I suspect I know considerably more about it than you. Preventative care is NOT always remotely cost-effective, as many studies have shown. Google up the societal cost/benefit of current prostate-screening, for example. And you are aware that “investing” in government does not generally lead to reduced future government costs? When government claims to be “investing,” hide your wallet.

In this case the investment is in preventive care. For example everybody in the entire universe agrees that pre-natal care for every baby costs less than caring for premature babies. Ergo, by simple math, the US could save money in the next nine months by increasing spending on pre-natal care today

Once again, I’m VERY familiar with those stats, and there’s just not that much room there for cost improvement. It’s not simple math at all, but patient compliance. Very few areas do not already have good pre-natal care available (the potential savings are already mostly realized) and most of the patients who need it and fail to obtain it do so for reasons other than cost.

Please feel free to fight their resistance. I do. Some of these patients have to be practically dragged into clinics for free pre-natal care. At what point do you make such care mandatory by law? Gonna send pregnant women to hospital jail for missing appointments? That’s a cultural problem leading to higher costs, but it can’t be fixed by simply waving a patient-compliance wand. (Some other nations “solve” that cost problem by simply not treating. We have that problem because we go to extreme lengths to treat and save preemies.)

Ditto with bad eating habits, smoking, drug and alcohol abuse, etc., the focus of so much of the “preventative care” approach. Yes, there are some efficiencies to be gained there, but much of it involves forcing behavioral changes on individuals in the “land of the free.” Nor would that necessarily reduce health care costs. Someone who dies of liver failure at age 50 is someone who doesn’t consume another thirty-plus years of health care, just to die of something equally expensive.

Let’s also note that preventative care and primary care are not the same things. When it comes to primary care, you betcha that’s one of our biggest sore spots, and also one of the biggest opportunities for real improvements. We are turning out fewer and fewer PCP’s (primary care physicians) and those working are getting so swamped that it boosts pressure on them to refer out to specialists rather than diagnose and treat simple issues themselves. We could double our PCP supply and still be short of what we need. But that’s a structural problem with the current system. Have to radically change structure to change the numbers, and not in the ways that are being proposed unless we’re gonna import one hellacious number of PCP’s from other nations. Which they might resent, needing them themselves.

But from later ages works fine.

Nope, it doesn’t. Pre-supposes that the ONLY relevant factor in life expectancy disparities is medical care, which isn’t true by a long shot. We are an incredibly diverse (racially and culturally and environmentally) nation, and you will find that nations showing higher life expectancies at higher ages are invariably racially/culturally homogenous and (usually) geographically smaller. Additonally, there are still reporting disparities.

In any case, I’m planning a post on health care soon.

In this case the investment is in preventive care. For example everybody in the entire universe agrees that pre-natal care for every baby costs less than caring for premature babies. Ergo, by simple math, the US could save money in the next nine months by increasing spending on pre-natal care today.

In economic terms the current market is distorted. There is low demand for low-cost, highly effective, primary care because much of the population has to pay for it out of pocket. Given the low odds that missing a single Doctor’s visit, or not having an ultra-sound will hurt people it is simply irrational for them to spend money on primary care.

There is high demand for high-cost procedures because most insurance policies cover much of the cost, and there’s a near certainty taking a premature baby home will result in death. The lack of primary care exacerbates this problem because many people think they’re fine until they end up in the ER.

That’s why high-deductible plans almost never cut costs, BTW. The insurer ends up paying through the nose to fix diabetic strokes rather than paying a couple bucks for insulin.

If this was almost any other market the distortion wouldn’t be a problem. But the health market’s high costs are sucking the life out of the economy.For example “entitlement reform” would be child’s play if increasing medical costs weren’t a factor. Note that I have specifically not mentioned the costs medical problems add to our economy. Dead people buy no widgets, produce no goods or services, and are really useless economically.

BTW, comparing health stats isn’t that hard. You can’t use them all — infant mortality is very difficult to compare across countries because some countries count stillbirths in their figures. Life expectancy from birth has the same problem.

But life expectancy from later ages works fine. And according to Wolfram Alpha a 30-year-old Swede is likely to live to 81, while Americans only make it to 79. Our numbers don’t catch up until you hit the 80s, and all American 80-year olds are in a socialized health payment system called MediCare. Try it yourself. Here’s the search string I used:
life expectancy sweden age 30

But I agree we already have rationing. Of course we do. We ration by price and access. As I’ve always said, we have the finest for-profit health care system in the world. It’s absolutely unequalled at producing profits. Anyone who thinks that’s gonna change without a bottom-up rehab is snorting fairy dust.

I remain continually amazed that people think we can “reign* in costs” by putting more money into the system. I blame American education for the rampant innumeracy. The main reason “reformers” want the “uninsured” in the system is to capture excess contributions from under-utilizers. The 15% of the population that is uninsured costs the system 3% of total revenues. Get them paying in on any remotely flat-rate scheme, and you get an instant 12% boost in revenues. Even with the newly-insured boosting their utilization, that’s still gonna be a major infusion of new revenue into the system, over and above any new services provided.

Fact: spending more on something does not make it cost less. Fact: Increasing demand does not reduce prices. Fact: Demand for health care is inelastic.

