Saturday, July 16, 2011

Why Do Medicare Patients See the Doctor Too Much? They Usually Pay Nothing Out-of-Pocket; So Demand Curves Really Do Slope Downward

From an editorial earlier this week in the WSJ:

"Almost all discussions about Medicare reform ignore one key factor: Medicare utilization is roughly 50% higher than private health-insurance utilization, even after adjusting for age and medical conditions. In other words, given two patients with similar health-care needs—one a Medicare beneficiary over age 65, the other an individual under 65 who has private health insurance—the senior will use nearly 50% more care.

Several factors help cause this substantial disparity. First and foremost is the lack of effective cost sharing. When people are insulated from the cost of a desirable product or service, they use more. Thus people who have comprehensive health coverage tend to use more care, and more expensive care—with no noticeable improvement in health outcomes—than those who have basic coverage or high deductibles.

In addition, Medicare's convoluted benefit structure encourages the purchase—either individually or through an employer—of various forms of supplemental insurance. Medicare covers roughly three-fourths of total costs, but about 85% of the Medicare population has expanded coverage with small to limited cost sharing. This additional cost insulation pushes seniors' out-of-pocket costs toward zero, thereby increasing overall utilization."

MP: This crystallizes one of our main health care problems: spending other people's money (see chart above, data here).  When out-of-pocket costs for medical care approach zero, it shouldn't be any surprise that utilization goes up, that's just the Law of Demand. 

59 Comments:

At 7/16/2011 8:53 AM, Blogger john_d said...

Because Medicare reimbursement rates are lower than private insurers, Medicare recipients get worse service than privately insured patients. For doctors who base their practices around Medicare patients, worse service means move office visits to treat the same malady means more money to the doctor. For doctors who do not want to treat Medicare patients at all, the poor service discourages the Medicare patients from returning.

 
At 7/16/2011 10:26 AM, Blogger Larry G said...

there are some things to understand about Medicare that, in turn, can lead to a better understanding of the problems.

First, there are actually 4 Medicares.

They are called A, B, C, and D.

C&D are "advantage/gap" and prescription drugs - both subsidized by taxes.

To give perspective - the unfunded liability for Part D for a 75 year horizon is MORE than all of Social Security.

The two PRIMARY Medicares A & B are very different in what they do and how they are funded.

Medicare Part A is funded from mandatory FICA taxes but it only pays for hospitalizations.

Medicare Part B is VOLUNTARY, no mandatory - you have to sign up for it.

Part B pays all medical providers including doctors.

Now the problem.

Most people who have Medicare Part B pay only about $100 a month for it but they use it at a rate of 300-400 a month.

Medicare Part B is 75% funded by taxpayers and only 25% by those 100 a month premiums.

So people who own 3 cars and 2 houses get 15-30K medical procedures for $100 a month premiums.

and because the premiums are so low and the rest financed by taxes, there is pressure to keep reimbursements low....

Part B... IS means-tested for higher income but the thresholds and higher premiums are similarly unrealistic.

The answer to the Part B Medicare "problem" is pretty simple in my view.

charge higher premiums and if people think those premiums are too high, they can go look for private insurance (which they will not find for anywhere near the $100 a month for people over 65).

but here's the biggest problem of all.

The Medicare issue is relentless demagogued and propagandized with false and misleading information such as conflating Medicare Part A and B such that the average person, even those who like Medicare do not know the basic facts related above in this post.

without people understanding the realities - we end up with interest groups and the two political parties playing what amounts to inside baseball with Medicare.

 
At 7/16/2011 11:33 AM, Blogger arbitrage789 said...

“Why Do Medicare Patients See the Doctor Too Much? They Usually Pay Nothing Out-of-Pocket”.

^^^^^^^^^^^^^^^^^^

Subsidize something, get more of it.

One of the many reasons why the CBO estimates of ObamaCare costs are wildly optimistic.

 
At 7/16/2011 12:05 PM, Blogger SBVOR said...

Everything government touches turns to shit. Health care is no exception.

For all practical purposes, we have endured a Socialist health care system ever since Medicare & Medicaid were passed into law in 1965. It will only get worse from here.

 
At 7/16/2011 2:22 PM, Blogger Benjamin said...

