Harold,

     Of health care dollars spent in this country, how much of that is research dollars.  I believe that the US leads the world in health care research dollars spent.  How does this factor into how much money we spend on health care versus the rest of the world.

     Then the next question, is that if there is little savings, why not simply give people a stipend to buy insurance for themselves?   Why not encourage people to use health savings accounts, not have lifetime maximum deductibles, eliminate networks of coverage, not allow preexisting conditions to be excluded, require doctors give an estimate of service provided like a car dealership.

     There are so many ways that health care could be reformed without throwing out the baby with the bath water.

     The first reform should be getting people to be responsible for their health by exercising and eating right.  Those two factors right there would eliminate about 50% of health care costs quickly.

Throw in elimination of advertising for drug companies.

I'd love to eliminate advertsing for drug companies and health care providers. It's wasteful marketing costs that reduce funds for care. Worse, it leads patients to find doctors who are yes men for pharma and are willing to over apply drug therapy instead of healthier living for their patients. The drug companies are the cartels and the doctors are pushers - no surprise there. There are few models that work as effectively against self and public interest like the drug trade. I guess thugs will be thugs.

I don't want to use taxpayer funds to buy private insurance. That's direct corporate welfare. We have to support providers with a livelihood. Why support an addtional layer of services unrelated to the actual care provided? It's Medicare Advantage on a grand scale.

HSAs are already out there to be used by people who think they can spare the money. If I'm not going to subsidize a marketing campaign for providers or drugs, I'm not going to waste resources advertising the HSAs.

If people want private insurance with no lifetime maximums, insurance companies can offer it to them. If the insurance companies fail to offer it, fail to address the demand, then where is the market principle that motivates such fear of public plans and praise for the private plans?

Same for pre-existing conditions. Are the insurance companies only willing to respond to forceful regulation? Don't they want to offer alternatives in response to market demand? Are they saying that they're forced by their boards and stockholders to be the way they are and that only regulation can stop it? Help! I can't stop hitting myself?

Required estimates like for car repairs? You mean like, if you go in for the $80 brake job and end up paying $150 because you also needed rotors? We have doctors because they are the experts when our bodies break. We and the doctors can't always know the extent of the damage beforehand and we don't always have lots of time to think about it. What if a surgeon goes in to fix something and sees something else along the way? Should he close you up and wait until you come around to make a new proposal, have you sign a change order, before going back in? How much transparency is reasonable to make a market decision about your health? This has been long-cited as a difference between health care markets and other markets.

I'll even throw this out there. The amount of paperwork required to satisfy the many insurance companies (the competition that exists, according to AHIP), is driving huge administrative costs outside the insurance companies. Each contract places different administrative needs on providers if only to determine what's covered for this person as opposed to the patient in the next bed. I'll even throw Medicare under the bus on this one. Admin costs and provider time allocated to compliance with insurance limitations is a major cost driver.

Eliminate coverage networks? That's the crux of private insurance's cost containment - negotiation with providers for a menu of services at pre fixe prices. If you scuttle the model, why keep private insurers?

All of the things you suggest point to single-payer as the best option and leave only one issue unresolved, mistrust of our ability to govern. None of your siggestions focuses directly on the cost drivers outside of insurance. They simply keep the funds flowing through a non-essential mediator. Wouldn't it be great for a care provider to simply say, I treated this patient, here's the bill, give the bill to one entity, all the time, and know that they'll get paid, all the time.

Oh, and the research is 40-50% funded by governmental and charity sources.

NIH - Overview

NIH Research Portfolio Online Reporting Tool (RePORT) - Estimates of Funding for Various Research, Condition, and Disease Categories (RCDC)

Public Versus Private Research Funding

Research funding - Wikipedia, the free encyclopedia

RAND_DB534.sum.pdf (application/pdf Object)

How about looking at we first fund the pharmaceutical research and then foot the bill for all of their international profits? We're the only idiots supporting their business. If market rules really obtain, they wouldn't sell their drugs in other nations for such ridiculously low prices unless we're the only patsies on the planet (and I think we are):

Planet Drugs Direct - Canadian Online Pharmacy & Drugstore - Order Prescription Drugs Online

Actually, Harold, giving people money to buy health insurance is not corporate welfare, it is individual welfare.  As the people primarily benefiting are the individuals being insured.  Not much different than paying a bunch of government workers for their administration capability.  

