Controlling healthcare costs.

[nitePhyyre]

And again, it's not clear to me at all that medical tourism figures even constitute a valid measure of healthcare system efficiency, as there are many other variables that can greatly influence those figures.

Statistically, the United States has higher survival rates for trauma care, serious illness, long-term illness, you name it, than nearly anyplace else in the world. We also enjoy shorter wait times for both emergency and non-emergency medical care. There is a reason that people come here from around the world when it really matters, rather than vice-versa.[snip]

This simply isn't true. Let's compare the US to Canada and the UK.

Originally, gavin wasn't making a point. He was just showing that cphite was wrong.

The person walking into a hospital doesn't buy healthcare. They buy insurance. Insurance companies buy healthcare. And yes, hospitals advertise their prices to insurance companies. That's why there are a bunch of Insurance policies that only cover services received in certain hospitals.

Insurance companies benefit as the prices are driven higher because they usually get the same percentage of profit regardless (so a larger pie means more money). They don't accept some hospitals because they still need to keep their premiums in competition with other companies so they need to have some sort of control over their intake vs. output.

If the insurance industry was a cartel, then yes, you would be right.

This seperation between the person and the cost of the care they're recieving is exactly one of the problems I'm talking about.

It isn't a problem, it is how the market works. Do you know what would happen if your idea came to pass, if there was a sign with all the prices of the different procedures listed on it? People would walk right past it without giving it a glance. They have insurance, they aren't buying their care piece-meal. Why would they care about piece-meal prices when they have insurance?

Additionally, can you even put up a price list? Something can go wrong in a surgery and it can take all day instead of a couple of hours. How do you reflect that on advertised prices? Although it would be kind of funny:
-$1500 per bullet removed (Stitches extra)

[Zamfir]

-$1500 per bullet removed (Snitches extra)

[stevenf]

Here's an illuminating recent study of cost-effectiveness:

http://image.guardian.co.uk/sys-files/G ... itWall.pdf

[gavin]

If the insurance industry was a cartel, then yes, you would be right.

Aren't they?

This seperation between the person and the cost of the care they're recieving is exactly one of the problems I'm talking about.

It isn't a problem, it is how the market works. Do you know what would happen if your idea came to pass, if there was a sign with all the prices of the different procedures listed on it? People would walk right past it without giving it a glance. They have insurance, they aren't buying their care piece-meal. Why would they care about piece-meal prices when they have insurance?

Additionally, can you even put up a price list? Something can go wrong in a surgery and it can take all day instead of a couple of hours. How do you reflect that on advertised prices? [/quote] I actually pointed the solution to all of this already.
1. Insurance companies should incentivize their customers to choose cheaper options. Anything from a lower premium to direct savings from out of pocket expenses. Just like we have in network and out of network providers, a tier could be provided for cost effective options that may end up saving them money. Two different providers in the in-network providers list may/do provide services at different costs. Therefore, to the insurance company, one is better than the other. I'm not talking about keeping the same system, everything needs to be tweaked a bit.

2. Most procedures (I'm guessing) aren't emergency (as in, requiring hours or just a few days or the person will die). Things like long-term cancer treatments, the family doctor one goes to (not expensive usually), most surgeries, etc. Patients should eventually have a plan for emergencies (such as which hospital the ambulances should take them to). It's actually a kind of cornering of the market that ambulances provide by only taking patients to those hospitals. I know it sounds a bit ridiculous to have medical emergency taxies, but it should help preventing the medical ogliopoly we're seeing today.

Although it would be kind of funny:
-$1500 per bullet removed (Stitches extra)

My day just got better, thank you.

[Emilia27]

Lots of things are contributing toward the rise not the least of which is that wages haven't kept pace with true inflation for the past 40 years, meaning anything created domestically like the health care industry is going to outpace anything we can get offshore in cost increase over time relative to wages.

