Getting Real About Health Care

Why is it that cutting costs and increaseing efficiency always is only directed at health care providers?
Where is the cost cutting and efficiencies from the insurance companies? They are posting record profits, while eating up half of every health care dollar. Why are they gettting a free ride, yet hospitals are closing and squeezing every dollar they can? This country should be absolutely outraged that it costs the same amount of money to actually care for a sick person as it does to process their insurance paperwork.

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There's nothing "dangerous" about health care as a right. It is surely part of the "pursuit of happiness" that the Founders envisioned. After al if you have your health, you have justabout everything...that's what the ad used to say any way. Of course the poor receive nearly as much health care spending as the wealthy: they rely on emergecy room services for their basic health care which is 7 times more costly than a visit ot a GP.
If everyone had access to basic health care without the private insurers involved, many basic illnesses could be treated for far less cost. Ever go into a typical emergency room?? Populated by babies and children and their worried parents. The children often are suffering withh basic childhood sicknesses or the flu, etc. They are seated often alongside the elderly, then on guernies in hall you have gunshot victims...what kind of crazy system is that?? In a single-payer system simple GP visits are covered, annual physicals can be given and much preventive care as a result will prevent the much higher costs of much more serious conditions later... By paying for less costly examinations now for all, we will prevent or reduce the cost of much costlier conditions in the future...this goes for ALL age groups. An adequately funded (use a dedicated tax) single-payer system is really the only alternative to this insanity we now have....get the babies and toddlers, along the elderly out of the emergency rooms and to an MD in their neighborhood...let the gunshot victims use the emergency room...

I agree with the writer that talking about health care as a "right" is dangerous. However, he tries to straw man the argument by dismissing those who want universal health care as someone who wants, "access to unlimited care paid for by someone else." After he burns the straw man down, he ends the article with ???let???s put some limits on this health care thing???. The idea has not even gotten off the ground yet and he wants to start cutting its budget.

For the record, I personally do not think that wanting better access to health care in this country means that someone else is going to be paying my way. I expect that I pay my taxes and so do they. Isn???t that the point of government anyway, Mr. Samuelson? Government is supposed to help the public obtain or produce those things that the individual is unable or unwilling (can???t see the profit) to do, right? That is why they buy those huge expensive warplanes and hadron colliders is it not?

I know the section is called ???Judgment Call???, but next time, let???s stick to the facts. Leave the obfuscation and characterizations for the blogoshere.

Your article is riddled with misstatements and fact picking from research that supports your position while ignoring the larger picture.

You state, "What makes people healthy or unhealthy are personal habits, good or bad (diet, exercise, alcohol and drug use); genetic makeup, lucky or unlucky, and age." While this holds true for some chronic conditions, your list is incomplete and misleading. Infectious disease has little to do with habits, genetic makeup, luck or age. Many of the most deadly and costly forms of cancer are not at all related to genetic makeup, luck, age, or personal habits. Smoking is a deadly habit, but to suggest that personal habits account for the majority of differences in morbidity and mortality is simply not at all true. There are decades of studies in respected medical, social science, and economics journals that demonstrate precisely the contrary.

You cite a study that compares the uninsured and the insured AFTER the onset of major illnesses like cardiovascular disease and diabetes. Insuring everyone is likely to reduce the incidence of major illnesses by reducing risks for a large segment of the population. The use of medicines to control cholesterol and high blood pressure in adults can drastically reduce the risk of serious diseases that require expensive treatments (for example cardiovascular disease). Our current system of fee for service and managed care via private or employer sponsored insurance does not adequately address the goal of a lifetime of inexpensive preventive care. Your article ignores research demonstrating that what is important for long term health isn???t just whether you have insurance today, lapses in health insurance have dramatic and negative consequences.

I agree that Medicare is large and has great bargaining power that is able to shape the entire health care system. You conveniently ignore the fact that private insurers of older adults have consistently been shown to do a poorer job at maintaining the health of older adults than Medicare. Reforming Medicare is not a solution for reforming private/employer purchased insurance and managed care. It is also interesting that large institutions that partially self-insure, or fully insure themselves also do much better at reducing costs than nearly every private managed care firm.

Most frustrating is that you seem to be denying that a policy of universal coverage would have a net social and fiscal benefit, but you present no evidence that directly demonstrates your point. Like you, I am an advocate for efficiency and cost reduction via means such as electronic health records and the elimination of wasteful spending on tests and procedures that do not improve health. However, I am not at all convinced by your reporting that the goal of an efficient health care system runs counter to the goal of health care for everyone.

mnjam, Privatized != GSEs. But go ahead and keep reading the headlines written by economic illiterates. Or maybe you'll read this one and actually learn something -- http://www.denverpost.com/harsanyi/ci_10412852

And this government is who we want to hand our health care over to? Seriously? It's the definition of insanity. No way, no how, no socialized medicine.

You and I are ideological opposites. I am a Libertarian and you are a Socialist. There's no use going around and around anymore. You want industries nationalized. I do not. Not the mortgage industry, not the health care markets, not energy. Nada. I want government completely out of all of it.

"Anything, a dead rat, is preferable to McCain."

I feel the same way about Obama.