Ahh, that profit motive again, how about the 11 trillion that the government owes.  Does not that profit motive cover that debt service.  Maybe the government needs to make more money than people realize to cover all of the unfunded liabilities that have been committed to.  To ease your concerns about lining the pockets of some fat cat, why not limit compensation to those that want to provide insurance to those individuals receiving government money to do so.

Wasting resources for advertising for HSA's.  You really have no concept of the benefits of essentially self insuring ones self, via a HSA and a high deductible.  Maybe you ought to do some research.  I have one with a $10000 deductible as I rarely go to a doctor, because of my lifestyle and it costs my family $2600/year, not the average of $1000+ per month I hear about.  I am not that young also.  I put away $5000 a year as I pay my own insurance costs towards any future medical bills and will stop when I have 3 times my deductible saved up, in a CD at my local small bank.

Yep, I went in for back surgery, the doctor preformed the surgery 4 times a week at their outpatient medical clinic and yet I could not get an estimate to know what my out of pocket cost was going to be, if nothing else needed to be done.  Yes there will be instances when additional work needs to be done and no estimate is possible.  But for a tonsil surgery, a broken bone, an MRI being done at 4AM or 4PM which could have a different cost based upon supply and demand.  There is the possibility to actually know and be a part of containing costs as a consumer.  Today the system is set up such that, the individual has no idea of the cost of care and does not pay most of the medical insurance they have.  So yes bringing about some way for an individual to know what they are being charged would be good.  As opposed to owing $20 for any time they go to the doctor.  That really provides a disconnect in the process of the individual contributing to cost containment in the medical establishment.

Yup and eliminate the networks, the insurance company sets up a menu of payouts for routine medical coverage/surgeries.  Compile a list of routine charges, and standard payments for those treatments.  Except in emergency treatments, let the doctor know what they will be paid for a treatment and if they require more, they can tell the patient they will need to come up with the additional funding.  That is unless they are the only option for the patient in a rural area.  Provide a cost of living adjustment for differing areas to compensate for differences in charges.  

Look at vehicle repairs, there is a chilton manual that states what a given repair will cost to fix.  If while fixing x problem y develops (needing additional blood, etc) then that is added onto the bill.  Don't go hog wild on me for bringing up auto repairs to compare to humans.  In reality the systems are not that much different, as when you open up an engine you never know exactly what is wrong until you tear into it.  Yes the human body is far more complicated.  However, trying to bring in ideas from other industries to solve the problem might go a long way to actually providing meaningful reform.  

As far as the cost drivers outside of insurance, Harlod, I believe in previous conversations, you completely understand that I think lifestyles changes would control that.  Heck 70% of all medical costs come from 4 lifestyle related diseases.  What is the best way to control that, giving people a reason to take responsibility in their lives.  

Heck, as opposed to single payer, why not make all insurance policies identical that insurers are able to give.  This way, they can only compete by being more efficient than their competition and/or providing better service.  With a single payer system, there is NO/ZERO/ZIP Incentive for our government to try and become more efficient.  

This option simply allows our government to act as the Sheriff of Nottingham and steal from the taxpayers to give to an inept/corrupt/inefficient government.

Robin Hood did not steal from the rich and give to the poor.  He took back excessive taxes and returned them to the taxpayers.

On big pharma, you will not find any arguments from me.  I think the US is getting the short end of the stick.  The comment was more about the research dollars being counted towards the US' total health care expenditures.

On people going bankrupt because of a health problem.  78% of those have health insurance, some probably have claims falsely denied.  However, as most people in this country live paycheck to paycheck.  Maybe the issue is not about health coverage.  Maybe it has more to do with people living beyond their means.  The debt load people carry, etc..

" giving people money to buy health insurance is not corporate welfare, it is individual welfare."  