Another thing driving costs is administrative overhead, from redundant bureaucracies in competing plans to bureaucracies in everything from doctor's offices and hospitals to deal with the often Byzantine paperwork they generate. Greed comes into play here because this is where the cadres of people whose jobs are to delay or deny coverage and care come in. It also covers stockholder profit and executive pay, plus advertising.

Still another thing is redundancy of expensive technology within a health care market. It's no secret that MRI scanners have been ridiculously overbuilt in this country, each competing hospital feeling the necessity to have the latest generation machine at all times when one or two machines would likely serve the whole market as well. This is why the Canadians famously schedule their MRI scans in the US. We overbuilt and charged ourselves a fortune for the privilege so they didn't have to.

Health care itself is labor intensive, and that will always drive costs that can't be contained without degrading service to the point it becomes more dangerous to seek care than do without it. We're almost there now, with cost cutting on the backs of health care staff at the maximum.

Single payer, the elimination of redundant bureaucracies, the consolidation of services and the common sense specialization of hospitals, and strict regulation can reduce the ridiculous costs we're bearing now while covering us all. However, don't ever expect health care to be inexpensive. That's why insurance to cover it is so desperately needed. Until we can pick and choose when and how to become ill, health care can't be forced into the consumer marketplace as a way to cut costs.

It just doesn't work that way.

[Cleverbeans]

The primary problem with healthcare costs in the US is the existence of the health insurance industry. The provide zero value to the health care process, and instead act as a middle man siphoning off legitimate funds while creating unnecessary red-tape for health care professionals. Beyond that, the hippocratic oath is in direct conflict with economic self-interest, and more or less exposes the free-market fallacy as applied to health care.

[CorruptUser]

Lots of things are contributing toward the rise not the least of which is that wages haven't kept pace with true inflation for the past 40 years, meaning anything created domestically like the health care industry is going to outpace anything we can get offshore in cost increase over time relative to wages.

The difference between inflation and wages can be explained entirely by payroll taxes; officially the employer pays them with no effect on wages, realistically anyone with any understanding of Economics 101 will tell you that's bullshit and the taxes are paid for through lower wages. If the employer is willing to pay $20/hr, and the payroll tax is 33%, that means the employer will pay at most $15 to the employee and $5 to the taxes. Yet, the 'official' wage will be $15 when it's really $20.

Another thing driving costs is administrative overhead, from redundant bureaucracies in competing plans to bureaucracies in everything from doctor's offices and hospitals to deal with the often Byzantine paperwork they generate. Greed comes into play here because this is where the cadres of people whose jobs are to delay or deny coverage and care come in. It also covers stockholder profit and executive pay, plus advertising.

The extra paperwork is caused by the legal system; less paperwork equals more risk in case of lawsuit. Think hospitals, which are strapped for cash, or those 'greed doctors' want to waste money doing the paperwork unless they were required to? Plus, all the unnecessary testing and 'aggressive medicine' that often does more harm than good (all tests do SOME kind of damage to the body), that's primarily done because even the most obvious hypochondriac gets sick, and if the doctor misses it s/he can be liable. Blame the ABA not the AMA.

The primary problem with healthcare costs in the US is the existence of the health insurance industry. The provide zero value to the health care process, and instead act as a middle man siphoning off legitimate funds while creating unnecessary red-tape for health care professionals. Beyond that, the hippocratic oath is in direct conflict with economic self-interest, and more or less exposes the free-market fallacy as applied to health care.

I... I don't think you actually understand the health insurance industry. Or any insurance. Or basic economics. At all.

Here, let me get you started on some basics.

[Cleverbeans]

I don't think you actually understand the health insurance industry. Or any insurance. Or basic economics. At all.

I'm completely aware of the system failure of capitalism, they myth of rational self-interest, and the widespread ignorance that the efficient-market hypothesis is completely unsubstantiated by empirical evidence. Perhaps you should consider reading the subsection titled "quantifying utility", or if you prefer I'll summarize - "utility theory is non-scientific bullshit based on verifiable false assumptions". Your faith in modern economic theory is misplaced.

