What do you see happening to your healthcare costs in the next few years

[Pete F.]

Originally Posted by detbuch

As I said--"as far as "country" or government run health care goes, Singapore and Switzerland are probably the two best and they are far closer to free market than the others. The more market oriented health care is, the better and less costly it is.

They are both highly market based plans which include a few government mandates which benefit the poor. The Swiss plan could work here without the buying mandate and some other minor changes--we are vastly different than Switzerland and Singapore (demographically, politically, culturally, immigration-wise, size of population and land to govern, constitutionally, etc.). Here are two articles of interest:

https://www.forbes.com/sites/theapot.../#637d799e7d74

http://www.forbes.com/sites/theapoth.../#a2878252e878

I posted above the Oklahoma surgery clinic (there are others including general care clinics) as an example of free market health care where prices are far lower than standard hospital prices for the same procedures. I also mentioned that other surgeries that are not supported by insurance or government subsidy such as Lasik and cosmetic surgery whose prices are way lower than insurance/government mandated procedures are and in which prices have even gone down due to market competition.

Try it when you have a heart attack feel free to test the “free” market with your life and financial well-being on the line
Posted from my iPhone/Mobile device

[scottw]

Originally Posted by Pete F.

Try it when you have a heart attack feel free to test the “free” market with your life and financial well-being on the line
Posted from my iPhone/Mobile device

this is why we can't have a rational discussion ....

[Pete F.]

Originally Posted by scottw

this is why we can't have a rational discussion ....

Saying that free market pricing for non essential elective medical procedures is a good example for how to provide healthcare is not rational.
I still would like an example of a country where the unorganized healthcare system is in place and working, other than the USA with the highest healthcare costs in the world.

[detbuch]

Originally Posted by Pete F.

Saying that free market pricing for non essential elective medical procedures is a good example for how to
provide healthcare is not rational.

I gave you an example, and said there were others, of "essential elective medical procedures" being provided by the Oklahoma clinic in which free market prices were way lower than in the highly regulated and controlled standard hospital prices.

My references to Lasik and cosmetic surgery (not what you refer to as "essential procedures") were examples of surgical procedures which are not highly regulated and which therefor have to compete on the open market. So prices are controlled by free competition and are far lower than if those procedures had to conform to costly government regulatory control. Do you believe that Lasik would be less expensive if it were provided under the same regulatory and insurance circumstances as hernia surgery?

You seem to assume that there cannot be a market based system of emergency care. Yes there can. The free market is not only good at responding to vanity and pleasure, it is just as good at responding to necessity.

I still would like an example of a country where the unorganized healthcare system is in place and working, other than the USA with the highest healthcare costs in the world.

Why by country? How about by individual providers such as the Oklahoma clinic that I mentioned? There may well be such individual providers in other countries. I haven't researched that.

[Pete F.]

Hip replacement costs
• $6,757 in Spain
• $7,685 in South Africa
• $15,465 in New Zealand
• $16,335 in the United Kingdom
• $17,112 in Switzerland
• $19,484 in Australia
• $29,067 in the United States
As far as other providers in other countries, you can save more than enough to travel and stay for the recovery period in many places.
10 to 20K will put you up very nicely.
That won't help you if you have a heart attack here, will it?
That won't help people who need primary care and cannot afford to go.
When they end up in the emergency room for issues that could have been dealt with in the early stages by a primary care physician and the costs end up shifted because they cannot pay, who does that help?
In our current somewhat freemarket system (actually the closest to your dream among developed nations) healthcare certainly is not inexpensive, though it can be for a lucky person who never has insurance and never has a need to use it.

[scottw]

Originally Posted by Pete F.

Saying that free market pricing for non essential elective medical procedures is a good example for how to provide healthcare is not rational.
I still would like an example of a country where the unorganized healthcare system is in place and working, other than the USA with the highest healthcare costs in the world.

do you ever read the stuff you write?

[Pete F.]

Originally Posted by scottw

you are like a wind-up toy

Originally Posted by scottw

it's really hard to get an answer to a question around here....

Originally Posted by scottw

if that is $1000 "per year" that is approximately what my car and life insurance costs and I can't remember the last time I made a claim for car ins...or life...obviously......you want a lot for a very little= health insurance for $83 a month...you want unlimited visits, no co-pay and free meds too?...my answer is I'd like to pay for what I want and need from a competitive market....

Originally Posted by scottw

seems all these sanctuary cities are having big homeless problems...=...tax and fix


May 14

By Matt Day and Daniel Beekman
Seattle Times staff reporters

After a weekend of high-stakes negotiations between Seattle City Council members and Mayor Jenny Durkan, the council voted unanimously Monday to tax the city’s largest employers to help address homelessness.