 That is incorrect. Even the food stamp program is a subsidy for agribusiness. Human welfare is the delivery of services, not cash. This has long been an error in our society's thinking on poverty relief. As long as business can milk the impoverished for government funds, poverty will be sustained because the profit motive dictates it. Why go the wrong route with health care funding? Keep it simple, pay for services rendered.

"how about the 11 trillion that the government owes."  

The federal deficit benefits investors and industry or the budget would be balanced. Even the causes of overspending can be related to government purchase, at high profit margins, of goods and services. Conservatives and many moderates are quick to blame the needy, the victims of the economy, not the contractors and investors benefitting from the larger outlays.

"why not limit compensation to those that want to provide insurance to those individuals receiving government money to do so."

$0 in operating fees and profits is the smartest limitation.

"You really have no concept of the benefits of essentially self insuring ones self"

You presume too much. I have said before that this is not about my ability to pay or the strategies that I have used to cope. Policy is not made by "what works for me" but by "what works for us." Our family made decisions, at various times, to forego the consumption added to the household by a second full-time worker (vehicle, daycare, clothing), to patronize local agriculture (CSAs), installed our first CFLs 14 years ago, keep vacations down to the local campground or daytrips, drive a 10 year old Civic (biggest car we owned, even with two kids, was a VW Quantum.) We held off buying a house until we had 50% down earned from a single income. Quite a feat when one lives where we do. Land here, in a rural area, sells for $100,000+ per acre. Finally, landed a deal under $300K for a 54 yr. old sort of Cape Cod on ¼ acre and got extra taken off for the termite damage.

I don't regret one decision we've made to move forward, build equity, and keep costs down. We've always had fun, we're tight family, my kids got by with books instead of game systems and TVs. We're strange by most American standards. Should I prescribe my life as the solution to affording health care? Maybe I should change mine and adopt yours? Maybe we should just think about ourselves and leave everyone who didn't do what we did to their own devices?

Last year we conserved heat and kept our oil bills down partially by putting up very heavy and unfashionable curtains across the arched entrances to a couple of rooms. Boy, did we tip the weirdness scale on that one. You understand, this makes us like the Addams Family where we live. We make our decisions based on less waste and making the most of our earnings. One of my friends is convinced that the decision to make sure that all of his children had an SUV was the best value for all of them.

"I pay my own insurance costs towards any future medical bills and will stop when I have 3 times my deductible saved up, in a CD at my local small bank."

Our local bank was replaced by Chase and TD North has provided the second bank within 9 miles of home. If I'm to have something within reach, those are my choices. Hooray for the marketplace!

I support local business. My medical insurance will not cover the local pharmacy. They like Wal Mart and internet scrips. But this guy in town fought for us in the past and we made the decision to give him as much of our business as we could afford. Again, my neighbors think we're crazy. The idea that his prices are higher because his market and his leverage are smaller doesn't cross their minds and doesn't matter to them. The notion that, if they give him more business, it would help someone whose children go to school with their children doesn't matter. Hey, we're all in it for ourselves, right?

"But for a tonsil surgery, a broken bone, an MRI being done at 4AM or 4PM which could have a different cost based upon supply and demand." 

 Such broadly flexible hours are not offered. How would you make the providers change their approach? If we're talking about consumers influencing the market, then keep to market principles and avoid wasted time and money on enforcement. What you're suggesting is fine but it's a product that the industry has opted not to deliver. Funny thing about demand, if no choices are offered, it is silenced. Suppliers know this and they know, with health care, it is a take it or leave it situation.

"Today the system is set up such that, the individual has no idea of the cost of care and does not pay most of the medical insurance they have."  

How so? I have always received and read the billing statements of what was and was not covered by insurance.

"Yup and eliminate the networks, the insurance company sets up a menu of payouts for routine medical coverage/surgeries."  

Like say, Medicare for all? Tell the insurers to act like the government. That explains why you suggest subsidizing the insurers with taxpayer funds, so that your solution to universal coverage is allowing the insurers to collect taxes. Better government by private capital than by our votes?