[* -- we already "reign" in costs. That's the problem! I think they mean "rein." :-) ]

The per capita cost of healthcare in the US in 2007 was $5711; the average per capita cost of the other 17 largest industrialized nations is…wait for it…$2952

Now, you could argue that for some, even many, the US healthcare system is better than anywhere else in the world, but is it $2,758 better?

In many ways, the US system is worse. Infant mortality in the US is among the highest of these nations (shameful), and life expectency is good, but not among the top nations.

So what does the US Healthcare system lead in–well, we have the wealthiest physicians, and the wealthiest healthcare CEOs, the largest private bureauracy (as opposed to the evil public one) and the highest rate of uninsured citizens and the greatest profit….but, our system is among the most responsive of all nations, the greatest access to advanced technolgy resulting from a greater number of resources available.

When the right says there will be rationing, I don’t doubt that–take the profit out of something and the access provided by people competing to make a profit will disappear.

But let’s not kid ourselves…there is rationing going on all the time. The entire profit-driven health system is geared toward saving as much money as possible however possible.

If you happen to be a person with vast resources, you are not going to be deprived of healthcare no matter what system we have–but there are a lot of wealthy people making a lot of money with the status quo and they will lie, cheat and anything else to keep it.

It’s not about preserving a great system–it’s about preserving a lucrative system

We pay half again as much as any other country in the world, with less success. Would we not gain substantially in revenues if we had say France or Canada’s system and better results?

This is purely logical. With private costs at 20% and public costs at 3%, combined with the private insurers increasing downward pressure on the providers in order to compete with the public plan, instead of passing along costs to their policy holders, we will see huge savings.

How will we end up spending more than other countries do unless they so screw up reform that it sends costs up? That would not be reform, would it?

And when you add $1000/yr to everyone’s bill for the uninsured, we’re already paying for it.

Just logic/fail all around.

I disagree that this is the wrong time to pursue healthy reform. The Wyden proprosal, for example, actually saves money in the long run. We’d be intensely stupid not to do it, or something better.

I agree that this alone probably won’t be enough. Trouble is with checks and balances it’s easy for an unhappy minority to check all progress. So you got to a little at a time.

In this case the minority isn’t evil. They’re people who actually help the health system function, but would be out of a job (or fear they’d be out of a job) under a single-payer system. Nobody hates Medical Billing Specialists. They work hard and they earn their money under the current system. Under a single-payer system, OTOH, they’re a boondoggle.

Firing thousands of people is politicaly impossible in a down economy, so we’re stuck with incrementalism. If it works (ie: saves money without screwing patients) great. If it kinda works we’re better off than we were before and we can pursue more radical reforms later. If it doesn’t work at all we lose nothing because the current system ain’t working wither. Every year it screws more people, and costs more.

Republicans imo will always be against the kind of reform you mentioned. Obama has more possibility to accomplish something than any Democrat in my lifetime. (I really don’t see Republicans pushing it)The can will get kicked so far down the road that I don’t see it happening for decades at the level you are talking about. Then, they’ll say “It’s too big a problem to touch or we can’t do it all at once.” Sound familiar??

The long term Norquist plan is to so screw all these types of things so that they will die easily. As long as his group is covered, I really don’t think he cares about anyone else.

I am curious since you said it was silly. What do you envision changing the scenario so that it would happen and who would be championing it down the road?

As far as reform of normal health care, I fear we’re going to see less of that and more ideas that will get everybody into the system in hopes that we can collectively force our insurance providers to reign in costs on their own now that they finally at 100% coverage. However, there will be significant reforms in the Medicare program, and that will hopefully lessen some costs.

Also, I think a tax hike is inevitable, but I’m personally fine with that. This is a big deal, and it’s zapping our budget. If I have to pay taxes on the health care my employer provides, well, that’s how it is. Ultimately we’re not talking about a ton of money for most people.

I think the current plan is a series of half-measures unlikely to substantially improve circumstances in any particular area. Instead, it will throw money at the problem by providing subsidized coverage for the uninsured. Taxing the insured more to do so, BTW. Not that I necessarily have a problem with that. I just don’t let anyone pretend that the money won’t be coming out of the pockets of whoever has it, and I don’t let them pretend that on that count, there are enough “rich” folks to go around.

I could care less if I pay my 150 bucks a month to the government or Allstate. And if the government can give me the same benefits for under 150 bucks, and use the rest to help pay for the healthcare of others, thats fine by me.

If it doesn’t happen now, IMO it never happens.
Can’t it be a phased in thing to recognize the current conditions and the long term need?

Everyone keeps talking about “expensive” seems to me a dead, sick, sickly and dying people does not get much more expensive than that. Heck it’s freaking expensive to care for a sick, sickly or dying family member.

I’ll be so glad when America gets off this suicide for a pair of pretty shoes kick. America is going to have to choose, live or die out faster.

I lean towards a healthcare reform that actually makes big substantial changes. I think if we are going to make big changes we should go a lot further than what is being suggested now…bite the bullet…comprehensively reform things to some sort of single admin/single payer system that de-links coverage from employment but still captures the employer-based contributions.

I think there is zero chance of that happening. There’s no way Obama plops them on the table and says “here’s how we’re going to do it.” The sries of half measure we are likely to be stuck with will not result in many improvements to the current situation and the costs will be as high as Nancy Pelosi can imagine.