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t.d. reid is the best spokesman i've seen yet for changing the US health care system and for explaining the myths and misinformation about foreign systems. he needs to be the face of health care reform, not nancy pelosi and harry reid.

In many ways, foreign health-care models are not really "foreign" to America, because our crazy-quilt health-care system uses elements of all of them. For Native Americans or veterans, we're Britain: The government provides health care, funding it through general taxes, and patients get no bills. For people who get insurance through their jobs, we're Germany: Premiums are split between workers and employers, and private insurance plans pay private doctors and hospitals. For people over 65, we're Canada: Everyone pays premiums for an insurance plan run by the government, and the public plan pays private doctors and hospitals according to a set fee schedule. And for the tens of millions without insurance coverage, we're Burundi or Burma: In the world's poor nations, sick people pay out of pocket for medical care; those who can't pay stay sick or die.

This fragmentation is another reason that we spend more than anybody else and still leave millions without coverage. All the other developed countries have settled on one model for health-care delivery and finance; we've blended them all into a costly, confusing bureaucratic mess.

Which, in turn, punctures the most persistent myth of all: that America has "the finest health care" in the world. We don't. In terms of results, almost all advanced countries have better national health statistics than the United States does. In terms of finance, we force 700,000 Americans into bankruptcy each year because of medical bills. In France, the number of medical bankruptcies is zero. Britain: zero. Japan: zero. Germany: zero.

Given our remarkable medical assets -- the best-educated doctors and nurses, the most advanced hospitals, world-class research -- the United States could be, and should be, the best in the world. To get there, though, we have to be willing to learn some lessons about health-care administration from the other industrialized democracies.

T.R. Reid, a former Washington Post reporter, is the author of "The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care," to be published Monday.

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From the article:

"The key difference is that foreign health insurance plans exist only to pay people's medical bills, not to make a profit. The United States is the only developed country that lets insurance companies profit from basic health coverage. "

Those profits plus the surprisingly ultra high adminitration and marketing costs of the American insurance companies consume 25% of all money that circulates in health care. You don´t need to be a mathematical genius to imagine that it would be enough to insure everyone if you trim it down to at least 10% instead of 25%

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From the article:

"The key difference is that foreign health insurance plans exist only to pay people's medical bills, not to make a profit. The United States is the only developed country that lets insurance companies profit from basic health coverage. "

Those profits plus the surprisingly ultra high adminitration and marketing costs of the American insurance companies consume 25% of all money that circulates in health care. You don´t need to be a mathematical genius to imagine that it would be enough to insure everyone if you trim it down to at least 10% instead of 25%

Yes, because the government is just so **** efficient at running large organizations.......... :blink:

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I'm not -- I'm pointing out that the point being made (that profit is somehow bad for healthcare pricing because it is "wasteful") is not valid in light of the alternative being proposed.
The assertion is not that profit is wasteful, it is that the profit gained by insurance companies makes health care overpriced, unattainable and bloated.
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Yes, because the government is just so **** efficient at running large organizations.......... :blink:

then explain why public health care systems in other countries run so much more efficiently than the US private insurance system. it's too easy to say "government is inefficient" and "government doesn't do anything right". yet there are several examples in this article that prove that other countries can run a government health care program more efficiently than the US private companies can.

how is that?

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The assertion is not that profit is wasteful, it is that the profit gained by insurance companies makes health care overpriced, unattainable and bloated.

the point about efficiency is actually weakly connected to profits. the broader point about administration costs is that government run programs in other countries have much lower administrative costs than private run companies in the US, showing that government CAN actually run things more efficiently (in some cases) than the private sector.

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The assertion is not that profit is wasteful, it is that the profit gained by insurance companies makes health care overpriced, unattainable and bloated.

But Medicare, the VA, etc. are streamlined, efficient and lean.

That's my point.

And to Mizzou's point, the U.S. government isn't running any of those plans. To pretend that they'll begin to do that which they have no history of doing is fun, I guess, but not really accurate.

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From the article:

"The key difference is that foreign health insurance plans exist only to pay people's medical bills, not to make a profit. The United States is the only developed country that lets insurance companies profit from basic health coverage. "

Those profits plus the surprisingly ultra high adminitration and marketing costs of the American insurance companies consume 25% of all money that circulates in health care. You don´t need to be a mathematical genius to imagine that it would be enough to insure everyone if you trim it down to at least 10% instead of 25%

If you look at a pharma company's financial statements in detail, you'll find that "Administration" largely refers to the oversight of the process of getting FDA approval for a new drug. That's not something that can really be done away with.