I say chuck, and do whatever the Japanese are doing when it comes to healthcare. They spend 4 percent of GDP on healthcare, and have an elderly population.

 
At 7/16/2011 3:47 PM, Blogger Larry G said...

all other industrialized countries have govt-involved health care and those countries have the highest life expectancies of the rest of the countries - though.

No other countries that do not have govt-involved health care come even close.

 
At 7/16/2011 4:28 PM, Blogger Michael said...

Economic reasoning can explain that something is occurring (we subsidize it, so we get more of it) but economics is no philosophy, and does not tell us what should be. Letting grandma die is the street is unacceptable, and so I would rather pay additional taxes and have her utilize the service to a greater degree. There is no reason to think that the utilization rate which occurs under private insurance is the "right" level, but rather the one people can afford.

 
At 7/16/2011 6:25 PM, Blogger SBVOR said...

Larry G,

Drink the Kool-Aid much?

Want some substantiated, quantitative facts proving you wrong?

http://sbvor.blogspot.com/2009/06/socialist-health-care-be-careful-what.html

Government began to take our health care system off the rails under FDR. LBJ put us firmly in the ditch when he signed Medicare & Medicaid into law in 1965. ObamaCare will only accelerate the disaster LBJ put in motion.

You can fantasize about all the health care entitlements you please. But, short of slave labor (that's coming), you cannot deliver on that fantasy:

http://sbvor.blogspot.com/2010/12/physicians-say-obamacare-will-severly.html

But, HEY! The Mafia love your fantasy:

http://sbvor.blogspot.com/2011/01/finally-somebody-who-benefits-from.html

Blame the American people (people like you) who drink the Kool-Aid and slit their own throats.

Two more sources for you quantfying this as true:

http://www.ncpa.org/pub/ba437
http://www.hoover.org/publications/digest/3459466.html

 
At 7/16/2011 6:32 PM, Blogger SBVOR said...

Michael,

Drink the Kool-Aid much?

The FACT is that your “granny” is -- by FAR -- the wealthiest age demographic in the nation. The FACT is that Medicare robs the poor and gives to the rich. The FACT is that Medicare robs us ALL (MANY times over). The FACT is that ONLY the Mafia benefit from Medicare. Well, okay, the Washington D.C. Mafia also benefit from Medicare (by using disgusting scaremongering of the sort you just mindlessly regurgitated).

Brave enough to face the SUBSTANTIATED FACTS about the most profoundly evil program our government EVER foisted upon us?

See the link below:
http://sbvor.blogspot.com/2011/04/think-medicare-serves-poor.html

 
At 7/16/2011 7:12 PM, Blogger Ron H. said...

SBVOR

I have but one question:

How did you get so many links past Prof Perry's spam filter on a weekend?

:)

 
At 7/16/2011 7:22 PM, Blogger Craig said...

all other industrialized countries have govt-involved health care and those countries have the highest life expectancies of the rest of the countries

Correlation does not prove causation. All those other countries do not have about 10% of the population living in a culture of drugs, crime, and family destruction. Corrected for that, American life expectancy is quite good and -- shazam -- so is educational achievement.

If that problem is not addressed, spending more won't solve a thing. As an aside, I don't think we can solve that problem.

 
At 7/17/2011 9:28 AM, Blogger Mark J. Perry said...

Ron H: The only option I have to control some of the spam attacks is the Blogger spam filter, which I have no control over (e.g. I can't change settings). And I do try to check for comments stuck in the spam filter almost every day, 7 days a week, but sometimes go for a few days without checking! Unfortunately, I don't get any messages alerting me that there are comments awaiting moderation, so I have to remember to check every day or few days. :)

 
At 7/17/2011 1:32 PM, Blogger Ron H. said...

Thanks, Prof. Perry, I understand that Blogger can be a pain, with one-size-fits-all, and lack of user control.

I'm still hoping for a Blogger update that allows commentators to use strike-out text.

 
At 7/17/2011 3:10 PM, Blogger Larry G said...

re: causation:

no universal health care systems with competitive life expectancy in any country in the world that does not have govt-involvement in the health care system.

govt does suck at health care - in many respects, I agree.. but what is in second place is much, much worse unless you can find me some examples of health care systems that do well but have no gov involved in them.

