[quote author="alan" date=1208582639]
The primary drivers of health care costs are drugs, hospital costs and imaging costs (also practicing defensive medicine, ording lots of expensive tests for fear of getting sued)
If you get a chronic disease you will pay, diabetes requires 2-4 drugs now costing over $100 month, hypertension, asthma all cost money, any cream you get for a rash will be expensive, now we are putting healthy people on drugs such as lipitor to keep them for getting heart attacks that cost $1000/yr and how many people are on prozac, not to mention viagra.</blockquote>
Well, these may be the facts but they aren't the cause of higher overall health care costs, merely symptoms of the underlying problem. The side effect of advances in phamacology is that people have come to expect and demand a medication to alleviate any malady. Supply and demand determine the price of anything in a free market and if people are willing to pay for an erection, that is their right. But the underlying problem is that people expect someone else (insurance) to pay those costs and don't bother shopping for a cheaper provider or source of drugs, essentially guaranteeing that there is no downside pressure on price via competition. This is compounded by a patent system that ensures a monopoly on a specific drug once discovered. If drug companies were only allowed to license their discoveries, other manufacturers could compete against each other and prices would finally have another force to counter the demand pressure, especially if health insurance providers used their purchasing power to drive down prices even further by buying in bulk or signing production contracts with manufacturers. If it works for Wal-mart is can work for Humana or Blue Cross.
<blockquote>Hospital costs have grown enormosly, salaries have driven some of this, look how many nurses are making $100k/yr. that money comes from somewhere. Nurses in England, Germany or Japan don't make anywhere near what US nurses make. Just 8 hrs in the ER can set you back $10K or more.</blockquote>
Yes, salaries are high, but there is also an almost constant shortage of nurses in this country. Why is that? Considering the relative differences between educational requirements between doctors and nurses, why is the average nurses salary so high? You have to consider that there may be a legitimate reason, either the money is an incentive to entice qualified employees or the job sucks so much that it commands that kind of compensation. It's probably both, but limiting a nurse's salary isn't going to result in more nurses, just fewer nurses per patient. Again, if the problem is demand driving costs, then the options are to reduce demand or increase supply. Our population is aging and further demand pressures are only going to increase. If nurse's salaries are high due to demand for nurses, then maybe offering free or subsidized nurse education will provide more of them and help lower costs, but as it stands right now there is nothing to put downward pressure on labor costs.
ER costs are a seperate matter. The impact of non-payment by those with no insurance or ability to pay when they visit the ER leads to hospitals charging more to compensate. Hospitals could do themselves a favor by establishing non-emergency, low-cost clinics to prevent non-emergency patients from seeing the ER as their only health care option, but your next point shows why this option can't work... yet. Still, the underlying drive to the cost increases is one of demand.
<blockquote>Defensive medicine is huge, it's the elephent in the garden. ER doc's are scared sh#tless, they don't even examine patients anymore, everyone with a headache gets a CT scan, anyone with a bellyache gets a CT scan. Someone has to pay for that.
Now evertime someone comes in with a joint ache they want an MRI. I tell them give it 6-8 weeks, it's probably just a sprain but no good, must have $1500 MRI to tell them they have a sprain.</blockquote>
Well, at least this isn't a demand problem... oops, it is. Malpractice insurance has risen because malpractice suits have either been settled or successful. Doctors hold some responsibility for that, as does the hospital system. ER shifts and residency programs practically guarantee mistakes by requiring doctors to work obscenely long shifts. Airline pilots, truck drivers, train engineers all have limits on consecutive hours with no rest break but ER doctors are routinely pulling 16, 18, 20 hour or longer shifts.
7nbsp;
But that's only half the story. Defensive tests and procedures are also the result of a customer base that expect the best possible care and have someone else paying for it. Don't do a procedure, expect a lawsuit. Do a procedure, expect to be portrayed as a robber baron. That is a no-win situation brought on by lawsuits and demand. Until the litigation issues are resolved, the demand is going to be there as doctors do whatever they can to prevent being sued. And in an ER, insurance companies have little choice but to pay up. But the underlying problem is still one of demand driving costs and a lack of offsetting price pressure.
<blockquote>Spending on back pain alone has doubled in the last 8 years without any improvement in outcomes, recent NEJM article.
Don't tell me I don't know what the cost drivers are, I know better than most.</blockquote>
Why are you so defensive? I never said anything about what you do or do not know. If you are trying to piss people off you are succeeding but I don't know that this approach is going to win anyone to your cause.
Aside from the litigation situation, the primary problem isn't one of rising costs. The primary problem is one of demand versus supply with all the momentum on the demand side and little or none on the supply side. Provide more comeptition, allow for more flexibility in consumer choices, and reduce the causes (and payoff) of practioner mistakes, and be more proactive in serving those with low-incomes and most of the "problem" with healthcare gets resolved.
That being said, I must strongly disagree with anyone who thinks healthcare is a "right". Freedom of speech is a right, the ability to defend oneself is a right, living without fear of oppression is a right. These are things that would exist even if there is only one person left on the planet. Health care is an option, like indoor plumbing. It is the cumulative result of the entire species' knowledge and practice, but it CANNOT be a right to recieve that benefit unless you can provide it to yourself from your own knowledge. We cannot compel another to heal us against their will, any more than we can compel a plumber to fix our toilet against their will. Therefore it is not possible for healthcare to be a right. If you, or anyone, wants to sell me on mandatory healthcare for everyone, you will have to present a logical argument that is convincing on it's own logical merits.
