My long-winded thoughts on healthcare topics…

[Wrong Direction]

As you can see from previous threads, PeterMP and I engaged in a debate about the wastes of government health insurance (post #140) and what I think is the benefit of private insurance. Peter’s response to my posts, in a nutshell, was “that’s all and good, but private insurance doesn’t actually save any money in reality.” Peter, I don’t mean to misrepresent, so please chime in on this point if you wish, as I’m sure you will do on others.

I posted some data on HSAs (post #167), but frankly haven’t had the time or energy to re-enter this conversation over the last week +. I’ve been really busy at work, have two very young kids (1, 4) and a wife at home…I’m sure many understand. So, Peter and any other folks who want to engage, this is my re-entry into the fray. Please don't hate me for jumping in and out. These posts take more than time. They take intellectual energy and I don’t want to respond with platitudes.

As you all can see from my post in the link above, I have pretty extensive experience with the problems with Medicare in particular. I’ve detailed several areas where payment is ridiculously incongruent with value. However, to better inform yourself about solutions, you must understand the problem. Medicare payment is set by politicians.

A digression:

I have a theory about cheating men. It’s simple. Some men like to judge other men who cheat on their significant others. The vast majority of those judging men have 1 of 2 things in common. They’re either 1) ugly/have no game, 2) don’t have opportunity. They are not some higher beings who are just better than other men. If you get them drunk and have a good looking girl throwing themselves at the man, and they know they won’t get caught, most will cheat. So, how do you not cheat on your significant other? Answer: don’t put yourself in the position to cheat. It’s 100% effective, just like the fact that girls who don’t have sex won’t get pregnant.

And that digression applies to politics. You can either fix all that ails Washington and our political system, or you can remove that political system from day to day topics they shouldn’t involve themselves in. If we don’t put politicians in the position of messing up healthcare, they can’t do it! As evidenced by my linked post above, the politicians have most definitely messed up Medicare. The politicians removed themselves to a decent degree with Medicare Part D, and costs have come in way under projections for real, market oriented, reasons. On this last point, Peter, your assertion that D is cheaper than expected because of generics is false. First, the CBO knew about generics coming to market when scoring the bill. Second, Part D has been cheaper from day 1. Generics did play a role, but Part D’s ability to move people to existing generics played the much bigger role.

So, why would private insurance plans be better?

First, we should recognize that not all private insurance plans are equal. Specifically, Medicare Part C plans have requirements vastly similar to Medicare FFS thanks to politicians. ObamaCare plans will have similar requirements. MassCare plans have high requirements. If you look across states, you can see how the costs of private insurance varies, very frequently in relation to state and federal mandates. See this report that points out:

“Premiums varied considerably by state, reflecting a variety of factors, including premium rating and underwriting rules, differences in health care costs, demographics, and consumer benefit preferences. For example, average

annual premiums for single policies reported in the survey ranged from $2,606 in Iowa to $6,630 in New York.”

So, I shouldn’t claim in blanket statements that private insurance is better than Medicare or government insurance. I should instead highlight the ruinous nature of politicians creating standards in our healthcare system, and I’d note that these standards sound good on paper, but don’t correlate with better outcomes or lower costs.

So how do you get low cost insurance coverage? Answer, require minimal mandates and some beneficiary cost sharing. Why doesn't this happen in Medicare? Answer: Politicians.

The solution for lower cost insurance is actually pretty simple. The federal government should allow 1) plans to be sold across state lines, 2) creative insurance pools (e.g., allow existing employer plans, add association health plans and national plans), and 3) disseminate information about cost as transparently as possible, perhaps even including federal counselors to assist customers with plan selection, and certainly information widely available on a single source web site.

What did ObamaCare do?

