Price controls coming for health care

Woo hoo!

My first thought at greensdale's posting the 1000th comment was "bad greensdale! I posted 999 so that stevejhx could have the honor of 1000." But then I reasoned that greensdale's bursted gameshow posts were so funny, that I have no problem with his taking the 1000 honors.

in honor of stevie, i was hoping the 1000th would be: feint, bs reference post, backpedal, repeat....

I also saw a double-digit rate increase, too, remember?

But it has nothing to do with Obamacare, which hasn't even started yet, though I did mention the hospital antitrust issue, as well.

That said, despite the rate increases, the rate of increase in healthcare costs as a whole has been slowing, though I wouldn't attribute it to a plan that hasn't started yet.

I believe you said that antitrust law would be able to deal with hospitals here. Please elaborate, starting with the efficacy of antitrust law in dealing with oligopolies. Make sure to include extended discussion of game theory. We're waiting . . .

Be glad to, novice, as soon as you provide me your analysis of the elasticity of demand for concierge healthcare services.

We're waiting....

steve - The demand for concierge healthcare services has zero to do with the point nyc1234 made or with the direction this discussion has taken. The direct pay/concierge discussion is an entirely separate discussion that I definitely know you are not equipped to have (though I am well equipped to have it because my primary care physician is in fact a FFS direct pay provider - any consumer of this model such as myself takes serious charge of their own healthcare and loves it; it is not intended for hospital stays, for which I have insurance coverage). If you could actually grasp the complexity of the healthcare industry, beginning with all the submarkets, you might have a clue as to what anyone was talking about in the multiple separate discussions that have gone on within this lengthy thread. With each comment you make, you demonstrate a new level of ignorance that is simply astounding. You have failed to grasp nyc1234's point at every turn, and have made it abundantly clear that you have not a clue as to the structure of the healthcare industry or any of the submarkets within it. What is interesting to me is that nyc1234 made a comment early on in this thread about what he was actually observing on the ground level; he was not speaking as an economist or a lawyer, but was describing a phenomenon with which economists and lawyers (intersection being antitrust lawyers - hello) are intimately familiar. I did some research, and he is right on the mark. Those who are charged with policymaking in this area are indeed concerned about this because antitrust law is not well equipped to deal with oligopolies, which is the way the structure of the hospital market has gone. Trying to discuss this with you is like talking to a 5-year old who watched an "econ for toddlers" segment on sesame street and thinks that qualifies them to call themselves an economist. Honestly, what is wrong with me that I keep getting sucked back into this?

rangersfan - I though steve had actually finally jumped in the hole he dug for himself and realize it, but instead he continues to shout up at me from the hole he has dug and jumped into.

P.S. to Steve - to the extent that you are genuinely curious, I suspect demand for direct pay/concierge is actually highly elastic because there are tons of substitutes (I can go to physician covered by my insurance at no extra charge). The great thing about this model is that you have a real relationship with your primary care physician and you can say "yay" or "nay" to any service. You can also get a second opinion from a competing physician (e.g., one within my PPO's plan) if your direct pay recommends anything from which s/he might profit and you suspect conflict of interet might be getting in the way of sound medical advice. Takes time and money to avail yourself of this model, but I know a number of people who prefer this model from the consumer side.

"The demand for concierge healthcare services has zero to do with the point nyc1234 made or with the direction this discussion has taken."

I never said it did. I said I agreed with 1234's points, so I don't know what you're talking about. You asked me a question about oligopolies out of nowhere, so I responded in kind. That said, I'm sorry you've had to resort to ad hominems - "is like talking to a 5-year old who watched an "econ for toddlers" - after a thousand posts.

I would be very concerned with oligopolies, as well, and I am, as most insurance companies act as oligopolies in the states where they operate. They deliberately don't compete with each other, and buy up their competitors. They're helped along by short-sighted states (like NY) that sell their publicly owned mutual insurance companies to private operators (HIPP, for example), reducing competition while simultaneously increasing prices through the added "profit" that private companies have to make, without instituting any effective cost controls, because they don't have to.

"With each comment you make, you demonstrate a new level of ignorance that is simply astounding."

Maybe, but I clearly said that the VA provides excellent care at an affordable price and is liked by its users (and has better outcomes) than Medicare or Medicare Advantage, and you still deny that's the case because 2 bloggers on this thread said so.

And you still have not told us what the uptake of concierge care is in the US, despite touting its benefits. But this is a killer: "The direct pay/concierge discussion is an entirely separate discussion that I definitely know you are not equipped to have (though I am well equipped to have it because my primary care physician is in fact a FFS direct pay provider...."

