Price controls coming for health care

NYCNovice
1 day ago
Posts: 291
Member since: Jan 2012
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HB - Please tell me you were just being contrarian in your reply to my last post. I can never tell if anyone is kidding on this board; I am just going to assume that you were.

On the contrary. Statements about subsidies are reflections of naiveté about business and investment.

Separately, I enjoy the discussion led by New York, New Jersey, Connecticut, Illinois, Maryland and California about how their states pay more to the federal government in taxes than they receive back.

steve,

No doctors can't charge anything they want. They can only charge what insurance companies and the government will pay.
So, to get around that, they order procedures and tests that are unnecessary.
It's very well documented.
I can't comment on the rest of your blather, though.

HUH?!?!
Doctors CAN charge whatever they want as long as they are not within the insurance network. This is FFS practice. Canada, for instance, will not let you set your own fee and set a limit to what you can earn. This results in shortage of physicians, since they will work 3days a week, 6hrs in a day.

Yes, there is something wrong with doctors who participate with insurance and orders unnecessary diagnosis but then we are talking fraud and ethics. You will find this in any other field, including yours.

Just feel compelled to post this. My mother-in-laws life was just saved because she could afford to have private tests,procedures,etc. performed for fee (which my husband and I guaranteed payment) in a private hospital overseas (Asia). Otherwise she would have died.

The public hospital would not have performed the tests, and procedures which would have saved her, because of the costs.

It involved emergency dialysis treatment - performed immediately which made all the difference

Best medical care (ignoring cost, if that is possible) is still in the US.

Brooksie writes, "The way I read this Steve...."

which proves again that he doesn't know how to read.

Still waiting on your convexity of MBS answer, Brooksie....

ph41: great contribution! Your mother-in-law was saved in a private hospital in Asia, so the best medical care is still in the US.

Good move!

yes steve - would have preferred that she be treated here, where the medical care is better, but that was now possible. Actually, when she had throat cancer some years ago, she did come to the US for treatment, where I believe her care (and thus cure) was far superior to what would have be the treatment in her home country.

"where I believe"

That is QUITE THE POWERFUL ARGUMENT, ph41.

Quite the powerful argument.

And as logical as your last one.

i usually dont touch a post started by redbaiter, but this one had grown so much i took the plunge.

and in fact redbaiter has had limited impact, given his disappearance following being debunked on nyc gerrymandering

net--thx to steve and jason for taking the time to argue (successfully, i might add) the correct case re issues in our health care system

"But the poor will give up their basic neccessity to buy pot"--thx for this gem, ba--and yes, you are a racist

I would really like to know how much money steve thinks a family practice doctor gets for ordering tests or procedures? The answer is (9 times out of 10) zero. In fact, there are very strong restrictions on this due to Stark laws. There are states with loopholes, like NY, where a doctor can put lab testing under the umbrella of their PC and get paid for studies they have ordered. I think this is seriously flawed. Thankfully, the vast majority of primary doctors don't do this (the numbers are less than 1 out of 10).

For outpatients with private insurances, such as GHI, Oxford/United, Aetna, BCBS, Hip, etc, there is actually a 3rd party service which controls which studies can be ordered. It is extremely difficult to get past this entity for the referring doctors. For example, it can take several hours for their staff members to get 1 MRI ordered and even then the VAST majority are denied. Many primary care doctors don't bother to order the appropriate tests now as a result of this policy. This is not the case for Medicare or Medicaid. Also, in the hospital setting, this is not the case as hospital doctors can order anything. This is why the majority of abuses, by far, occur in the hospital setting, which is now going to control this process for all patients.

Your thought that all doctors just order unnecessary tests is not grounded in any basis for reality. The doctors doing this are usually in violation of Stark or operating in a loophole state.

Oh, please, 1234. Such malarkey, even Wikipedia knows better:

"The Stark law is a limitation on certain physician referrals. It prohibits physician referrals of designated health services ("DHS") for Medicare and Medicaid patients if the physician (or an immediate family member) has a financial relationship with that entity. 42 U.S.C. 1395nn"

That's not EVEN what anybody was talking about.

Try this one on for size:

"Incentives Spike Fee-for-Service Health Costs"

Anyone care for Upcoding?