Starting next year, the tax will be $275 per employee, per year on for-profit companies that gross at least $20 million per year in the city — down from a $500-per-head proposal that Durkan threatened to veto.


The city declared a homelessness state of emergency in late 2015. A point-in-time count last year tallied more than 11,600 homeless people in King County and one in 16 Seattle Public Schools students is homeless.

“We have community members who are dying,” Councilmember Teresa Mosqueda said before the 9-0 vote. “They are dying on our streets today because there is not enough shelter” and affordable housing.

Originally Posted by scottw

rich liberals should adopt the homeless

Originally Posted by scottw

so you'd like the public to give you $4000 per year for your healthcare?

Originally Posted by scottw

I don't believe that there is some fixed monthly/yearly number that everyone should pay for their healthcare....you were asked because you seem to think that there is.....

Originally Posted by scottw

why?

Originally Posted by scottw

he should just mail it to Pete for his healthcare

Originally Posted by scottw

are you and Spence drinking together today?

Originally Posted by scottw

Originally Posted by scottw

the roads are nicer too...was up there visiting a customer the other day....leaving Mass where the road looked like someone bombed it, as soon as I hit the NH line, the road was pristine....go figure?

Originally Posted by scottw

this is why we can't have a rational discussion ....

Originally Posted by scottw

do you ever read the stuff you write?

Yes and what you write also

[scottw]

Originally Posted by Pete F.

Yes and what you write also

some great stuff in there!

[detbuch]

Originally Posted by Pete F.

Hip replacement costs
• $6,757 in Spain
• $7,685 in South Africa
• $15,465 in New Zealand
• $16,335 in the United Kingdom
• $17,112 in Switzerland
• $19,484 in Australia
• $29,067 in the United States
As far as other providers in other countries, you can save more than enough to travel and stay for the recovery period in many places.
10 to 20K will put you up very nicely.
That won't help you if you have a heart attack here, will it?
That won't help people who need primary care and cannot afford to go.
When they end up in the emergency room for issues that could have been dealt with in the early stages by a primary care physician and the costs end up shifted because they cannot pay, who does that help?
In our current somewhat freemarket system (actually the closest to your dream among developed nations) healthcare certainly is not inexpensive, though it can be for a lucky person who never has insurance and never has a need to use it.

The Oklahoma clinic which is basically a free market model that I posted in this thread, in response to you, lists a hip replacement full out the door cost, including exams and hospital stay, at $15,499. That beats your Switzerland, UK, Australia costs, is comparable to New Zealand (but would be a lot more expensive there if you add the cost of getting and staying there--which also would raise the Switzerland, UK, and Australia costs more also) and would be competitive with your Spain and South Africa costs when you include travel to and staying in those countries as well. And it beats the hell out of US typical hospital costs that insurance and government would have to pay. The clinic accepts insurance. It has payment plans, and accepts credit cards.

[scottw]

Originally Posted by detbuch

The Oklahoma clinic which is basically a free market model that I posted in this thread, in response to you, lists a hip replacement full out the door cost, including exams and hospital stay, at $15,499. That beats your Switzerland, UK, Australia costs, is comparable to New Zealand (but would be a lot more expensive there if you add the cost of getting and staying there--which also would raise the Switzerland, UK, and Australia costs more also) and would be competitive with your Spain and South Africa costs when you include travel to and staying in those countries as well. And it beats the hell out of US typical hospital costs that insurance and government would have to pay. The clinic accepts insurance. It has payment plans, and accepts credit cards.

this can't be true...there is NO way that a free market hip is better....or cheaper...than a government hip....government does EVERYTHING better and cheaper and more efficiently

[Pete F.]

Originally Posted by detbuch

The Oklahoma clinic which is basically a free market model that I posted in this thread, in response to you, lists a hip replacement full out the door cost, including exams and hospital stay, at $15,499. That beats your Switzerland, UK, Australia costs, is comparable to New Zealand (but would be a lot more expensive there if you add the cost of getting and staying there--which also would raise the Switzerland, UK, and Australia costs more also) and would be competitive with your Spain and South Africa costs when you include travel to and staying in those countries as well. And it beats the hell out of US typical hospital costs that insurance and government would have to pay. The clinic accepts insurance. It has payment plans, and accepts credit cards.

IF this is a successful business model, why is it not repeated in other places?
Posted from my iPhone/Mobile device

[detbuch]

Originally Posted by Pete F.