With respect to my points above, ObamaCare is flawed for several reasons. First, the mandates. The IOM released a report yesterday recommending that certain preventive services be covered for free for anyone who wants them. Things that aren’t cost effective, like alcohol counseling, will certainly be on the list. Note, insurance companies can cover that stuff, but the government wants to make them free. There’s a large suite of these products in Medicare as well. These particular services aren’t the problem, they’re a small example of the problem. When you add mandates for things like breast feeding counseling, and you’re giving bureaucrats the ability to expand the list of services, you’ve created a recipe for overflowing mandates. These mandates range from cost sharing, to coverage of specific drugs, to provider access and rules for hospital discharges. In total, the mandates add massive costs and undermine the individual’s ability to choose what they value. Perhaps they don’t want a big provider network, for example, because the small network offered by cheap company x includes your preferred physicians.

Second, ObamaCare puts both federal and state governments in between consumers and the plans of their choice with respect to pooling. You can buy a plan from out of state if your state agrees to group with another state, applies to the federal government, and is approved. This will result in somewhat larger insurance pools (some small benefit), but benefit packages are likely to remain very similar in states, meaning those cheaper benefit package options won’t be available to new people. Indeed, mandates from ObamaCare will mean that the cheaper benefit package options will not be available through the Obama health insurance exchanges even in lower cost states now without some sort of federal waiver. Yet again, the feds are in between you and your potential plan of choice.

Third, ObamaCare created a panel to change payment policies for Medicare. This was sold as a Republican idea. Indeed, it has its merits, but it’s equally rife with potential to be highly politicized. Who will nominate people to sit on this panel? Answer: Politicians. Who will name the panel? Answer: Political appointees. What will happen when the panel makes its first recommendation that lowers payment for a huge lobby? Answer: Washington will go crazy. I have my doubts on whether this will ever be put in place. If it is, I have my doubts that it will either 1) remain in place 2) operate without congressional threats or 3) make non-political decisions. Once again, this panel will be telling people what they should pay for a service and they will have to answer to politicians. It’s better than the status quo, but probably only on paper.

Fourth, ObamaCare does create a website showing options within the exchanges. As a stand-alone tool, this is a good thing that should eventually be transferrable to a better political system.

Fifth, an unintended consequence of ObamaCare might actually turn out to be a good thing. Out of pocket costs are projected to skyrocket, based on certain private projections. It’s sort of backward, but Obama’s own failed benefit structure might ironically result in more consumer involvement. Of course, this also undermines the Mandate because people will be even less likely to buy expensive insurance, but whatever. It's a good thing.

What does the Ryan plan do?

For Medicare, the Ryan plan tells new enrollees, starting in 2025ish, that they have to join a Medicare insurance plan instead of a the government run, politician priced, traditional Medicare. If this is implemented, insurance companies would have the ability to negotiate their own payment rates with providers, and manage their networks. They’d be able to negotiate their own rebates with pharmaceutical and DME providers, instead of following government mandates. They’d have high incentive to negotiate better rates because they’d be competing for your business.

The pitfalls with the Ryan Medicare plan are in the details. What Medicare mandates will carry over? How will markets be divided? Will devices have specific identifiers (which would provide a much more competitive marketplace for pricing)? Cost sharing? There are many more. These details are extremely important, and must be spelled out in detail for confidence in real reform of pricing. However, what this plan does is provide a path to where politicians are much less involved in allowing lobbyists to grossly inflate healthcare prices. Consumers care about costs, and they’ll reward the plans that offer services at lower costs.

The alternative is really simple. We have a few choices if we want to keep Medicare as it exists. We will either 1) have massive benefit cuts, 2) massive tax increases at all levels of income (we can’t tax the rich enough to pay for Medicare's projected costs), 3) rely upon Congress to suddenly better manage Medicare.

If you trust in #3, I have a bridge to sell you.

Not addressed in this post: Ryan’s Medicaid plan, Medicaid pricing in general and why Medicare can’t do that, changes Congress could make to better manage Medicare now.

[NoCalMike]

It seems like the statement "Obamacare is flawed" has been a justification by the right to simply do nothing and let the status quo keep going. In fact, everytime I hear "free market solution" it sounds like more code for, let the insurance companies keep gouging clients and then dropping them from coverage whenever the feel like it, and if you don't like it, go find another insurer.