How about overprescribing of drugs?

http://articles.mercola.com/sites/articles/archive/2011/07/02/new-study-finds-doctors-are-massively-overprescribing-drugs.aspx

How about overprescribing of procedures?

http://www.jonbarron.org/article/heart-surgeries-healthy-patients

How about the rate of c-sections in the US?

http://www.childbirthconnection.org/article.asp?ck=10456

"Your thought that all doctors just order unnecessary tests is not grounded in any basis for reality."

Really? Let me refer you again to the Rand Corporation's study of the VA:

http://www.rand.org/pubs/research_briefs/RB9100/index1.html

Or do we need to go back to the statistics that show that the US pays twice as much as a % of GDP on healthcare as any other OECD country, but gets worse results from it?

The facts are the facts - you haven't shown a single piece of evidence that would account for why what we pay on healthcare is worth the cost. Not morbidity, not mortality, not nothing.

The Stark laws have nothing to do with it - obviously, if you know what they are.

Forgot a link:

"Incentives Spike Fee-for-Service Health Costs"

http://www.thefiscaltimes.com/Articles/2012/08/17/Incentives-Spike-Fee-for-Service-Health-Costs.aspx#page1

Try again, 1234.

"Best medical care (ignoring cost, if that is possible) is still in the US."

But the entire point is only 10% of Americans can afford this. 15% have NO insurance and and another 30% have barely tolerable coverage. Other countries make it so 100% of people can have at least ADEQUATE coverage. Hence, on average, people in other countries started living longer than us about 25 years ago. It used to just be Japan. Then the Swiss. Now like 39 other countries have people living longer than us. We get worse relative to the rest of the world each and every year, and yet our cost per person keeps getting worse also. its unsustainable!

Here is the the thing - if we spent the OECD average per person on healthcare, we as a country would have MORE money left over to spend on other things than the ENTIRE defense budget. A trillion dollars a year more!!!!

I'm not sure it's worth talking sense to these people, Jason - 1234 is intent on claiming that everybody but doctors is responsible for the fact that our healthcare costs twice as much as anybody else's, and ph41 has determined that because his or her mother-in-law was treated in a private hospital in Asia, healthcare in America is the best.

It is not possible to have a discussion based on logic like that.

This great - from the comments section on Nate Silver's blog.

"Here's something for you to chew on, Nate. I obtained the CDC's figures for obesity by state (the percentage of the population with a Body Mass Index of 30 or higher) and ranked them in ascending order. Of the top ten (skinniest) states, Obama carried nine, Romney one. Of the bottom ten (fattest) states, it was Romney nine, Obama one. Maine (Obama) and North Dakota (Romney) make up the median at 27.8% each.

Obama carried 18 states above the median and 7 below; Romney carried 17 below and 6 above (District of Columbia is counted as a state). Alaska is just above the median with 27.4% of its population being grotesquely overweight. In any case, thee is obviously a correlation between obesity and a propensity to vote Republican."

http://fivethirtyeight.blogs.nytimes.com/2012/12/05/alaska-future-swing-state/#more-37768

Cause and effect?

:0

Or, since the correlation is actually between education level, poverty level, recipients of federal largesse and who voted for Romney, I am sure that you will find that the states with the highest number of uninsured are also the states with the highest levels of obesity, poverty, recipients of federal largesse, and the lowest levels of education.

But you can certainly see that the most obese states are the ones that oppose Obamacare the most:

http://www.nationalmemo.com/states-with-most-obesity-oppose-obamacare-the-most/

Oh, whatever, you guys:
You think that those "poor" states have gyms in their neighborhoods?
Gym memberships? Yoga?
That there are natural-food shops in their neighborhoods?
Paint them as sloppy-assed poor people.
That's so easy to do.

HB - No matter what you say, I am going to continue to assume you are just being contrarian focusing on semantics (i.e., you are thinking in terms of pure economics of price discrimination) and that even your 12-year old mind can understand the use of the term "subsidize" in this context. As for my being politic - not so much. As I have demonstrated on at least one other occasion on this board, I can be quite awful if I cannot see the other side of an issue (such as someone with means not repaying a debt knowingly incurred where costs of default will fall on innocent third parties). However, re best approach to healthcare for society, I really do see both sides.

There really aren't "both sides" of healthcare costs. The figures are fully documented, and real.

Our system costs twice as much as the next most expensive one, with a much worse outcome.