As far as marketing, let's just think about that idea for a second. The whole point of buying an ad, for instance, is that it will bring in more for you in revenue than you paid for it. Marketing costs don't drive up drug prices-- the whole point of marketing is that if it's successful it'll pay for itself.

The bottom line is that it's really silly to compare the performance of the U.S. system with that of other nations around the world because every single developed nation free-rides and feeds on the innovation in drugs and procedures that only exists because of the profit motive here in the U.S. Remove the [relatively] high margins for US sales from the drug companies, and your PIRATED VIDEO IS ILLEGAL of new drugs dries up almost immediately. As a result, everyone is screwed.

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That was a very good article. I've been doing some serious soul-searching on how I feel about a public option. In this issue, it seems that the best ideological options and the most pragmatic are quite different. This is not something I've been able to find a bridge to.

The question I have is whether co-ops accomplish the same thing, and whether protections are in place to stop government from using its tax and regulatory power to streamline more and more people onto the public option.

But real reform would include doing away with the employer-provided model, allowing sales of health insurance across state lines (talk about stifling competition -- why do we not allow that now?), allowing states to regulate insurers on their own (i.e., repeal ERISA and allow states to hold insurers accountable without federal intrusion) and encouraging both patient accountability for cost containment (through HSAs, etc.) and equal access to "discounted" healthcare instead of the current "if you have insurance you pay 1/3 what the uninsured pay" thing.

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If you look at a pharma company's financial statements in detail, you'll find that "Administration" largely refers to the oversight of the process of getting FDA approval for a new drug. That's not something that can really be done away with.

As far as marketing, let's just think about that idea for a second. The whole point of buying an ad, for instance, is that it will bring in more for you in revenue than you paid for it. Marketing costs don't drive up drug prices-- the whole point of marketing is that if it's successful it'll pay for itself.

The bottom line is that it's really silly to compare the performance of the U.S. system with that of other nations around the world because every single developed nation free-rides and feeds on the innovation in drugs and procedures that only exists because of the profit motive here in the U.S. Remove the [relatively] high margins for US sales from the drug companies, and your PIRATED VIDEO IS ILLEGAL of new drugs dries up almost immediately. As a result, everyone is screwed.

that is based on the assumption that most innovations actually come from the US. With a quick look on the world wide drug market I noticed that there is just one US based company in Top8 and only Pfizer making more profit than the European ones who have the majority of their revenues in Europe. That market is as competetive as the American market and it results in the same competition based innovations as in the US. And it is just a matter of time until we see the Chinese enter the market. It´s a $450 billion market even without the US which accounts for $250 billion

But I am talking about insurance companies who offer neither any real value or innovations. Their profit is not re-invested into the health care market, it is paid out to the share holders. Name me one good reason why there should be a profit motive for insurance companies? It´s a pure financial and administrative service that has no effect on the quantity or quality of innovations regarding drugs and practices.

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Who said the government should run it? Non profit cooperatives work wonders in alot of countries.

I don't have much issue with non profit cooperatives as long as they are one element.

I disagree with the premise that profit is the reason we have problems with our healthcare system.

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I don't have much issue with non profit cooperatives as long as they are one element.

I disagree with the premise that profit is the reason we have problems with our healthcare system.

I also didn´t say that there are one element. Not going into detail but you can choose from hundreds of insurance funds in Germany and they are competetive and efficient. The more competetive and efficient they are, the bigger the yearly bonus for the management which provides a market motive. This may be regulated by the government, but it doesn´t mean the government has to run it. But it is definately possible to take profit out of the equation and increase the efficiency regarding those who offer the administrative and financial services in a health care system.

But I do agree with the critics that the Obama administration so far lacks the courage and creativity and vision to do just that. But you really have to question the motive for the insurance companies. There can´t be any real discussion about the need for a profit motive for pharma companies (research) and physicians (actual service on the customer) but I still need to hear a good argument how profit for the insurance companies has a positive effect on the health care system as a whole.

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I also didn´t say that there are one element. Not going into detail but you can choose from hundreds of insurance funds in Germany and they are competetive and efficient. The more competetive and efficient they are, the bigger the yearly bonus for the management which provides a market motive. This may be regulated by the government, but it doesn´t mean the government has to run it. But it is definately possible to take profit out of the equation and increase the efficiency regarding those who offer the administrative and financial services in a health care system.

But I do agree with the critics that the Obama administration so far lacks the courage and creativity and vision to do just that. But you really have to question the motive for the insurance companies. There can´t be any real discussion about the need for a profit motive for pharma companies (research) and physicians (actual service on the customer) but I still need to hear a good argument how profit for the insurance companies has a positive effect on the health care system as a whole.