 
At 7/17/2011 6:31 PM, Blogger Dr. T said...

Mark Perry paints a nice picture of demand rising due to low costs. The problem is that in this case he is wrong. His analysis is flawed because he completely disregards the effects of Medicare reimbursement policies on health care providers. The federal government repeatedly reduced inflation-adjusted reimbursements to clinicians for office visits by Medicare patients. Clinicians have responded to these reduced reimbursements in three ways: 1. Stop seeing Medicare patients, 2. Reduce time spent with Medicare patients and order more laboratory tests and imaging studies to compensate, 3. Schedule more visits such that a problem that previously required two visits now is handled with three or four shorter visits. The latter two responses are most common. The proportion of Medicare patient office visits due to response 3 is unknown but likely exceeds one-third and possibly exceeds one-half.

The above explanation fits the facts and logic. Few retirees rush to their clinicians whenever they sneeze, cough, ache, or feel fatigued, because going to a physician has costs. Even if the direct monetary cost is low or zero, there are other costs such as travel time and travel hassles (especially for those who can't drive), filling out forms and questionnaires, waiting in the clinician's office, undressing and donning flimsy gowns, answering numerous questions (some embarrassing), feeling cold stethoscopes, undergoing poking and prodding, etc. Because of the above costs, one of the common difficulties clinicians face is Medicare patients failing to keep their appointments. Visits by Medicare patients for trivial medical problems are much less frequent than missed appointments.

 
At 7/17/2011 9:33 PM, Blogger Hydra said...

It is 50% higher because Medicare cannot cancel your coverage.

 
At 7/17/2011 9:40 PM, Blogger Hydra said...

Correlation does not prove causation. All those other countries do not have about 10% of the population living in a culture of drugs, crime, and family destruction. Corrected for that........

====>>>>>>>>>
Try telling that to someone convicted on DNA evidence..

 
At 7/18/2011 1:20 AM, Blogger misterjosh said...

Michael has used a false dichotomy.
A) Letting granny die in the streets;
B) Pay all our taxes like good little boys and girls.

People are mostly not evil, and will not let granny die in the streets. A small minority of seniors were fated to some awful circumstances in the early parts of last century, but so were a lot of people. We were POOR. REALLY REALLY POOR.

The GDP/person now is almost 10X what it was then. If there was no SocSec & no Medicare, the poorest seniors would still be helped 10X more than they were 100 years ago.

 
At 7/18/2011 8:41 AM, Blogger Larry G said...

"Michael has used a false dichotomy"

......

". If there was no SocSec & no Medicare, the poorest seniors would still be helped 10X more than they were 100 years ago. "

the estimates that I've seen say that about 1/3 of the seniors would live in poverty and few could afford what the private sector would charge for insurance.

without question, seniors who could not get health care would be showing up at the hospital ERs to get care - and those costs shifted via EMTALA to others.

Now, it's true that out of about 200 countries, only 40 offer universal health care to everyone including seniors but it's also true that the other 160 countries have horrible life expectancy statistics.

Essentially what you are advocating is that the US revert back to 3rd world status,

And in a representative/elected form of government, if that is what people voted for it would be the will of the people.

But I think you're going to find that it is YOU that is in the minority on this issue and you won't be gaining many more converts.

but let's try. Name the top 5 countries in the world in terms of life expectancy that do not have universal health care or other forms of govt-involved health care.

and then compare them to the top 5 industrialized countries who do.

 
At 7/18/2011 9:15 AM, Blogger juandos said...

"the estimates that I've seen say that about 1/3 of the seniors would live in poverty and few could afford what the private sector would charge for insurance"...

Hmmm, I've seen similer...

So Larry would that condition have happened if the federal government hadn't intruded into the healthcare market?

 
At 7/18/2011 9:49 AM, Blogger Hydra said...

So Larry would that condition have happened if the federal government hadn't intruded into the healthcare market?


===============================
Where are the real world examples that Larry asked for: places with good healthcare and no government involvement?

What-if, doesn't cut it. Anyone can postulate how things would be in some hypothetical perfect world.

 
At 7/18/2011 9:52 AM, Blogger Hydra said...

On July 1, 1966, millions of Americans lost all financial responsibility for their health-care decisions, because many of them had proven themselves incapable of managing those responsibilities.