WHOA! You go to a FFS direct-pay provider so YOU KNOW!

That's some mighty bona fides you're brandishing there, novice.

BTW one of the great benefits of Obamacare will be that each state exchange will have to offer at least 2 national health plans, one of which will be the plan for federal employees that anybody can join.

That should be a kick in the pants for competition.

in terms of care, what do u think has a more inelastic demand curve: critical/emergency/inpatient care (ie hospital) or outpatient practices?

stevie:
"What is wrong with "NYCNovice", "that(she)keeps getting sucked back into this?"

Will her condition be covered by:
A) ObamaCare
B) does she just need to buy more fruit
C) or clean out her fridge before going out of town for 10 days
D) volunteer weekly at a soup kitchen
E) Get off her high horse and resign from her self-appointed status as the streeteasy community organizer

From Steve: "You asked me a question about oligopolies out of nowhere, so I responded in kind."

My response: If you had a clue, you would understand that my question was not "out of nowhere." You have made my point yet again.

@nyc1234: Exactly. Completely separate markets. Outpatient - highly elastic demand; inpatient care - inelastic demand. Steve does not understand the myriads of submarkets within the greater market for healthcare services; this is problematic on every level and makes intelligent discourse impossible. My first clue here was his continual focus of measuring a system's quality primarily on its mortality rate. Simply maddening.

Truth: Stuff a sock in it already. Don't you get it that HB is the community organizer? I would never presume to take his place.

NYCNovice:
Stuff your own community organizer sock in it, already.

huntersburg has never directed any poster: "Can't you do the same for your streeteasy community?"
He knows this is a website discussion board, not a "community".
He's never attempted to make the rules around here.

novice - "oligopoly" doesn't appear anywhere in this thread; we did discuss it tangentially, but not specifically, though I'd be happy to if you'd like, as I started part of it with the oligopolies of health insurance companies.

1234: "in terms of care...."

As the system currently works, a lot of "emergency" care isn't "emergency" at all, as you know. True emergency care would probably be very inelastic; but unlike what novice - expert of experts in "submarkets" - says, in the US "emergency" care is routinely used for non-emergency purposes, by those who have no insurance.

"inpatient care - inelastic demand" is not correct, novice - people routinely postpone elective or non-emergency (and even emergency) interventions. You didn't even answer the question properly; 1234 asked it properly, however.

"Outpatient - highly elastic demand": well I'm glad you finally recognized the fundamental flaw in your "concierge healthcare" model.

Thank you for proving my point.

Truth - How is asking you to refrain from interrupting a conversation with an attack on any poster who is participating in the discussion "attemtping to make a rule?" You may not have noticed, but HB has gently tried to steer you away from such behavior on a number of occasions - e.g., lay off adoption, enough with the fruit, etc. I was warned that you would turn on me with a vengeance if I ever hinted at appreciating certain other posters; I did not really believe it, but point to those who warned me. Feel free to continue your random remarks about me; I am on the Internet after all and everything I say is fair game. However, if you ever want to resume polite conversation, I would be happy to talk to you as if whatever you have said or continue to say never occurred. I have no issue with you. If you have an issue with me, there is nothing I can do about that. Carry on.

Why do you even pay attention to them, when they are gray for a reason?

Frome Steve: "novice - "oligopoly" doesn't appear anywhere in this thread; we did discuss it tangentially, but not specifically, though I'd be happy to if you'd like, as I started part of it with the oligopolies of health insurance companies."

My Response: Really? what about my post from 5 day ago, reproduced for convenient reference below. Your credibility destroyed, yet again.

NYCNovice
5 days ago
Posts: 515
Member since: Jan 2012
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steve - I think the point nyc1234 was making re creating a monopolistic system is the following: The Affordable Care Act (Obamacare) is resulting in increasing concentration among the providers of healthcare. Small, independent and more efficient providers are being gobbled up by large hospital systems and hospitals are merging. This concentration is increasing the bargaining power of healthcare providers vis-a-vis both private insurance providers and the government. Once consolidation is complete, we will all be at the mercy of these large hospital systems. There will probably be enough of them that each can avoid monopolopy scrutiny; it will be more like an oligopoly, and his prediction of tacit collusion merits consideration.

I am now going to have some intelligent conversation, with my dogs.

My bad - missed that one!

But as I mention above (without having seen that post) - I agree with the concern.

Now how's about some explanation of "outpatient - highly elastic demand" as it will affect the concierge healthcare model?