It makes no sense.

stevejhx - no argument re costs; the point where I believe reasonable minds can differ "worse outcome." The outcome of current system is not worse for everyone; I am happy to pay physicians who do not take insurance at all to diagnose and treat people who are dear to me. I am glad I currently have a selection of such physicians and do not want their existence threatened. I agree that current U.S. system is broken for a large percentage of the population, but I disagree that physicians are to blame. I would blame lawyers such as myself before I would blame the physicians.

revolting. simply revolting.

CC - Hi - I have missed you. Have you ever had a family member with a rare form of cancer that was misdiagnosed by multiple doctors? Have you ever been faced with conducting a nationwide search for the absolute best physician in the field and finding that such physician does not take insurance? Have you ever had such physician then properly diagnose your loved one and prescribe an experimental treatment that you then willingly paid for out of pocket? Multiple physicians stated unequivocally that the patient would be dead by 2000; we are now about to enter 2013, and he is still here with a great quality of life. You've never been faced with such a situation and cannot understand my perspective? What a shock.

"The outcome of current system is not worse for everyone"

I do object that the basis of your argument, such as it is, is that the wealthy should get better healthcare simply because they have more money. That means it is broken for them, too, as they are being forced to pay a price for healthcare that is unrelated to the marginal cost of production.

For that physicians are partly to mostly to blame - they are the ones who directly control what work gets done. But the problem is not with physicians as people; they are merely responding to the incentives that are placed before them.

stevejhx - Whether rich and poor should get the same standard of care is a value judgment. I get it that you do not respect that my values differ from yours here, and I respect that.

it must be comforting to be so sure of everything with so little factual basis.

It can be a value judgment, but it is not necessarily. A lot of things in life are value judgments. For instance it could also be a value judgment that people should not be allowed to die of starvation in the richest country in the world, but it is not necessarily one.

That is because it is NOT a value judgment that our healthcare system is inefficient; it is proved with the facts. It is likewise NOT a value judgment that even if you can "afford" to pay for out-of-pocket medical expenses, you are not paying an economically efficient price, because the price mechanism in the American healthcare system does not work. The prices that are paid are unrelated to the marginal cost of production; even a wealthy person who pays out-of-pocket is effectively subsidizing the healthcare of those who are given services but cannot pay. They are subsidizing the healthcare of those who received care but cannot pay, and so are forced to declare bankruptcy (60% of all bankruptcies in the US, in fact).

Looked at in that way, providing basic healthcare services to all is not a value judgment because it is an economically more efficient delivery mechanism. The value judgment would then be how much to charge / subsidize individuals for their care - right now the cost / subsidy is completely random.

Moving beyond pure economic efficiency, there are certain things that we do in society that could be viewed as a value judgment if we were in a purely Darwinian world. Fortunately, we are not. We don't let people starve to death or let them die on the streets unattended, leaving their bodies there. In a purely Darwinian world - which is the logical conclusion of what you espouse - we would let people die of starvation if they couldn't afford food, and leave their dead bodies where they lay.

Why we don't do that is not necessarily out of our values - it is because in economics, sometimes the benefits to the whole exceed the costs to each individual. I may not want to pick up dead bodies in the street, but were they allowed to lay there they would spread disease. I may not want to pay for the police to investigate the murder of someone I don't know because I don't care, but it is in society's interest not to have murderers roam the streets with impunity: lest they kill again.

The problem with healthcare is that a) it is very expensive; b) it is unpredictable in terms of when you will need it and what you will need of it; c) many diseases are communicable; and d) it is not possible to know beforehand whether a sick person has a communicable or noncommunicable disease.

Your argument is that rich and poor should not necessarily get the "same standard of care." Then, when there is an epidemic - of influenza, for instance - were we not to treat the poor because they can't afford treatment, the epidemic would spread, even to the wealthy, who would likewise die because the flu is very difficult to treat or prevent.

Then - would you say? - everybody should be treated for the flu, but not for cancer. Well, if you're sick, with leukemia, for instance, the symptoms may at first mimic the flu. So a person who is covered for the flu - because it is communicable - goes to the hospital thinking he has the flue and is diagnosed with leukemia. Do you retroactively charge him for the diagnostic services to find out he has leukemia - because it's not covered - and then let him die?

If you do that, the dead man with no money will not ever pay the bill for the diagnostic services he got to determine that he had leukemia, not the flu. Who will pay for that?