IF this is a successful business model, why is it not repeated in other places?
Posted from my iPhone/Mobile device

I believe their are other clinics like this one which is completely owned by its doctors. There are also clinics modeled on this one that provide medical services other than surgery.

The main problem in expanding this model is government. Many states require proof that there is a need to establish a medical facility if an entrepreneur wants to do so. The boards that determine that are staffed by administrators of current hospitals (who pour in donations to political campaigns and are crony benefactors of government regulations) and who are not, understandably, friendly to competitors who provide services at fractions of fees that crony capital hospitals do.

Apparently, Oklahoma doesn't have that requirement. And it does have other clinics, as I mentioned, who provide other, general, medical services other than surgery. The surgery clinic gets patients from other states and Canada who have found out about it.

[Pete F.]

So it would seem based on this clinic, that your opinion is that horizontal and vertical integration is not a viable method of reducing costs and providing better service. Most businesses would disagree with that, sounds like health care is special.

[scottw]

Originally Posted by Pete F.

So it would seem based on this clinic, that your opinion is that horizontal and vertical integration is not a viable method of reducing costs and providing better service. Most businesses would disagree with that, sounds like health care is special.

now you sound like Spence....

[Pete F.]

Originally Posted by scottw

now you sound like Spence....

I'll just add that to the whole list of critical thinking you've exhibited in this thread.

[scottw]

Originally Posted by Pete F.

I'll just add that to the whole list of critical thinking you've exhibited in this thread.

cool...thanks for keeping track...that's a Spencism too! "critical thinking"

[Pete F.]

Originally Posted by scottw

cool...thanks for keeping track...that's a Spencism too! "critical thinking"

I think it came way before Spence and the internet. I think this paragraph is quite applicable.
The earliest documentation of critical thinking are the teachings of Socrates recorded by Plato. Socrates established the fact that one cannot depend upon those in "authority" to have sound knowledge and insight. He demonstrated that persons may have power and high position and yet be deeply confused and irrational. He established the importance of asking deep questions that probe profoundly into thinking before we accept ideas as worthy of belief.

[scottw]

Originally Posted by Pete F.

Socrates established the fact that one cannot depend upon those in "authority" to have sound knowledge and insight.

.

can't argue with that....

[detbuch]

Originally Posted by Pete F.

So it would seem based on this clinic, that your opinion is that horizontal and vertical integration is not a viable method of reducing costs and providing better service. Most businesses would disagree with that,

On what basis do you assume that that is my opinion?

If you want larger, corporate business entities, horizontal and vertical integration strategies can reduce costs, but not necessarily better service. Nor is it a given that the savings in cost will be reflected in lower prices. Rockefeller's Standard Oil Co. was very successful using those strategies, so much so that it drove out competitors and delivered high quality product at low prices to the consumers. But Big Government thought that was unfair so preferred to crony-up with his failing competitors and bust up his monopoly. That crony capitalist move saved those that couldn't compete with Rockefeller, and drove up prices.

What we have in U.S. Health Care is a corporatist model using vertical and horizontal integration AS WELL AS a crony symbiotic relation with government. However, rather than passing on any savings those strategies garner it, the Health Care cartel actually uses the destruction of competition those models afford it to RAISE prices to the consumer. Especially when the consumer is represented by third party insurance or government payers. The corporatist model might actually work for it AND THE CONSUMER if the government would stay out of market competition and if that competition led to a giant health care corporation or two or three, and the government let them monopolize health care. Given what the government did to Standard Oil, it is doubtful that the government would let an unfettered, unregulated health care corporation monopoly to exist. Especially since government control is more of a goal than lower, competitive, free market prices.

And the cartel can use government regulatory power to eliminate free market competition, which leads to lots more money for all the willing participants . . . including the government bureaucracy--at the expense of the consumer.

A mostly unregulated corporate health care market along with, as well, mostly unregulated, free market, insurance companies (which would not be rescued from failure by government bailout) could lead to far lower prices, a la Standard Oil.

But I thought you didn't like corporatism. That you bemoaned the disappearance of small business and of the middle class. The Oklahoma City Surgery Clinic is a small business model that I thought you would like. It is not afraid of competition. It doesn't try to stifle it with horizontal and vertical integration in order to monopolize its product. In fact, its mission is that others will copy its model throughout the U.S. There are, BTW, other such clinics in other states including Virginia, New York, and California. Dismantling the ACA and having an actually free market insurance system would help to blossom free market clinics to compete with the American Hospital cartel.

sounds like health care is special.

Making it "special" makes it expensive. Marketing it like most everything else, including necessities such as food and shelter, would lead to affordable prices in the coming years.

