Single payer is the best option to control costs. Of course the right-wing will cry rationing, which only proves they live in a fantasy world of unlimited resources.

Seeing what the unions are doing in the public sector, do you REALLY think single payer as run by the government can possibly control costs ?

The only way to control costs is put the cost controls back into private hands and away from governments and insurance companies.

It would seem to me letting unfettered Capitalism with the cronie laws removed would go a long way in not only binging prices under control but access to more people.

1 payer system is BS. Please show me that part in the Constitution. Our .Gov is bloated and a distorting force in this country. Why would you even consider it as a viable option KD???????????

Just because it works mathematically doesn't seem like a valid argument here. The boys on K street thought there math would work too.

Have we all lost sight of what it means to be free?????

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The only way to control costs is put the cost controls back into private hands and away from governments and insurance companies.

Sounds nice... but what the hell does that mean?

I like the idea of your fifth point which would help bring down drug prices overall and subsidies Ex-US but it could never be put in place due to logistics.

The two major reasons are

1) A large amount of imported drugs are generics that were approved overseas sometimes through non-standardized practices. The risk with these drugs are taken on by the patient who wants to save money but they may not actually be high quality. That would officially flood the market with lower quality drugs over time. This essentially overrides and destroys the power of the FDA.

2)Once a drug leaves the pharmacy/supplier and gets into the hands of a patient or un-licensed seller the stability of the product comes into serious question. If someone is accumulating drugs in their closet in FL/LA in the middle of summer and reselling them while not keeping them stored under proper temp/humidity they could become useless and then resold to some bagholder/patient who doesn't know any better.

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Single payer is the best option to control costs. Of course the right-wing will cry rationing, which only proves they live in a fantasy world of unlimited resources.

Right, just like the current Democrat-owned "single payer" bankster bailout is the best way to control the cost of fixing our completely ****ed economy, proving that the Democrats live in a fantasy world of unlimited US Government ability to tax and borrow.

Disclosure: Not a Republican.

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1) A large amount of imported drugs are generics that were approved overseas sometimes through non-standardized practices. The risk with these drugs are taken on by the patient who wants to save money but they may not actually be high quality. That would officially flood the market with lower quality drugs over time. This essentially overrides and destroys the power of the FDA.

2)Once a drug leaves the pharmacy/supplier and gets into the hands of a patient or un-licensed seller the stability of the product comes into serious question. If someone is accumulating drugs in their closet in FL/LA in the middle of summer and reselling them while not keeping them stored under proper temp/humidity they could become useless and then resold to some bagholder/patient who doesn't know any better.

Meanwhile, back at the ranch, that same FDA that worries itself sick over us buying cheap drugs from overseas thinks it is just hunky dory for China to sell toxic food, supplements, and chemicals that go into producing drugs domestically.

The more government gets involved in anything, the less choice you will have and the more expensive that item will become. Look how well near total government involvement with education, the post office, Amtrak, the "Big Dig", etc. have worked out.

Or to put another way - if I gave you $50,000 and you had to invest that money for your retirement - where would you choose to put that money: You own IRA or social security?

It is interesting to note that cosmetic medicine not covered by most insurances have dropped their cost streadily throughout the decade. For instance, lasik eye surgery is now about 1/3 the cost of what it was 10 years ago.

It is fascinating how the market forces prices down when people pay 100% of the cost, do comparision shopping and government/insurance are not involved in "controlling costs".


FYI - boob jobs are also much less expensive too.

Single payer is bull**** and won't fix anything, most specifically it will not fix COSTS. Get the government out of setting medical procedure and drug costs. I know it's a dumb question but what happened to the free market?

There are many problems, but the one that I keep coming back to as the main problem with health care costs: monopoly power.

In Massachusetts, there is no competition. Blue Cross (the dominant insurer) and Partners Health (the dominant provider network) set the reimbursement rates. Everybody else can just suck it.

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The only way to control costs is put the cost controls back into private hands and away from governments and insurance companies

The only way to control costs is to put the FULL cost of a **** lifestyle DIRECTLY on the people who practice it and need medical care as a result!