 
At 7/18/2011 9:55 AM, Blogger Hydra said...

"HMOs can keep millions of dollars from premium-paying patients. "

So can insurance companies. They just collect your premiums for twenty years, then kick you off the rolls.

 
At 7/18/2011 9:58 AM, Blogger Hydra said...

HMOs allowed politicians to promise access to comprehensive health-care services without actually delivering them. Because treatment decisions could not be linked directly to Congress, HMOs provided the perfect cover for its plans to contain costs nationwide through health-care rationing.

OK, how is that different from managing ones own financial responsibility for health care decisions?

"Gee, I think I will ration myself out of this procedure because I cannot afford it?"

 
At 7/18/2011 10:07 AM, Blogger misterjosh said...

Thanks for the reply Larry.

Regarding poverty, I'm in no hurry to scrap SocSec altogether. I think we could without old people dying in the streets, but that's a different discussion.

Regarding seniors being unable to afford insurance, I'm agree with Juandos' comment that if the medical insurance market were de-regulated, rates would plummet. Insurance should be insurance, not a 100% middleman between patient and care. Many of the countries with universal health care have higher co-pays than we do.

Nobody would be able to afford the kind of care that Medicare puts out, but that's hardly news. The country can't afford it right now, or at least we aren't bringing in enough taxes to cover it.

Seniors over-using ERs - Last I read, Massachusetts' universal health care hasn't actually pushed ER visits down. Also, "without question" is one of those phrases that rings alarm bells in my head. This is the social sciences we're talking about - there are always questions.

I don't think we can draw any conclusions from the fact that there is a high correlation between universal health care and life expectancy. It's a matter of wealth. Americans can afford to live longer, and Americans can afford universal senior health insurance. There seems to be a decent y=x^z correlation between GDP & life expectancy. http://www.indexmundi.com/g/correlation.aspx?v1=67&v2=30&y=2003

It comes as no surprise to me that I am in the minority regarding this issue. I understand that taking other peoples' money is a popular notion. I just hope that we as a people don't get so fond of it that we lose sight of the fact that the free exchange of goods between free people is the reason we are as rich as we are.

 
At 7/18/2011 10:19 AM, Blogger Hydra said...

"In 2014 applicants of the same age will obtain health insurance at the same published rate regardless of health status — the first time in U.S. history that insurers will lose the right to load the premium or deny coverage prior to contract, or cancel a policy after contract due to an adverse health condition, or test result indicating that one may be imminent."

Is that what you call intruding on the health care market? Demanding that those who offer isnurance, actually provide said insurance?

 
At 7/18/2011 10:28 AM, Blogger Hydra said...

Maybe you prefer the Swiss system.

Insurors are required to provide insurance without refard to age or pre-existing conditions, and citizens are required to buy health insurance.

However, insurors are required to provide the basic insurance program on a not for profit basis.

Premiums are high, about $13,000 for a family of four. Employers may offer isnurance plans, but they are not tax deductible.

 
At 7/18/2011 10:44 AM, Blogger Larry G said...

" So Larry would that condition have happened if the federal government hadn't intruded into the healthcare market? "

for all industrialized countries with universal health care?

is that your question?

 
At 7/18/2011 11:04 AM, Blogger juandos said...

"for all industrialized countries with universal health care?

is that your question?
"...

Not even close Larry...

I've been to several many countries over the last thirty years that had 'universal' health care and they all sucked, every last one of them if the health problem was more complicated than needing a simple band aid...

 
At 7/18/2011 12:10 PM, Blogger Mike said...

2 things...

One, I've been trying to get an answer to this question with no luck: what is the ultimate penalty for those who refuse to pay their fine to the IRS for not buying health insurance (after ObamaCare kicks in)?
I know what happens if you don't pay other fines....are we going to lock them up?

Two, Dr. T said:
"Few retirees rush to their clinicians whenever they sneeze, cough, ache...."

That may depend on who these seniors are and where they live. I've seen and read stories about the growing 'social club atmosphere' of seniors, living in nice retirement communities, basically using their extremely -regular office visits as little more than gossip time.
Are you an MD, Dr. T?

 
At 7/18/2011 12:48 PM, Blogger Ron H. said...