You will - because you can afford it.

Of course if it wound up being TB and not the flu, he would be covered because that is highly contagious, as well. Pity him, though, if it's leukemia, because it's not contagious.

And thus we're right back at the original situation: someone will pay for the poor man's medical services because it is in society's interest to treat everyone, because we're all susceptible to the same diseases, rich or poor. Back in the days of the plague the rich tried to escape it - and TB - by fleeing to the countryside, because they could afford it.

But they wound up dying of it anyway.

It's not a "value judgment" at all - it is a matter of survival of the species, and a rational distribution of the costs.

Stevejhx - Whether the species should survive is a value judgment. As for who pays for what, I believe the able/fortunate have a responsibility to pay for the less able/less fortunate; I have no problem with paying higher taxes to fund a public health system should one ever come to pass in the United States.

CC - I remain flattered by the attention you pay me, but am not sure what you think I am so sure of or what facts I have ever professed to have but am lacking; nevertheless, I do like the attention, so by all means, keep the comments coming. You are sounding particularly intelligent/fetching tonight. Unfortunately I have to go to dinner, but I have to work this weekend, so I will definitely be checking back later.

according to you i know nothing about dire medical situations. i'm wondering how you could possibly know that. but, do me a favor, don't respond because i do think you are revolting.

One of the reasons I enjoy streeteasy is the opportunity to see the occasional complete meltdown. Call me whatever nasty name you want, but that old show the Running Man hosted by Richard Dawson, that was quite popular if you remember: people love to watch meltdowns, man hunts, executions, OJ chases, chair throwing, hair pulling, paternity tests, yelling judges, etc.

NYCNovice, you are on to something, keep it up, columbiacounty is on the edge like he hasn't been in 2 months.

the angel of death arrives.

Meltdown
10
...

do you need some water?

yes, we all need water. In fact, the human body is more than 60 percent water. Blood is 92 percent water, the brain and muscles are 75 percent water, and bones are about 22 percent water.

columbiacounty, what is your water percentage?

CC - Me thinks thou doth protesteth too much.
Hi HB.

"Whether the species should survive is a value judgment."

That is crazy. (Which is a value judgment.)

Stevejhx: I heard Jane Goodall speak once; her arguments about trying to preserve her gorillas from human expansion were interesting. Just because a value is beyond your comprehension does not mean it is crazy.

People keep using personal anecdotes. Ok fine. I have been unemployed and uninsured twice in my life for months long periods. And coincidently both times I ended having to go to the emergency room to get care for severe maladies. And both cases ended up fucking up my credit badly. I have first hand experience with NOT having insurance in this country. It is evil.

And Steve has destroyed novice.

novice is a lawyer. many lawyers like to argue for the sake of arguing.

novice is never wrong.

who cares?

Novice, you are destroying Steve and Jason. Although you are not destroying Jason as much as he was destroyed in his convenient triple whammy story that happened to occur identically twice.
Ok fine, you aren't destroying Steve, he is holding his own. I guess only Jason is losing, yet again.

columbiacounty, you aren't holding water

NYCNovice: Sorry to read that you have been destroyed by stevie.
Don't let anybody at your law firm office know about it and maybe you won't be thrown out of work.

However, if they find out about your destruction at the hands of stevie here, you can use all of your new-found time to chat with c.c.
He will always be around trailing you.

Just so the record is clear:

(1) I disagree that my preferred approach of a public option that does not outlaw a private sector FFS market would lead to the extinction of the species; no statistic or argument that anyone has put forth anywhere makes a convincing case that it would;

(2) Why are you so opposed to allowing incredibly talented people to become doctors and charge whatever they want for their services? Why do doctors have some moral obligation to work for free that others (teachers, lawyers) don't have. Society guarantees a basic level of education and legal representation through a public option but does not outlaw a FFS private market in education or law; why is medecine different exactly?

Jason: I hardly see how stevejhx has "destroyed" my position. All I see is someone who cannot win the argument because we don't agree on facts (he thinks my approach will lead to the demise of humans) or values (I think doctors should be able to charge whatever the market will bear; that does not mean that I do not support a public option that I am willing to pay for, even if I have occasion to use the private option that I believe has a right to exist). Because stevejhx cannot win the argument, he has resorted to calling me crazy. I doubt a thorough review of this thread would lead most neutral observers to come to the same conclusion.

