accepting one subsidy, why
>> not another, and another, and another? It becomes a Hobbesian war
>> of all against all, in which everyone is out to get whatever they
>> can, at the expense of everyone else. People will also stop
>> donating to voluntary charities.
> So how does this gloomy projection compare to the reality of places
> such as Canada, the United Kingdom, and France?
I answered that elsewhere in that message. As I said there, mandating
that everyone buy insurance, and giving subsidies to those who can't
afford to do so, would be even *worse* than socialist medicine in
which the government covers everything.
David Loewe, Jr.
<m...@murkyether.com> wrote:
>On Mon, 21 Dec 2009 18:35:26 -0500, David Friedman
><dd...@daviddfriedman.nopsam.com> wrote:
>
>>What are the total profits of insurance companies and drug companies,
>>and how do they compare to total health care spending in the U.S?
>
>In 2007, the top 12 drug companies made just under 79 billion dollars
>in profits (Source: Fortune Global 500).
What were their profits from US drug sales?
>According to a lobbying
>group, http://healthcareforamericanow.org/, the top 10 health insurers
>made 12.8 billion dollars. (I presume that's a more relevant number
>than for all forms of insurance.)
>
>Healthcare expenditurs in 2007 in the U.S., according the Health and
>Human Services, were $2.2 trillion.
--
"Anything a human being does to a LaRouche follower is justifiable on
the grounds of self-defense."
- Kevin Bold
David V. Loewe, Jr
<k...@KeithLynch.net> wrote:
>Michael Benveniste <m...@murkyether.com> wrote:
>> In 2007, the top 12 drug companies made just under 79 billion
>> dollars in profits (Source: Fortune Global 500). According to a
>> lobbying group, http://healthcareforamericanow.org/, the top 10
>> health insurers made 12.8 billion dollars. (I presume that's a
>> more relevant number than for all forms of insurance.)
>
>> Healthcare expenditurs in 2007 in the U.S., according the Health and
>> Human Services, were $2.2 trillion.
>
>Thanks. So drug companies and insurance companies account for about
>four percent of total medical costs. That's obviously not why medical
>care is so expensive.
Worse, Michael gives what appear to be global profits for the drug
companies.
--
"My doctor told me to stop having intimate dinners for four.
Unless there are three other people."
- Orson Welles
rksh...@rosettacondot.com
> Paul Ciszek <nos...@nospam.com> wrote:
>> The enormous difference between what the uninsured pay and what
>> insurance companies pay for the same care indicates just how much
>> costs could be cut without changing anything. In a discussion in
>> another newsgroup long ago, someone found an example of a uninsured
>> patients being billed $200 just to start an IV, while insurers were
>> billed $15. Same hospital, same nurses starting the IV, etc.
>
> Did the hospital have any explanation for the discrepancy?
>
> I'd refuse to pay the $200, as that's completely ridiculous. Even $15
> is very steep for something that takes less than a minute. If I ever
> need an IV, I'll start it myself.
I think a discount of around a third is more typical. My daughter spent
the evening in the emergency room and two nights in the hospital a few
months ago. The total amount billed to my insurance was $9550.41, the
total amount covered was $5923.25 and my responsibility was 10% of the
covered amount. Interestingly enough the covered amount for the ambulance
service was the entire billed amount of $1718.75.
Robert
--
Robert K. Shull Email: rkshull at rosettacon dot com
--
Robert K. Shull Email: rkshull at rosettacon dot com
David Loewe, Jr.
<k...@KeithLynch.net> wrote:
>Paul Ciszek <nos...@nospam.com> wrote:
>> The enormous difference between what the uninsured pay and what
>> insurance companies pay for the same care indicates just how much
>> costs could be cut without changing anything. In a discussion in
>> another newsgroup long ago, someone found an example of a uninsured
>> patients being billed $200 just to start an IV, while insurers were
>> billed $15. Same hospital, same nurses starting the IV, etc.
>
>Did the hospital have any explanation for the discrepancy?
>
>I'd refuse to pay the $200, as that's completely ridiculous. Even $15
>is very steep for something that takes less than a minute.
I've had it to take hours.
>If I ever need an IV, I'll start it myself.
I don't have good veins.
--
"A generation that ignores history has no past - and no
future."
-Lazarus Long
Michael Benveniste
<dlo...@mindspring.com> wrote:
>What were their profits from US drug sales?
That's a bit harder to determine because of the various accounting
tricks that are available. But using Pfizer's own numbers as a guide,
somewhere between 45 and 50% of their profits are generated by U.S.
operations.
Note that neither income figure says anything about the cost structure
of the firms nor the efficiency by which those profits are generated.
--
Mike Benveniste -- m...@murkyether.com (Clarification Required)
Its name is Public opinion. It is held in reverence. It settles
everything. Some think it is the voice of God. -- Mark Twain
David Friedman
Michael Benveniste <m...@murkyether.com> wrote:
> On Mon, 21 Dec 2009 21:12:48 -0600, "David Loewe, Jr."
> <dlo...@mindspring.com> wrote:
>
> >What were their profits from US drug sales?
>
> That's a bit harder to determine because of the various accounting
> tricks that are available. But using Pfizer's own numbers as a guide,
> somewhere between 45 and 50% of their profits are generated by U.S.
> operations.
It's hard to determine because it isn't a meaningful number. Profit is
revenue minus cost. But the cost of developing a new drug can't be
assigned to a particular market it is sold in, unless that's the only
market for that drug or the particular cost--FDA approval, say--is only
relevant to that market.
Steve Cooper
> In article <3je1j55b34bs18bh7...@4ax.com>,
> Michael Benveniste <m...@murkyether.com> wrote:
>
>> On Mon, 21 Dec 2009 21:12:48 -0600, "David Loewe, Jr."
>> <dlo...@mindspring.com> wrote:
>>
>>> What were their profits from US drug sales?
>> That's a bit harder to determine because of the various accounting
>> tricks that are available. But using Pfizer's own numbers as a guide,
>> somewhere between 45 and 50% of their profits are generated by U.S.
>> operations.
>
> It's hard to determine because it isn't a meaningful number. Profit is
> revenue minus cost. But the cost of developing a new drug can't be
> assigned to a particular market it is sold in, unless that's the only
> market for that drug or the particular cost--FDA approval, say--is only
> relevant to that market.
>
The only relevant number surely has to be the price payed for the drug,
and this is one area where the Single-Payer model has advantages in that
it can take advantage (fairly or unfairly depending upon your POV) of
being a large monopolistic purchaser. So you get the result that the
same brand drugs can cost 35%-45% less in Canada than in the US. (And I
believe there are similar price differentials with other monotheistic
purchasers, such as the NHS in the UK)
But then I'm not complaining, it's the high price of drugs in the US
that gives the producers the income and the incentive to continue
pouring billion of dollars into research that benefit patients not just
in the US, but in Canada and Europe.
Steve Cooper
David Friedman
"David Loewe, Jr." <dlo...@mindspring.com> wrote:
> >In 2007, the top 12 drug companies made just under 79 billion dollars
> >in profits (Source: Fortune Global 500).
>
> What were their profits from US drug sales?
>
I don't think that's a meaningful figure, since the cost of research and
development is a joint cost for all sales. But we don't need the
information, since even if all of the profits were from U.S. sales, the
total profit figure is still only about 4% of total health care spending.
I gather, by the way, that a number of states have recently increased
their taxes on health care providers. Apparently that somehow lets them
get more medicare money from the federal government, but I haven't
followed the details of how.
David Friedman
> >In 2007, the top 12 drug companies made just under 79 billion dollars
> >in profits (Source: Fortune Global 500).
>
> What were their profits from US drug sales?
>
I don't think that's a meaningful figure, since the cost of research and
development is a joint cost for all sales. But we don't need the
information, since even if all of the profits were from U.S. sales, the
total profit figure is still only about 4% of total health care spending.
I gather, by the way, that a number of states have recently increased
their taxes on health care providers. Apparently that somehow lets them
get more medicare money from the federal government, but I haven't
followed the details of how.
--
David Friedman
"Keith F. Lynch" <k...@KeithLynch.net> wrote:
> Paul Ciszek <nos...@nospam.com> wrote:
> > The enormous difference between what the uninsured pay and what
> > insurance companies pay for the same care indicates just how much
> > costs could be cut without changing anything. In a discussion in
> > another newsgroup long ago, someone found an example of a uninsured
> > patients being billed $200 just to start an IV, while insurers were
> > billed $15. Same hospital, same nurses starting the IV, etc.
>
> Did the hospital have any explanation for the discrepancy?
>
> I'd refuse to pay the $200, as that's completely ridiculous. Even $15
> is very steep for something that takes less than a minute. If I ever
> need an IV, I'll start it myself.
In previous discussions, I've seen the opposite story as well--uninsured
patients persuading the hospital to charge them considerably less than
it charges the insurance company. Which case is more common I don't know.
David Friedman
Michael Benveniste <m...@murkyether.com> wrote:
> On Mon, 21 Dec 2009 18:35:26 -0500, David Friedman
> <dd...@daviddfriedman.nopsam.com> wrote:
>
> >What are the total profits of insurance companies and drug companies,
> >and how do they compare to total health care spending in the U.S?
>
> In 2007, the top 12 drug companies made just under 79 billion dollars
> in profits (Source: Fortune Global 500). According to a lobbying
> group, http://healthcareforamericanow.org/, the top 10 health insurers
> made 12.8 billion dollars. (I presume that's a more relevant number
> than for all forms of insurance.)
>
> Healthcare expenditurs in 2007 in the U.S., according the Health and
> Human Services, were $2.2 trillion.
Thanks.
So if you could reduce that to zero, by a well run government program
that somehow got its needed capital at zero interest rate, you would
reduce total costs by about 4%.
David Friedman
Steve Cooper <Steve....@ccfe.ac.uk> wrote:
> David Friedman wrote:
> > In article <3je1j55b34bs18bh7...@4ax.com>,
> > Michael Benveniste <m...@murkyether.com> wrote:
> >
> >> On Mon, 21 Dec 2009 21:12:48 -0600, "David Loewe, Jr."