This comment has been removed by the author.

 
At 7/18/2011 5:29 PM, Blogger Dr. T said...

@Mike: Yes, I'm a physician. The situation you describe is uncommon among retirees. A few years ago I worked at a VA medical center where the Medicare-eligible veterans got almost free care, had lounges for watching TV and chatting with others, and had free transportation to and from the med center. Not showing for appointments was still a far bigger problem than overuse by patients.

 
At 7/19/2011 8:00 AM, Blogger juandos said...

"Where are the real world examples that Larry asked for: places with good healthcare and no government involvement?

What-if, doesn't cut it. Anyone can postulate how things would be in some hypothetical perfect world
"...

Well hydra there is NO free lunch and there are NO socialist utopias on this planet that I know of...

Do you know of any?

 
At 7/19/2011 10:02 AM, Blogger Larry G said...

re: socialist utopias

we were not asking for them. we were asking for the top 5 ranked countries on health care that had free markets and no govt involvement - and the silence is deafening and the conversation diversion comical.

the original comment is much like saying our form of govt itself is really bad... until you compare the alternatives....

 
At 7/19/2011 10:23 AM, Blogger juandos said...

"we were asking for the top 5 ranked countries on health care that had free markets and no govt involvement"...

Well since the question makes little sense (its so open ended regarding the definition of what makes the top 5) there's really no way to answer such a question...

Here you go Larry get a dose of basic education courtesy of John Stossel: John Stossel - Top 10 Politicians' Promises Gone Wrong

One should also remember that they're are relatively few real democracies on planet Earth today and the US isn't one of them anymore...

 
At 7/19/2011 10:43 AM, Blogger Larry G said...

re: rating the top 5 "free market" health care systems.

Lord Juanos..

I gave YOU to OPPORTUNITY to DEFINE what constitutes the "top".

I like things like life expectancy myself but perhaps you have other values you rank higher.

What I'm trying to understand is that if we have one of the worst systems and, in fact, any/all "socialist" (where govt involves itself) health care systems are considered HORRIBLE - then let's hear about the better ones that don't have that nasty govt influence.

 
At 7/19/2011 10:45 AM, Blogger Larry G said...

Oh.. and now that the US has ALSO FAILED the Democracy test, how about naming the top 5 Democracies in the world who do NOT have govt-influenced health care?

 
At 7/19/2011 10:46 AM, Blogger Jet Beagle said...

Larry G,

The goal of the U.S. health care industry is not to increase life expectancy. So why would you use life expectancy as a metric for "the top 5 ranked countries on health care"?

 
At 7/19/2011 11:08 AM, Blogger misterjosh said...

What silence? I remarked that you were conflating correlation with causation & noted that the exact same correlation existed with wealth & lifespan. Bhutanese have universal health care & live to 66.5; Colombians have UHC & live to 73; Brazilians have UHC & live to 73; Peruvians have UHC & live to 73.5.

Americans in 1964 with 47 year old technology and no UHC had life expectancy of 70.2. In 1975, 10 years after medicare was passed, we were up to 72.6. We were also more than twice as wealthy on a GDP/person basis.

You can say increased life expectancy is due to UHC, but all you have is correlation. If you can show that, controlling for income, UHC shows differences in life expectancy, please let me know.

Please also control for homicide, accidental death, exact definition of stillbirth vs death of a baby, and nation of origin.

 
At 7/19/2011 11:12 AM, Blogger juandos said...

"I gave YOU to OPPORTUNITY to DEFINE what constitutes the "top""...

Its NOT my job to define the top for YOU...

Personally as far as I'm concerned the US lost its credibility as a real democracy when the citizens allowed FDR foist a Ponzi scheme on them...

"I like things like life expectancy myself but perhaps you have other values you rank higher"...

Ahhh, the age old question of quality versus quanity...

What goes into your 'life expectancy' metric?

How much of it is actually tied to what you'd consider 'good healthcare'?

Is this supposed metric by you valid from country to country?

Personally off hand I don't know of any country where government hasn't seen fit to give up the chance to impose itself into the medical sector in order to have more control over its citizens...

 
At 7/19/2011 11:15 AM, Blogger Larry G said...