Beyond that, since doctors will treat you regardless of your ability to pay it's a public good. Privatized insurance allows individuals to receive care without paying for it, which leads immediately to the free-rider problem. Beyond that, health care is a lemon market, and since health-care is a life and death issue consumers require reasonable protection against exploitation. By and large the medical community has done an excellent job building the public trust, the insurance industry however has no such compunction. Between the lack of professional ethics and corporate profit motive insurance companies have a systemic bias toward unethical behavior for personal gain. All of these factors lead point to a single solution - socialized health insurance. Americans continue to ignore the fact that every other industrialized nation on earth pays less, and has better health outcomes than US which is the single example of a fully private health care system.

Oh, and of course, one could argue that letting babies die for profit is evil, but it's very difficult to convince the ownership class that they aren't entitled to do it. With that in mind, Even Bill O'Reilly recognizes that we're being screwed over, it's hardly controversial...

[CorruptUser]

1) No country has ever had pure capitalism, ever. Because everyone (except the Randians) knows it doesn't work in all situations. Just as there has never been pure Communism, because everyone (except the Marxists) knows it doesn't work.
2) Markets have been proven to be efficient. Very efficient. Even more efficiently than humans, thanks to computers. Just because they don't choose the equilibrium point that you think it 'should' doesn't mean they don't work.
3) The entire point of government in a 'capitalist' society is a) to regulate and police the market to prevent 'cheating' such as coercion, false advertising, violation of contracts, etc, and b) provide the goods/services the free market can't, such as security, public education, etc. Yes, it's possible that rudimentary healthcare is included.
4) The reason for the 'flaw' that you see in capitalism is because government is not impartial, because of lobbying and fundraising, and so forth. One of the few things I agree with the OWSers about.
5) Most people have higher utility by paying $12.5k a year than having a 10% chance of paying $100k a year. THAT is why insurance exists.
6) As I always say, if you think you can do a better job than X, why aren't you? In this case, if doctors are sooo overpaid, why the hell didn't you become a doctor? Don't say "I couldn't afford medschool" or some other lame excuse, because there are MANY doctors who worked their asses off and got scholarships and worked their way through college/grad-school.

[mmmcannibalism]

they myth of rational self-interest

The myth of rationally considering what will make your life the most satisfactory and choosing to act based on your understanding of that information...seems very mythical.

[Cleverbeans]

1) No country has ever had pure capitalism, ever. Because everyone (except the Randians) knows it doesn't work in all situations. Just as there has never been pure Communism, because everyone (except the Marxists) knows it doesn't work.

Red herring - the US is the only country in the developed world with fully privatized health insurance.

2) Markets have been proven to be efficient. Very efficient. Even more efficiently than humans, thanks to computers. Just because they don't choose the equilibrium point that you think it 'should' doesn't mean they don't work.

This is simply false, empirical evidence has consistently shown markets are inefficient.

3) The entire point of government in a 'capitalist' society is a) to regulate and police the market to prevent 'cheating' such as coercion, false advertising, violation of contracts, etc, and b) provide the goods/services the free market can't, such as security, public education, etc. Yes, it's possible that rudimentary healthcare is included.

We certainly agree there, that's in fact exactly why I'm advocating nationalization of the health insurance industry.

4) The reason for the 'flaw' that you see in capitalism is because government is not impartial, because of lobbying and fundraising, and so forth. One of the few things I agree with the OWSers about.

A second red herring, my objections to capitalism are distinct from my objections to cronyism, and have little to do with the ownership classes influence over the government.

5) Most people have higher utility by paying $12.5k a year than having a 10% chance of paying $100k a year. THAT is why insurance exists.

There is nothing wrong with a group of people pooling their resources to reduce risk, it's simply a question of who should be controlling that pool, and how they should be allowed to use it.