Insurance, as an industry, is profitable simply because it avoids paying out. Whether it's for your house, your car, or your health, it relies on networks of providers with negotiated pricing and denial of coverage to achieve this end. If you scuttle networks, you scuttle half the concept. If you leave them without both denial and negotiation, you might as well simply eliminate them. All you're left with is a pool of cash from which to draw and no incentive to control withdrawals. We can run on a principle of promoting the General Welfare and hove no more to show for it, business cannot.

"trying to bring in ideas from other industries to solve the problem might go a long way to actually providing meaningful reform."

I have no objection to the analogy. Maybe other industries can learn from insurers. Why hire your labor direct, pay them what you were going to but hire them from another company at cost + 20%? What has the insurance industry learned from other industries? Is not the market the teacher of the market? What's stopping them? There have been voices raised for decades saying things have to change - we want a different product -  costs are too high - we're relying on you, the insurers, to bring costs down.

"Heck 70% of all medical costs come from 4 lifestyle related diseases.  What is the best way to control that, giving people a reason to take responsibility in their lives."  

Big number - what's your source? And while you build consensus on the best life and take on the corrupters of national health, how will you stop the bleeding? Looking at the fight by the AMA and insurers, what do you think you'd confront with Monsanto and factory farming when you approach diet? I'd like to see you tackle their toadies in the USDA. They'll have deluded Iowa corn farmers marching on Washington. Have you seen coal and big oil clinging to their right to pollute? Cigarette makers are clinging to their corps of addicts and their handily owned southern congressmen. Even exercise is limited by the burdens of commuting and the industrial work day. You're talking about deep sociological and political changes, not ready-to-go solutions with sponsors in power, to spur on the economic changes. All laudable and proper battles in a larger struggle for better health but falling short on addressing the immediate need.

"Heck, as opposed to single payer, why not make all insurance policies identical that insurers are able to give.  This way, they can only compete by being more efficient than their competition and/or providing better service."

If you don't trust the government to run health care, why trust them to tell anyone how to run it? Either we're competent or we're not.

On past posts and other blogs on other sites, I've suggested this as a compromise alternative but incurred the wrath of Republicans and libertarians who do not see our right to tell business what to do but insist that we listen to business and have them tell us the best way because the profit motive is more reliable than government, even a government of the people. I include among these, my own Republican congressman. The "take no prisoners" approach by the opposition to reform manifests itself over a broad range of industry-friendly, democracy-hating individualism and economic dogma. I will not waste my time trying to fix what they and Wall St insist is best fixed by the market. Let them have it. Get the industry out of our government. The problem with trying to compromise with the opponents of reform is that only the reformers end up compromised.

"This option simply allows our government to act as the Sheriff of Nottingham and steal from the taxpayers to give to an inept/corrupt/inefficient government."

I will not surrender the fight to retain control of our government. The success of a republic, or any democracy, depends on the degree of citizen participation. A greater number of inputs, voters, involved in making the decisions reduces the probability of error. Allowing a more limited number of interests, with limited scope, to make decisions for us increases the probability of error. If the government or our republic is inept or inefficient, it is due to voter apathy and the influence of interests outside the governed. Surrendering by alienating ourselves from the government, our exercise of power for our benefit, in order to directly patronize the outside interests which have undermined our governance defeats the very foundation of our nation. Arguments for limited government which proceed from the premise of surrendering or accepting alienation from our government have no Constitutional merit. The right of a people to govern is baseless if it is conceded that the people cannot govern.

"However, as most people in this country live paycheck to paycheck...Maybe the issue is not about health coverage.  Maybe it has more to do with people living beyond their means.  The debt load people carry, etc.."

In a market economy, prices for all gods and services are driven by the common practices. If DINK families are the norm, prices will rise to meet the higher incomes. If an income floor of $100,000 per households were established, the top would rise sufficiently to leave those at the $100,000 in poverty. There is a circularity involving the supply of more labor in the market and the rising prices which demand more labor to acquire. The sociological, psychological, and ethical changes required for people to jump off the hamster wheel will not happen in any timeframe that will provide health care to those who need it now.