As a liberal, of course I find faults in Obamacare, it is nowhere near a perfect piece of legislation, but I feel it is a lot better than what the other side is offering.

Medicare for all.

[Jumbo]

This is just a (relatively) quick reply as time allows, but I wanted to acknowledge your effort at a quality post and reasonable engagement on a complicated topic, WD.

I can agree with a fair amount of what you address, but also am one of those who has no special love or admiration for the level of integrity, competency, ethics, or efficacy often offered by the private arena in healthcare, especially insurance companies.

So attacking either the government's or the private sector's products/results in this area (and most all others) while comparatively ignoring the other speaks more to be of ideological partisanship and reflexive reactions of ingrained belief systems that no mater how intellectually presented usually seem to originate in the amygdala more than the cerebral cortex as compared to truly objective analysis looking at all angles with an equally critical eye, partnered with pragmatism and a goal of evolving the best system for the most people--and (yes here it comes) with special attention to those most unable to help themselves (socialism FTW! ).

But, seriously, on the last point, I certainly advocate demanding personal accountability on the individual by the system (just as I with demanding accountability of those working for/with the system) and stringent over-seeing of appropriate use of resources. This means hard work from competent and honest people in all such areas, and may well be quite unrealistic in this world, but that's my story in short and I'm sticking to it (for now:ols:).

[NoCalMike]

Something neither plan addresses though are why our costs keep going up but the services rendered keep giving us less. Why do we spend so much to get so little? How can we make it stop?

[shk75]

When it comes to politics and the health care system in the US it really boils down to the fact that we have been stuck in a middle ground of supporting government run services without supporting the greater government power necessary to truly hold down costs.

What I mean by this is that politicians and voters have been reluctant to support global budgets and stricter universal rules for insurers in order to try to cut down on cost shifting and exorbitant price inflations. It is in this middle ground that the US has hurt itself because programs like Medicare are so entrenched and loved by the public yet the reforms necessary to either abolish it or give the government more power over it are not supported by the public. We have relied on an incremental approach to try to solve our problems but the root cause is that we really do not know what we want and are unwilling as a nation to support the kind of steps necessary to alleviate the problems we are facing.

[Burgold]

Mine is a non-realistic thought, but it's a long held one. The real problem is that health care should not be a for-profit business. It should be not-for-profit. The nature of the for profit mindset runs counter to the needs of providing support to those who are ill or injured. The first question should be what is the nature of your problem not what insurance do you have? That's the core of why Obamacare is problematic. The idea behind universal healthcare efforts, which Obamacare isn't really, but tries to move us closer to, is that your bank account should not determine the quality of care you get. That's the ideal anyway. It is a socialist thought. It is a noble thought. It's not necessarily an economically sound thought. So, the attempt of trying to build a capitalist universal healthcare program is awkward, ill fitting, and problematic.

Anyway, that's my first thought. It's not entirely useful because we're not going to make that dramatic a paradym shift in how we deliver or think about health care. Most of hate insurance, but the reason we hate insurance is because it behaves exactly as it is supposed to. As a for profit business, it's goal is to maximize profits for its board, shareholders, and the company. It's secondary or perhaps tertiary goal is to see that its clients recover and get what they need and even that is qualified by making them just happy enough to keep them as clients and get more.

[shk75]

Something neither plan addresses though are why our costs keep going up but the services rendered keep giving us less. Why do we spend so much to get so little? How can we make it stop?

I know I have explained why this occurring on other threads but to make a long story short it is because providers in the US charge higher prices for the same services than anywhere else while at the same time providing a more intense array of services and treatments than any other nation.

[Springfield]

Mine is a non-realistic thought, but it's a long held one. The real problem is that health care should not be a for-profit business. It should be not-for-profit.

I was actually coming into this thread to post this exact thought. I'm glad that somebody as highly esteemed as Burgold would agree.