6) As I always say, if you think you can do a better job than X, why aren't you? In this case, if doctors are sooo overpaid, why the hell didn't you become a doctor? Don't say "I couldn't afford medschool" or some other lame excuse, because there are MANY doctors who worked their asses off and got scholarships and worked their way through college/grad-school.

Three red herrings in one post? Insurance companies are not doctors...

[pizzazz]

Cleverbeans, you are going to be hard-pressed to prove that "empirical evidence has shown markets are inefficient" as anyone who has cracked open an introductory economics textbook knows that the vast majority of serious economists disagree with you. Similarly, any such person should be able to explain to you why a nationalized health market is a Bad Idea (I actually quoted a relevant passage in the other health care thread). And if they read a little further, said economics textbook will probably have a fair amount of evidence supporting the efficient markets hypothesis.

The free-rider problem is not really a problem here because anyone can choose not to pay the costs for others. Moreover, it is not invalid to view insurance as merely selling risk reduction. This is a real good with real utility and benefit, and those who do not pay do not receive this good.

And no, no other country has superior health care to the US; please actually read all of that WHO study before blindly repeating it.

There is nothing wrong with a group of people pooling their resources to reduce risk, it's simply a question of who should be controlling that pool, and how they should be allowed to use it.

In an open market, the controller is implicitly agreed upon by anyone voluntarily entering the pool. He/she/it should be allowed to use it in any way he/she/it does not contractually agree not to use.

What is hard or controversial about this? Oh right, it's only a "problem" because you don't think it should be voluntary.

[Soralin]

5) Most people have higher utility by paying $12.5k a year than having a 10% chance of paying $100k a year. THAT is why insurance exists.

Most people have higher utility paying $10k a year, then they have paying $12.5k a year. He wasn't looking at the difference between the existence of insurance and nothing, but instead, between insurance and something like single payer. If the government payed for medical costs, then the total would only be the actual medical costs. That $2.5k/person/year in the example above, that currently goes to the insurance companies, could be eliminated entirely without any loss in service.

[CorruptUser]

That would be impossible. Most insurance policies pay 80 cents for every dollar received in premiums (which is why I had $12.5k premium for $10k expected costs). 10 cents goes to marketing costs, including salesmen. 5 cents goes to legal and fraud detection, and even then, fraud is still huge. The remaining 5 cents is administrative costs, and maybe a penny of that is profit.

Eliminate the profit, and the insurance is maybe 1% cheaper in the short-run; in the long-run nonexistent. Eliminate the marketing, the insurance may theoretically be 10% cheaper, but that's meaningless because you won't sell any policies and the administrative costs (being fixed) would quickly bloat.

As for single payer, you will STILL have fraud detection and administrative costs. Administrative costs which, being government, will easily bloat and become larger than the private sector's marketing costs. The public sector is notorious for being unable to rid itself of incompetent/redundant employees, inflated pensions, etc, so don't think it will be cheaper. And if Medicaid/Medicare/IRS/SEC is anything to go by, government is crap at fraud detection.

[Yakk]

Hypothesis: Health care under government will have bloated administrative costs.

Prediction: Canada will have a much higher administrative cost than US for health care.

Test: Failed.

http://www.nejm.org/doi/full/10.1056/NEJMsa022033

Conclusion: Hypothesis rejected.

[CorruptUser]

You do realize that Canada and the US have different legal systems, right? As in, the primary reason for health administrative costs in the first place?

And that the Canadian and American governments are run differently, and that the US government is far more notorious for administrative waste than Canada's?

And most importantly, I'm referring to the administration costs in running an insurance company, not a hospital or the health system overall? For a decent comparison, go look at Medicaid's costs. As much as I hate the Heritage foundation, here is something they have to say.

[Yakk]

You had a hypothesis. I tested it against reality. It failed. Feel free to come up with non-rhetorical examples of universal public health care with high administrative costs.

