Understanding the Issues 2008: Health Care

Nobody's voted for Guliani! Where's the love?

Didn't you get the memo? He changed his name to 911.

Im a republican, but Obama seems like a man among boys, so i am siding democrat. I dont care about Hillary, she is nothing like her husband, and is simply unelectable.

With any government run health care system, you should expect all the compassion of the IRS and the efficiency of FEMA.

Just walk into any post office and ask yourself if that's the environment you'd like to find yourself in when you have to go to the doctor.

With any government run health care system, you should expect all the compassion of the IRS and the efficiency of FEMA.

Just walk into any post office and ask yourself if that's the environment you'd like to find yourself in when you have to go to the doctor.

People don't want to hear this argument even though it is the best one out there. Can anyone name a major government program that runs well? And I mean well by quality and efficiency. All I get when I make this argument is "Well market forces aren't working and it's so broke that someone just needs to take it over" Nevermind that the government has empirically showed that it can't ever fix anything. They just make it worse usually.

LOL. I always end up laughing my ass off when health care is debated. I spent half my time in grad school getting the facts across all OECD countries (Organisation of Economic Cooperation and Development), which basically means first world countries, and then putting economic analysis to work.

First off, I'm independent politically like most folks i know here in the land of Cowboys and Indians, so I could give a shit about the partisan implications of the health care debate.

The first thing people need to understand is that our system is the most inefficient and ineffective among all OECD countries. The standard here is an apples to apples comparison ie percentage of total GDP (gross domestic product) spent on health in relation to the percent of the population covered. America spends about 17% of its GDP on health w/ the spottiest coverage. The average spent among OECD countries is around 11%, with Canada spending under 10% and Switzerland (the highest aside from us) at about 14%). However, every other modern country has 100% coverage.

My research focused on efficiency first and later on quality, which is more difficult to measure but there are some conclusive results. It's a simple explanation as to why our system is so inefficient but let me share a few important (and shocking) bits about quality. First of all, in overall quality America rates next to Cuba (that's right people, fucking Cuba) according to the World Health Org and several other major independant health studies. If memory serves, in 2006 we rated 36th (way below other modern countries) and Cuba 37th. The basic criterion here is longevity, infant mortality, death due to medical error, death from typically treatable diseases, etc. Among OECD countries the U.S. has just below average longevity, the worst infant mortality, by far the worst rate of death due to medical error, and an above average rate of death from typically treatable diseases. The major health studies do not place a lot of emphasis on the wait time for non-emergency health issues. In other words, people in other modern nations have to wait longer for routine surgeries and much longer for cosmetic surgeries, but the health system also does a much better job keeping people alive. Here, with enough money you can have your tits and ass done tomorrow if you wish, but you may be turned down for cancer treatment (like my step-grandfather was) because the insurance doesn't want to cover it.

Ok, back to the big picture: efficiency and effectiveness (effectiveness means quality). Our system is the most inefficient because there is no uniformity across the healthcare community. As much as 30% of costs are unnecessary paperpushing, mailing, etc. etc. It's a little hard to grasp at first but a comparison can help. A country w/ a universal health system will logically use the same IT network, health forms and records format, etc. This means information does not have to be reproduced over and over and over and over for various providers, insurers, HMOs and what have you. In our system, the providers, insurers, HMOs etc have had little incentive to coordinate, largely because they're in competition. Thus, everything gets recorded over and over again which costs enormous sums of money. For example, the overhead among our best health insurance companies runs at 10% of revenue for all the paperpushing, HR, advertising, etc. Overhead in the more efficient health systems worldwide run less than 1% (not a typo, 1%). The other reason our system is so inefficient is because of fraud and we simply see the doctor more often.

The reason for our Cuban level quality is more complicated. America is off the charts, literally, when it comes to medical error. That has a lot to do w/ our lack of a uniform system. Example: somebody w/ a complicated medical history goes on vacation or simply moves, gets sick or in an accident. The records are scattered all over, an already stressed doctor makes a decision w/o pertinent information and you can figure out the rest... IMHO quality here also has a lot to do w/ our lifestyle. Too much stress and junk food, too little sleep make a bad combination and probably have a lot to do w/ our longevity.

I don't know if this really helps w/ the debate over candidates. Anyone who spends a day studying health care knows we have to address cost before coverage, but I sincerely doubt anyone has the political capital to get it done. Lowering cost will require significant government involvement no matter what: whether to force the health community to adopt a uniform system through severe penalties for not complying and tax benefits for doing so (the sticks and carrots people talk about); or to just create a universal system like the other modern nations.

Dmek, with all due respect, you apparently know nothing on how pay for performance works. Quality is not "judged" or "graded" by someone who comes in and peeks under the hood of your hospital. It is judged by hard numbers standardized within the industry:

- % of people dying compared to the expected death rate
- % of patients receiving unplanned return to surgery
- % of patients discharged within a predetermined time frame appropriate for their illness

You either meet those numbers or you don't, it's not subjective. If you meet them, IBC and Aetna give you a 5% increase on your reimbursement rates next year. If you fail, they only give you a 2% increase. Cut and dry. It's widely regarded as one of the best innovations to come about in healthcare reimbursement recently.
this is where the issue is. you have to meet certain " goals " to get the reimbursement. if this happens, there will be an accountant in every hospital in charge of the numbers. those numbers will be scrutinized over and over again to make the " goal " you probably know as well as i do that anyone can make numbers look and say anything that they want. im lucky. i have a top 25 hospital right here in my home town. i have access to some of the very best care available.

this is where the issue is. you have to meet certain " goals " to get the reimbursement. if this happens, there will be an accountant in every hospital in charge of the numbers. those numbers will be scrutinized over and over again to make the " goal " you probably know as well as i do that anyone can make numbers look and say anything that they want. im lucky. i have a top 25 hospital right here in my home town. i have access to some of the very best care available.

Incorrect. You have to report the numbers to the government via the Medicare Cost Report, and are subject to an annual audit. Allegheny (a former Philadelphia hospital group since taken over by Tenet) got themselves into a lot of hot water when they fudged some reimbursement documents in the 1990s. They were fined a crapload of money which weakened their balance sheet, and they were eventually taken over by Tenet.

It doesn't pay to fudge those kinds of numbers.

With any government run health care system, you should expect all the compassion of the IRS and the efficiency of FEMA.

Just walk into any post office and ask yourself if that's the environment you'd like to find yourself in when you have to go to the doctor.

Best post on here so far.

Name one government agency that you've ever had a positive experience from a service and quality standpoint. USPS, IRS, your local DMV office, FEMA, the list goes on. I've worked for city government, my dad worked for the federal government for 30 years. Having also worked in the private sector, everything I know about ANY government agency leads me to believe that they are almost universally inefficient, mismanaged and miserable places to work.

I just don't understand this incredible desire people have for socialism. Capitalism works, folks. Let the free market do it's thing and pare this massive beast of a government down.

Granted this poll is a tiny sample, but I'm pretty damned surprised that McCain came out on top of the Republican side, and tied with Obama. Really not what I expected.

Best post on here so far.

Name one government agency that you've ever had a positive experience from a service and quality standpoint. USPS, IRS, your local DMV office, FEMA, the list goes on. I've worked for city government, my dad worked for the federal government for 30 years. Having also worked in the private sector, everything I know about ANY government agency leads me to believe that they are almost universally inefficient, mismanaged and miserable places to work.

I just don't understand this incredible desire people have for socialism. Capitalism works, folks. Let the free market do it's thing and pare this massive beast of a government down.
this is the issue. free market with health care isn't working. and the costs are skyrocketing. people are ready to try something new. even if it means the government gets involved