This poll needs to change format so you can select multiple responses. The answer is all of the above.
The core issue that needs solving is aligning incentives for people to do the right thing cost effectively. The profit motive will drive both good behavior (new drug R&D, more doctors entering the field, etc) and undesirable behavior (expensive drugs and medical malpractice lawsuits). The best use of federal resources is on public goods that are not addressed by the free market: disease prevention, promoting access to care and insurance, and rewarding physicians who do right by their patients.
Controlling (or reducing) the cost of healthcare requires we break the delivery of care into four levels. Two levels we can control costs, in fact reduce costs, the other two levels are almost impervious to cost contrl without a major societal upheaval. Consumerism will definitely work in the first level, somewhat on the second and not at all on the third or fourth. Unfortunately it is the last two levels that usurp the bulk of the health care dollars.
The first level is cosmetic procedures. Clearly consumerism and competition have worked here and will continue to do so. Look at Lasik surgery. When it first came out around 1996 cost per eye was about $3,000. Today I see ads for $300/eye. Same for breast implants, liposuctions, dental implants and many others.
The second level is for routine outpatient care and non-emergent elective procedures, such as knee and hip replacement, carpal tunnel procedures, cataracts, etc. There is a definite role here for price/ quality comparisons. That is, unless the patient has significant comorbit issues or other complications. Then choices can get limited fast.
The third level is emergent care, and unspecified diagnoses. Clearly a patient who can’t breathe or bleeding profusely is not going to check his/her ”health consumer app”. Take me to the nearest hospital, more so if it involves your child or loved one. Patients admitted to a hospital with an unspecified diagnosis are another costly group. Simply trying to find out what the real problem is can eat up major resources and if the patient remains in pain through the search process he/she will go anywhere regardless of cost to try to alleviate the pain.
The last level is made up of the aged and terminally ill. Numerous academic research and government studies state that 80% of health care dollars is spent in the last two years of life. Even though we have expanded services like home care and hospice still a minority of cases utilize these services. Many debates have raged over whether the approach of ‘save a life at any cost, at any age’ is appropriate. In this country the general approach is if you have the resources, or government or third party coverage, you fight death with dollars to the end. This I submit is not a cost or care quality problem but a societal one and no amount of consumerism, regulatory attack, or system reorganization will change it.
In my opinion don’t expect consumerism to make a big dent in health care expenditures when in the end consumerism will only have an impact on levels one and two. Levels three and four will remain unchanged while baby boomers age and medical technology continues to advance, thereby identifying more deceases to attack with more technology. Without a significant social and attitudinal change cost will continue to rise.
Be Ware What You Ask For - 8 years ago
A single payer system reduces the quality of patient care. When the government is in control they start to dictate the number of tests that can be performed, where the locations are, level of reimbursement. The fact that one can get an MRI or CAT Scan as needed, if not an emergency, will be severely restricted and will have long wait lists for services. Don't think that the stories of dying from a disease before one can obtain treatment is a fairytale, it happens due to restricted numbers of services offered. Appreciate what we have today, a single payer system will create a complete new set of problems, you just haven't heard about them.
HIT Girl - 8 years ago
Re: eliminating the middleman. Moving to single payer will eliminate the *profit seeking* middleman, which is the difference between commercial insurance and single-payer government-managed. There will always be a middle-man, since most people can't afford to pay cash for all medical services up front (I don't have a spare $10K lying around ready to blow on a CT scan, sorry); that's not the problem. The problem is when the middle man is skimming billions of dollars in profit off the top.
Cash payer - 8 years ago
While everyone is quick to think that moving to a single-payer system will eliminate middlemen, it won't, what it will do is insert the government between the patient and their healthcare decisions. Standardize the price that everyone pays so that consumers can effectively shop for care. They have too much leverage in the system and effectively control the movement of cash through the system.
AC - 8 years ago
I think it will take a combination of these factors to bring down costs. The major reasons though are consolidations in both the insurance market and the healthcare provider market. Companies are getting way too big in order to use it as leverage. We need to stop this and reverse it. Everyone loves competition and free market right? You can't have a free market if you can't choose where to go or what insurance to get. Start there, which can probably be done with existing anti-trust laws.
Then move to force providers to advertise and actually stick to their prices. How can you competitively shop if you don't know the prices??
Reduce the time and money it takes to bring generics to market. There is no reason to pay some of these exorbitant drug prices.