The heritage foundation link points out that much of the costs has to do with excluding service from the unworthy (enrollment issues). Canadian health care administrative costs are lower than US enrollment administrative costs.

The claim you made was that administrative bloat was inevitable under a public system. This claim is blatantly falsified. A nation with comparable health care outcomes (and better health outcomes) can, using a public system, spending as little per capita as the US does on their limited-enrollment public spending (All of Canadas health care spending, public and private, as a percentage of GDP, is less than what the US government alone spends on health care -- and then US private spending is greater than US public spending on top of that). Meanwhile, it has a lower per-person and percentage-of-expenditures administrative cost.

If your theory was right, the above situation wouldn't be possible, because Canadian administrative costs would bloat up. Or is the bloat supposed to be so small as it isn't important compared to other things?

[Soralin]

That would be impossible. Most insurance policies pay 80 cents for every dollar received in premiums (which is why I had $12.5k premium for $10k expected costs). 10 cents goes to marketing costs, including salesmen. 5 cents goes to legal and fraud detection, and even then, fraud is still huge. The remaining 5 cents is administrative costs, and maybe a penny of that is profit.

Eliminate the profit, and the insurance is maybe 1% cheaper in the short-run; in the long-run nonexistent. Eliminate the marketing, the insurance may theoretically be 10% cheaper, but that's meaningless because you won't sell any policies and the administrative costs (being fixed) would quickly bloat.

As for single payer, you will STILL have fraud detection and administrative costs. Administrative costs which, being government, will easily bloat and become larger than the private sector's marketing costs. The public sector is notorious for being unable to rid itself of incompetent/redundant employees, inflated pensions, etc, so don't think it will be cheaper. And if Medicaid/Medicare/IRS/SEC is anything to go by, government is crap at fraud detection.

Yeah, it's not profit that's the big thing, it's that if you go to single-payer, and thus essentially eliminate insurance, you eliminate all of their costs, not just profit.

Fraud and administrative costs should be significantly less as well. I mean, if someone needs a treatment, then they get it, what is there to administer there? For insurance companies, they have to deal with a whole additional level of customer service, and dealing with claims, dealing with all those individuals making payments, and marketing related stuff, like making deals with hospitals for preferential service or pricing. As well as denying service because of things like preexisting conditions, or because you didn't fill in the forms right, or just because they can get away with it, and spend less on average in legal fees for denying service than they would have for providing it. That covers a lot of the legal and fraud stuff they do as well, which may often be focused on if patients get treatment or not. You could eliminate that whole side of it, since if everyone is covered, patient fraud becomes impossible, you only have to worry about the hospital side.

A government wouldn't have to deal with any of those things, payment is already handled through the IRS, and made by the same people who do so already, there's no additional overhead there. There's no need to hire a bunch of people to try and figure out what claims, and how many claims, that they can deny, and turn a profit off of doing so. When your only policy is that everyone is covered, always (or at least, that x set of procedures is always covered) there's not a whole lot of administration required.

And yeah, advertising costs are obviously unnecessary in such a scenario.

And most importantly, I'm referring to the administration costs in running an insurance company, not a hospital or the health system overall?

Well that's the point, if everyone is covered, then there is no insurance system, the government isn't providing insurance, they're just paying the medical bills directly, the only costs are those of the hospitals or the health system overall. There's no need to deal with who's covered, and who's not, and all the potential reasons for that, when the answer to "who's covered?" is "everyone". It makes the sort of administration that is done by insurance companies, but not hospitals or the overall health system, into something trivial.

[CorruptUser]

If you go to single-payer, and thus essentially eliminate insurance, you eliminate all of their costs, not just profit.

You will always have administrative costs.

I mean, if someone needs a treatment, then they get it, what is there to administer there?

It's called fraud. I even saw you use that word in your post, but I was uncertain as to whether you understood what it meant. The hospital/doctor has to prove that the treatment was both rendered and necessary, unless you think that the government just writes a check every time a hospital files a claim. Which it seems to, as evidenced by the proliferation of medical mills*; in which case your medical costs will rise due to fraud.