@beagle -

well what IS the GOAL of the US healthcare system?

or for that matter, ANY govt-influenced health care system?

 
At 7/19/2011 11:32 AM, Blogger Larry G said...

re: causation -

I'm asking what other criteria you would use to rank health care especially the kind that if free-market without govt influence.

I'm asking for examples of that kind of health care.

 
At 7/19/2011 11:35 AM, Blogger Larry G said...

we know the complaints with regard to govt-influenced health care and "claimed" Democracies.

Fair enough.. the list of "complaints" is substantial.

What I'm asking for is - better systems that exist - both govts and free market health care systems.

It's easy to find fault with the current systems - they do have their faults.

But show me better. Show me a better model to shoot for.

that would be:

1. - a better, more effective form of Governance

2. - a universal health care system that is "better" in YOUR DEFINED CRITERIA than the ones that have govt influences.

GOT answers?

or just more blather?

 
At 7/19/2011 12:54 PM, Blogger Mike said...

Dr. T,
Thanks for the reply. I'll defer to you since you clearly know much more on the topic than I do.

Now if you (or anybody) would like to take a stab at my other question:
what is the ultimate penalty for those who refuse to pay their fine to the IRS for not buying health insurance (after ObamaCare kicks in)?
Prison?

 
At 7/19/2011 12:59 PM, Blogger juandos said...

"well what IS the GOAL of the US healthcare system?"...

Make a profit...

"I'm asking what other criteria you would use to rank health care especially the kind that if free-market without govt influence"...

Larry I'm thinking you haven't looked at US domestic history of the mid 20th century to closely...

Government interference into the medical sector became overarching with LBJ's Great Socialists society programs, especially medicare and medicaid...

That was followed by the another government assault (to fix the problems caused by LBJ's nonsense) by the HMO act that was cooked up by Ted Kennedy and Richard Nixon...

So we as a nation have had 50+ years of government interference in the medical market place which have caused all manner primary, secondary, tertiary problems that continue drive the cost of medical services up...

Is it any wonder why the clueless don't understand why today's American medical services are starting to come apart?

 
At 7/19/2011 1:06 PM, Blogger Ron H. said...

This comment has been removed by the author.

 
At 7/19/2011 1:14 PM, Blogger Ron H. said...

juandos,

You've done it now! You have 2 of the 3 happy, hopping, collectivist stooges fired up with their single issue nonsense.

If you can somehow include ethanol in your comments you might attract Mr. Ethanol Plant in Every County, then you would have all three.

 
At 7/19/2011 2:09 PM, Blogger misterjosh said...

I couldn't resist the urge to snark - "...GOAL of the US healthcare system..."

There is no one goal of the US healthcare system, any more than there is one goal of the American people.

The doctors want to make money, heal people, have a high status.

Nurses are there for the money & the healing.

The businessmen are in it for the profit.

Bureaucrats are in it for the paycheck and the power.

"The government" inasmuch as it is an entity, is in it to serve the will of the lobbyists.

Politicians are in it for pandering, power, & perhaps a touch of misguided instinct to help person b with person c's money.

The patients are in it because they just want to feel better.

 
At 7/19/2011 3:00 PM, Blogger Jet Beagle said...

Larry G: "well what IS the GOAL of the US healthcare system?"

To treat medical conditions.

Factors which greatly influence life expectancy, but which are not influenced one bit by the U.S. health care industry:

1. lifestyle choices (smoking, obesity, for example)

2. murders

3. genetics (persons of African descent, everywhere on the globe, have lower life expectancies)

4. drug and alcohol abuse

5. traffic fatalities

I'm sure you can think of others. The point is, health care spending cannot fix stupid (or genes).

 
At 7/19/2011 3:09 PM, Blogger Jet Beagle said...

juandos: "Make a profit..."

Well, I agree that some parts of the health care system are set up to make a profit. However, only 18% of the hospitals in the U.S. are for-profit hospitals.

Also, my experiences with doctors leads me to believe that they spend many years getting trained and many, many hours of overtime for one simple reason: they want to heal the ill. Yes, they are well-compensated. But the doctors I know are absolutely, truly intent on healing, first and foremost.