[wdmso]

Just went on this site you see on TV GOOD RX my insurance is not covering a med my wife takes 40mg doxycline they want to change her to the generic called oracea its 1825.00 for 90 day supply with out insurance the non generic is guess what 1825.00 for a 90 day supply

in Canada the price for 100 pills of tetracycline is under $50. this is a 50-year-old antibiotic

2013 According to a U.S. House committee investigating price hikes in several generic drugs, the average wholesale price of 500 tablets in October 2013 was $20. Seven months later, the average wholesale price for the same amount was $1,849, an increase of more than 8,000 per cent.

just another example of big business fleecing of America

[Pete F.]

You can get them in Canada
1700+ is a good price for driving and staying over a night
Posted from my iPhone/Mobile device

[wdmso]

Originally Posted by Pete F.

You can get them in Canada
1700+ is a good price for driving and staying over a night
Posted from my iPhone/Mobile device

fortunately I belong to one of those public sector the unions who account for only 10% of the work force the the right loves to hate mostly because I have better benefits AKA Health insurance ...

I felt bad for those with out insurance before the ACA was passed and now since Trump isn't do a thing now and this is only one 50 year old drug.. But I honestly had no idea of the real costs I should say the price gouging and profit taking of the industry as a whole... is a crime

it Just re enforces my believe health care is a right not a choice ... its not a choice that The wealthiest 1 percent of American households own 40 percent of the country's wealth... But its not in the constitution thats the rights argument .... yep they will die with their guns because they cant pay to live longer to use them.... ironic

[detbuch]

Originally Posted by wdmso

fortunately I belong to one of those public sector the unions who account for only 10% of the work force the the right loves to hate mostly because I have better benefits AKA Health insurance ...

You are wrong about why the "right" thinks Public sector unions are a bad idea. Ironically, the "right" agrees with the "left's" biggest icon, FDR, on why it is a bad idea. This has been discussed a few times on this forum, but you seem to have a tin ear to anything that contradicts your Marxist orientation. Your narrow mind-in-the-Progressive bubble can only believe that the "right" loves to hate, rather than understand where it's coming from.

I felt bad for those with out insurance before the ACA was passed and now since Trump isn't do a thing now and this is only one 50 year old drug.. But I honestly had no idea of the real costs I should say the price gouging and profit taking of the industry as a whole... is a crime

That's what happens when the free market is strangled by crony regulation.

it Just re enforces my believe health care is a right not a choice

What does this mean? A right to what? Someone else's labor? We all have the right to our neighbor's labor? This could be an enlightening discussion--if you care to have it. I doubt that you do.

... its not a choice that The wealthiest 1 percent of American households own 40 percent of the country's wealth... But its not in the constitution thats the rights argument .... yep they will die with their guns because they cant pay to live longer to use them.... ironic

That is a messy stream of consciousness lacking in reasoned choice of words and thought. In other words, incoherent.

[JohnR]

Originally Posted by wdmso

Just went on this site you see on TV GOOD RX my insurance is not covering a med my wife takes 40mg doxycline they want to change her to the generic called oracea its 1825.00 for 90 day supply with out insurance the non generic is guess what 1825.00 for a 90 day supply

in Canada the price for 100 pills of tetracycline is under $50. this is a 50-year-old antibiotic

2013 According to a U.S. House committee investigating price hikes in several generic drugs, the average wholesale price of 500 tablets in October 2013 was $20. Seven months later, the average wholesale price for the same amount was $1,849, an increase of more than 8,000 per cent.

just another example of big business fleecing of America

So - let's apple to apples here.

You state Doxycline generic Oracea $1800 for 3 month supply yet you compare it to Tretracycline, a different drug, in 100 pills for $50.

Doxycline is kindasorta Oracea but not Tretracycline and a 90 day supply usually does not equate to 100 pills. This is a Word Salad.

What is the equivalent of Oracea, 90 Day Supply, in Canada? Still probably a lot cheaper in Canada. It is also a lot cheaper as a pet medication (not saying or insinuating anything mean - purely open discussion). So yes, Big Pharma is gouging here under the top cover of Congress.

This is normally where I would ask where this is Trump's Fault but he wasn't pres in 2013. Congress and both parties have been screwing this up for a while now.

[DZ]

IMO in today's society you should be able to purchase most non-controlled medications anywhere you choose. Of course it would be "caveat emptor".

[Pete F.]