People are engaging in market commerce with corporate entities shielded from risk, availing themselves of bailout money, lobbying congress to work against the people's interest, building oil dependence, building the corn crop fiasco, creating the mock wealth of third-party services. All most people want is the necessities and some frills to make them happy and they are taught to labor long and hard for them. Marketing works because people can be influenced in their choices.

We're not talking simply about just providing for you, me, and the literate people on this blog. We're talking about birthers, tea baggers, death-panel mongers, laborers who identify with Donald Trump, investors who think Stephen Hawking owes his life to American medicine, people who bring automatic weapons to presidential press conferences and think that anti-Bush t-shirts are a threat, believers in clean coal burning. They are pro-life, pro-choice, pro-Harley, pro-Honda, Christian, Jewish, Buddhist, vegan, vegetarian. What's that line from Dire Straits - "two men say they're Jesus/ one of them must be wrong." For every one of these we agree with, there's the view that the others' have been sold a bad bill of goods. Do those that agree with us have more value than those that differ? Does every person of means work harder than every one without?

Whether the specific goods that they think will make them feel good are genuine or come from an ad-cultivated desire, it doesn't diminish them as human beings or diminish their immediate need for care. Don't compound the confusion and the search for value with yet another product tied to their labor and not their value as people or by insisting that they come to see the light of an idea antithetical to the perceptions of friends, neighbors, their schooling, their political leaders, or their families.

Harold,

Too many items to reply to.

Take it as you think that paying for an individuals health care is corporate welfare or individual.  It is still benefitting the individual who now has insurance.

==For every one of these we agree with, there's the view that the others' have been sold a bad bill of goods. ==

Right there is the primary responsibility of government, in a free society.  To protect the individuals property rights.  You see you made the perfect argument against the government being in health care.  They overpaid for certain items, how do you eliminate the time tested problem in governing bodies, that they eventually corrupt.  

If the majority of the people believe that drinking milk is a sin, then that becomes illegal.   You might scoff at the thought, that we the people would do such a thing.  When you have a group of people writing our proposed legislation and those voting on the 1100 page bills unable to read them prior to voting on them, their is an issue.

The government should do all it can to protect a free and competitive marketplace.  First and foremost is having a currency which is not manipulated by a private corporation, not subject to audit, etc..

While you sit and wish for universal health care where the docs can set their own rates the proposed legislation actually states that the government gets to set doc rates, lets them have access to all of our finances.  If they see we do not spend as much as our neighbor or we save more so that we can retire, buy a milk cow to make a little extra money, etc..  The government is going to be so deep in our lives at the rate you KNUCKLEHEADS are driving for we will no longer be a free country by a dictatorial one.  

I believe that we agree on most points.  However, the means to that end is totally divergent.  

Government should only protect its people and not be the social engineers it has been in facilitating guaranteed loans through Fannie and Freddie, benefitting the banks.  Telling us to carry debt on our homes in order to receive a tax break (benefitting the banks), telling us to save for retirement via and IRA or 401K (benefitting the banks).

Maybe your work should be towards getting house speaker Pelosi to bring forth legislation to audit the federal reserve, who has given out 10 trillion in unaccounted loans, which will probably never be seen again.  

The system is broken I agree, but the fundamental problem is the government and more so the FEDERAL RESERVE.  WIthout the federal reserve, and CONDITIONING via the TAX CODE, corporations would not have so much control.

Insurance companies do not make their money by disallowing claims.  They make their money, when properly regulated, by spreading risk over a broad population and taking a portion of the premiums to cover the overhead.

I had a house burn down and the insurance company was great.  My car accident, that another hit me or where a truck hit my two bulls were all handled in a very professional way.  

My health care experience was great for our childs birth and subsequent initial problems.  For my back surgery it was awful.

But that is where regulation should come in.  The government should act as a regulatory agency, not as the lackey to private industry it seems to have become.

The comment about people having a HSA and working towards controlling costs of medical care.  Was meant that most people have been conditioned into having a copay and that is there medical expense.  If one had a larger deductible, with a cash reserve they would be more mindful of how much the actual bill was, not just simply looking at it and throwing it in the medical file.