CC - Oops, I didn't see you there, but am glad that you are there. You remind me of this boy in third grade who used to follow me around the playground at recess and once in awhile would come up to me and literally hit me! My little third grade self could not understand, even when my parents explained that he behaved this way because he LIKED me. I continue to be captivated by your brilliance and thank you for your continued presence on SE; you provide the substance and wit on SE that keeps me coming back.

Hi Truth.

lol,NYCNovice.

Regarding (1), that is not what you stated at first, and it is quite different from " The outcome of current system is not worse for everyone; I am happy to pay physicians who do not take insurance at all to diagnose and treat people who are dear to me."

Regarding (2), I would have no problem with their charging whatever they want if they were not simultaneously the people who are effectively deciding what services you are getting.

Moreover, the patient is not actually the person paying for the care; the insurance company or the government is. That leads to perverse incentives for a) doctors to order too much (FFS), and b) patients to demand too much (because they're not paying for it). That's why market forces don't work.

The way the market is currently structured it would be like me saying that you have to buy a car, and that car has to be a Mercedes Benz, and your neighbor has to pay for it.

Unlike most goods and services, the average person is not in a position to make an educated choice about what healthcare services he gets. That is why the VA and others have implemented medical protocols - which are far more effective and much less expensive.

And for the record - I did not call you crazy; I called calling "survival of the species a value judgment" crazy, notwithstanding whatever Jane Godall thinks about gorillas (that I don't care about).

I knew there was something I really liked about Stevejhx. Free Mercedes! I'd like mine in red. And send the bill to my neighbor in Apartment 23.

Mine is brown, HB, but I pay for it.

I'm loling, huntersburg.

NYCNovice: It's only a matter of time before stevie starts asking for an apology from you.

stevie, you know I have a song for Mercedes but I'm not gonna sing it.
I'm saving my voice for The Stones tonight.
Rock on here, stevie.

Stevejhx -

(1) That is exactly what I said "at first," and I have been consistent throughout. Please re-read my initial post on this thread (and an apology would be nice), copied, in pertinent part, below for convenient reference, as well as all of my subsequent posts (not excerpted below b/c they are in closer proximity above):

"While I do believe U.S. needs some system for universal healthcare, price controls would be devastating. Many phyisicians I know do not take any insurance at all already; as long as they can continue to practice medecine on their own terms, I think there will be high quality options available for people who can afford it. I do think the public system will be lower quality, but that is better than non-existent. As for pharmaceuticals, if we want to do away with effective R&D, then by all means, take away the last country where market forces rule and have single payer in the form of USG. . . . In terms of what makes sense for society as a whole, this is obviously a value judgment and why it is so political; I do not rule out the possibility that pure public system might result in greatest good for the greatest number, but there are two small people who are very dear to me that suffer from a rare form of muscular distrophy that nobody would pay attention to if we were only looking at greatest good for the greatest number."

(2) Agreed that you did not call me crazy. Frankly the whole tangent about the extinction of the species was started by your absurd assertion that the status quo is going to lead to the demise of the human race. I just wanted to end the discussion and make clear that this whole debate does come down to value judgments. I cannot understand why this is so hard for you to understand.

(3) Note the topic of this thread. You have gone off in so many directions on this thread that I cannot figure out what your point is anymore. My only point was, and remains, that I do not want price controls in medecine, including pharmaceuticals.

(4) I enjoy reading your thoughtful input on a variety of subjects; as stated previously, you are consistent in what I understand you to be advocating, and I respect your right to disagree with my worldview. I am not quite sure why you engaged me at all, but I do enjoy discussion, so I am happy to continue as long as we are discussing the same thing. Simple question: Do you, or do you not, support price controls in healthcare?

P.S. to Truth - I saw BD in concert a few weeks ago in DC; we started a little game in our box where the first person to identify any song would get a certain number of points, with the winner to then control post-concert venue selection. We thought the real challenge would be familiarity with his prolific work; there was that, but the greater challenge was his bastardizing even the songs whose lyrics we think we were able to recognize. We knew that was his MO, but nostalgia got the best of us; painful evening. Game ended with zeros all around b/c even when we thought we recognized lyrics of "Tangled Up In Blue," we could not reach consensus on whether that was the song at issue. The rest of the concert sounded like one of my dogs getting sick. This is coming from someone who actually really loves Dylan's voice.