> >> <dlo...@mindspring.com> wrote:
> >>
> >>> What were their profits from US drug sales?
> >> That's a bit harder to determine because of the various accounting
> >> tricks that are available. But using Pfizer's own numbers as a guide,
> >> somewhere between 45 and 50% of their profits are generated by U.S.
> >> operations.
> >
> > It's hard to determine because it isn't a meaningful number. Profit is
> > revenue minus cost. But the cost of developing a new drug can't be
> > assigned to a particular market it is sold in, unless that's the only
> > market for that drug or the particular cost--FDA approval, say--is only
> > relevant to that market.
> >
>
> The only relevant number surely has to be the price payed for the drug,
Profit is revenue minus cost. It's the cost that can't be meaningfully
assigned to a particular market.
> and this is one area where the Single-Payer model has advantages in that
> it can take advantage (fairly or unfairly depending upon your POV) of
> being a large monopolistic purchaser. So you get the result that the
> same brand drugs can cost 35%-45% less in Canada than in the US. (And I
> believe there are similar price differentials with other monotheistic
> purchasers, such as the NHS in the UK)
I'm not sure whether what's going on is monopsony power or the implied
threat that if the drug companies are not willing to sell the drugs to
the government at the price it is offering, it will refuse to enforce
their patents.
...
Nels Satterlund
> On Tue, 22 Dec 2009 02:36:49 +0000 (UTC), "Keith F. Lynch"
> <k...@KeithLynch.net> wrote:
>
>> Paul Ciszek <nos...@nospam.com> wrote:
>
>>> The enormous difference between what the uninsured pay and what
>>> insurance companies pay for the same care indicates just how much
>>> costs could be cut without changing anything. In a discussion in
>>> another newsgroup long ago, someone found an example of a uninsured
>>> patients being billed $200 just to start an IV, while insurers were
>>> billed $15. Same hospital, same nurses starting the IV, etc.
>> Did the hospital have any explanation for the discrepancy?
>>
>> I'd refuse to pay the $200, as that's completely ridiculous. Even $15
>> is very steep for something that takes less than a minute.
>
> I've had it to take hours.
For a transfusion it takes 2 hours to put it back in.
>> If I ever need an IV, I'll start it myself.
>
> I don't have good veins.
I ask them to use the back of my hand or lower arm near my wrist as near
the elbow my veins are hard to find.
Nels
--
Nels E Satterlund I don't speak for the company
Ne...@Starstream.net <-- Use this address please,
My Lurkers motto: I read much better than I type.
Michael Benveniste
<dd...@daviddfriedman.nopsam.com> wrote:
>It's hard to determine because it isn't a meaningful number. Profit is
>revenue minus cost. But the cost of developing a new drug can't be
>assigned to a particular market it is sold in, unless that's the only
>market for that drug or the particular cost--FDA approval, say--is only
>relevant to that market.
Development costs can be and are in fact assigned to and apportioned
among particular markets. In fact, the IRS has regulations on how to
do so:
http://law.justia.com/us/cfr/title26/26-9.0.1.1.1.0.4.92.html
As you might expect, other countries have their own rules and
regulations as well. Also as you might expect, interpretation of and
compliance with these varying and sometimes conflicting rules is not
an insignificant cost in itself.
So while such assignments are possible, I _do_ doubt their value once
you move beyond tax evaluation into areas of policy and strategy.
David V. Loewe, Jr
<Ne...@starstream.net> wrote:
>David Loewe, Jr. wrote:
>> On Tue, 22 Dec 2009 02:36:49 +0000 (UTC), "Keith F. Lynch"
>> <k...@KeithLynch.net> wrote:
>>> Paul Ciszek <nos...@nospam.com> wrote:
>>
>>>> The enormous difference between what the uninsured pay and what
>>>> insurance companies pay for the same care indicates just how much
>>>> costs could be cut without changing anything. In a discussion in
>>>> another newsgroup long ago, someone found an example of a uninsured
>>>> patients being billed $200 just to start an IV, while insurers were
>>>> billed $15. Same hospital, same nurses starting the IV, etc.
>>> Did the hospital have any explanation for the discrepancy?
>>>
>>> I'd refuse to pay the $200, as that's completely ridiculous. Even $15
>>> is very steep for something that takes less than a minute.
>>
>> I've had it to take hours.
>
>For a transfusion it takes 2 hours to put it back in.
The blood or the needle?
>>> If I ever need an IV, I'll start it myself.
>>
>> I don't have good veins.
>
>I ask them to use the back of my hand or lower arm near my wrist as near
>the elbow my veins are hard to find.
I just went ahead and got a port.
Unfortunately, the phlebotomists at the VA are not trained to access a
port, so when I get blood drawn for tests there, I have to go through
the ordeal.
--
"Quantum particles: the dreams that stuff is made of."
- David Moser
Lee Ratner
> In article <hglr8d$65...@reader1.panix.com>,
> Keith F. Lynch <k...@KeithLynch.net> wrote:
>
> >If you put half the population on medical welfare, you'll not only do
> >immense damage to their self esteem, you'll open the floodgates to all
> >other benefits. If someone is accepting one subsidy, why not another,
> >and another, and another? It becomes a Hobbesian war of all against
> >all, in which everyone is out to get whatever they can, at the expense
> >of everyone else. People will also stop donating to voluntary
> >charities.
>
> So how does this gloomy projection compare to the reality of places
> such as Canada, the United Kingdom, and France?
>
reality of Canada, the UK, or France because it would require them to
concede that sometimes, government is the SOLUTION.
This post was not against universal healthcare. I believe that the
American government should use its power to provide universal
healthcare to the American people. However, I think many of my fellow
progressives are missing the forest for the trees in this debate. They
are focused on universal healthcare through a very particular method,
single-payer healthcare. Many of my fellow progressives believe that
this is the ONLY way to provide universal, affordable healthcare to
people.
My problem is that progressives have been arguing for single-
payer healthcare since TR's second run for the Presidency in 1912. We
failed every time. We haven't been able to even make it out of
committee in most of our previous tries. The only time we were really
successful was under LBJ and that was because we tried for single-
payer healthcare for particular groups of people rather than for the
entire population. Even then it was a near thing. I think we
progressives should rethink the situation and maybe try for universal
healthcare on the Bismarckian model rather than the single-payer
model. We might have more luck that way. The Dutch system or the Swiss
system might be particularly good models for us.
The current and flawed healthcare bill represents a baby step
towards a Bismarckian system in the United States. It is the farthest
we have ever gotten towards a healthcare bill that would provide for
near universal through coverage while regulating away some of the
worst practices of the insurance companies. Like many Bismarckian
systems, subsidies from the government will help pay the cost of
insurance for those who need it. Yet many progressives want to kill
this bill and seem only to accept single-payer as a solution. "Single-
payer now, single-payer forever."
This post was basically a bit of rage at my fellow progressives
who only want a single-payer solution. Lets try something else, we
might win. We are certainly not winning on the single-payer argument.
Keith F. Lynch
> gold...@ocf.berkeley.edu (David Goldfarb) wrote:
>> "Keith F. Lynch" <k...@KeithLynch.net> wrote:
>>> If you put half the population on medical welfare, you'll not only
>>> do immense damage to their self esteem, you'll open the floodgates
>>> to all other benefits. �If someone is accepting one subsidy, why
>>> not another, and another, and another? �It becomes a Hobbesian war
>>> of all against all, in which everyone is out to get whatever they
>>> can, at the expense of everyone else. �People will also stop
>>> donating to voluntary charities.
>> So how does this gloomy projection compare to the reality of places
>> such as Canada, the United Kingdom, and France?
> Conservatives, libertarians, and others will never address the
> reality of Canada, the UK, or France because it would require them
> to concede that sometimes, government is the SOLUTION.
I replied to the above yesterday. Are you going to respond, or just
pretend I didn't post at all, and congratulate yourself for having
said something I had not response to?
Keith F. Lynch
>>> I'd refuse to pay the $200, as that's completely ridiculous. Even
>>> $15 is very steep for something that takes less than a minute.
>> I've had it to take hours.
> For a transfusion it takes 2 hours to put it back in.
To start the IV? Or to complete it? Someone doesn't have to be
watching you the whole time.
>>> If I ever need an IV, I'll start it myself.
>> I don't have good veins.
I do. Or so I'm told every time I donate blood. It's never taken
them more than half a minute to start the donation, even if you count
all the rubbing with disinfectant.
Keith F. Lynch
> In previous discussions, I've seen the opposite story as
> well--uninsured patients persuading the hospital to charge them
> considerably less than it charges the insurance company.
That sort of thing rubs me the wrong way. It's one thing for a
procedure to cost a certain large but fixed amount. I can save up
for it, perhaps for years, cutting out books, cons, movies, etc.
But if the person next to me getting the same procedure says, "Doc, I
don't have any money," and the doctor says, "Well then, don't worry
about it. I'll do it for free," that would really bug me.
Whatever the price is, it ought to be the same for everyone.
Keith F. Lynch
> But then I'm not complaining, it's the high price of drugs in the US
> that gives the producers the income and the incentive to continue
> pouring billion of dollars into research that benefit patients not
> just in the US, but in Canada and Europe.
I agree. Patents in the US last 20 years. So the rich get the latest
and potentially greatest medicines, and the rest of us can use the
better-tested medicines, the ones that were available in 1989, which
wasn't exactly the dark ages.
Bringing the price of all medicines down would be a short-term benefit
but a long-term loss, like rioters who loot the stores in their own
neighborhood and are then upset when the stores close and they can't
get necessities even if they're willing to pay.
David V. Loewe, Jr
<k...@KeithLynch.net> wrote:
>Nels Satterlund <Ne...@starstream.net> wrote:
>> David Loewe, Jr. wrote:
>>> "Keith F. Lynch" <k...@KeithLynch.net> wrote:
>>>> I'd refuse to pay the $200, as that's completely ridiculous. Even
>>>> $15 is very steep for something that takes less than a minute.
>
>>> I've had it to take hours.
>
>> For a transfusion it takes 2 hours to put it back in.
>
>To start the IV? Or to complete it? Someone doesn't have to be
>watching you the whole time.
>
>>>> If I ever need an IV, I'll start it myself.