As long as there is a third party payer, there will be runaway costs for healthcare. We are insulated from just who is paying for our care and really, do not want to know. We are delusional in thei s regard. When government both insures and delivers healthcare, we have the Canadian system which is on its knees. Previous administrations there introduced clumsy measures in an attempt to control spending by controlling the number of doctors that the universities(govenment funded always) could train. Currently, wait lists and unavailability of doctors mean that people are dying because their much vaunted "FREE" healthcare is for them,actually non-exixtant. We all really need a simple dose of reality. The government can not, will not take care of us. Get used to it.

Healthcare costs are ridiculous. The answer is to address the high costs . Why does someone like Michelle Obama make anywhere from $317,000 to reports of as high as $1 Million dollars a year working for a Chicago Hospital? She saves no lives, Performs no surgery and cannot even administer a $20.00 Aspirin. The healthcare system has THOUSANDS like her.

The fact is that Fannie Mae was entirely successful from 1938 through 1969, when it was privatized. It's purpose was to drive up homeownership rates, which it did from around 40% to 67%, by creating a secondary market for mortgage loans which met certain underwriting guidelines. It did not lose a dime or cost taxpayers a dime. Since 1969, the rate of homeownership has not increased. The "private" Fannie Mae has been a disaster -- just read the headlines. I think Barr is a good choice. Anything, a dead rat, is preferable to McCain.

You're dead wrong, mnjam. But hey, maybe now you and your Socialist Democrats are getting your way (with plenty of help from the Socialist Republicans), you'll finally all shut your whining, complaining mouths once every industry in this country has been nationalized. At some point in the future, I expect my paycheck will go directly to the government, and they will send me back what they think I "deserve" once the "have nots" get "their share" of MY income.

I am disgusted by my fellow countrymens' constant demands for handouts from the government. Have you people no dignity or self-respect?

And at the same time, I am appalled by the breathtaking ignorance of the electorate (as you have just illustrated in spades) thanks to the Orwellian media in this country, and the lies told by our so-called public servants who serve only themselves and care only about their own power.

We are either on the fast track to full-blown Socialism, or another civil war fought by people who have finally had enough of the welfare-welfare state and are done being stripped of their Constitutional liberties. Our brave Founders fought a bloody revolt over far less than this, and they are no doubt rolling in thier graves. "A Republic, if you can keep it." Sorry, Ben. We obviously couldn't, and it was a bipartisan-lead fall of the Republic.

I, for one, am voting for Bob Barr who is the only POTUS candidate who dares to even mention the Constitution, and who is systematically silenced by the political duopoly's strangehold on this nation with an assist by their minions in the media.

Fannie Mae and Freddie Mac turned to crap when they were privatized.

I, for one, do not trust the government to do anything right, especially with regard to my health care. Everything the gubbmint touches turns to crap (See Fannie may and Freddie Mac). The fact of the matter is, the reason health care is so high-priced is because of government intervention. Of course, now that they've trashed the health care market, they want to come in and "fix it." God help us all.

There are two answers. First, health care must be made much more expensive -- then people will use less of it. Second, globalization. Health care tourism. You can get much better care overseas so go overseas. Most competent doctors in this country are from overseas. So why not go to the source.

Something I used to hear from Kaiser was that the primary driver in the cost of health insurance was medications: brand name prescription medications heavily advertised on TV. These medications may be no better than other brand or generic medications, but the advertising creates a demand that doctors can't always counter with simple logic: people trust the actors more than their MD's.

And privately administered Medicare Advantage plans cost the government 30% more than regular Medicare, not to mention all the paperwork and our doctors' time spent arguing with HMO administrators. Medicare's efficiency percentage is in the high 90's. The average Medicare payout per (frequently ailing) senior is approximately $600 per month; private insurance for otherwise health individuals in their 50's and 60's can easily cost more than that.

The health care provider has an interest to maximize costs. The patient wants as much "care" as possible because he pays the same amount (the insurance premium) irrespective of what he consumes. The insurance company tries to lower costs through statistical reports. How can this possibly work? One way to lower costs is to increase a patient's co-payments AND DECREASE the fixed insurance premium.


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I basically agree with Samuelson's diagnosis of our health care system. Not everyone can afford a 2,000+ sq. ft. house, a new car every 2 years, etc. I think there needs to be a basic health care safety net as determined by a select and representative group comprised of senior medical doctors, social workers, economists, etc. Our conventional understanding of basic health care sometimes may include only outpatient services, etc. By basic health care I mean total coverage that would include essential surgery, hospital stays, etc. And I think registered nurses could do much more of the initial processing and basic treatment. Giving seniors (of which I am one) heart bypass surgery that may have minimal at best results is probably more than our society can afford to pay. However, re. Medicare and Social Security benefits, why does the government, as expressed by President Bush, think we will be lucky to get our money back? Al Gore wanted to put Social Security benefits in a lock box. Social Security collected funds should be making a good interest rate on all the money the U.S. government has taken (stolen?) from it. I think that interest compounded would have paid for any future social security benefit deficits for the next 30+ years. Returning to health care in general, I think beyond the basic health care there must be an option for individuals to add to that benefit by individually paying for addtional health insurance which might be part of a group health care plan, or an individual plan. This additional insurance would cover types of medical treatment that would be too costly for society to be able to pay for every U.S. citizen. With greater use and manufacturing of medical equipment, etc. the cost of these forms of additionally insured for treatment might be reduced, so that these treatments might later become part of the basic guaranteed medical health care.