Profit is good because it leads to competition for that profit which means that they have to do more than the other guy to entice the customers. Less customers, less profit. Private industry is setup to allow people to vote with their dollars. The real problem with the system is that insurance is tied to employers. Employers have a different objective than the actual consumer, which is the individuals who use the plan. You have to get the employers out of the equation in order for any system to work effectively. So far, I haven't seen how any of the plans in Washington will increase individual choice.

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Profit is good because it leads to competition for that profit which means that they have to do more than the other guy to entice the customers. The real problem with the system is that insurance is tied to employers. Employers have a different objective than the actual consumer, which is the individuals who use the plan. You have to get the employers out of the equation in order for any system to work effectively. So far, I haven't seen how any of the plans in Washington will increase individual choice.

I made that point in another thread, and it is exactly true. We have insulated consumers from the cost of healthcare on two levels: 1) Cost of insurance (most have it subsidized by employers) and 2) cost of care (insurers insulate the consumer from the impact of the costs of their healthcare decisions).

So to take a system that is messed up because of a third-party payor system and just change the payor in some cases and regulate other payors is not really helpful. In fact, it has the potential to make costs skyrocket (due to artificial demand created by a ton of new insulated consumers on the market).

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Profit is good because it leads to competition for that profit which means that they have to do more than the other guy to entice the customers. Less customers, less profit. Private industry is setup to allow people to vote with their dollars

I mastered in economics so I pretty much know the concept of competition and profit. Everyone knows the principles of supply and demand.

The question is if the health insurance market is actually a functional market that is solely determinated by those rules. Is profit achieved by winning as many customers as possible? Do the companies minimize their internal and external costs to offer their products for less money and winning customers? Is profit achieved by winning new customers with more services? Do people really have the option to vote with their dollars? Do all people actually have a choice?

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I mastered in economics so I pretty much know the concept of competition and profit. Everyone knows the principles of supply and demand.

The question is if the health insurance market is actually a functional market that is solely determinated by those rules. Is profit achieved by winning as many customers as possible? Is profit achieved by winning new customers with more services? Do people really have the option to vote with their dollars? Do all people actually have a choice?

If you mastered in Economics, then you'll understand scarcity of capital, and effective management of it, which is what is really provided by insurance companies. Otherwise, capital must be coerced from the market via government. Furthermore, the measure of the effectiveness of that capital management is reflected in profit in the private market or deficits in the public market. By any measure, the private market has proven to be the best manager of that capital. Public health costs are continuing to spiral out of control in socialized health care states, especially places like Britain, Canada, and France, and even Germany has an issue, but it has at least defrayed some of that to the private sector, thus giving them a leg up over their counterparts.

But what's not regularly included in this discussion is the vast difference in demographics, rural concentrations, and lifestyle when doing comparatives between these other states. It is much easier to find a one size fits all effective solution in more homogeneous, smaller countries than it is to deal with the US. Aside from having a population larger than all of the aforementioned combined, we are a melting pot by all stretches of the term, including our health, culture, and lifestyles.

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If you mastered in Economics, then you'll understand scarcity of capital, and effective management of it, which is what is really provided by insurance companies. Otherwise, capital must be coerced from the market via government. Furthermore, the measure of the effectiveness of that capital management is reflected in profit in the private market or deficits in the public market. By any measure, the private market has proven to be the best manager of that capital. Public health costs are continuing to spiral out of control in socialized health care states, especially places like Britain, Canada, and France, and even Germany has an issue, but it has at least defrayed some of that to the private sector, thus giving them a leg up over their counterparts.

If scarcity of capital is really the problem on the health care market, how do you explain the German (and other) systems that do provide the needed capital for research and the services itself without any government money? An insurance company is not a bank, you seem to get those two mixed up.

Banks provide capital to players on a market who do not have the needed money for their planned investment that will amortize over time into that money.

Insurance companies just straightens out unknown und unregular cash flow and unpredictable risk into a regular cash flow and predictable risk for the customer. Their service is not to manage the capital of the consumer and scarcity of capital is usually not the motive to insure yourself. The administration of coordinating a vast number of players on the market (from doctors to pharma companies to customers), not to provide capital that is not there is the main objective of an insurance company these days. Certainly the drug companies have their own money for R&D and I doubt the insurers give out credits to the physicians if they want to equip their offices with the newest state of the art medical devices.

And to be honest, how do you explain that the drug cost trippled on the US market in the last decade while it is actually steady in Europe? And nope, it is not because we rationalize medicine over here (Britain doesn´t count, they are placed last within the EU on nearly every social system). Looking at what the average Joe American has to pay for his insurance, I really can´t say that looks too attractive financially.