>
>>> I don't have good veins.
>
>I do. Or so I'm told every time I donate blood. It's never taken
>them more than half a minute to start the donation, even if you count
>all the rubbing with disinfectant.
Well, people like you are balanced by people like me. Since they have
to charge a single price for it, they charge based on starting an IV on
someone in between the two extremes.
--
"What can you do when your dreams come true
And it's not quite like you planned?
What have you done to be losing the one
You held it so tight in your hand?"
Don Henley & Glenn Frey
David Loewe, Jr.
<k...@KeithLynch.net> wrote:
>Steve Cooper <Steve....@ccfe.ac.uk> wrote:
>> But then I'm not complaining, it's the high price of drugs in the US
>> that gives the producers the income and the incentive to continue
>> pouring billion of dollars into research that benefit patients not
>> just in the US, but in Canada and Europe.
>
>I agree. Patents in the US last 20 years. So the rich get the latest
>and potentially greatest medicines, and the rest of us can use the
>better-tested medicines, the ones that were available in 1989, which
>wasn't exactly the dark ages.
Someone doesn't understand the drug patenting and approval process...
For example, one of the drugs I am on is Ondansetron [1] - an
anti-emetic (aka anti-nausea) drug.
http://en.wikipedia.org/wiki/Ondansetron#History
"Ondansetron was developed around 1984 by scientists working at Glaxo's
laboratories in London. It is in both the Imidazole and Carbazole
families of heterocyclic compounds. After several attempts the company
successfully filed for U.S. patent protection for the drug in 1986. U.S.
Patent 4,695,578 was granted in September 1987 while U.S. Patent
4,753,789 was granted in June 1988. U.S. Patent 5,578,628, a divisional
patent of U.S. Patent 4,753,789, was granted in November 26, 1996.
Ondansetron was granted Food and Drug Administration (FDA) approval as
Zofran in January 1991. Glaxo did pediatric research on Zofran's uses,
and gained patent extension as a result. Consequently U.S. exclusivity
ended December 24, 2006. The FDA subsequently approved the first generic
versions in December 2006, with marketing approval granted to Teva
Pharmaceuticals USA and SICOR Pharmaceuticals. It is currently marketed
by GlaxoSmithKline (GSK) under the trade name Zofran; other
manufacturers include Cipla Ltd. (Emeset), Gedeon Richter Ltd.
(Emetron), Korea United Pharmaceuticals (Emodan), Zentiva a.s. (Ondemet)
and Novell Pharmaceutical Laboratories (Ondavell). On May 29, 2006,
Baxter Healthcare received tentative approval[1] to market its own label
of Ondansetron Injection, USP, 8 mg/50 mL and 32 mg/50 mL iso-osmotic
sodium chloride solution, after GSK's patent expired on December 24,
2006."
So, approved for use in 1991 and came off extended patent in 2006.
>Bringing the price of all medicines down would be a short-term benefit
>but a long-term loss, like rioters who loot the stores in their own
>neighborhood and are then upset when the stores close and they can't
>get necessities even if they're willing to pay.
[1] I recently had my VA ondansetron prescription refilled. In the
past, neither Medicaid nor the VA have been willing to give me more than
20 of these pills at a single shot because they are so expensive ($16.67
a pill for generic ondansetron from Walgreens). To get the refill, I
had to f=go into the VA clinic and talk to my PCP. She agreed to give
me more, but, since she is a PA, she could not write the script - it had
to be written by an MD. Therefore I couldn't pick it up that day while
at the clinic - so it was mailed to me. Much to my surprise, they sent
me 270 pills - over $4500 worth at the price Walgreens sells them for.
This is so many that I probably won't be able to use them all before
they expire if I take them strictly "as needed" as I have been doing in
the past.
--
"The morning after blues from my head down to my shoes
Carefree Highway let me slip away let me slip away on you."
- Gordon Lightfoot
Nels Satterlund
> On Tue, 22 Dec 2009 08:01:35 -0800, Nels Satterlund
> <Ne...@starstream.net> wrote:
>
>> David Loewe, Jr. wrote:
>>> On Tue, 22 Dec 2009 02:36:49 +0000 (UTC), "Keith F. Lynch"
>>> <k...@KeithLynch.net> wrote:
>>>> Paul Ciszek <nos...@nospam.com> wrote:
>>>>> The enormous difference between what the uninsured pay and what
>>>>> insurance companies pay for the same care indicates just how much
>>>>> costs could be cut without changing anything. In a discussion in
>>>>> another newsgroup long ago, someone found an example of a uninsured
>>>>> patients being billed $200 just to start an IV, while insurers were
>>>>> billed $15. Same hospital, same nurses starting the IV, etc.
>>>> Did the hospital have any explanation for the discrepancy?
>>>>
>>>> I'd refuse to pay the $200, as that's completely ridiculous. Even $15
>>>> is very steep for something that takes less than a minute.
>>> I've had it to take hours.
>> For a transfusion it takes 2 hours to put it back in.
>
> The blood or the needle?
THe blood ...though at times ...
>
>>>> If I ever need an IV, I'll start it myself.
>>> I don't have good veins.
>> I ask them to use the back of my hand or lower arm near my wrist as near
>> the elbow my veins are hard to find.
>
> I just went ahead and got a port.
>
> Unfortunately, the phlebotomists at the VA are not trained to access a
> port, so when I get blood drawn for tests there, I have to go through
> the ordeal.
Oh I have a port (But only for about another week!) but as you've found
out not everyone has the correct needles.
Nels
Like today
Nels Satterlund
> Nels Satterlund <Ne...@starstream.net> wrote:
>> David Loewe, Jr. wrote:
>>> "Keith F. Lynch" <k...@KeithLynch.net> wrote:
>>>> I'd refuse to pay the $200, as that's completely ridiculous. Even
>>>> $15 is very steep for something that takes less than a minute.
>
>>> I've had it to take hours.
>
>> For a transfusion it takes 2 hours to put it back in.
>
> To start the IV? Or to complete it? Someone doesn't have to be
> watching you the whole time.
To complete it. Where I did it they have a room with a number of chairs
so one nurse can keep an eye on a number of people.
>>>> If I ever need an IV, I'll start it myself.
>
>>> I don't have good veins.
>
> I do. Or so I'm told every time I donate blood. It's never taken
> them more than half a minute to start the donation, even if you count
> all the rubbing with disinfectant.
Nels
David Friedman
"Keith F. Lynch" <k...@KeithLynch.net> wrote:
> David Friedman <dd...@daviddfriedman.nopsam.com> wrote:
> > In previous discussions, I've seen the opposite story as
> > well--uninsured patients persuading the hospital to charge them
> > considerably less than it charges the insurance company.
>
> That sort of thing rubs me the wrong way. It's one thing for a
> procedure to cost a certain large but fixed amount. I can save up
> for it, perhaps for years, cutting out books, cons, movies, etc.
>
> But if the person next to me getting the same procedure says, "Doc, I
> don't have any money," and the doctor says, "Well then, don't worry
> about it. I'll do it for free," that would really bug me.
>
> Whatever the price is, it ought to be the same for everyone.
Why?
I give public lectures; you attended one of them. As best I recall, Cato
didn't pay me for that one, although they did arrange for one of their
people to drive me down to Charlottesville afterwards. On other
occasions, I get paid a substantial amount for a similar lecture.
Is it immoral for me to be willing to give the talk for free to Cato and
take a sizeable payment when I give a similar talk for someone willing
to pay it?
Keith F. Lynch
> Keith F. Lynch wrote:
>> Nels Satterlund <Ne...@starstream.net> wrote:
>>> For a transfusion it takes 2 hours to put it back in.
>> To start the IV? Or to complete it? Someone doesn't have to be
>> watching you the whole time.
> To complete it. Where I did it they have a room with a number of
> chairs so one nurse can keep an eye on a number of people.
Blood donation is the same way.
Keith F. Lynch
> "Keith F. Lynch" <k...@KeithLynch.net> wrote:
>> That sort of thing rubs me the wrong way. It's one thing for a
>> procedure to cost a certain large but fixed amount. I can save up
>> for it, perhaps for years, cutting out books, cons, movies, etc.
>> But if the person next to me getting the same procedure says, "Doc,
>> I don't have any money," and the doctor says, "Well then, don't
>> worry about it. I'll do it for free," that would really bug me.
>> Whatever the price is, it ought to be the same for everyone.
> Why?
Let me think about that and get back to you.
Wouldn't you feel the same way?
David Friedman
"Keith F. Lynch" <k...@KeithLynch.net> wrote:
> David Friedman <dd...@daviddfriedman.nopsam.com> wrote:
> > "Keith F. Lynch" <k...@KeithLynch.net> wrote:
> >> That sort of thing rubs me the wrong way. It's one thing for a
> >> procedure to cost a certain large but fixed amount. I can save up
> >> for it, perhaps for years, cutting out books, cons, movies, etc.
>
> >> But if the person next to me getting the same procedure says, "Doc,
> >> I don't have any money," and the doctor says, "Well then, don't
> >> worry about it. I'll do it for free," that would really bug me.
>
> >> Whatever the price is, it ought to be the same for everyone.
>
> > Why?
>
> Let me think about that and get back to you.
>
> Wouldn't you feel the same way?
In general? No. I don't see anything immoral about price discrimination.
Or charity, for that matter.
David V. Loewe, Jr
<Ne...@starstream.net> wrote:
>Keith F. Lynch wrote:
>> Nels Satterlund <Ne...@starstream.net> wrote:
>>> David Loewe, Jr. wrote:
>>>> "Keith F. Lynch" <k...@KeithLynch.net> wrote:
>>>>> I'd refuse to pay the $200, as that's completely ridiculous. Even
>>>>> $15 is very steep for something that takes less than a minute.
>>
>>>> I've had it to take hours.
>>
>>> For a transfusion it takes 2 hours to put it back in.
>>
>> To start the IV? Or to complete it? Someone doesn't have to be
>> watching you the whole time.
>
>To complete it. Where I did it they have a room with a number of chairs
>so one nurse can keep an eye on a number of people.
I've only needed one - a two bagger.
It was done in the same facility where IV chemo is performed at Barnes,
which is like the setup you describe.