Originally Posted by JohnR

What is the equivalent of Oracea, 90 Day Supply, in Canada? Still probably a lot cheaper in Canada. It is also a lot cheaper as a pet medication (not saying or insinuating anything mean - purely open discussion). So yes, Big Pharma is gouging here under the top cover of Congress.

This is normally where I would ask where this is Trump's Fault but he wasn't pres in 2013. Congress and both parties have been screwing this up for a while now.

Big Pharma's lobbyists rewrote the regs for congress
Eliminated the ability of drug companies to have sales reps wine and dine prescribers, Hint while this purportedly made it so the doctors didn't push certain drugs it actually saved the companies money.
They dumped the money saved into those stupid adds pushing drugs and raised prices since Congress made it so they could not negotiate pricing.

[JohnR]

Originally Posted by Pete F.

Big Pharma's lobbyists rewrote the regs for congress
Eliminated the ability of drug companies to have sales reps wine and dine prescribers, Hint while this purportedly made it so the doctors didn't push certain drugs it actually saved the companies money.
They dumped the money saved into those stupid adds pushing drugs and raised prices since Congress made it so they could not negotiate pricing.

Certainly agree with you on the Congress and Big Pharma lobbying part ; )

Let's eliminate all lobbying, corporate, Union, etc - and Term Limits

[Pete F.]

From The Grumpy Economist
https://johnhcochrane.blogspot.com/
Single payer sympathy?
A July 30 2018 Op-Ed in the Wall Street Journal, titled "The tax and spend health care solution"
Why is paying for health care such a mess in America? Why is it so hard to fix? Cross-subsidies are the original sin. The government wants to subsidize health care for poor people, chronically sick people, and people who have money but choose to spend less of it on health care than officials find sufficient. These are worthy goals, easily achieved in a completely free-market system by raising taxes and then subsidizing health care or insurance, at market prices, for people the government wishes to help.
But lawmakers do not want to be seen taxing and spending, so they hide transfers in cross-subsidies. They require emergency rooms to treat everyone who comes along, and then hospitals must overcharge everybody else. Medicare and Medicaid do not pay the full amount their services cost. Hospitals then overcharge private insurance and the few remaining cash customers.
Overcharging paying customers and providing free care in an emergency room is economically equivalent to a tax on emergency-room services that funds subsidies for others. But the effective tax and expenditure of a forced cross-subsidy do not show up on the federal budget.
Over the long term, cross-subsidies are far more inefficient than forthright taxing and spending. If the hospital is going to overcharge private insurance and paying customers to cross-subsidize the poor, the uninsured, Medicare, Medicaid and, increasingly, victims of limited exchange policies, then the hospital must be protected from competition. If competitors can come in and offer services to the paying customers, the scheme unravels.
No competition means no pressure to innovate for better service and lower costs. .....
...

As usual, I have to wait 30 days to post the whole thing. It synthesizes some of my earlier blog posts (here here here) on how cross subsidies are worse than straightforward, on budget, taxing and spending.

Let me here admit to one of the implications of this view. Single payer might not be so bad -- it might not be as bad as the current Medicare, Medicaid, Obamacare, VA, etc. mess.

But before you quote that, let's be careful to define what we mean by "single payer," which has become a mantra and litmus test on the left. There is a huge difference between "there is a single payer that everyone can use," and "there is a single payer that everyone must use."

Most on the left promise the former and mean the latter. Not only is there some sort of single easy to access health care and insurance scheme for poor or unfortunate people, but you and I are forbidden to escape it, to have private doctors, private hospitals, or private insurance outside the scheme. Doctors are forbidden to have private cash paying customers. That truly is a nightmare, and will mean the allocation of good medical care by connections and bribes.

But a single provider than anyone in trouble can use, supported by taxes, not cross-subsidized by restrictions on your and my health care -- not underpaying in a private system and forcing that system to overcharge others -- while allowing a vibrant completely competitive free market in private health care on top of that, is not such a terrible idea, and follows from my Op-Ed. A single bureaucracy that hands out vouchers, pays full market costs, or pays partially but allows doctors to charge whatever they want on top of that would work. A VA like system of public hospitals and clinics would work too. Like public schools, or public restrooms, you can use them, but you don't have to; you're free to spend your money on better options if you like, and people are free to start businesses to serve you. And no cross-subisides.

Whether we restrict provision with income and other tests, and thus introduce another marginal disincentive to work, or give everyone access and count on most working people to choose a better product, I leave for another day. It would always be an inefficient bureaucratic problem, but it might not be the nightmare of anti-competitive inefficiency of the current system.

[detbuch]

[spence]

Wow, that's some hard hitting investigative journalism. They should have consulted with Veritas, could have helped with production quality.