Somewhat off-topic but relevant to the overall subject; Wasn't health care, at some point in history, not for profit? Didn't the health care system work better back then? If this is the case, then shouldn't the possibility of switching to a not for profit health care industry be on the table at least?

I'm just looking for answers to questions as to why the health care system got so unfair shortly after it became a for profit industry (if that is actually the case, as I have limited knowledge on the subject).

[Burgold]

I think it's pretty much always been for profit in the U.S. whether we're talking about barbers as doctors or herbal woman treating with poultices. Not sure about that though.

[Springfield]

I think it's pretty much always been for profit in the U.S. whether we're talking about barbers as doctors or herbal woman treating with poultices. Not sure about that though.

I decided to do a little google searching and it seems it wasn't always for profit, per se. However, our "socialize" or "not to socialize" problem has been around for decades and decades.

I'm not sure if Slate leans right or left or if it even matters. The article seemed to have a bit of a left lean to me, with the jist of it being... capitalism is bad for health care.

http://www.slate.com/id/2161736/

[shk75]

I think it's pretty much always been for profit in the U.S. whether we're talking about barbers as doctors or herbal woman treating with poultices. Not sure about that though.

Actually this is not true. Historically, until around the mid-50s health care in the US was non-profit. Traditionally health providers were religious based or community based with some private practices mixed in. Hospitals were especially dominated by the non-profit sector. Blue Cross and Blue Shield were started as non-profit community rated organizations but over time the for-profit institutions have taken over.

[Thiebear]

I've always believed we needed Clinics like the military and only use hospitals for those that need it.

It would save a fortune and benefit all.

We should have created a Frankenstein of Hawaii, Canada and France.. we instead took the worst of the American one and made everyone mad.

[Burgold]

Actually this is not true. Historically, until around the mid-50s health care in the US was non-profit. Traditionally health providers were religious based or community based with some private practices mixed in. Hospitals were especially dominated by the non-profit sector. Blue Cross and Blue Shield were started as non-profit community rated organizations but over time the for-profit institutions have taken over.

Thanks for the correction. Both of you. Seems we need to get back to the good ole days of the founding fathers when medicine was socialized.

I've always believed we needed Clinics like the military and only use hospitals for those that need it.

It would save a fortune and benefit all.

We should have created a Frankenstein of Hawaii, Canada and France.. we instead took the worst of the American one and made everyone mad.

Yup. That would have been much closer to what I would have liked. I think if all sides would have been working towards something instead of trying to bash the hell out of each other we might have gotten there. Sadly, for at least 14 years, Congress has acted as if it were manned by three year olds with a rash.

[Wrong Direction]

I can agree with a fair amount of what you address, but also am one of those who has no special love or admiration for the level of integrity, competency, ethics, or efficacy often offered by the private arena in healthcare, especially insurance companies.

So attacking either the government's or the private sector's products/results in this area (and most all others) while comparatively ignoring the other speaks more to be of ideological partisanship and reflexive reactions of ingrained belief systems

Guess what? I actually agree with most of this critique of what I wrote. My only retort is relatively simple though. I do support safeguards to protect consumers because I know and understand the financial incentive for insurance companies to deny care.

The primary protections I support are twofold:

1) don't allow denial based on pre-existing conditions. The financial risk assumed by an insurance company can and, I think, should be shared by the taxpayer. Plus, by not offsetting some of the insurance company's financial risk, you actually incent them to have worse behavior with respect to cost avoidance through coverage denials.

2) a universal exceptions and appeals process. The point of this is every consumer should be familiar with their rights to obtain certain coverage, and the process for appealing negative coverage decisions.

I concede that I didn't mention these in the write-up above, and I should have. Maybe too much in the weeds? Don't know.

---------- Post added July-23rd-2011 at 02:57 PM ----------

Something neither plan addresses though are why our costs keep going up but the services rendered keep giving us less. Why do we spend so much to get so little? How can we make it stop?