>>>>> If I ever need an IV, I'll start it myself.
>>
>>>> I don't have good veins.
>>
>> I do. Or so I'm told every time I donate blood. It's never taken
>> them more than half a minute to start the donation, even if you count
>> all the rubbing with disinfectant.
--
"Clams on the half shell...and rollerskates."
Bernard Edwards & Nile Rodgers
Nels Satterlund
> <Ne...@starstream.net> wrote:
>
>> Keith F. Lynch wrote:
>>> Nels Satterlund <Ne...@starstream.net> wrote:
>>>> David Loewe, Jr. wrote:
>>>>> "Keith F. Lynch" <k...@KeithLynch.net> wrote:
>
>>>>>> I'd refuse to pay the $200, as that's completely ridiculous. Even
>>>>>> $15 is very steep for something that takes less than a minute.
>>>>> I've had it to take hours.
>>>> For a transfusion it takes 2 hours to put it back in.
>>> To start the IV? Or to complete it? Someone doesn't have to be
>>> watching you the whole time.
>> To complete it. Where I did it they have a room with a number of chairs
>> so one nurse can keep an eye on a number of people.
>
> I've only needed one - a two bagger.
>
> It was done in the same facility where IV chemo is performed at Barnes,
> which is like the setup you describe.
All three of mine were two baggers. Four hours! I felt bad for the
young women who were there getting hydrated due to morning sickness,
there was one woman there all three time I went in even though the
visits were separated by weeks. :-(
>>>>>> If I ever need an IV, I'll start it myself.
>>>>> I don't have good veins.
>>> I do. Or so I'm told every time I donate blood. It's never taken
>>> them more than half a minute to start the donation, even if you count
>>> all the rubbing with disinfectant.
Nels
Kip Williams
> David Friedman<dd...@daviddfriedman.nopsam.com> wrote:
>> "Keith F. Lynch"<k...@KeithLynch.net> wrote:
>>> That sort of thing rubs me the wrong way. It's one thing for a
>>> procedure to cost a certain large but fixed amount. I can save up
>>> for it, perhaps for years, cutting out books, cons, movies, etc.
>
>>> But if the person next to me getting the same procedure says, "Doc,
>>> I don't have any money," and the doctor says, "Well then, don't
>>> worry about it. I'll do it for free," that would really bug me.
>
>>> Whatever the price is, it ought to be the same for everyone.
>
>> Why?
>
> Let me think about that and get back to you.
>
> Wouldn't you feel the same way?
FWIW, my senior year in high school, there was a hefty 'activities fee'
-- around $25, which was a chunk -- which we paid promptly. Other
families complained about it, and they decided they didn't have to pay,
but wouldn't give our money back. I did not attend a single 'activity,'
of course.
Kip W
Keith F. Lynch
> FWIW, my senior year in high school, there was a hefty 'activities
> fee' -- around $25, which was a chunk -- which we paid promptly.
> Other families complained about it, and they decided they didn't
> have to pay, but wouldn't give our money back. I did not attend a
> single 'activity,' of course.
Then you have some idea what I'm talking about. Imagine if if the fee
was enormously higher. Perhaps your parents had to sell their house
and move into a small apartment, and also had to give up the college
fund for your and your siblings. And no more vacations. This was
because they were told unless they paid this large sum you wouldn't be
allowed in high school.
And then the family next door -- who are actually slightly wealthier
-- simply tells the school they can't afford this fee, so the school
says, "Okay, then you don't have to pay."
I can't easily put into words why this feels worse than everyone
having to pay the same.
Keith F. Lynch
> I felt bad for the young women who were there getting hydrated due
> to morning sickness, there was one woman there all three time I went
> in even though the visits were separated by weeks. :-(
I was reading about a woman who was hydrated due to morning sickness.
The doctor, reached by phone, told the nurse to give D5W, and to keep
giving more bags until he called back. He forgot about it and never
called back. Can anyone guess what happened? I'll give a hint:
That doctor was very glad he had no-limit malpractice insurance.
David Loewe, Jr.
<k...@KeithLynch.net> wrote:
>Kip Williams <k...@rochester.rr.com, mrk...@gmail.com> wrote:
>> Keith F. Lynch wrote:
>>> Wouldn't you feel the same way?
>
>> FWIW, my senior year in high school, there was a hefty 'activities
>> fee' -- around $25, which was a chunk -- which we paid promptly.
>> Other families complained about it, and they decided they didn't
>> have to pay, but wouldn't give our money back. I did not attend a
>> single 'activity,' of course.
>
>Then you have some idea what I'm talking about. Imagine if if the fee
>was enormously higher. Perhaps your parents had to sell their house
>and move into a small apartment, and also had to give up the college
>fund for your and your siblings. And no more vacations. This was
>because they were told unless they paid this large sum you wouldn't be
>allowed in high school.
>
>And then the family next door -- who are actually slightly wealthier
>-- simply tells the school they can't afford this fee, so the school
>says, "Okay, then you don't have to pay."
Except that you have to prove inability to pay to get charity medical
care...
>I can't easily put into words why this feels worse than everyone
>having to pay the same.
--
"I took a shower and I put on my best blue jeans,
I picked her up in my new VW van.
She wore a peasant blouse with nothing underneath,
I said, Hi, and she said, Yeah, I guess I am."
Dean Friedman
David Friedman
"Keith F. Lynch" <k...@KeithLynch.net> wrote:
> Paul Ciszek <nos...@nospam.com> wrote:
> > The enormous difference between what the uninsured pay and what
> > insurance companies pay for the same care indicates just how much
> > costs could be cut without changing anything. In a discussion in
> > another newsgroup long ago, someone found an example of a uninsured
> > patients being billed $200 just to start an IV, while insurers were
> > billed $15. Same hospital, same nurses starting the IV, etc.
>
> Did the hospital have any explanation for the discrepancy?
>
> I'd refuse to pay the $200, as that's completely ridiculous. Even $15
> is very steep for something that takes less than a minute. If I ever
> need an IV, I'll start it myself.
In previous discussions, I've seen the opposite story as well--uninsured
patients persuading the hospital to charge them considerably less than
it charges the insurance company. Which case is more common I don't know.
--
David Friedman
Michael Benveniste <m...@murkyether.com> wrote:
> On Mon, 21 Dec 2009 18:35:26 -0500, David Friedman
> <dd...@daviddfriedman.nopsam.com> wrote:
>
> >What are the total profits of insurance companies and drug companies,
> >and how do they compare to total health care spending in the U.S?
>
> In 2007, the top 12 drug companies made just under 79 billion dollars
> in profits (Source: Fortune Global 500). According to a lobbying
> group, http://healthcareforamericanow.org/, the top 10 health insurers
> made 12.8 billion dollars. (I presume that's a more relevant number
> than for all forms of insurance.)
>
> Healthcare expenditurs in 2007 in the U.S., according the Health and
> Human Services, were $2.2 trillion.
Thanks.
So if you could reduce that to zero, by a well run government program
that somehow got its needed capital at zero interest rate, you would
reduce total costs by about 4%.
--
David Friedman
"Keith F. Lynch" <k...@KeithLynch.net> wrote:
> David Friedman <dd...@daviddfriedman.nopsam.com> wrote:
> > "Keith F. Lynch" <k...@KeithLynch.net> wrote:
> >> That sort of thing rubs me the wrong way. It's one thing for a
> >> procedure to cost a certain large but fixed amount. I can save up
> >> for it, perhaps for years, cutting out books, cons, movies, etc.
>
> >> But if the person next to me getting the same procedure says, "Doc,
> >> I don't have any money," and the doctor says, "Well then, don't
> >> worry about it. I'll do it for free," that would really bug me.
>
> >> Whatever the price is, it ought to be the same for everyone.
>
> > Why?
>
> Let me think about that and get back to you.
>
> Wouldn't you feel the same way?
In general? No. I don't see anything immoral about price discrimination.
Or charity, for that matter.
--
David Friedman
"Keith F. Lynch" <k...@KeithLynch.net> wrote:
> David Friedman <dd...@daviddfriedman.nopsam.com> wrote:
> > "Keith F. Lynch" <k...@KeithLynch.net> wrote:
> >> That sort of thing rubs me the wrong way. It's one thing for a
> >> procedure to cost a certain large but fixed amount. I can save up
> >> for it, perhaps for years, cutting out books, cons, movies, etc.
>
> >> But if the person next to me getting the same procedure says, "Doc,
> >> I don't have any money," and the doctor says, "Well then, don't
> >> worry about it. I'll do it for free," that would really bug me.
>
> >> Whatever the price is, it ought to be the same for everyone.
>
> > Why?
>
> Let me think about that and get back to you.
>
> Wouldn't you feel the same way?
In general? No. I don't see anything immoral about price discrimination.
Or charity, for that matter.
--
Kevin J. Maroney
<m...@murkyether.com> wrote:
>In 2007, the top 12 drug companies made just under 79 billion dollars
>in profits (Source: Fortune Global 500). According to a lobbying
>group, http://healthcareforamericanow.org/, the top 10 health insurers
>made 12.8 billion dollars. (I presume that's a more relevant number
>than for all forms of insurance.)
>
>Healthcare expenditurs in 2007 in the U.S., according the Health and
>Human Services, were $2.2 trillion.
So those top companies' profits by themselves account for 5% of all
health care spending in the US. That's not insignificant.
In a later post, you added:
>Note that neither income figure says anything about the cost structure
>of the firms nor the efficiency by which those profits are generated.
Forgive me if the following points have been made here recently, but
they're worth repeating fairly frequently.
Agreed. Counting just profits does not take into account the friction
and waste introduced into the system by aggressive marketing of new
pharmaceuticals ("big pharma" spends much more on marketing than on
R&D).
A worse expense is the billions of man-hours of bureaucratic waste at
the medical provider end and at the insurance claim denial end. Every
doctor's office I've been in for the last five years has at least two
administrative support personnel for every doctor and nurse; a very
large percentage of the work time of those administrators is spent
dealing with insurance companies. That's where the biggest savings
from single payer come.