Well okay then! That is progress. What is your specific question about how highly elastic demand will affect concierge healthcare model? You have to understand that there are multiple models actually within the label "concierge." I prefer direct pay. For me, I don't pay a flat fee, but rather do full on FFS with my primary care provider who takes no insurance whatsoever and you pretty much have to have an interview for her to accept you as a patient. She was top of her class at Johns Hopkins and has built up a loyal patient base such that she is in a position to choose her patients. I have never personally spent more than $1000 on her services in any given year, but I love being able to get in to see her whenever I want and call her up to ask her about specialized services I might be receiving from another healthcare professional. I find her prices totally reasonable, but to the extent that they weren't, I would simply stop using her and go to one of her competitors (she is not the only direct pay in town) or go to a physician within my PPO, so I am not sure what your question is.

NYCNovice just can't help herself from referring to huntersburg and tries to interpret his comments to me.

She "was warned" (by who? the "gym-rat"?)
that I would turn on her with a vengeance, if she ever hinted at appreciating certain other posters..."

What a load of BS.

I don't care who you appreciate, NYCNovice.
"Turn on you with a vengeance"?!

You started posting comments on se ,under several noms de se after lurking or whatever.
You act as if other se comment-posts never existed until you started posting here.

You really don't know what it is to be: "turned on with a vengeance" because you agree/disagree with comments posted on se.
Yeah, "point to those who warned (you)..."

You asked me "to refrain from interrupting a conversation..."

""hb" has not tried to gently steer me away..."
I explain my point and he's good with it.

You however, have selected to direct only me to post comments that you agree with.
And then, only about commenters that you "appreciate".

"Lay off adoption"?!
I wasn't the one who started posting comments about adoption.

"Enough with the fruit"?!
I wasn't the one who started posting comments about fruit.

"Feel free to continue my random remarks about you"?!
"You would be happy to resume polite conversation with me..."?!
"As if whatever I have said or continue to say never occurred..."?!

Don't do me any favors, NYCNovice.

Go buy an expensive treadmill for your apartment and declare yourself to be "a gym rat", for all I care.
Get over yourself, NYCNovice.

Unlike what you think, novice, when I am wrong I clearly admit it. I don't always like to, but I do.

And I actually did not see that post, & I only searched on the earlier pages, not this one, which is why I didn't find it. But I 100% agree with it as it relates not only to hospitals, but also (and especially) to insurance companies, as they are much bigger players. I also agreed with 1234's recommendations.

I disagreed with you and him on the VA model - which is actually just a very large HMO - and so do its patients. Its outcomes are also better than Medicare's even when adjusted for the different population sizes; it's something that you should be willing to recognize as a viable option moving toward the future.

My question on concierge call is always the same: for all of its modalities, what is its uptake?

Because I agree with you that outpatient care demand is elastic, though maybe not highly, and if it is a negligible segment of the market (as I believe it is) it's not even worth talking about.

"concierge call" = "concierge care."

OOPS!

stevie: you might want to get that checked out.

I'm confused. stevejhx says he agrees with nyc1234, but nyc1234 doesn't seem to think Steve agrees with him.

huntersburg: Are you trying to gently steer them away from such behavior?

Hey Truth, I have a riddle.
What do you get when you cross a lawyer with an economist?

an Anti-Trust Lawyer!

come on, the answer was right above. This thread is so exciting!

What do you get when you cross a translator with a concierge?

What do you call a man with no arms and legs floating in the pool?

Steve - the businessweek article that I posted weeks ago discussed its uptake. The point I was making is that primary care physicians are already in short supply. The more they are squeezed by insurance companies, the fewer physicians will choose that area and those who are already in it will be inclined to stop participating in cheap insurance plans and medicare. When I was on my cheap insurance plan through my federal employer 10 years ago, I could not find a single primary care provider in NW DC who would take me as a patient. I went to one in NE DC who mistook me for the pharmaceutical sales representative he was waiting for and could not believe I was actually considering being one of his patients - first time I was subjected to racial discrimination in my life. I have no idea how many primary care physicians have a patient base that could make this work, and I have no idea who many people have enough money to make this work; my whole point from the get go was that these people have a right to exist and the market should decide whether that segment grows or not. I will also note that Yikes chimed in at one point, wholly unsolicited, and stated that this segment was growing, so he might have some additional information here.

Re the VA model, I think we are all in agreement that such would be a great safety net that many would welcome. However, as far as the HMO model for the entire population of the United States, didn't we already try that in the 90's? and didn't consumers reject it? We all acknowledge the FFS model is fraught with moral hazard, but so is HMO model. This is what nyc1234 was explaining - with hospital administrators trying to protect their bottom line, there will be temptation to skimp on services. The price-control-lite system that the ACA has put in place still lets insurance premiums rise if they are justified based on actual costs, and the insurers are able to demonstrate increased costs based on the prices the hospitals are charging due to their increased bargaining power. The ACA has left us with the same cost problem; it is just that the profits are being transferred from insurance companies to hospital systems.