I would argue very strongly that the only way to keep costs from going up and value from going down is to institute a plan like mine where the market is incented to provide more value to consumers.

Of course, I'd also argue that health insurance shouldn't necessarily include every little treatment. I sign on to the idea that car insurance shouldn't cover oil changes and health insurance shouldn't cover every dental cleaning.

---------- Post added July-23rd-2011 at 03:05 PM ----------

When it comes to politics and the health care system in the US it really boils down to the fact that we have been stuck in a middle ground of supporting government run services without supporting the greater government power necessary to truly hold down costs.

What I mean by this is that politicians and voters have been reluctant to support global budgets and stricter universal rules for insurers in order to try to cut down on cost shifting and exorbitant price inflations. It is in this middle ground that the US has hurt itself because programs like Medicare are so entrenched and loved by the public yet the reforms necessary to either abolish it or give the government more power over it are not supported by the public. We have relied on an incremental approach to try to solve our problems but the root cause is that we really do not know what we want and are unwilling as a nation to support the kind of steps necessary to alleviate the problems we are facing.

I think you're missing the point about the real problem. It's not about not giving government enough power, it's about the fact that politicians have huge incentives to not run an efficient program. It's the politician's involvement that is the problem. In a true competitive marketplace, where everyone follows the same rules, prices and value will improve.

Also, I think if you look at profits as a % of financial risk or gross revenue, insurance company profits aren't absurd. The costs of paying for insurance are really high because the costs of doctors, hospitals, DME, etc etc are extremely high, and of course because we have an aging and fattening population.

---------- Post added July-23rd-2011 at 03:18 PM ----------

Mine is a non-realistic thought, but it's a long held one. The real problem is that health care should not be a for-profit business.

I used to think this way until I realized what the actual problems with healthcare are, and learned a little more about for-profit/not-for profit incentives. If you want to make healthcare bad in this country and stagnate improvements, take away the profit.

As the post I linked to in the OP pointed out, Medicare recently implemented a competitive bidding program for some durable medical equipment like diabetic supplies and oxygen. With simple competition, instead of politician-based payment rates, prices for those products have fallen a ton. I don't know the exact numbers yet, but between the price falling and overuse diminishing, cost savings have to be in the 25-40% range. That's obviously huge and I believe those savings could be achieved in several other areas of payment.

---------- Post added July-23rd-2011 at 03:20 PM ----------

I've always believed we needed Clinics like the military and only use hospitals for those that need it.

It would save a fortune and benefit all.

We should have created a Frankenstein of Hawaii, Canada and France.. we instead took the worst of the American one and made everyone mad.

If everyone had a simple $250 deductible for hospital treatments, and we disallowed our huge uncompensated care system (another topic very worthy of discussion), those clinics would pop up everywhere and costs would drop huge amounts. Instead, we mandate hospitals take anyone and we compensate by overpaying them through Medicare rates so they don't lose all their money on uncompensated care. It's a total politician-created, hundred billion dollar (ish) joke.

[Hubbs]

I've always believed we needed Clinics like the military and only use hospitals for those that need it.

It would save a fortune and benefit all.

We should have created a Frankenstein of Hawaii, Canada and France.. we instead took the worst of the American one and made everyone mad.

Can you (or someone else knowledgable) elaborate on this a bit? I don't really know what you mean by a Frankenstein of Hawaii, Canada, and France.

[shk75]

I think you're missing the point about the real problem. It's not about not giving government enough power, it's about the fact that politicians have huge incentives to not run an efficient program. It's the politician's involvement that is the problem. In a true competitive marketplace, where everyone follows the same rules, prices and value will improve.

Also, I think if you look at profits as a % of financial risk or gross revenue, insurance company profits aren't absurd. The costs of paying for insurance are really high because the costs of doctors, hospitals, DME, etc etc are extremely high, and of course because we have an aging and fattening population.