And don't think legal expenses will disappear.

All you eliminate is marketing and profit, for a ~11% reduction in cost. Short run. Long run costs are much, much higher.

*I have a theory as to why this is. Medicaid is 50% funded by the Fed, 25% by State, 25% by county. Every quarter stolen from the county is a dollar spent in that county, for a gain for that county. Every quarter stolen from the state is a dollar spent in the state, for a gain for the state. It might cost 50 cents, but it's still an extra dollar in the country, and besides, the states and counties wouldn't lie to the Fed, would they? So everyone grows fatter because everyone gets a slice of everyone else's pie. The fact that no one involved is actually baking pies...

[Yakk]

All you eliminate is marketing and profit, for a ~11% reduction in cost. Short run. Long run costs are much, much higher.

And yet, other nations save far, far more than that off administration with a single-payer model than 11%. More like 66% than 11%.

The OECD median administrative costs is 1/6th what the US pays. That's 83% savings, not the 11% you claim. And as a percentage of health care spending, it is 1/3 what the US spends.

The only OECD nation that has a higher admin overhead is Luxembourg (which happens to also be one of the only 2 OECD nations with a bigger per-capita health care spending from the government. That's right, every other OECD nation (except Mexico) spends less per capita on their health care just counting government spending -- and manages to provide something like universal coverage with it. The US's choice to provide free health care only to the most expensive people (over 65 group) generates lots of suffering, little savings, and lots of admin overhead and profit.) Note that Lux is also a huge outlier -- behind the USA, the next highest admin cost nation is France, who is about 1/2 the admin cost of the USA.

Basically, with the exception of one small nation (which happens to have a GDP per capita 130% higher than the USA), every first world nation has managed to at least halve their administrative health care costs compared to the USA. A myriad of nations with government bureaucracies which provide a darn close semblance of universal health care that have magically avoided your inevitable claims of admin cost bloat, who deliver this universal health care in almost every case for less than the USA government health care budget is to every citizen.

I'm really not sure at what level of actual evidence you'd consider your hypothesis (that administrative bloat would grow massively under a government-run plan) to be invalidated. Would I have to build an few 100 universes in which everything was exactly the same, then run the experiment in a double-blind fashion? With a few universes getting placebo universal health care?

[CorruptUser]

Like I said before, other countries are not burdened with the American legal system. The US is the only Developed country where the loser doesn't have to pay legal costs.

What works in other countries won't necessarily work in the US.

[Yakk]

So the answer is "none", no possible experience outside of the USA matters, because the USA is exceptional.

Despite the fact that admin costs have not ballooned without bound outside of the USA, in the USA any admin costs would massively balloon without bound if they where government based. Because you have faith that this is so, not because you have any evidence you can pull out at all, but just because.

Is that roughly your position? Because I'm having problems imagining why someone would think that position is a good one to hold.

[CorruptUser]

First of all, ALL countries are unique, and have their own problems. What works in France won't necessarily work in Spain.

Second, are you actually asking for evidence of bureaucratic bloat in the US government? Where would you like the evidence from, US examples only? Government postal service vs Fedex? The fact that the government can't even handle its own hiring procedures?

[stevey_frac]

First of all, ALL countries are unique, and have their own problems. What works in France won't necessarily work in Spain.

It's true, that what works in one country won't necessarily work in others. However, universal health care works in Austria, Denmark, Finland, France, Germany, Ireland, Italy, Holland, Norway, Sweeden, Switzerland, Australia, New Zealand, Canada, and England. To name a few. So... perhaps it's time to take a peek at it?

Also, despite the vaunted status of the American system... People live longer in Canada. Despite the freakin cold. I'm not sayin, i'm just sayin...

[mmmcannibalism]

First of all, ALL countries are unique, and have their own problems. What works in France won't necessarily work in Spain.

