njlauren
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Joined: 10/1/2011
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The real problem is that competition works best when you have products that lend themselves to economies of scale and automation and such. I have heard health care compared to something like tv sets, but the problem is tv sets are a fungible item, made with discrete components that are subject to economies of scale, efficient production methods and other factors to make them cheaper...which doesn't hold for medicine. Sure, we have modern equipment like MRI's, and cat scans and diagnostic tests, but a lot of medicine doesn't lend itself to the economies of scale and efficiency because it is a service industry...and each patient and case is different. Sure, some things, like getting treated for poison ivy, is easy, or maybe setting a broken bone, but if someone is battling cancer, how do you compete on price when you don't even know what will work? Are you going to advertise like Earl Scheib "I'll treat any cancer, 99.99"? It is true that some procedures, like Lasik and boob jobs and the like, are advertised at a flat rate (that have their own problems), but those are repeatable procedures where the steps are discrete and where there are efficiencies of scale, it is a bit different then treating someone with cancer or a chronic illness.
Part of the problem with a multi payer system is obvious. Medicare advertises how efficient it is, how they are cutting costs, but they do so with a shell game. Medicare says "I'll pay 500 bucks for that procedure", that actually costs the provider 1500..to make up for it, they overcharge their private insurance patients to make up the difference (same with the uninsured). There are a lot of routine medical procedures that can be done by someone like a nurse or nurse practioner, like a strep throat, that doesn't require an expensive MD to do it, but the AMA wouldn't be happy about that. Same thing with going overseas for medical care, the AMA would be pretty pissed if health insurance allowed you to go overseas for cheaper care.
We have pharmaceuticals in cahoots with doctors, who prescribe expensive, new generation drugs when a generic of an older drug would do just as well. We have advertising, showing an old lady running with her dog after taking celebrex, or the ads for other drugs, to convince people to use them ('talk to your doctor about XXXX").....the problem is there is no incentive to rational medical care, and some big ethical issues. Last numbers I saw said 70% of the cost of medicine was maintaining the last month of life......which means we are extending lives but at a huge cost. Every time they rescusitate Grandma who is 85 and has a failing heart, it is 100k+ in costs, keeping someone in late stage cancer alive with all kinds of heroics is costly as well.....
The private sector can be efficient where the means exist for it to be, but the current medical setup has so many bellies to feed, has so much ambiguity around it, so many players, that you end up with many ways to game the system, robbing peter to pay paul, and end up with a mess. The one thing single payer does do is stop some of the chicanery, like cost shifting, since they would be screwing themselves, likewise, private insurers collect 22% more in premiums then they pay out to make a profit; if single payer was non profit it would be a reduction in costs.
I don't know what the answer in the end will be, I just doubt 'free market capitalism' will work, it works for plastic surgery and lasik because the former is a luxury item with stuff that is pretty routine and easy to estimate costs on, the latter is heavily automated. One idea might be something to make the AMA have kittens, develop automated medical scans like in "The Andromeda Strain" where computers do all the main work and a human doctor simply monitors it, in theory with the kind of knowledge we have now, the technology is probably there and it would save money, since among other things, if programmed right, machines won't prescribe a drug so it can get a junket to Cancun the way human doctors do.
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RE: Private sector is efficient? explain!!!! - 
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