Well some feel that this is accurate which is why part of the reform under Obama set up the independent CMI which is not run by politicians but independent bureaucrats who have been given the power to control the purse strings themselves and will theoretically be absent of politicians control. Of course the problem with you argument is often the same with those who advocate communism, in that in theory is sounds good but a true free competitive marketplace is and has never been existent when it comes to health care. It is why other nations introduce regulation to control this disharmonious relationship because they know it is not real.

Now with regards to your second point I am not sure why you aimed it at me as I did not target the insurance industry just the fact that the lack of direction and patchwork policies which characterize our government's involvement in health care has proven detrimental to the system.

Furthermore, if we are going to debate whether or not health care should be a for profit industry or not, Peter Singer often asks why it is OK for other lifeline products like food and housing to be for profit but not health care. When you look at what the actual social determinants of health are they are not limited to just lack of access to medicine or physicians. People are also unhealthy in this nation because of a lack of access to healthy and affordable foods, safe and affordable housing, and environments which put their lives at an unfair risk. If anyone is to argue that health care should be run as a non profit, than so to should these other industries.

---------- Post added July-24th-2011 at 04:10 PM ----------

Can you (or someone else knowledgable) elaborate on this a bit? I don't really know what you mean by a Frankenstein of Hawaii, Canada, and France.

Well I am not sure what he means by this exactly but I can describe each system for you.

Hawaii - each employer is mandated to provide health insurance for any worker who works 20 hours or more. The government provides help for smaller businesses and tightly controls the health insurance market

Canada - Each province has their own independent health care system which is composed of a single-payer system and must cooperate with the 5 federal principles that hold true for each province (Public Administration, Comprehensiveness, Universality, Portability, Accessibility)

France - national single-payer system based on a FFS schedule determined by government officials.

[PeterMP]

I don't see where the OP really addresses any of the points in the original thread beyond what was already stated. Was anything really said here that wasn't already said, and I hadn't already commented on?

Instead of breaking out a new thread on a topic that has been discussed ad naseum, it would have been nice to see a reply to the points left off in the last thread. Defend the Ryan plan by commenting on the points I've already made in that thread in the context of the Ryan plan.

Burgold- with respect to hospitials, there are quite a few non-profits, and studies show that when you take into account to their benefit from not paying taxes, the difference in terms of costs and care out comes is slight. The non-profits do slightly better, but not a whole lot, and certainly not enough to suggest that's the solution.

However, for people that want to try and claim such systems kill innovation, this simply isn't true. The same sort of studies show non-profits are at least if not more innovative than for profits.

John Hopkins is a non-proft. Anybody want to claim they aren't innovative?

**EDIT**

In terms of medical care and costs, the Mayo Clinic is probably even a better example.

[Wrong Direction]

However, for people that want to try and claim such systems kill innovation, this simply isn't true. The same sort of studies show non-profits are at least if not more innovative than for profits.

John Hopkins is a non-proft. Anybody want to claim they aren't innovative?

Surely you know the difference between a couple of islands in the stream and a system-wide change to non-profit, right? Mayo and Hopkins have all kinds of things going their way that couldn't be duplicated system wide, from grants to prestige and outside opportunity to working hours and staff.

If the country could replicate Hopkins and Mayo, it would be everyone's focus to do so.

[shk75]

Surely you know the difference between a couple of islands in the stream and a system-wide change to non-profit, right? Mayo and Hopkins have all kinds of things going their way that couldn't be duplicated system wide, from grants to prestige and outside opportunity to working hours and staff.

If the country could replicate Hopkins and Mayo, it would be everyone's focus to do so.

I agree with this statement. Trying to replicate clinics like Mayo and Cleveland have proven nearly impossible so much so that even when these very clinics try to open up new branches in other parts of the country they are not nearly as successful as the original branches.

However, this does not mean that for profit is inherently more innovative than not for profit. Some studies have shown that European health care markets are much more innovative than US markets but they operate under tight government regulation and many are non-profit.

[Thiebear]

Can you (or someone else knowledgable) elaborate on this a bit? I don't really know what you mean by a Frankenstein of Hawaii, Canada, and France.