Nurses are definitely dedicated to treating patients. Anyone who has spent lots of time with nurses knows this to be true. These professionals put up with one hell of a lot of crap from doctors, from hospital administrators, and from patients' families. What makes their day is not the paychecks, but the true satisfaction from making people comfortable and helping them heal.

 
At 7/19/2011 3:50 PM, Blogger Larry G said...

Is the CONTEXT of healthcare and it's goals in the US different from other countries in the world?

Do Doctors and Nurses in India, or Australia or Canada have any different goals than in the US?

Is the U.S. healthcare system more profit-oriented than other countries?

Bonus Question: If life expectancy and/or infant deaths are not a good criteria for evaluating the value of healthcare - what would be better?


what country has the most profit-seeking health care system in the world if not the US?

rank the top 5 free-market, profit-driven health care systems in the world.

 
At 7/19/2011 4:10 PM, Blogger juandos said...

"Do Doctors and Nurses in India, or Australia or Canada have any different goals than in the US?"....

Gee! When a lot of those doctors end up over here what do you think?

"Is the U.S. healthcare system more profit-oriented than other countries"...

It used to be...

"Bonus Question: If life expectancy and/or infant deaths are not a good criteria for evaluating the value of healthcare - what would be better?"...

Jet Beagle answered this question...

 
At 7/19/2011 4:11 PM, Blogger juandos said...

"However, only 18% of the hospitals in the U.S. are for-profit hospitals"...

Be that as it may Jet Beagle but how many 'intentionally non -profit' doctors have you heard of?

 
At 7/19/2011 4:19 PM, Blogger Larry G said...

"Jet Beagle answered this question.."

Nope. I asked for specific alternate valuation criteria.. not a laundry list of things that affected life expectancy.

be specific in your answers and stop sliding sideways into obtuseness.

how many hospitals in other countries are profit operations?

Name the countries with the most profitable hospitals compared to the US....

 
At 7/19/2011 4:40 PM, Blogger Jet Beagle said...

juandos: "how many 'intentionally non -profit' doctors have you heard of?"

Your assertion was that the one goal of the entire U.S. health care system was to make a profit.

We cannot know what the true goal of all the individual physicians really is. We just cannot get into their heads and know this.

My opinion - based on conversations with medical students, residents, and practicing physicians - is that the primary goal of physicians is to heal patients.

You, of course, may believe otherwise.

 
At 7/19/2011 4:46 PM, Blogger Jet Beagle said...

Larry G: 'I asked for specific alternate valuation criteria"

IMO, there is no one measure of the effectiveness of the entire health care system. The customers of that system have many and diverse demands.

Many in the U.S. are ignorant of the complex industry which is encompassed by the term "health care system". They are too lazy to learn, and instead resort to lazy measures such as life expectancy.

Larry G: "be specific in your answers and stop sliding sideways into obtuseness."

Forget you. I'll answer however I wish to answer.

 
At 7/19/2011 5:14 PM, Blogger Jet Beagle said...

Several of you who seem to desire a single measure for the U.S. health care system. Please consider these few of the many thousamds of demands which the hospitals and medical practitioners attempt to meet:

1. surgical closing of the cleft palate of a newborn or infant;

2. straightening of a child's teeth through orthodontia devices;

3. reattachemnt of a thumb severed in a woodworking accident;

4. LASIK surgery for correction of nearsightedness;

The success of each of these four treatments is measured in very different way from the others. And none of them have anything to do with increasing life expectancy.

 
At 7/19/2011 5:18 PM, Blogger Jet Beagle said...

Economists and politicians and many others seek the one answer to explain the much larger health care expenditures of the U.S. relative to other nations.

I don't believe there is one answer. But I do think one important reason - one ignored by some economists - is simply this:

We are collectively so wealthy. We have more discretionary income than any other nation, and we choose to spend much of it on health care.

 
At 7/19/2011 9:40 PM, Blogger Larry G said...

we certainly are willing to pay more and do, in part, because we often pay whatever is charged ... often not even knowing what the charges are or caring as long as they are "covered".

two things to keep mind with Medicare (part b) is that 1. it's voluntary, you have to sign up for it. 2. It covers 80% of the charges unless you have an additional gap policy.

Medicare Part B is not an "entitlement" in the conventional sense that Medicare Part A is - which is paid for through FICA payroll taxes prior to your retirement.

 

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