Single payer would be nice, but that's a big change. There is a lot more that can be done to bring down costs without going to single payer.
This poll needs to change format so you can select multiple responses. The answer is all of the above.
The core issue that needs solving is aligning incentives for people to do the right thing cost effectively. The profit motive will drive both good behavior (new drug R&D, more doctors entering the field, etc) and undesirable behavior (expensive drugs and medical malpractice lawsuits). The best use of federal resources is on public goods that are not addressed by the free market: disease prevention, promoting access to care and insurance, and rewarding physicians who do right by their patients.
Controlling (or reducing) the cost of healthcare requires we break the delivery of care into four levels. Two levels we can control costs, in fact reduce costs, the other two levels are almost impervious to cost contrl without a major societal upheaval. Consumerism will definitely work in the first level, somewhat on the second and not at all on the third or fourth. Unfortunately it is the last two levels that usurp the bulk of the health care dollars.
The first level is cosmetic procedures. Clearly consumerism and competition have worked here and will continue to do so. Look at Lasik surgery. When it first came out around 1996 cost per eye was about $3,000. Today I see ads for $300/eye. Same for breast implants, liposuctions, dental implants and many others.
The second level is for routine outpatient care and non-emergent elective procedures, such as knee and hip replacement, carpal tunnel procedures, cataracts, etc. There is a definite role here for price/ quality comparisons. That is, unless the patient has significant comorbit issues or other complications. Then choices can get limited fast.
The third level is emergent care, and unspecified diagnoses. Clearly a patient who can’t breathe or bleeding profusely is not going to check his/her ”health consumer app”. Take me to the nearest hospital, more so if it involves your child or loved one. Patients admitted to a hospital with an unspecified diagnosis are another costly group. Simply trying to find out what the real problem is can eat up major resources and if the patient remains in pain through the search process he/she will go anywhere regardless of cost to try to alleviate the pain.
The last level is made up of the aged and terminally ill. Numerous academic research and government studies state that 80% of health care dollars is spent in the last two years of life. Even though we have expanded services like home care and hospice still a minority of cases utilize these services. Many debates have raged over whether the approach of ‘save a life at any cost, at any age’ is appropriate. In this country the general approach is if you have the resources, or government or third party coverage, you fight death with dollars to the end. This I submit is not a cost or care quality problem but a societal one and no amount of consumerism, regulatory attack, or system reorganization will change it.
In my opinion don’t expect consumerism to make a big dent in health care expenditures when in the end consumerism will only have an impact on levels one and two. Levels three and four will remain unchanged while baby boomers age and medical technology continues to advance, thereby identifying more deceases to attack with more technology. Without a significant social and attitudinal change cost will continue to rise.
A single payer system reduces the quality of patient care. When the government is in control they start to dictate the number of tests that can be performed, where the locations are, level of reimbursement. The fact that one can get an MRI or CAT Scan as needed, if not an emergency, will be severely restricted and will have long wait lists for services. Don't think that the stories of dying from a disease before one can obtain treatment is a fairytale, it happens due to restricted numbers of services offered. Appreciate what we have today, a single payer system will create a complete new set of problems, you just haven't heard about them.
Re: eliminating the middleman. Moving to single payer will eliminate the *profit seeking* middleman, which is the difference between commercial insurance and single-payer government-managed. There will always be a middle-man, since most people can't afford to pay cash for all medical services up front (I don't have a spare $10K lying around ready to blow on a CT scan, sorry); that's not the problem. The problem is when the middle man is skimming billions of dollars in profit off the top.
While everyone is quick to think that moving to a single-payer system will eliminate middlemen, it won't, what it will do is insert the government between the patient and their healthcare decisions. Standardize the price that everyone pays so that consumers can effectively shop for care. They have too much leverage in the system and effectively control the movement of cash through the system.
I think it will take a combination of these factors to bring down costs. The major reasons though are consolidations in both the insurance market and the healthcare provider market. Companies are getting way too big in order to use it as leverage. We need to stop this and reverse it. Everyone loves competition and free market right? You can't have a free market if you can't choose where to go or what insurance to get. Start there, which can probably be done with existing anti-trust laws.
Then move to force providers to advertise and actually stick to their prices. How can you competitively shop if you don't know the prices??
Reduce the time and money it takes to bring generics to market. There is no reason to pay some of these exorbitant drug prices.
Single payer would be nice, but that's a big change. There is a lot more that can be done to bring down costs without going to single payer.