It's true, that what works in one country won't necessarily work in others. However, universal health care works in Austria, Denmark, Finland, France, Germany, Ireland, Italy, Holland, Norway, Sweeden, Switzerland, Australia, New Zealand, Canada, and England. To name a few. So... perhaps it's time to take a peek at it?

Also, despite the vaunted status of the American system... People live longer in Canada. Despite the freakin cold. I'm not sayin, i'm just sayin...

How fat are people in Canada?

[CorruptUser]

Try breaking it down by state when comparing countries to the US. Life expectancies vary wildly by state, as do overall education and other common statistics used to compare countries. And by wildly, I mean wildly, though a pattern does emerge. Mississippi is a continuous source of embarrassment for the US. Comparing the entire US to the 'best' countries in Europe is about as fair as comparing the 'best' states in the US to all of Europe (former Iron Curtain included).

Perhaps we should copy the health systems of Hawaii, Minnesota, and Connecticut instead?

[Cleverbeans]

How fat are people in Canada?

They're much thinner, in no small part due to public health care. Nutrition and active living educational initiatives are part of a comprehensive health care program, something very much missing in the US system. The same goes for alcohol and tobacco use.

[pizzazz]

How fat are people in Canada?

They're much thinner, in no small part due to public health care. Nutrition and active living educational initiatives are part of a comprehensive health care program, something very much missing in the US system. The same goes for alcohol and tobacco use.

This is patently false. The US government mandates education in all of these areas in government schools, though it falls under the auspices of education rather than health care. There's also the presidential fitness challenge and any number of independent organizations devoted to educating young people about drugs and alcohol.
The effectiveness (or lack thereof) of such methods may be chalked up to a variety of sources, many having to do with government education here, but very few having to do with the health care system.

[Cleverbeans]

This is patently false. The US government mandates education in all of these areas in government schools, though it falls under the auspices of education rather than health care. There's also the presidential fitness challenge and any number of independent organizations devoted to educating young people about drugs and alcohol.

Yet cigarettes are a fraction of the price, have stronger filters, and giant warnings in the package, all missing in the US. Almost nothing is done to regulate food advertising by comparison, in particular advertising targeting children. All of this policy centered around the health care debate, because when it's part of the government, people simply start taking it seriously. The cultural and emotional realities of socialized health insurance are one of the greatest benefits it has over the private system.

[CorruptUser]

Speaking of food, I really don't see how taxing grease/sugar/salt in food is all that different than taxing tobacco or alcohol. That seems to be the current debate, what with Michelle Obama's "war on greasy food" or however it's framed by certain parts of the media.

[pizzazz]

This is patently false. The US government mandates education in all of these areas in government schools, though it falls under the auspices of education rather than health care. There's also the presidential fitness challenge and any number of independent organizations devoted to educating young people about drugs and alcohol.

Yet cigarettes are a fraction of the price, have stronger filters, and giant warnings in the package, all missing in the US. Almost nothing is done to regulate food advertising by comparison, in particular advertising targeting children. All of this policy centered around the health care debate, because when it's part of the government, people simply start taking it seriously. The cultural and emotional realities of socialized health insurance are one of the greatest benefits it has over the private system.

In the US, none of these things are regulated by any of the health care bureaucracies, and none of it proves that US health care is less effective.

The price and effects of cigarettes is only relevant if the government is gauranteeing health care. As with some other things, the US may be in the worst possible spot here, paying for effects without regulating their cause, so you could use it to argue for less government spending on health care as much as anything else (also, cigarettes do have labels here, though not quite as large). Similarly, you mention food advertising; that's only relevant if you assume that you're going to pay for every fat person to get heart surgery at age 30.

I'm still trying to get some useful sense out of your last two sentences.

[Angua]

The obese need a lot more treatment overall than just heart surgery. The increased risk of type 2 diabetes alone is enough to put substantial burdens on healthcare.

edit: also, doesn't the US government still spend way more of it's GDP on healthcare than any other country? You'd think that would be enough incentive to try and stop people from smoking/drinking in excess/getting obese.