The other really big savings in universal coverage is the expansion of
preventative medicine. You can have universal coverage without
single-payer, but I don't know if anywhere has single-payer without
universal coverage (except for Medicare). The current health care
provision restructuring sitting in Congress provides for universal
coverage, but does very little to streamline payment.
--
Kevin J. Maroney | k...@panix.com | www.maroney.org
Games are my entire waking life.
David Friedman
Kevin J. Maroney <k...@panix.com> wrote:
> On Mon, 21 Dec 2009 20:46:35 -0500, Michael Benveniste
> <m...@murkyether.com> wrote:
> >In 2007, the top 12 drug companies made just under 79 billion dollars
> >in profits (Source: Fortune Global 500). According to a lobbying
> >group, http://healthcareforamericanow.org/, the top 10 health insurers
> >made 12.8 billion dollars. (I presume that's a more relevant number
> >than for all forms of insurance.)
> >
> >Healthcare expenditurs in 2007 in the U.S., according the Health and
> >Human Services, were $2.2 trillion.
>
> So those top companies' profits by themselves account for 5% of all
> health care spending in the US. That's not insignificant.
1/2 %. You misplaced your decimal point.
And, of course, "profits" are in part return on capital. If the
government ran the industry, it would have to pay interest on its
capital too.
...
Keith F. Lynch
> at the medical provider end and at the insurance claim denial end.
> Every doctor's office I've been in for the last five years has
> at least two administrative support personnel for every doctor
> and nurse; a very large percentage of the work time of those
> administrators is spent dealing with insurance companies.
I've heard that there are increasing numbers of doctors who for this
reason either don't take insurance at all or give deep discounts for
patients who pay cash. I hope this is correct.
I'm skeptical that that's the main reason medical care is so
expensive. But if it is, the no-insurance model is sure to do well
(unless government bans it) and cut the insurance companies out.
> That's where the biggest savings from single payer come.
How would that help? Doctors or their employees would still have
plenty of bureaucratic paperwork to fill out to get paid. So what
if it's for the government rather than for an insurance company? At
least with insurance companies there's selective pressure -- the ones
with the most onerous paperwork requirements will find fewer and
fewer doctors willing to sign up, which in turn means fewer and
fewer patients will be willing to sign up. Conversely, government's
paperwork requirements will increase every time there's another
single-payer fraud scandal. And with trillions of dollars available
to doctors, nurses, clinics, hospitals, nursing homes, pharmacies,
medical equipment suppliers, home care providers, hospices, etc.,
there will be plenty of such fraud scandals.
> The other really big savings in universal coverage is the expansion
> of preventative medicine.
We have preventive medicine now. Doctors advise their patients to
quit smoking, eat right, get plenty of exercise, lose weight, use seat
belts, bike helmets, and condoms, wear a hat or sunscreen, and have
certain inexpensive tests (e.g. blood pressure) done regularly.
And people without doctors can find this information online or in
innumerable books, magazines, and newspapers. That doesn't mean
everyone will take this advice, of course.
And even when someone does take this advice, that doesn't guarantee
good health, though it improves the odds.
Seth
Paul Ciszek <nos...@nospam.com> wrote:
>In article <078b22cb-27ef-470b...@b2g2000yqi.googlegroups.com>,
>T Guy <Tim.B...@redbridge.gov.uk> wrote:
>>Unless you pick one particular way of reducing cost: omit the cost of
>>insirance companies and possibly drug companies making profits from
>>the health industry.
>
>The enormous difference between what the uninsured pay and what
>insurance companies pay for the same care indicates just how much
>costs could be cut without changing anything.
Costs for whom? If the insurance companies pay 99% of the time, and
the rest of the time the charge is mostly written off or negotiated,
then the savings from charging everyone the insurance company rate is
well under 1% of the total cost.
> In a discussion in
>another newsgroup long ago, someone found an example of a uninsured
>patients being billed $200 just to start an IV, while insurers were
>billed $15. Same hospital, same nurses starting the IV, etc.
And how many of those uninsured actually paid the $200?
Seth
Seth
David V. Loewe, Jr <dave...@charter.net> wrote:
>On Wed, 23 Dec 2009 00:31:00 +0000 (UTC), "Keith F. Lynch"
><k...@KeithLynch.net> wrote:
>>I do. Or so I'm told every time I donate blood. It's never taken
>>them more than half a minute to start the donation, even if you count
>>all the rubbing with disinfectant.
>
>Well, people like you are balanced by people like me. Since they have
>to charge a single price for it, they charge based on starting an IV on
>someone in between the two extremes.
Why do they have to charge a single price for it? Many businesses
charge for services by the hour.
Seth
Seth
David Loewe, Jr. <dlo...@mindspring.com> wrote:
>On Thu, 24 Dec 2009 02:06:12 +0000 (UTC), "Keith F. Lynch"
><k...@KeithLynch.net> wrote:
>>And then the family next door -- who are actually slightly wealthier
>>-- simply tells the school they can't afford this fee, so the school
>>says, "Okay, then you don't have to pay."
>
>Except that you have to prove inability to pay to get charity medical
>care...
Sometimes. Sometimes you don't.
A doctor I know runs a free clinic 2 days a week. He doesn't require
anything other than that the patients show up and wait their turn.
Seth
Seth
David Friedman <dd...@daviddfriedman.nopsam.com> wrote:
>What are the total profits of insurance companies and drug companies,
>and how do they compare to total health care spending in the U.S? I
>would be surprised if they represented a significant fraction, but I
>don't actually know.
It isn't just the profits of the insurance companies; the amount they
spend deciding whether or not to pay (and fighting having to pay) is a
cost for them, but doesn't help provide healthcare to anybody. The
total revenues of health insurance companies might be a better number
to look at.
Likewise, some expenses of drug companies (e.g. marketing) are only
there to increase profits, not provide health benefits.
Seth
Konrad Gaertner
>
> Likewise, some expenses of drug companies (e.g. marketing) are only
> there to increase profits, not provide health benefits.
Are you implying that the radio ad I hear several times a day, every
day, desperately begging me to keep using a product which I (like
the vast majority of the population) can't legally buy in the first
place, isn't providing any health benefits?
--
Konrad Gaertner - - - - - - - - - - - - email: kgae...@tx.rr.com
http://kgbooklog.livejournal.com/
"I don't mind hidden depths but I insist that there be a surface."
-- James Nicoll
Seth
Keith F. Lynch <k...@KeithLynch.net> wrote:
>> In 2007, the top 12 drug companies made just under 79 billion
>> dollars in profits (Source: Fortune Global 500). According to a
>> lobbying group, http://healthcareforamericanow.org/, the top 10
>> health insurers made 12.8 billion dollars. (I presume that's a
>> more relevant number than for all forms of insurance.)
>
>> Healthcare expenditurs in 2007 in the U.S., according the Health and
>> Human Services, were $2.2 trillion.
>
>four percent of total medical costs.
No, their *profit* does.
> That's obviously not why medical care is so expensive.
And the expenses caused (but not paid) by insurance companies (one
surgeon who operated on me had three full-time employees who only
dealt with insurance companies) aren't included in that calculation,
either.
Seth
David Friedman
wrote:
> In article <ddfr-C7D1B4.1...@newsfarm.iad.highwinds-media.com>,
> David Friedman <dd...@daviddfriedman.nopsam.com> wrote:
>
> >What are the total profits of insurance companies and drug companies,
> >and how do they compare to total health care spending in the U.S? I
> >would be surprised if they represented a significant fraction, but I
> >don't actually know.
>
> It isn't just the profits of the insurance companies; the amount they
> spend deciding whether or not to pay (and fighting having to pay) is a
> cost for them, but doesn't help provide healthcare to anybody.
A public provider of health insurance has the same problem. It doesn't
have an infinite amount of money, and will have to make decisions as to
what it is or isn't willing to pay for.
> The
> total revenues of health insurance companies might be a better number
> to look at.
>
> Likewise, some expenses of drug companies (e.g. marketing) are only
> there to increase profits, not provide health benefits.
That's an exaggeration. Someone has to let potential users know about
drugs, after all.
Seth
David Friedman <dd...@daviddfriedman.nopsam.com> wrote:
>I'm not sure whether what's going on is monopsony power or the implied
>threat that if the drug companies are not willing to sell the drugs to
>the government at the price it is offering, it will refuse to enforce
>their patents.
In Canada, at least, that threat has been more than merely implied.
Seth
Seth
Keith F. Lynch <k...@KeithLynch.net> wrote:
>> That's where the biggest savings from single payer come.
>
>How would that help? Doctors or their employees would still have
>plenty of bureaucratic paperwork to fill out to get paid. So what
>if it's for the government rather than for an insurance company?
It could be a lot less: the government might be satisfied that the
doctor spent X hours treating patients (or per patient), without
having to get into the details of exactly what was done and how much
should be paid for it.
> At least with insurance companies there's selective pressure -- the
>ones with the most onerous paperwork requirements will find fewer and
>fewer doctors willing to sign up,
Nice theory. What does practice say?
> which in turn means fewer and
>fewer patients will be willing to sign up.
Patients don't have much choice. The last time I did was job[-3].
> Conversely, government's paperwork requirements will increase every
>time there's another single-payer fraud scandal.
That's not what I've seen with Medicare. If they really wanted to
stop fraud, they could try punishing it instead of just letting it go
(unless it's too egregious: they'll prosecute companies that invent
patients and claim to have provided equipment to them, but not those
that "merely" put patients and equipment into the wrong category to
increase their payments).
> And with trillions of dollars available
>to doctors, nurses, clinics, hospitals, nursing homes, pharmacies,
>medical equipment suppliers, home care providers, hospices, etc.,
>there will be plenty of such fraud scandals.
Which will differ from today how?
>> The other really big savings in universal coverage is the expansion
>> of preventative medicine.
>
>We have preventive medicine now.
For some people.
And the advice you read in magazines isn't it.
Seth
Keith F. Lynch
> Keith F. Lynch <k...@KeithLynch.net> wrote:
>> And with trillions of dollars available to doctors, nurses,
>> clinics, hospitals, nursing homes, pharmacies, medical equipment
>> suppliers, home care providers, hospices, etc., there will be
>> plenty of such fraud scandals.
> Which will differ from today how?