I can't speak to the difference in quality between various hospitals, but I do know physicians who feel strongly that such quality differences exist, and I tend to defer to their opinions, academic studies notwithstanding. With that said, I would be delighted to hear from a physician who has been in both the VA system and the private system say that the VA system yields the same results.

Finally, accepting your position that the VA system yields the same quality in healthcare, I have always said that there are value judgments at play. If one of my loved ones needs urgent medical care, I don't want them waiting in line to get it, and I don't want someone telling me that my loved one's medical needs are not as important as those of another.

P.S. re why I read the grays - I think they are generally hilarious. It is like having the TV on in the background while you are having a discussion.

Hey remember that episode of The Office when Michael Scott was visiting that business school class, and someone asked him about the Herfindahl–Hirschman Index. That was funny.

What do you cal a man with no arms and legs floating in the pool?

with this venue i'd say HB

WRONG - Bob.

huntersburg:
I would have given you an answer but I was refraining from interrupting this conversation.
So don't attack any poster having a conversation on this discussion thread.
Mind your behavior!

with this venue

Not sure why you worry about that. Neither you, nor me, nor aboutready interrupt stevejhx since we are grey.

Eh, not worried about that.
stevie wasn't the one complaining about it.
It was the community organizer giving directives.

Steve, the exact paragraph from the businessweek article posted weeks ago earlier on this thread (http://mobile.businessweek.com/articles/2012-11-29/is-concierge-medicine-the-future-of-health-care)re uptake excerpted below:

"There are 4,400 concierge doctors in the U.S., 30 percent more than there were last year, according to the American Academy of Private Physicians, their professional association. “This is all doctors want to talk about,” says Jeff Goldsmith, a health-care industry analyst and trend spotter. “ ‘I want to go off the grid. I’m done billing Blue Cross. I can’t deal with this anymore. It’s destroying my life and my relationship with my patients.’ ”

You cannot claim not to have seen my post where I provided the link above weeks ago because you commented on a quote from within the article regarding a physician's wanting to be in top 1%, so now you have me really confused. What do you have to say for yourself on this one?

Yes he can. He does it all the time. When will you learn.....

Soon he will say you said something that you did not actually say.

Bob I was thinking Matt

I am still trying to figure out if he really does not understand or if he is arguing in bad faith. I deal with this professionally all the time, but I am used to having a referee. In steve's case, I believe he is arguing in good faith and really simply does not understand, but his continuing to ask questions suggests that he wants to understand, so I don't think it is fair to leave a very specific question unanswered, as long as I have the time and the inclination to answer it. If he asks a question that would require me to get into anything complex, then I will just exit the conversation yet again with the happy acknowledgment that I am just an anonymous nitwit on the Internet with no idea what I am talking about.

Actually, when I click on your post nothing happens; I get a blank page.

You didn't post the uptake of concierge healthcare; you posted the supply. The supply of those services is potentially limitless - ask anybody and they'll gladly do their job for more money than they're currently making.

The point is the uptake of demand, because as you yourself state the demand for outpatient services is elastic.

"didn't we already try that in the 90's?"

It still exists and is quite healthy today in Kaiser Permanente (the most famous one) and even in my lovely Florida:

http://ahca.myflorida.com/mchq/managed_health_care/CHMO/docs/May_2012_GSA.pdf

"and didn't consumers reject it?"

No, consumers didn't reject it - health insurers rejected it because they make more money by passing through the costs under the now more prevalent PPO model.

I perfectly understand what you're saying novice; if you think I don't then just tell me specifically where. I ask you for the uptake of concierge healthcare services & you give me the number of doctors using the model rather than the number of patients, which is not at all the same thing and completely irrelevant.

I tell you the VA has excellent medical outcomes that exceed Medicare and Medicare Advantage at significantly lower costs, with much happier patients, and you deny that it is true and say that it would be "a great safety net that many would welcome," when in fact it is the largest single provider of healthcare in the country.

Your entire problem can be summed up in this sentence: "I would be delighted to hear from a physician who has been in both the VA system and the private system say that the VA system yields the same results."

That's like asking the old GM if they thought the cars they were manufacturing were great - OF COURSE THEY DID! And of course no one else did which is why they kept on losing market share.

As long as you continue to look at the supply side of the equation and ask yourself whether the suppliers are happy, without any regard whatsoever to outcomes and costs of outcomes you will never reached any change in outcomes. It doesn't matter what the supplier of any good or service "thinks" about his product - what matters is what the customers think, and who can afford to buy the product.