[pizzazz]

The obese need a lot more treatment overall than just heart surgery. The increased risk of type 2 diabetes alone is enough to put substantial burdens on healthcare.

edit: also, doesn't the US government still spend way more of it's GDP on healthcare than any other country? You'd think that would be enough incentive to try and stop people from smoking/drinking in excess/getting obese.

Indeed, and they should either do that, or even better, not spend so much on health care. The fact that the US government spends a large amount on health care is largely due to the fact that it does, in fact, gaurantee a large amount of health care to those who can't afford it, regardless of their behavior and without any compensating factor. On the other hand, health care in general is top-notch quality, which to me says government should just be providing a lot less care, rather than providing all of it and then dictating what everyone is and is not allowed to do to themselves.
With some adjustments to the tort system and insurance structure, we can bring the price way down as well.

[CorruptUser]

Think more adjustments to tort and less to insurance. While as a whole, massively expensive healthcare doesn't hurt (or in some ways helps) the insurance industry, each individual insurance company has a huge incentive to keep their costs down. Trying to get everyone to agree to raise costs is like herding cats, which is exponentially harder with more cats, which is why we should promote the breeding of cats. If all else, we can slaughter them and make cat-leather quivers and cat-meat roasts, or just cat-leather crafts to sell to those tree-hugging hippies elves- wait, enough dwarf fortress for me.

[pizzazz]

There are definitely some ways to make insurance cheaper. For example, there's no reason for insurance to cover small and/or predictable costs such as check-ups; this would be like auto insurance covering your oil change and broken headlights.

[The Great Hippo]

There are definitely some ways to make insurance cheaper. For example, there's no reason for insurance to cover small and/or predictable costs such as check-ups; this would be like auto insurance covering your oil change and broken headlights.

Isn't it actually in the insurance company's best interest to cover check-ups and preventative care, though? Catching a disease or problem early means a cheaper cure; it's a good long-term tactic.

[pizzazz]

There are definitely some ways to make insurance cheaper. For example, there's no reason for insurance to cover small and/or predictable costs such as check-ups; this would be like auto insurance covering your oil change and broken headlights.

Isn't it actually in the insurance company's best interest to cover check-ups and preventative care, though? Catching a disease or problem early means a cheaper cure; it's a good long-term tactic.

For some people, maybe, but for others it's less efficient.
Also, it's certainly more efficient, generally, to give one person preventative care than to fix a serious problem later. However, it's less efficient to give preventative care to everyone if 99% of those people would never get seriously sick anyway.
It would also be possible to adjust the price of premiums based on whether or not someone gets checkups (as they do for many other behaviors), and this better allows people to choose if they want check-ups or not.

[The Great Hippo]

For some people, maybe, but for others it's less efficient.
Also, it's certainly more efficient, generally, to give one person preventative care than to fix a serious problem later. However, it's less efficient to give preventative care to everyone if 99% of those people would never get seriously sick anyway.
It would also be possible to adjust the price of premiums based on whether or not someone gets checkups (as they do for many other behaviors), and this better allows people to choose if they want check-ups or not.

The fact that insurance companies encourage preventative care and often cover regular check ups makes me suspect that they've already done the math, and that math lead them to a different conclusion.

How much does a regular check up cost, anyway? A hundred dollars or so every year? Is that a substantial cost that we need to reduce?

[EdgarJPublius]

It can be beneficial to the insurance agencies that everyone receives regular preventative care, without being beneficial enough to actually cover the costs of preventative care for everyone.

[The Great Hippo]

It can be beneficial to the insurance agencies that everyone receives regular preventative care, without being beneficial enough to actually cover the costs of preventative care for everyone.

I'm sure it varies from type to type; not all preventative treatments are made equal, after all. But is this the case with check-ups?