But what's not regularly included in this discussion is the vast difference in demographics, rural concentrations, and lifestyle when doing comparatives between these other states. It is much easier to find a one size fits all effective solution in more homogeneous, smaller countries than it is to deal with the US. Aside from having a population larger than all of the aforementioned combined, we are a melting pot by all stretches of the term, including our health, culture, and lifestyles.

First of all there is not much difference between the populus of the US and a European country, certainly not on lifestyles and also not in demographics as we are all getting very old which is a burden for every western country these days. I also fail to see the relevance of culture or even race in this debate. It is nothing more and nothing less a financial and administrative issue. And the it also doesn´t matter that your population is bigger because you have a comparable GDP per person as these other countries, sometimes even higher.

I know this might offend some people but America is really not that different and nothing about different lifestyle, culture, demographics or ethnic is either not existing or relevant because - as I said - it is purely a financial and administrative issue.

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If scarcity of capital is really the problem on the health care market, how do you explain the German (and other) systems that do provide the needed capital for research and the services itself without any government money? An insurance company is not a bank, you seem to get those two mixed up.

Banks provide capital to players on a market who do not have the needed money for their planned investment that will amortize over time into that money.

Wow, you have a rudimentary understanding of capital markets, along with where the money comes from for research and development in the health care market. Access to capital isn't a "bank only" function. Any retirement accounts you hold today are a simplistic way to break that perception.

Insurance companies just straightens out unknown und unregular cash flow and unpredictable risk into a regular cash flow and predictable risk for the customer. Their service is not to manage the capital of the consumer and scarcity of capital is usually not the motive to insure yourself.

Managing and/or protection of risk against a large capital requirement is managing the reality of scarcity.

The administration of coordinating a vast number of players on the market (from doctors to pharma companies to customers), not to provide capital that is not there is the main objective of an insurance company these days. Certainly the drug companies have their own money for R&D and I doubt the insurers give out credits to the physicians if they want to equip their offices with the newest state of the art medical devices.

They are a third party payer, and technically (although I know there are practical differences) no different than an individual paying for themselves as it relates to drug companies, physicians, or hospitals.

And to be honest, how do you explain that the drug cost trippled on the US market in the last decade while it is actually steady in Europe? And nope, it is not because we rationalize medicine over here (Britain doesn´t count, they are placed last within the EU on nearly every social system). Looking at what the average Joe American has to pay for his insurance, I really can´t say that looks too attractive financially.

Price controls have the biggest in price difference between the US and Europe. It's no secret that the US pharma market is the most profitable for all drug companies. And while many pharmaceutical companies remain headquartered in Europe, their R&D has shifted dramatically to the US over the past 20 years due to the very issue of price controls and return on R&D investment.

First of all there is not much difference between the populus of the US and a European country, certainly not on lifestyles and also not in demographics as we are all getting very old which is a burden for every western country these days. I also fail to see the relevance of culture or even race in this debate. It is nothing more and nothing less a financial and administrative issue. And the it also doesn´t matter that your population is bigger because you have a comparable GDP per person as these other countries, sometimes even higher.

I know this might offend some people but America is really not that different and nothing about different lifestyle, culture, demographics or ethnic is either not existing or relevant because - as I said - it is purely a financial and administrative issue.

Oh really? Is that why disease management strategies are different from nation to nation? Is that why rural health care is a much bigger issue in the US than it is in Europe? I'm not sure why you're bringing up race, but the cultural aspects aren't necessarily race relevant. Take for example that we have a commuter, sedentary, free to do what we want, higher stress culture than Europe. Those are all relevant to health care services, cost, and management.

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I didn´t say it´s a bank only function but it´s not a primary function of a health insurer. You still refer to financial needs of the pharma industry that would be unchanged no matter what kind of system you have for the insurers.

Just wanted to say that not every financial service is based on the shortage of capital and not every financial service will most effectively work with a profit motive. Thus far nobody was yet able to show me why a non profit cooperative model for insurers would not work... especially when you have the living proof in other countries that it does work. I am fully aware that we are talking about the holy cow of redistribution of wealth here but at some point you need to know if you can justify millions of uninsured people with the profits for a handful who don´t use the profits to create new jobs or use in R&D (other than new methods how to rip your customers most effectively)... and i don´t mean the phama industry, let them make insane profits as long as they put more money into R&D than marketing

Every country has a different system, different needs, you are right about that, but there is no significant different in the US compared to those other three dozen countries that explains why the US is either incapable or cuturally different that it can not have at least basic health insurance for everyone. Well maybe the holy cow is the difference ;)

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