Did I say it would? With insurance companies, there are limits to the
anti-fraud paperwork burden. Doctors' offices, hospitals, etc., will
only put up with so much. But when there's single-payer, the doctors,
hospitals, etc., either put up with its paperwork burden or they
go out of business. With single-payer there is, by definition, no
competing payer with less paperwork burden.
Actually, it will differ from today in that there will be a lot more
money involved. Even if, as some proponents claim, per-patient
medical costs don't go up (ha!), the total amount of money involved
will go up since more people will be covered. Covering more people
is of course the *whole point* of this alleged reform.
Also, government is less competent at detecting fraud than private
businesses are, since government and its employees will be paid the
same no matter what. And this will encourage fraudsters.
When frauds *are* discovered, they will be much larger.
>> We have preventive medicine now.
> For some people.
> And the advice you read in magazines isn't it.
What do you mean by the term? Anyone who can afford to live indoors
can afford routine medical tests. And "the advice you read in
magazines" includes what tests you should have at what age, and
how often they should be repeated.
That's not to say everyone will follow all of these recommendations,
of course.
Keith F. Lynch
> And the expenses caused (but not paid) by insurance companies (one
> surgeon who operated on me had three full-time employees who only
> dealt with insurance companies) aren't included in that calculation,
> either.
Then doctors who work only for cash, not for insurance, will have a
strong competitive advantage, as they can charge far lower rates.
Unless, of course, government bans that. (That is, by definition,
incompatible with "single payer.")
Paul Ciszek
In article <ddfr-C7D1B4.1...@newsfarm.iad.highwinds-media.com>,
David Friedman <dd...@daviddfriedman.nopsam.com> wrote:
>
>What are the total profits of insurance companies and drug companies,
>and how do they compare to total health care spending in the U.S? I
>would be surprised if they represented a significant fraction, but I
>don't actually know.
According to someone who was involved in the billing end of things,
the amount that insurers spend trying to weasel out of as many claims
as possible, plus the amount doctors, clinics, and hospitals pay the
staff in their billing departments whose job it is to defeat the efforts
of the insurers to weasel out of as many claims as possible, may add up
to as much as a third of what is spent on "health care". This doesn't
show up as a "profit"--indeed, the efforts of the two groups cancel, to
the profit of no one--but only as "operating expenses" that have nothing
to do with actually taking care of sick people.
--
Please reply to: | "Any sufficiently advanced incompetence is
pciszek at panix dot com | indistinguishable from malice."
Autoreply is disabled |
Paul Ciszek
In article <hhblhp$pfg$2...@reader1.panix.com>,
Keith F. Lynch <k...@KeithLynch.net> wrote:
>> And the expenses caused (but not paid) by insurance companies (one
>> surgeon who operated on me had three full-time employees who only
>> dealt with insurance companies) aren't included in that calculation,
>> either.
>
>Then doctors who work only for cash, not for insurance, will have a
>strong competitive advantage, as they can charge far lower rates.
>
>Unless, of course, government bans that. (That is, by definition,
>incompatible with "single payer.")
But not with socialized medicine on the British model.
David Friedman
nos...@nospam.com (Paul Ciszek) wrote:
> In article <ddfr-C7D1B4.1...@newsfarm.iad.highwinds-media.com>,
> David Friedman <dd...@daviddfriedman.nopsam.com> wrote:
> >
> >What are the total profits of insurance companies and drug companies,
> >and how do they compare to total health care spending in the U.S? I
> >would be surprised if they represented a significant fraction, but I
> >don't actually know.
>
> According to someone who was involved in the billing end of things,
> the amount that insurers spend trying to weasel out of as many claims
> as possible, plus the amount doctors, clinics, and hospitals pay the
> staff in their billing departments whose job it is to defeat the efforts
> of the insurers to weasel out of as many claims as possible, may add up
> to as much as a third of what is spent on "health care". This doesn't
> show up as a "profit"--indeed, the efforts of the two groups cancel, to
> the profit of no one--but only as "operating expenses" that have nothing
> to do with actually taking care of sick people.
Do you have a cite to his analysis? "According to someone ... may,"
while interestingly suggestive, isn't by itself much evidence.
Paul Ciszek
In article <ddfr-53B07B.1...@newsfarm.iad.highwinds-media.com>,
David Friedman <dd...@daviddfriedman.nopsam.com> wrote:
>>
>> Likewise, some expenses of drug companies (e.g. marketing) are only
>> there to increase profits, not provide health benefits.
>
>That's an exaggeration. Someone has to let potential users know about
>drugs, after all.
I'll bet that a fair number of doctors, clinics, etc. would be quite
willing to pay a subscription fee for a publication that provided
information--not marketing, not hype, just the facts m'am--about new
medications. In fact, I would be surprised if the existing medical
journals do not already do this in some capacity. If there is no
publication that collects and summarizes this information in one
place with some sort of journalist-like standards of integrity, well,
there should be. It would sell. And it would cost a lot less than
all of those "Ask you doctor for a reason to take Damnitol" commercials.
Paul Ciszek
In article <ddfr-29B919.1...@newsfarm.iad.highwinds-media.com>,
David Friedman <dd...@daviddfriedman.nopsam.com> wrote:
>In article <hhd5qe$bd7$2...@reader1.panix.com>,
> nos...@nospam.com (Paul Ciszek) wrote:
>
>> According to someone who was involved in the billing end of things,
>> the amount that insurers spend trying to weasel out of as many claims
>> as possible, plus the amount doctors, clinics, and hospitals pay the
>> staff in their billing departments whose job it is to defeat the efforts
>> of the insurers to weasel out of as many claims as possible, may add up
>> to as much as a third of what is spent on "health care". This doesn't
>> show up as a "profit"--indeed, the efforts of the two groups cancel, to
>> the profit of no one--but only as "operating expenses" that have nothing
>> to do with actually taking care of sick people.
>
>Do you have a cite to his analysis? "According to someone ... may,"
>while interestingly suggestive, isn't by itself much evidence.
How does one cite an ex-girfriend? Her company developed software
for hospitals, clinics, etc. and the second category--people trying
to defeat the claims-denialists of the insurance companies--was their
bread and butter.
David Friedman
nos...@nospam.com (Paul Ciszek) wrote:
> In article <ddfr-29B919.1...@newsfarm.iad.highwinds-media.com>,
> David Friedman <dd...@daviddfriedman.nopsam.com> wrote:
> >In article <hhd5qe$bd7$2...@reader1.panix.com>,
> > nos...@nospam.com (Paul Ciszek) wrote:
> >
> >> According to someone who was involved in the billing end of things,
> >> the amount that insurers spend trying to weasel out of as many claims
> >> as possible, plus the amount doctors, clinics, and hospitals pay the
> >> staff in their billing departments whose job it is to defeat the efforts
> >> of the insurers to weasel out of as many claims as possible, may add up
> >> to as much as a third of what is spent on "health care". This doesn't
> >> show up as a "profit"--indeed, the efforts of the two groups cancel, to
> >> the profit of no one--but only as "operating expenses" that have nothing
> >> to do with actually taking care of sick people.
> >
> >Do you have a cite to his analysis? "According to someone ... may,"
> >while interestingly suggestive, isn't by itself much evidence.
>
> How does one cite an ex-girfriend? Her company developed software
> for hospitals, clinics, etc. and the second category--people trying
> to defeat the claims-denialists of the insurance companies--was their
> bread and butter.
"No" is an adequate answer.
I'm not objecting to your passing on that sort of soft information--it's
interesting, and I sometimes do the same thing. But it is worth
distinguishing "someone told me that she had estimated that" from "I
have a cite to an article showing how such an estimate was made." In my
experience, guesses get converted into facts in two or three
repetitions, and I think it prudent to slow the process where possible.
Seth
Keith F. Lynch <k...@KeithLynch.net> wrote:
>> And the expenses caused (but not paid) by insurance companies (one
>> surgeon who operated on me had three full-time employees who only
>> dealt with insurance companies) aren't included in that calculation,
>> either.
>
>Then doctors who work only for cash, not for insurance, will have a
>strong competitive advantage, as they can charge far lower rates.
Only for those people who pay cash (and are willing to forego
insurance company reimbursement even if they should be entitled to it,
because the chances of a patient being able to do the appropriate
paperwork are approximately nil).
That's not a large enough market to keep a doctor in business.
Seth
Seth
Konrad Gaertner <kgae...@tx.rr.com> wrote:
>Seth wrote:
>>
>> Likewise, some expenses of drug companies (e.g. marketing) are only
>> there to increase profits, not provide health benefits.
>
>Are you implying that the radio ad I hear several times a day, every
>day, desperately begging me to keep using a product which I (like
>the vast majority of the population) can't legally buy in the first
>place, isn't providing any health benefits?
A friend of mine says that anger is keeping him healthy, so perhaps it
is.
But that isn't the ad's _purpose_.
Seth
Seth
David Friedman <dd...@daviddfriedman.nopsam.com> wrote:
>In article <hhb7c1$1ad$4...@reader1.panix.com>, se...@panix.com (Seth)
>wrote:
>> It isn't just the profits of the insurance companies; the amount they
>> spend deciding whether or not to pay (and fighting having to pay) is a
>> cost for them, but doesn't help provide healthcare to anybody.
>
>A public provider of health insurance has the same problem. It doesn't
>have an infinite amount of money, and will have to make decisions as to
>what it is or isn't willing to pay for.
But it doesn't have any reason to expend effort proving that a
condition was pre-existing so that some other insurer (or the patient)
has to pay for treatment. And it has the incentive to fund the
treatment with the lowest long-term cost, not the one with lowest
one-year cost (because it plans to cancel the patient's insurance
before the end of that year).
>> Likewise, some expenses of drug companies (e.g. marketing) are only
>> there to increase profits, not provide health benefits.
>
>That's an exaggeration. Someone has to let potential users know about
>drugs, after all.
Sending every doctor in the country a monthly (or even weekly)
newsletter listing new drugs, their purpose, indications, and
contra-indications, etc. would cost under 1% of what the drug
companies currently pay for marketing.