That is just fundamental economics and marketing, novice. Asking a doctor if he thinks he's a good doctor is like asking a lawyer if he thinks he's a good lawyer - of course they do.

What matters is the objective outcomes and the costs of those outcomes. As long as you deny that - which is the essence of any good or service sold - nothing will ever change.

>Bob I was thinking Matt

What has two arms and two legs laying in front of your doorway?

Steve - I disagree with a number of your statements above, but none of those are material to the discussion. Re the concierge/direct pay model, we are pretty much talking past each other, but none of that matters because I don't disagree with you regarding the future of direct pay/concierge model being far from certain. My initial fear of additional regulations on these direct pay providers remains, but that initial fear is now subordinate to greater fear that it will be in the best interest of physicians such as my direct pay primary care provider to sell out to large hospital system, leaving me, the patient, with no choice but to go to large system for healthcare run not by physicians but rather by business people. As I have stated numerous times, I was prepared for my taxes, personal insurance premiums and out-of-pocket costs to rise under the ACA - I am willing to pay to protect the uninsured from bankruptcy due to serious injury or illness. However, I am not on board with receiving medical care in an HMO market, particularly one structured as an oligopoly.

P.S. to Brooks2 - btw, out of sheer curiosity, I actually read all the back and forth between you and Steve last night. I am not even remotely sophisticated in finance, but I got your point well before Steve did. I think he finally got it, but then tweaked his position to fit his new understanding without ever acknowledging that he had been wrong or had not understood your point. I don't think he has done that in my discussion with him, but I do think he did that in his discussion with you.

Novice, there is not one of Brooksie's "positions" on the matter we were discussing that I ever switched my position on.

I figured I couldn't get a straight answer out of you on those issues that I raise.

"I am not on board with receiving medical care in an HMO market, particularly one structured as an oligopoly."

You already have insurance structured as an oligopoly, so your protests are coming too late.

And nobody said you had to receive medical care in an HMO market - though if it's a market structured like the VA you'll wind up richer and healthier because of it.

These oligopolistic health insurers and hospitals - how have their stocks performed relative to the S&P?

http://stockcharts.com/h-sc/ui

http://www.foxnews.com/us/2012/06/28/hospital-stocks-jump-after-health-care-ruling/

pretty well for hospitals. not so much for insurance companies. that makes sense. insurance companies are going to have no power. hospital CEOs, on the other hand...

whoops that link didn't work for the chart, try this:

http://stockcharts.com/h-sc/ui?s=HCA:SPY&p=D&b=5&g=0&id=p74807239662

Steve - so that we can end on positive note/common ground, I will grant your point re uptake in concierge care. I did not post any meaningful statistic there, and I while I have not done a search for any statistics there, if I did and were I to find one, I suspect the uptake would not be significant. Also agreed that I currently do not have to receive medical care in an HMO market; there is currently a robust FFS system that I use on a voluntary basis despite the availability of cheaper alternatives, and I hope that system remains both available and open to competition for those who are willing to pay for it. Finally, in an attempt to close out this discussion once again and bring it back to original topic, this consumer does not want price controls in healthcare. Can we be done now?

And once again, thank you to nyc1234 for participating in the discussion and giving insight from the front line. Good luck to your and your brethren; I don't envy you.

I'm not sure that there is an ETF that tracks just hospitals, but IHF tracks healthcare providers and biotech companies.

Its performance is virtually identical to the S&P 500:

http://www.marketwatch.com/investing/fund/ihf/charts?symb=IHF&time=8&startdate=1%2F4%2F1999&enddate=1%2F16%2F2013&freq=1&compidx=SP500&compind=none&comptemptext=Enter+Symbol%28s%29&comp=none&uf=7168&ma=1&maval=50&lf=1&lf2=4&lf3=0&type=2&size=2&style=1013

XLV is also a broad ETF that includes pharmaceuticals & others. It has performed better than the S&P:

http://www.marketwatch.com/investing/fund/xlv/charts?symb=XLV&time=8&startdate=1%2F4%2F1999&enddate=1%2F16%2F2013&freq=1&compidx=SP500&compind=none&comptemptext=Enter+Symbol%28s%29&comp=none&uf=7168&ma=1&maval=50&lf=1&lf2=4&lf3=0&type=2&size=2&style=1013

XLV has a beta of .68; IFH has a beta of .99. That is why they have performed as they have.