P.P.S. to the board re the two little ones who are dear to me who suffer from rare form of muscular distrophy. This is tough; I have personally donated quite a bit to fund the research to cure them. I have not asked others to assist me in this because it is hard to ask people to donate funds to cure a disease that affects only a few thousand people on the planet. Should I do nothing and let them die and dedicate resources to curing a disease that affects more people? Perhaps, but I am weak and selfish and am trying to save the ones I love. I am not saying it is right, but it is what I am doing. I challenge anyone to tell me that were they in my position, they would not do the same.

What you first said was not, "my preferred approach of a public option that does not outlaw a private sector FFS market," though you may have meant it. That, in fact, is the approach that they use in many countries, including the UK & Spain, whose health services I used. I have no problem with buying something supplemental either.

However, price controls must exist where market forces do not work. And in healthcare market forces do not work - they never have and they never will. Ours is the most market-based approach to healthcare in the developed world, and consequently (by far) the most expensive.

All goods must be rationed, because there is not an endless supply of them; usually price is the rationing method, but it doesn't work in this case. So rationing is based on need - which will cause waiting lines for nonessential services, to be sure, and end-of-life care to be scaled back considerable. If anyone wants to pay to get around that, that's fine, as long as that does not exempt them from contributing to the basic system.

What you will find in the supplemental insurance market, though, is that that insurance does NOT cover rare diseases, because they are uninsurable as there is no way to determine the cost of the care. In countries with parallel systems such as the UK and Spain, supplemental insurance will get you a semiprivate or private room, and will help you jump the queue, but it will not get you a liver transplant if you don't qualify for one.

Because insurance companies must be able to calculate their risk, and the risk of rare diseases can't be calculated.

The topics I've "gone off on" were in response to what others have written, though the extinction of the species comment was merely taking a purely Darwinian approach - approximating what we currently have - to its absurd conclusion.

If it isn't too late (hope Apt23 hasn't yet paid the bill, maybe she's busy welcoming w67 in the back door), I'd like to change the Mercedes to Emerald, apparently it is the "it" color, and I'm hoping that it still will be the "it" color when I turn 18.
http://online.wsj.com/article/SB10001424127887323501404578161320542643546.html

Steve - As I suspected, we are not talking about the same thing. I am not talking about insurance but rather physicians who operate outside all insurance, paid for entirely out of pocket and charge whatever that market will bear. Are such individuals lawful/allowed to co-exist with your proposed system?

NYCNovice, remember, you are very close to getting columbiacounty to have a complete meltdown, so don't lose focus.

NYCNovice:
That's true about Bob. He gets a kick out of fooling around with singing his songs.
His voice isn't what it used to be and many didn't care for his voice back then.
He's an eccentric genius.
Mark Knopfler more than makes up for Bob's vocals.
My fave song: "Romeo and Juliet".

stevie, it's a good thing you didn't need dental treatment while living in the U.K.
You would have had to buy one of those dental-repair kits that are sold in grocery shops there.
They have ones with glue to put a fallen tooth back into the remaining set of choppers.
But the U.K. is not known for caring about dental care.
Even Camilla had an ugly set of choppers until she was made-over after the engagement.
and she had the money to fly over the pond to the USA, as most residents there do to receive quality dental care.

"I am not talking about insurance but rather physicians who operate outside all insurance, paid for entirely out of pocket and charge whatever that market will bear."

That is a tiny minority of doctors. This may not be allowed in Canada, but it IS in the UK and many other countries with various forms of universal health care - private, hybrid, government-run, whatever. So yes rich people in the UK and France and other places can see other doctors that normies cannot - but for 95% of people, and the system works and is 35-70% cheaper per person overall INCLUDING what is paid by the richie riches. No one is talking about BANNING for fee doctors for the very rich. EVERYONE is talking about reforming the HC payment and deliver system for the 99%.

...and as Steve has pointed out, even the richie-riches pay LESS in other countries than everyone does in the US for the vast majority of the HC they receive.

...So you two have been arguing against me and Steve over a fictional version of universal care. Trust me, top earners in London pay for extra special care out of pocket for VIP things not covered by National Health. Same goes for Romneycare in MA. Try learning something about the topic before wasting so much time arguing.