You want to eat **** and not exercise then don't force me (indirectly, albeit) to pay for it!!!!

BTW, Most, like 90%++ of disease in this country is caused by people's lifestyle choices!

You want to play with a gun, fine but don't point it in my direction, ever!

Don't have the figures in front of me, but I'm almost certain I've read that health care is much less expensive under Medicare than it is under the private system. Medicare insures millions (including the heaviest users of health care, the elderly), so why is everyone so sure a "medicare for all" system could not work?

Yes I know "Medicare is bankrupt" but that has nothing to do with the efficiency of the system itself - no matter how efficient a system is, it won't matter if you keep "borrowing" money from it to spend on other things.

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We in America are forced to pay for all of the medical innovation in the world, as a direct and proximate consequence of the acts of the douchebags in Congress who have (1) banned reimportation of drugs and devices, and (2) exempted drug and device makers from anti-trust laws that would otherwise make their conduct felonious in The United States.

Huh? Could you explain that please.

I am aware of medical innovation that has recently taken place in Canada, Germany, and the UK. In order to sell in the US, the companies involved do have to meet the ever more stringent requirements of the FDA and run clinical trials in the US. To a considerable extent, the cost of new drugs is hugely impacted by the increasing time and testing required to get FDA approval (now typically seventeen years from discovery to approval - and increasing).

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Single payer is the best option to control costs. Of course the right-wing will cry rationing, which only proves they live in a fantasy world of unlimited resources.

Single payer will restrict costs until politicians allow it to cover any and all elective procedures because they're "free" and "people are paying for it anyway". It will also invite fraud as government run insurance is rife to do. It will work fine for a decade and degrade into another huge albatross hanging over the taxpayer that hemorrhages money for disproportionately small gain.

I'm convinced in my mind that very soon this is coming to us all ... where "typical" plans will be running in the neighborhood of $25k per year. I can see it and it's scary as all get out. These criminals are folowing the "higher education" game plan ... and winning big time at the expense of everyone.

Debt Slave

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I am aware of medical innovation that has recently taken place in Canada, Germany, and the UK. In order to sell in the US, the companies involved do have to meet the ever more stringent requirements of the FDA and run clinical trials in the US. To a considerable extent, the cost of new drugs is hugely impacted by the increasing time and testing required to get FDA approval (now typically seventeen years from discovery to approval - and increasing).

In order to make money the companies sell at 10x or even 100x what you pay in Canada.

If the laws prohibiting the owner of a product sold at "first sale" from doing what he wants with it (including reimporting it into the US) then your prices in Canada would rise and ours would fall. Ours would fall A LOT and yours would rise some (since the "yours" is not just Canada, it's the entire rest of the world.)

We effectively pay for ALL new medical technologies and drugs, but you get to enjoy them, effectively for the cost of reproduction rather than innovation.

Capeman:

We can still mandate truthful labeling regardless of who is producing/distributing the products. If someone misrepresents their product, no matter where they are, legal authorities go after them with whatever means are available.

I would actually be okay with having the option to purchase drugs that have not been reviewed at all by the FDA. Maybe a private firm would step up to approve drugs. Who knows? Given the frequent allegations of political influence in the FDA, who is to say that a private option wouldn't prove to be better? If you want your drugs to be FDA approved, a seller may only legally label his drugs as such if it actually was so approved. If, on the other hand, you want to buy drugs of questionable quality from an unapproved source, whose business is it but your's? Yes, there are sticky issues to deal with if the drugs actually harm you, requiring medical intervention for which you can not pay. No one should argue that any issues surrounding this debate are simple. But I am of the position that many of our problems are born from too much centralized control.

KD:

I like the point that you make about allowing the re-sale of products even across international borders. It's an easy to miss subsidy for the rest of the world, and we should cut it off immediately.

Regarding tort reform (following the link to your 9/9/09 article), I have an alternative suggestion. Mandate that all parties agree in advance to reimbursement for adverse outcomes and that health care providers obtain quotes from insurers willing to insure against those potential outcomes. A number of points follow from this:

1) The doctors and patients may purchase insurance coverage if they wish would not be required to.

2) The patient could potentially waive the right to reimbursement in all but the most gross negligence, thereby reducing their expense.