Seth
Seth
Paul Ciszek <nos...@nospam.com> wrote:
>In article <ddfr-29B919.1...@newsfarm.iad.highwinds-media.com>,
>David Friedman <dd...@daviddfriedman.nopsam.com> wrote:
>>Do you have a cite to his analysis? "According to someone ... may,"
>>while interestingly suggestive, isn't by itself much evidence.
>
>How does one cite an ex-girfriend?
"Her name, personal communication."
You needn't specify just how personal.
Seth
Keith F. Lynch
> But it doesn't have any reason to expend effort proving that a
> condition was pre-existing so that some other insurer (or the
> patient) has to pay for treatment. And it has the incentive to
> fund the treatment with the lowest long-term cost, not the one with
> lowest one-year cost (because it plans to cancel the patient's
> insurance before the end of that year).
The lowest long-term cost will be the same as the lowest one-year cost
if the patient doesn't live more than a year. It's not as if the
patient's heirs could sue the government for mandating a cheap and
worthless treatment.
David V. Loewe, Jr
As context fades away...
Keith was talking about a large, fixed cost procedure - ostensibly an
operation of some sort.
--
"I would like to electrocute everyone who uses the word 'fair'
in connection with income tax policies."
- William F. Buckley
David Loewe, Jr.
Ciszek) wrote:
>Keith F. Lynch <k...@KeithLynch.net> wrote:
>>Seth <se...@panix.com> wrote:
>>> And the expenses caused (but not paid) by insurance companies (one
>>> surgeon who operated on me had three full-time employees who only
>>> dealt with insurance companies) aren't included in that calculation,
>>> either.
>>
>>Then doctors who work only for cash, not for insurance, will have a
>>strong competitive advantage, as they can charge far lower rates.
>>
>>Unless, of course, government bans that. (That is, by definition,
>>incompatible with "single payer.")
>
>But not with socialized medicine on the British model.
On the gripping hand, it is incompatible with the (original) Canadian
version of universal coverage...
--
"...and Socialist governments traditionally do make a financial mess.
They [socialists] always run out of other people's money. It's quite a
characteristic of them."
- Margaret Thatcher
Keith F. Lynch
47 million uninsured Americans isn't a large enough market to keep a
doctor in business?
Paul Ciszek
In article <ttglj5pqtdejq9ieb...@4ax.com>,
>Ciszek) wrote:
>
>>Keith F. Lynch <k...@KeithLynch.net> wrote:
>>>Seth <se...@panix.com> wrote:
>
>>>> And the expenses caused (but not paid) by insurance companies (one
>>>> surgeon who operated on me had three full-time employees who only
>>>> dealt with insurance companies) aren't included in that calculation,
>>>> either.
>>>
>>>Then doctors who work only for cash, not for insurance, will have a
>>>strong competitive advantage, as they can charge far lower rates.
>>>
>>>Unless, of course, government bans that. (That is, by definition,
>>>incompatible with "single payer.")
>>
>>But not with socialized medicine on the British model.
>
>On the gripping hand, it is incompatible with the (original) Canadian
>version of universal coverage...
Which is why I think the British model is a better one to point to.
It also avoids the "but they all just go south of the border for
American health care" counterargument.
Seth
Keith F. Lynch <k...@KeithLynch.net> wrote:
>Seth <se...@panix.com> wrote:
>> Keith F. Lynch <k...@KeithLynch.net> wrote:
>>> Seth <se...@panix.com> wrote:
>>>> And the expenses caused (but not paid) by insurance companies
>>>> (one surgeon who operated on me had three full-time employees
>>>> who only dealt with insurance companies) aren't included in
>>>> that calculation, either.
>
>>> Then doctors who work only for cash, not for insurance, will have a
>>> strong competitive advantage, as they can charge far lower rates.
>
>> Only for those people who pay cash (and are willing to forego
>> insurance company reimbursement even if they should be entitled
>> to it, because the chances of a patient being able to do the
>> appropriate paperwork are approximately nil).
>
>> That's not a large enough market to keep a doctor in business.
>
>47 million uninsured Americans isn't a large enough market to keep a
>doctor in business?
You're one of them. How much business have you provided doctors in
the last 10 years?
How many of those 47 million get medical treatment *and pay the full
bill*? (Hint: how many of those 47 million can't afford insurance?
They certainly can't afford a full medical bill, either.)
Seth
David Friedman
wrote:
> >47 million uninsured Americans isn't a large enough market to keep a
> >doctor in business?
>
> You're one of them. How much business have you provided doctors in
> the last 10 years?
>
> How many of those 47 million get medical treatment *and pay the full
> bill*? (Hint: how many of those 47 million can't afford insurance?
> They certainly can't afford a full medical bill, either.)
The figure I've seen is that a sizable minority, perhaps a third or more
(I'm going by memory), of the uninsured have incomes above the national
average.
Of course, I would expect those to be largely younger people, with
relatively low need for medical services.
T Guy
wrote:
> In article
> <078b22cb-27ef-470b-a7d1-646a62e2b...@b2g2000yqi.googlegroups.com>,
> T Guy <Tim.Bate...@redbridge.gov.uk> wrote:
>
>
> > (T Guy):
>
> > Unless you pick one particular way of reducing cost: omit the cost of
> > insirance companies and possibly drug companies making profits from
> > the health industry.
( David Friedman <d...@daviddfriedman.nopsam.com> ):
> What are the total profits of insurance companies and drug companies,
> and how do they compare to total health care spending in the U.S? I
> would be surprised if they represented a significant fraction, but I
> don't actually know. Presumably you do know, since without that
> information you can't have any basis for what you just posted--so tell
> us.
(T Guy):
No, sorry, I don't know. I was using the logic that the profits made
by medical insurance and drug companies are the only extra over what
other systems use. It appears this assumption was incorrect regarding
the insurers, at least.
So why does it cost so much? Anyone know?
T Guy
T Guy
>
> > What are the total profits of insurance companies and drug companies,
> > and how do they compare to total health care spending in the U.S? I
> > would be surprised if they represented a significant fraction, but I
> > don't actually know. Presumably you do know, since without that
> > information you can't have any basis for what you just posted--so tell
> > us.
>
> (T Guy):
>
> No, sorry, I don't know. I was using the logic that the profits made
> by medical insurance and drug companies are the only extra over what
> other systems use. It appears this assumption was incorrect regarding
> the insurers, at least.
>
> So why does it cost so much? Anyone know?
(T Guy
Thanks, Paul Ciszek on 29th Dec.
T Guy
Daniel R. Reitman
wrote:
>In article <hhd74m$bd7$5...@reader1.panix.com>,
>Paul Ciszek <nos...@nospam.com> wrote:
Fortunately, my glass was empty when I saw that.
Dan, ad nauseam
David Friedman
<5e536f15-e7c5-42dd...@26g2000yqo.googlegroups.com>,
T Guy <Tim.B...@redbridge.gov.uk> wrote:
One theory that has been offered is that there are large costs
associated with conflicts between insurance companies and their
customers--that the insurance companies spend a lot, directly or via
what they require the providers to do, in order either to:
a. Prevent their customers and providers from cheating them
or
b. Try to cheat their customers.
(or both)
Another theory is that there are lots of unnecessary costs associated
with malpractice liability--both the direct cost of insurance and the
cost of things done to avoid the risk of liability. It's generally
believed that problems of tort liabiliy are much worse in the U.S. than
elsewhere--whether correctly I don't know.
Another theory is that various forms of government regulation, in some
cases used by medical providers to reduce competition, drive up the cost.
Another theory is that, because of the tax advantage to (employer
provided) insurance, people insure when they ought not to--in
particular, insure against costs that aren't large and unpredictable.
That results in costs due to people overusing what the insurance
companies pay for, costs due to the insurance companies trying to
prevent people from overusing, ... .
One further issue might be the requirement of a prescription for many
forms of medicine--a requirement which I think is considerably more
stringent in the U.S. than elsewhere. I've seen it claimed that imposing
that requirment roughly doubled the demand for physician services, with
people going to see a doctor to get a prescription which they would
otherwise have just bought from the drug store.
I'm sure there are other possible explanations. But the one you
initially offered has the advantage that one can easily check it--and
doing so demonstrates that it isn't a plausible answer.
Kevin J. Maroney
Ciszek) wrote:
>>Do you have a cite to his analysis? "According to someone ... may,"
>>while interestingly suggestive, isn't by itself much evidence.
>
>How does one cite an ex-girfriend? Her company developed software
>for hospitals, clinics, etc. and the second category--people trying
>to defeat the claims-denialists of the insurance companies--was their
>bread and butter.
Back in 2003, I posted on my Livejournal about a study in the New
England Journal of Medicine that indicated that a single-payer system
would reduce US health costs by 20%, with the largest single savings
coming from elimination of that bureaucratic friction.
Unfortunately, my post
(http://womzilla.livejournal.com/21228.html?nc=2) linked to an article
in the online version of the Financial Times, and that article is no
longer available. However, one of my friends who worked in a hospital
billing department added this comment:
Here at the hospital, one of the big systems I manage, IDX, has an
entire module dedicated to determining if the charges that a doctor
has entered will pass the muster of the various health insurance
companies. Then, then insurance companies send us the money for the
services that we've rendered in what is possibly the most
complicated way possible, which actually involves them sending it
to us in on phone-book sized listings of payments, accompanied by a
single phat check. We actually employ teams of people to enter this
information back into IDX and our various other financial
databases.
Yes, they could send it digitally. No, they don't. They will once
that part of HIPAA is enforced, but, of course, enforcement of the
part of HIPAA that will actually make life easier for health care
providers has been pushed back.
I don't know what progress has been made on this front in the six
years since that comment.
--
Kevin J. Maroney | k...@panix.com | www.maroney.org
Games are my entire waking life.
Keith F. Lynch
> One further issue might be the requirement of a prescription for
> many forms of medicine--a requirement which I think is considerably
> more stringent in the U.S. than elsewhere. I've seen it claimed
> that imposing that requirment roughly doubled the demand for
> physician services, with people going to see a doctor to get a
> prescription which they would otherwise have just bought from the
> drug store.
Also, doctors can't give indefinite prescriptions. You have to get a
permission slip all over again every year. The hassle and expense of
getting this permission slip reduces patient compliance, and that can
often result in serious complications.