Of the two of those, IHF is the one that contains the most health insurance companies; there isn't (that I know of) an ETF that tracks JUST health insurance companies. There is a list of healthcare-related ETF's here:

http://seekingalpha.com/article/670421-top-10-healthcare-etfs

As a general rule health insurance stocks have underperformed the S&P. Here is UnitedHealth:

http://www.marketwatch.com/investing/stock/UNH/charts?symb=UNH&time=8&startdate=1%2F4%2F1999&enddate=1%2F16%2F2013&freq=1&compidx=SP500&compind=none&comptemptext=Enter+Symbol%28s%29&comp=none&uf=7168&ma=1&maval=50&lf=1&lf2=4&lf3=0&type=2&size=2&style=1013

Hospital corporations done much better than the S&P:

http://www.marketwatch.com/investing/stock/HCA/charts?symb=HCA&time=8&startdate=1%2F4%2F1999&enddate=1%2F16%2F2013&freq=1&compidx=SP500&compind=none&comptemptext=Enter+Symbol%28s%29&comp=none&uf=7168&ma=1&maval=50&lf=1&lf2=4&lf3=0&type=2&size=2&style=1013

And also better than than insurance companies. See UnitedHealth (blue line) versus HCA (orange line):

http://www.marketwatch.com/investing/stock/UNH/charts?symb=UNH&time=8&startdate=1%2F4%2F1999&enddate=1%2F16%2F2013&freq=1&compidx=none&compind=none&comptemptext=HCA&comp=HCA&uf=7168&ma=1&maval=50&lf=1&lf2=4&lf3=0&type=2&size=2&style=1013

These comparisons are not uniform, however, especially over long periods of time.

I don't think it's so much that "hospitals are going to have power," though, as it is that hospitals will no longer have such high default ratios.

a sincere thx for the support, novice.

steve, why don't you go to drudge report. just click on any politically based link and scroll to the bottom. u will find "ur people" in those comment threads. there, u will have hours to share ur wisdom to a large community. there u won't be bothered by people with "degrees". u will be both kaiser and king in that world.

Why thank you, 1234, but the Drudge Report is about as far away from "my people" as you could possibly imagine. I watch MSNBC and have never been able to stand more than 3 minutes of Fox News in one week.

I've agreed with most everything you said so I really don't see why you need to be nasty about it.

@steve

first of all, lighten up. everything is not always meant seriously. it's an anon internet board!

second of all, u really should look at the threads there. i'm pretty far left-wing, although i know it sounds the other way based upon what i have written. if u were to read those threads alone, u would prob never come back here ever again. people post the most crazy racist, close-minded, backasswards ideas on there, with the bonus being that they actually use their facebook profiles (pics and all)!!!

I've looked at redstate.com - that's enough. I can't risk my browser exploding.

>i'm pretty far left-wing, although i know it sounds the other way based upon what i have written.

Makes sense. Bigger government as long as you, your money, and your livelihood aren't impacted.

http://www.arthritisinsight.com/archives/test8028.htm

"...This is the chart that I think ought to dominate the conversation about public-sector health care spending in the United States, and yet it is curiously ignored. The data show government health care spending per capita in the United States and Canada. The United States spends more. And that's not more per person who gets government health insurance, it's more per resident. And yet Canada covers all its citizens, and we don't. That should be considered shocking stuff, and yet I rarely hear it mentioned...."

http://www.slate.com/blogs/moneybox/2013/01/23/chart_us_government_spends_more_on_health_care_than_the_canadian_government.html?wpisrc=obnetwork

insane. For what we spend per person on Medicare, Medicaid, the VA, and public-sector employees, we STILL spend more per person than Canada does to cover EVERYBODY. Colossus waste!!!!!!!!!!

Colossus?

@huntersburg

not quite. to me, far-left means social policy. i don't see that the republicans and democrats are very different from each other, they both sell different products. also there is not much evidence that democrat presidents have increased govt size much more than republicans. also not the case that the dems put us in more debt than the republicans although that may have changed after obama came.

http://www.politicususa.com/big-government-obama-reagan.html

also, i'm def not one going around bitching about my tax load. never have

If you don't "bitch" about your tax load, would you agree to pay more?

"Colossus?"

Yes, I love the X-Men!!!!!!

http://en.wikipedia.org/wiki/Colossus_(comics)

@greensdale

i am already paying more this year and i have not sent a letter to the IRS stating that i refuse to pay 39.6%. so yes, i have "agreed" to pay more. i don't spend a lot of time thinking about the overall tax rate as it changes for everyone around me at the same time (at my income level).

i also love living in nyc so i don't compare the taxes here to other parts of the world where the services are different (maybe i would if the difference became severe). i don't get excited about paying taxes, but it is at the bottom of my list of financial concerns/worries. i know it is popular to complain about but i have noticed amongst several friends that are very well off, they don't typically give a crap either. they are more concerned with growing at 20-30%+ annually

"Dutch health system hopes fall short

By Matt Steinglass in Amsterdam
Of all the universal healthcare systems in the world, the one that most resembles the one the US will begin putting into place this year is that of the Netherlands...."