3) If you're a fan of government entitlements (I'm not), you could provide for some poorer patients to receive coverage through the government.

4) Quotes for experimental or risky procedures may either be unavailable or exceedingly high. This is valuable feedback for the patient to set expectations.

5) Insurance companies could experience rate providers. This already happens to some extent, but this would formalize and make transparent the process. If you're evaluating doctors and discover that one doctors has rates twice his peers, that is valuable information.

6) Of course, in emergency situations, prior agreement is not possible. In those cases, we are probably back to your recommendation unless we want a third party (the government, perhaps) to step in to provide some kind of coverage in emergency situations. Or you could even purchase adverse outcome insurance for emergency care.

The devil would be in the details for this reform. I admit that these proposals could result in challenging contract disputes. But I like it in that it moves in the direction of better doctor-patient relations. It allows people to choose the level of guarantee that they want and forces them to realistically assess the cost of that guarantee.

Doctors and hospitals cannot refuse to care for people, so there is a safety net. Maybe we should remove that safety net.

Swarf_maker:

I think that KD addresses your question more fully in the ticker linked below. Look for the part in which he discusses "cross-border arbitrage".

http://market-ticker.org/archives/1599-H....

We already have single payer and it's called Medicaid/Medicare. Expand it to cover everyone without insurance and then cut the crap out of it. Death Panels??? Hell yes there will be death panels. Rationing?? Of course. You get what you pay for...sorry but that is the truth. This is where politicians want to go but they can never sell the truth of this course of action.

All others can choose to be covered by some health savings account or some other high deductible plan. Companies will save tons by offering this instead of prepaid medical plans they use now.

A two tiered system is where we are headed I think.

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We already have single payer and it's called Medicaid/Medicare. Expand it to cover everyone without insurance and then cut the crap out of it. Death Panels??? Hell yes there will be death panels. Rationing?? Of course. You get what you pay for...sorry but that is the truth. This is where politicians want to go but they can never sell the truth of this course of action.

Medicare/Medicaid are MASSIVELY subsidized by private insurance at present, as they set reimbursement rates and then the providers cost-shift.

This is felonious in other lines of work when done under the table as is done in this business as it constitutes an illegal trust.

This is part of what has to go away - the true cost MUST be exposed across teh board.

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put the cost controls back into private hands and away from governments and insurance companies

Reset the medical system back to what was done in the 50s. Insurance was for catastrophic procedures, not routine doctors visits and tests.

Most medical procedures were paid in cash by the individual cared for, therefore people only got the healthcare they could afford. No cost-shifting onto others, making the cost of healthcare rise for all. No lawsuits for "pain and suffering", a higher standard for lawsuits altogether for malpractice. It used to have to be a preventable error, not just a "bad outcome". No mandates to accept any and all patients in hospitals where many can't or won't pay.

As others have noted, voluntary procedures (cosmetic, lasik, chiropractic, etc) where some get them for free while others cover the cost have absolutely gone DOWN in price. Those procedures mandated or paid for by insurance have gone thru the roof.

Right now - if I pay in cash, I can get a 40-60% discount off the "list price" of an office visit or a procedure. Essentially, a doctor will charge me the same amount that is reimbursed by insurance companies. So, without government interference and insurance intermediation, costs would be much lower, right now.

None of the proposed "solutions" are solutions at all for an industry that is driven by greed, avarice, and predation. The one and only solution is to make all health related services and products non-profit, including the pharmaceutical industry, so that all proceeds above operating expenses and reasonable salaries are plowed back into R&D and more facilities.

Medical care is simply NOT a capitalist product. That's why ALL attempts to make it conform to the laws of capitalism have failed.

EVERY OTHER INDUSTRIALIZED NATION ON THE PLANET has solved this problem by recognizing this fact. 37 governments have been able to deliver medical care to their citizens at costs far lower than the US with far better results.

Every time this topic comes up on this forum I am amazed that people who are savvy enough to parse the most nuanced Fedspeak cannot see this.

Universal access to quality, affordable healthcare is a constitutional mandate covered under providing for the general welfare of the population. Period.