Hawaii health care system (head and neck bolts)

Frances health care system (torso and arms)

Canada health care system (legs and platform shoes)

American health care system (voice and demeanor)

Germany health care sysetm (Fear of fire)

spend a year taking the best parts from the best systems in the world and create your own system.

[Wrong Direction]

However, this does not mean that for profit is inherently more innovative than not for profit. Some studies have shown that European health care markets are much more innovative than US markets but they operate under tight government regulation and many are non-profit.

What are you all referring to when you say "for profit?" Are you talking about only providers (Docs, Hospitals, pharmacies) or are you talking about medical innovation (DME, drugs, etc.)?

Even if you're talking about the former, I don't understand how it could be implemented. I suppose step one would be that professional societies would need to end their opposition to more medical professionals being admitted to med schools, etc. There's no way docs would work their crazy hours without additional profit incentive, and we already have a shortage of clinicians.

[PeterMP]

Surely you know the difference between a couple of islands in the stream and a system-wide change to non-profit, right? Mayo and Hopkins have all kinds of things going their way that couldn't be duplicated system wide, from grants to prestige and outside opportunity to working hours and staff.

If the country could replicate Hopkins and Mayo, it would be everyone's focus to do so.

Yes, they are the extremes, but they are non-profit and they are very innovative.

If you went entirely to non-profit, there is no reason to believe they would go away. You'd still have cases of spectacular innovation from those institutions.

And there are studies that show on average the non-profits aren't less innovative than the for profits.

---------- Post added July-25th-2011 at 11:42 AM ----------

What are you all referring to when you say "for profit?" Are you talking about only providers (Docs, Hospitals, pharmacies) or are you talking about medical innovation (DME, drugs, etc.)?

Even if you're talking about the former, I don't understand how it could be implemented. I suppose step one would be that professional societies would need to end their opposition to more medical professionals being admitted to med schools, etc. There's no way docs would work their crazy hours without additional profit incentive, and we already have a shortage of clinicians.

People working at non-profits don't make 0 income. There are plenty of doctors that work at non-profits, like the Mayo Clinic.

[shk75]

What are you all referring to when you say "for profit?" Are you talking about only providers (Docs, Hospitals, pharmacies) or are you talking about medical innovation (DME, drugs, etc.)?

Even if you're talking about the former, I don't understand how it could be implemented. I suppose step one would be that professional societies would need to end their opposition to more medical professionals being admitted to med schools, etc. There's no way docs would work their crazy hours without additional profit incentive, and we already have a shortage of clinicians.

The point I am making is that the truth is not always as obvious as it would seem. It would seem to make sense that the professions that pay you the most money will attract the brightest people and lead to more innovation. This is the argument used by Wall St. when arguing for their bonuses.

However, the medical field is different, and money, while important, is not the sole motivator for innovation. The medical field is also filled with those primarily motivated by the greater good and who innovate not solely for income but to improve the livelihood of the population at large. Like Peter said, they are not going to be working for free, and will still be well paid (doctors in Europe make around 100K a year) they just won't be filthy rich.

[Wrong Direction]

So, are we talking about providers only or manufacturers as well?

[shk75]

So, are we talking about providers only or manufacturers as well?

I think there is no answer to that question just speculation. The point is that in some markets profit is not number one yet innovation is still high from all players (providers, manufacturers, policy makers, etc.). In other markets profit tends to be the key driver. It is not as black and white as make it profit/non-profit and the health care industry will improve/falter.

There is a plethora of reasons contributing to our failing system yet many seek a magic bullet that will help cure all our ills. The simple truth is that there is no one obvious or easy reform, it is not about profit or non-profit. There are always externalities and while Europe and other OECD nations seem to have the best model we know of, it is still far from perfect. There are many changes I would advocate to help improve the system in the US but I would also be the first person to admit my solutions would raise newer, different problems. It comes down to what do we value as a society and what tradeoffs are we willing to make.