Basically costs have exploded since they moved from a Canadian style to a Rombamacare system. Interesting. More competition among private insurance made costs go up much faster than they did even in the US over the past few years.

http://www.ft.com/intl/cms/s/0/e79a8cda-63e2-11e2-b92c-00144feab49a.html#axzz2IuRmxpjQ

Sound familiar? From the above story:

"...According to studies by the CPB, much of the problem is that private healthcare providers can “create their own demand”. One study found that a 10 per cent increase in the number of hernia specialists would lead to a 7 per cent increase in the number of operations.

Another study found that having more providers led to a large increase in demand for operations when the providers were paid by the procedure, rather than on salary – suggesting the demand was being induced by the providers themselves...."

Are you saying doctors are making it up? Those Hernias didn't really exist?

Read this article. Very interesting. Explains a lot

http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande

Ny1234. I appeciate your posts, but I challange this"i don't get excited about paying taxes, but it is at the bottom of my list of financial concerns/worries. i know it is popular to complain about but i have noticed amongst several friends that are very well off, they don't typically give a crap either"

Thanks for the article ph41

@brooks2

what is there to challenge? when i meet someone who talks about taxes a lot, i move on (it's not a common topic in my friend circle). there are definitely doctors i work with that complain about them but 90% of those are the laziest ones anyways so i try to avoid them. i don't have alot of friends who are W2 and this may bias my sample and experience.

btw that is a great well-known article by atul. he is one of the sharpest guys at understanding all of this.

@brooks2

also, i forgot to add, my sample is biased also because i gravitate towards people who love what they do, have middle/lower income backgrounds growing up, but have now become successful, ie, rags-to-riches stories. many of these individuals have been on the other side of the fence and needed govt assistance at some point. for ex, in my case, i was given a student loan to go to medical school to supplement my scholarship. i know i am fortunate to live in a country where someone who is not very rich can test well, study hard, and still have a nice career as a result.

If you are a smoker, you could pay as must as a 50% penalty. I have no problem with that but a smokers may not be able to pay the additional penalty and therefore be uncovered when they are covered now.

"Are you saying doctors are making it up? Those Hernias didn't really exist?"

There have been endless studies (some of which I expect Steve has posted) that show this in the US. For example, people who visit doctors in the US when the doctor partially owns or otherwise benefits from a separate CAT or MRI scanner are MANY MANY times more likely to be prescribed such a scan. Like 2-10X as likely. Versus doctors who don't own or benefit from such scanners. Doctors are far more likely to tell people they need a specialist if they have a financial interest in that specialist's practice than not. And the list of similar things go on and on. Its just as the article says - the doctors create demand when its in their interest to do so.

When you have SALARIED doctors at Mayo or Cleveland or Kaiser - amazingly (or not) these sorts of things decrease DRAMATICALLY and yet the patients have the same or better health outcomes with far lower costs per patient.

Jason, you posted about Hernia operations. So I asked you a question about the Hernia operations. You chose not to answer about the Hernia operations or any operations and instead talked about diagnostic tests. It is very different to order an MRI than to order a patient under the knife.

So Jason, what should we assume about your posts, Jason?

All summed up nicely here:

"Another study found that having more providers led to a large increase in demand for operations when the providers were paid by the procedure, rather than on salary – suggesting the demand was being induced by the providers themselves."

See my earlier waiter analysis - what happens when it's the waiter ordering your food for you so he can get a 20% tip, and you think that your neighbor is paying the bill. Read waiter = doctor, your neighbor = insurance company.

Steve, that's a great analogy. Because people go to the restaurant and have no other choices like eating at home. Also, at the restaurant, patrons don't pick what they are eating, it's determined before they got there and told to the waiter in advance based on either food preferences inherited from their parents, or based on the environment and circumstances before they even got to the restaurant.

I like it - maybe we can get this thread to 2000 by starting the whole conversation over again! Re Atul Gawande's 2009 article, see my post from two weeks ago below. Nobody has disputed the conflict of interest inherent in the FFS/insurance model (Steve's waiter analogy is apt). Nobody has disputed that healthcare in U.S. is expensive and inefficient. I also believe the majority of posters believe the ACA was a step in the right direction towards providing universal coverage. Accordingly, repeating all of those points ad nauseam strikes me as a bit odd, but again, I now want the thread to get to 2000, so encore!