How many americans have dental insurance? Braces are definitely not covered for almost all circumstances and run in NYC $8000ish per child. In NYC we have the NYU dental hospital/university which provides high quality care at very low costs and takes Medicaid. But that is an exception, I think, in terms of dental care generally nationally.

Jason, what on earth are you talking about? This discussion was about price controls in health care insurance and what the effects would be; I believe the effects would be more doctors opting out of insurance system altogether. I am okay with that as long as such physicians can charge whatever a private market would bear; many physicians have already made that choice with the current system. Yes, the U.S. system is incredibly expensive and inefficient, but I prefer it to a system where doctors are precluded from charging market rates in a transaction between two consenting parties. What I cannot figure out is whether Steve wants to eliminate FFS by physicians who choose to opt out of insurance networks completely. You are one comment away from my joining the "Jason is an idiot" camp, our mutual love of Nate Silver notwithstanding.

Hi AR.

Jason - Someone also introduced pharmaceutical prices into the discussion and you and Steve put in your two cents about how you'd overhaul that system. A number of people have respectfully disagreed. I do believe that going to a single payer system for pharma and/or reducing patent protection would be disastrous for R&D; I stand by my position here and maintain that I am entitled to that opinion, which I would also point out is shared by many who are certainly more knowledgeable on the subject than you. You need not post anymore for me to join the "Jason is an idiot" camp; you are an idiot.

Jason says nobody is arguing for Canada's system, yet he himself wants Canada's system:

"jason10006
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...and yet Canadians, like those in all other OECD nations, have 100% coverage and longer life spans. I will take that over what we have now OR Obamacare."

Moron.

No dummy I would take it over what we have. That does not mean its my dream system. Any OECD sysytem not ours is better than ours, just about.

I disagree.

I also disagree.
Also, US health care system will never run as efficiently as any other country under any system.

>You are one comment away from my joining the "Jason is an idiot" camp,

Camp is a lot of fun, even on rainy days. We have many people in this camp, people who don't necessarily agree on other issues but agree on this one thing. Our favorite fundraiser is the 1 way ticket back to Oakland.

"I believe the effects would be more doctors opting out of insurance system altogether."

I don't think so, and I don't know of any evidence that shows they would. Some specializations operate outside of the insurance system, notably plastic surgery (though not entirely). Medical services as a whole are too expensive for most people to afford them out-of-pocket. That is why insurance exists: to pool risk.

In the UK doctors in private practice must maintain NHS practices, as well. Dentistry is not covered in the NHS, and the Brits have some of the worst teeth anywhere.

Given that the number of people who could afford to pay for all healthcare outside of the system is so small, no, I don't think it's even a meaningful discussion, at least until I see some evidence that it works someplace.

I disagree steve. We'll get more doctors interested in plastic surgery or dermatology instead of primary care. But the real impact happens in college (and I'm not talking about Berkeley College or University of Phoenix) when the smart students look what is happening in medicine and decide instead to go into finance and join a hedge fund. I see it plenty already, sons and daughters of doctors, so many of them today work on Wall Street or in the investment community just moving money around or investing into Foursquare.

No, HB. There are plenty of doctors in the UK, very few leave the system, and a lot of immigrants are trying to join the system.

Ditto the VA.

Money is not the only thing that attracts people to their jobs.

How many of the doctors in the VA are exclusive to the VA system?

Money isn't the only thing that attracts people, there are factors including a highly educated, very specialized in-demand person being forced into a huge bureaucracy.

This may explain some of the differences in medicine in other countries:

http://www.nytimes.com/2012/12/09/sports/drugs-injected-at-the-racetrack-put-europe-off-us-horse-meat.html

Steve - Agree to disagree.
HB - Agree re real effect will be fewer of the best and brightest choosing medecine. And P.S. re fundraiser - I laughed out loud. I used to feel guilty about laughing out loud at the Jason-mocking comments, but no more. I had never really noticed him until the poll debate he had with Lucille. As a fellow lover of Nate Silver, I was cringing for him as Lucille dominated him in that discussion. My faith in his reading comprehension skills took another hit in the climate change discussion. It pains me when I see a fellow Dem represent defensible positions so poorly. Were I coach of Team Blue, Jason would be on the bench, at the end, with tape over his mouth.