I wish they'd go back to treating adults as adults. The only thing
an adult ought to need in order to buy medicine is money. Yes, some
people will buy the wrong thing, resulting in harm to themselves. But
that's pretty much the definition of adulthood -- being allowed to do
things that if done wrong can seriously harm yourself.
Steve Coltrin
"Keith F. Lynch" <k...@KeithLynch.net> writes:
> I was reading about a woman who was hydrated due to morning sickness.
> The doctor, reached by phone, told the nurse to give D5W, and to keep
> giving more bags until he called back. He forgot about it and never
> called back. Can anyone guess what happened?
She turned into Andy Warhol?
--
Steve Coltrin spco...@omcl.org Google Groups killfiled here
"A group known as the League of Human Dignity helped arrange for Deuel
to be driven to a local livestock scale, where he could be weighed."
- Associated Press
Keith F. Lynch
> "Keith F. Lynch" <k...@KeithLynch.net> writes:
>> I was reading about a woman who was hydrated due to morning
>> sickness.
Oops, that should have been "dehydrated," not "hydrated," of course.
>> The doctor, reached by phone, told the nurse to give D5W, and to
>> keep giving more bags until he called back. He forgot about it and
>> never called back. Can anyone guess what happened?
> She turned into Andy Warhol?
Her blood sodium level dropped too low, and that destroyed nearly all
the motor nerves in her body. So she suffers from locked-in syndrome.
The only thing she can move is her eyes, and even them only up and
down, not left or right.
It doesn't take many cases like that to greatly increase malpractice
insurance premiums. And that cost is of course passed on to patients
or their insurance companies.
David Loewe, Jr.
<k...@KeithLynch.net> wrote:
>David Friedman <dd...@daviddfriedman.nopsam.com> wrote:
>> One further issue might be the requirement of a prescription for
>> many forms of medicine--a requirement which I think is considerably
>> more stringent in the U.S. than elsewhere. I've seen it claimed
>> that imposing that requirment roughly doubled the demand for
>> physician services, with people going to see a doctor to get a
>> prescription which they would otherwise have just bought from the
>> drug store.
>
>Also, doctors can't give indefinite prescriptions. You have to get a
>permission slip all over again every year. The hassle and expense of
>getting this permission slip reduces patient compliance, and that can
>often result in serious complications.
There are vanishingly few instances where it is not a *good* idea to do
at least an annual checkup to see how the medication is affecting you.
Does the dosage need to be upped? Can it be decreased? Does it need to
be changed for some reason?
>I wish they'd go back to treating adults as adults. The only thing
>an adult ought to need in order to buy medicine is money. Yes, some
>people will buy the wrong thing, resulting in harm to themselves. But
>that's pretty much the definition of adulthood -- being allowed to do
>things that if done wrong can seriously harm yourself.
--
"Getting a SCSI chain working is perfectly simple if you remember that there
must be exactly three terminations: one on one end of the cable, one on the
far end, and the goat, terminated over the SCSI chain with a silver-handled
knife whilst burning *black* candles." -- Anthony DeBoer
Jette Goldie
> Steve Coltrin <spco...@omcl.org> wrote:
>> "Keith F. Lynch" <k...@KeithLynch.net> writes:
>>> I was reading about a woman who was hydrated due to morning
>>> sickness.
>
> Oops, that should have been "dehydrated," not "hydrated," of course.
>
>>> The doctor, reached by phone, told the nurse to give D5W, and to
>>> keep giving more bags until he called back. He forgot about it and
>>> never called back. Can anyone guess what happened?
>
>> She turned into Andy Warhol?
>
> Her blood sodium level dropped too low, and that destroyed nearly all
> the motor nerves in her body. So she suffers from locked-in syndrome.
> The only thing she can move is her eyes, and even them only up and
> down, not left or right.
>
> It doesn't take many cases like that to greatly increase malpractice
> insurance premiums. And that cost is of course passed on to patients
> or their insurance companies.
Nurses are trained medical personnel who usually understand quite well
what happens to the body when it's over-hydrated. You're telling me
that *none* of them thought to question the treatment?
--
Jette Goldie
jette....@gmail.com
http://www.flickr.com/photos/wolfette/
http://www.jette.pwp.blueyonder.co.uk/
http://wolfette.livejournal.com/
("reply to" is spamblocked - use the email addy in sig)
netcat
@btinternet.com says...
> Keith F. Lynch wrote:
> > Steve Coltrin <spco...@omcl.org> wrote:
> >> "Keith F. Lynch" <k...@KeithLynch.net> writes:
> >>> I was reading about a woman who was hydrated due to morning
> >>> sickness.
> >
> > Oops, that should have been "dehydrated," not "hydrated," of course.
> >
> >>> The doctor, reached by phone, told the nurse to give D5W, and to
> >>> keep giving more bags until he called back. He forgot about it and
> >>> never called back. Can anyone guess what happened?
> >
> >> She turned into Andy Warhol?
> >
> > Her blood sodium level dropped too low, and that destroyed nearly all
> > the motor nerves in her body. So she suffers from locked-in syndrome.
> > The only thing she can move is her eyes, and even them only up and
> > down, not left or right.
> >
> > It doesn't take many cases like that to greatly increase malpractice
> > insurance premiums. And that cost is of course passed on to patients
> > or their insurance companies.
>
> Nurses are trained medical personnel who usually understand quite well
> what happens to the body when it's over-hydrated. You're telling me
> that *none* of them thought to question the treatment?
And did they get away with it?
rgds,
netcat
Kip Williams
> Steve Coltrin<spco...@omcl.org> wrote:
>> "Keith F. Lynch"<k...@KeithLynch.net> writes:
>>> The doctor, reached by phone, told the nurse to give D5W, and to
>>> keep giving more bags until he called back. He forgot about it and
>>> never called back. Can anyone guess what happened?
>
>> She turned into Andy Warhol?
>
> Her blood sodium level dropped too low, and that destroyed nearly all
> the motor nerves in her body. So she suffers from locked-in syndrome.
> The only thing she can move is her eyes, and even them only up and
> down, not left or right.
So that's a "yes"?
Kip W
Paul Ciszek
In article <hhu7se$c79$1...@reader1.panix.com>,
Keith F. Lynch <k...@KeithLynch.net> wrote:
>> "Keith F. Lynch" <k...@KeithLynch.net> writes:
>>> I was reading about a woman who was hydrated due to morning
>>> sickness.
>
>Oops, that should have been "dehydrated," not "hydrated," of course.
>
>>> The doctor, reached by phone, told the nurse to give D5W, and to
>>> keep giving more bags until he called back. He forgot about it and
>>> never called back. Can anyone guess what happened?
>
>> She turned into Andy Warhol?
>
>Her blood sodium level dropped too low, and that destroyed nearly all
>the motor nerves in her body. So she suffers from locked-in syndrome.
>The only thing she can move is her eyes, and even them only up and
>down, not left or right.
>
>It doesn't take many cases like that to greatly increase malpractice
>insurance premiums. And that cost is of course passed on to patients
>or their insurance companies.
This is one case where the charge "malpractice" seems appropriate.
If it were up to me, though, cases like this would be treated more
like criminal than civil matters--someone gets punished, but no one
makes a profit.
Keith F. Lynch
> This is one case where the charge "malpractice" seems appropriate.
> If it were up to me, though, cases like this would be treated more
> like criminal than civil matters--someone gets punished, but no one
> makes a profit.
Then who will pay to take care of the "locked-in" woman for the rest of
her life? And, quite aside from the cost of her care, isn't she owed
something for the loss of -- well -- everything?
For how much money would you agree to be rendered permanently unable
to move a muscle except your eyes?
Keith F. Lynch
Sorry, all I know about Andy Warhol is that he was an artist who
painted random stuff such as images of soup cans.
Keith F. Lynch
> Nurses are trained medical personnel who usually understand quite
> well what happens to the body when it's over-hydrated. You're
> telling me that *none* of them thought to question the treatment?
Found it! It's in _Trials of an Expert Witness_ by Dr. Harold
L. Klawans. Copyright 1991.
The patient had been unable to keep anything down for several days,
and had a BP of 90/55. The doctor ordered the overnight obstetric
nurse to provide IV D5W (sugar water) until he showed up. He then
forgot all about it. When each IV bag ran out, the nurse hung
another. The nurse only sought help when the patient went into
convulsions the following morning, eight bags later. This was in
a hospital, but only that one nurse was involved.
As always in such books, names and locations have been changed, so
there's no point in my reporting those.
Kip Williams
> Kip Williams<k...@rochester.rr.com, mrk...@gmail.com> wrote:
>> Keith F. Lynch wrote:
>>> Steve Coltrin<spco...@omcl.org> wrote:
>>>> She turned into Andy Warhol?
>
>>> Her blood sodium level dropped too low, and that destroyed nearly
>>> all the motor nerves in her body. So she suffers from locked-in
>>> syndrome. The only thing she can move is her eyes, and even them
>>> only up and down, not left or right.
>
>> So that's a "yes"?
>
> Sorry, all I know about Andy Warhol is that he was an artist who
> painted random stuff such as images of soup cans.
He didn't seem to believe in putting out too much effort.
Kip W
William December Starr
Kip Williams <k...@rochester.rr.com> said:
> Keith F. Lynch wrote:
>
>> Sorry, all I know about Andy Warhol is that he was an artist who
>> painted random stuff such as images of soup cans.
>
> He didn't seem to believe in putting out too much effort.
Not even at self-promotion?
-- wds
netcat
> Paul Ciszek <nos...@nospam.com> wrote:
> > This is one case where the charge "malpractice" seems appropriate.
> > If it were up to me, though, cases like this would be treated more
> > like criminal than civil matters--someone gets punished, but no one
> > makes a profit.
>
> Then who will pay to take care of the "locked-in" woman for the rest of
> her life? And, quite aside from the cost of her care, isn't she owed
> something for the loss of -- well -- everything?
>
> For how much money would you agree to be rendered permanently unable
> to move a muscle except your eyes?
None, unless I was shortly scheduled to die from something anyway and
the money could save someone else I cared about.
rgds,
netcat