For those with a serious interest in the topic, a diligent reading of this thread will reveal that the real topic of discussion here was legitimacy of concerns about the unintended effects of the ACA. Even Atul Gawande is keeping his eye on these (see his 2012 "Big Med" article from the New Yorker). For those who want to continue that conversation, this poster would appreciate any new thoughts about what is happening today and why, including thoughts about whether the "price controls" are working out as legislators intended and what the country should do about it. This poster would also appreciate any insight on whether both employees and employers will decide that both may be better off by having employees purchase their insurance on the exchanges rather than through their employers and what this will do to public spending on healthcare. For anyone with a deep and genuine interest in the topic, I suggest the following as starting point: http://www.mckinseyquarterly.com/How_US_health_care_reform_will_affect_employee_benefits_2813.

For those with a purely superficial interest in the topic, I believe Jason has you covered.

NYCNovice
about 2 weeks ago
Posts: 544

"Steve - I think I need to clarify that I do not mean to imply that The Economist shares my POV; the editors have taken no position re values or future and there is much in their coverage of healthcare policy that can be used to support your POV. But actually the best article I found supporting your POV was this one from Atul Gawande: http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande
I really do see both sides of this debate."

Yes, the waiter analogy makes all the sense on the world. Waiters study for over a decade and are specially trained and understand what their customers need to eat which is good since the customers have no idea.

There have been studies that show hernia operations are over prescribed, yes, if you are too stupid to understand the point I was making.

Makes no difference, greensdale - the point is that the supplier is setting the demand rather than the demander, and that consumers think that somebody else is paying for it, when they're really not.

You need to learn about allegory. And there are waiters with PhD's.

novice, sorry, but "a diligent reading of this thread will reveal that the real topic of discussion here was legitimacy of concerns about the unintended effects of the ACA" is really not at all what I had in mind.

Oh - and I'd already read the New Yorker bit, but I wasn't impressed, as it is not at all rigorous.

too funny steve - Obama was impressed by that article. Oh that's right, you're smarter than Obama. LOL

That was an impressive article. I've been a big fan of Atul Gawande since his article on whether doctors should be paid the same for a procedure, and how to properly compensate for a good doctor vs. bad. One takeaway from another article - never be the first patient after surgeon's vacation.

And also another one on how doctors fought like hell against following checklists for standard procedures, but that they eventually conceded to statistics. It turns out that modern medicine does benefit from a better scrutiny of practices.

Sorry ph41, but every point, such as this one, "The primary cause of McAllen’s extreme costs was, very simply, the across-the-board overuse of medicine," has already been made elsewhere, and every time I made it here I was accused of "cutting and pasting."

10023 is correct: " It turns out that modern medicine does benefit from a better scrutiny of practices," and that was my point on the VA, and novice pooh-poohed it because she "would be delighted to hear from a physician who has been in both the VA system and the private system say that the VA system yields the same results," regardless of what the statistics say.

Those sorts of opinions don't impress me.

ps: there are things that impress the pope, too, that don't impress me. Your logic is highly faulty.

Steve, no one on this board is trying to "impress you", to the contrary it would seem that you are trying, oh so hard, to impress everyone here with your endless posts. Sorry that your job doesn't give you much outlet for original thought or creativity, but you must admit that using a real estate chat board to harangue people and let your frustration out is kind of pathetic.

jason10006
about 4 hours ago
Posts: 4620
Member since: Jan 2009
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There have been studies that show hernia operations are over prescribed, yes, if you are too stupid to understand the point I was making.

Why didn't you make the point you were trying to make, instead of making another point that made no sense?

stevejhx
about 3 hours ago
Posts: 12460
Member since: Feb 2008
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Makes no difference, greensdale - the point is that the supplier is setting the demand rather than the demander, and that consumers think that somebody else is paying for it, when they're really not.

That point is fine, I get it. (Jason, however, does not, and wants to put himself in the position of being the decision maker about operations - Jason is neither the supplier or the "demander")

>You need to learn about allegory. And there are waiters with PhD's.

but the waiter allegory just doesn't tie.
And as far as the waiters with PhDs, is that your serious argument? Is their PhD in waitering?

>Steve, no one on this board is trying to "impress you", to the contrary it would seem that you are trying, oh so hard, to impress everyone here with your endless posts. Sorry that your job doesn't give you much outlet for original thought or creativity, but you must admit that using a real estate chat board to harangue people and let your frustration out is kind of pathetic.

More than just stevejhx is guilty on this board of harassing and haranguing on topics distant from real estate.