I was pointing out to stevie the fact that dental care in the U.K. is not good quality dental care.
People there who have money don't go to U.K. dentists, instead they pay to travel here to see dentists in the USA.
There are dentists in the U.K.

Somebody made an issue about the amount of people in the US who have dental insurance.
My point is that the dentists in the US are skilled and we have that advantage.
Those that do have dental insurance, which I've always had and most working professionals I know have, receive quality dental care.
My dentist charges more than most other dentists but he is an excellent dentist so he is well worth it.
I happily pay him out of pocket for the amount exceeding insurance coverage although I'm free to go to a less expensive dentist.

In the case of some people I've referred to him, he has given them a discount if they don't have insurance. They still receive the same excellent care from him. He doesn't give them inferior care just because they don't have insurance.
He loves being a dentist. He has great chair-side manner.
His kid may or may not grow up to be a dentist.

Braces are cosmetic and like other cosmetic procedures aren't covered under any insurance.
Crooked teeth are common in the U.K. it doesn't seem to bother them.

NYCNovice: lucille usually kicks butt while debating just about anybody on se.
But she just likes to argue.

Novice, you can believe anything you want - that doesn't make it supported by data.

"...and that is why I believe".

"I'm a believer,
I couldn't leave her if I tried..."

Stevejhx - I have read all of your posts in addition to doing my own research and have made my own determination. I do not agree with your characterization of the data you have presented, but I understand your points. I am not interested in convincing anybody else of my point of view and could not care less whether you or anybody else thinks I am an idiot. Carry on if you would like to try to convince anybody else of your position, but this poster does not agree. We are done here.

"you have gone off in so many directions on this thread that I cannot figure out what your point is anymore."

"Steve - As I suspected, we are not talking about the same thing."

SOP(standard operation procedure) for Steve.. through enough BS out there he will be right about something.. maybe

if he has enough posts

operating. throw

"I am not interested in convincing anybody else of my point of view and could not care less whether you or anybody else thinks I am an idiot."

20 + plus posts and naming me and Steve by name frequently tells us you DO care what others think and are clearly tring to change other people's POV.

Novice, I'd love to see some of that "research" you've done.

Brooksie - waiting on your MBS convexity answer. Until that time, hush.

Stevejhx - As CC noted, why do you care what I think? Just dismiss me as an idiot and be done with me. Then again, with Jason on your side, I can see why you might want some additional affirmation from someone, anyone really.

"Now hush, hush
I thought I heard you callin' my name
Now hush, hush..."

stevie and jason can go for a jet ride with Brooks.

"Sky pilot,
how high can you fly..."

I don't care what you think. I'm simply noting that it is unsubstantiated by fact. As an attorney that should concern you.

Or maybe not.

"on a jet to the Promised Land..."

"You may be wrong
or you may be right
you may be wrong
or you may be right..."

Stevejhx - Disagree.

you clearly stated that you were done here. stay done.

Hi CC. I was worried you had lost interest; SE would be a wasteland without your wit and charm.

Disagree on what? That there is any evidence of a burgeoning market for physicians who work outside of insurance and/or single payer systems?

I think medical tourism pretty much puts that theory to the lie.

Get your butt-lift in Brazil.
Medical tourism at its best.

ba294: price controls is not the major reason for a shortage of physicians in Canada. Canada, unlike the U.S., has a very small number of medical schools for its population. Today, Canada also has almost insurmountable barriers to foreign-trained medical graduates (including Canadian-born & bred graduates of other Western, English countries such as the UK, US, Aus, NZ).

The U.S. lacks a basic medical safety net for someone who does not have group insurance through work and does not qualify for Medicaid/Medicare. Whether that causes the U.S. to have worse longevity and infant mortality rate is a question of "value judgment". I have no idea what the best way to implement this safety net would be. Would I prefer to pay more taxes to have such a safety net? Yes. Would I give up my private "options"? No. If it were one or the other? I'd probably go for a basic medical safety net, and opt for medical tourism.

Typo - whether the lack of a safety net is directly correlated to longevity and infant mortality is irrelevant to me. But whether there should be a basic medical safety net for all is a question of "value judgment".

Why does columbiacounty hate so many women on streeteasy?
Does anyone think it is because of his mother, or his wife?

Here's some safety net for you: http://www.nytimes.com/2012/12/09/opinion/sunday/kristof-profiting-from-a-childs-illiteracy.html?ref=opinion