Ricky:

Ray, seniors are indeed very carfeful shoppers. How many of them do you see staning in front of the doctors office looking over the doctors price list before they enter and ask for an appointment?
Are you actually claiming that seniors, are engaging in the same kind of price shoipping regarding medical prodcures that they do with other commodities.
That they shop for drugs based upon price, and are denied access to cheap drugs, demonstrates that perhaps if Doctors began to advertise their services based on price that you could see an influx of shopping. You honestly think doctors are going to start advertising their prices?

They probably won't advertise their prices, but they will certainly disclose them if asked. And if a senior is on a budget, they will ask. Not all medical procedures are life and death. Sometime a procedure ameliorates pain, or has a chance to do that. Or it may enable an activity. Or it may just be information. I'm just saying that people are rational and can make informed decision. But if it is other people's money, the vast majority of people don't worry about it, or certainly don't worry about it as much. That's just human nature.

You yourself have recognized that RK has come down in price over the years. It's not covered by insurance but it is worthwhile.

ray

You yourself have recognized that RK has come down in price over the years. It's not covered by insurance but it is worthwhile

Yes. Because it has entirely elastic demand. By decreasing the price, practitioners increased the market for the procedure.
Appendectomy's are NOT something one can hold off on for a year or two.... RK certainly is...
If you can point to a place or time when modern medical services that a patient would consider essential treatment, became price sensitve you'd have more to support your arguement. RK is almost unique. (Maybe plastic surgery for cosmetic reasons as well?)
The point is that the bargaining position between patients and doctors is not equal. A patient can shop, but for how long? Even if it isn't life or death there is a pressing need on the pateints behalf. (Pain is a pressing need...as any discomfort is...) With much less knowledge on the side of the patient versus the doctor, and an industry that doesn't want to include price negotiation as part of the process (you need top ASK doctors for their pricing) everything is weighed against the consumer.
By banding together in buying cooperatives a group of consumers could bargain with a supplying service and hire professional negotiators to administrate and achieve a pricing schedule for a group of consuemrs that could lower their costs... That would be the beginning of a balanced negotiating relationship between service providers and patients.
Carried to its logical conclusion, ALL patients band together and negotiate lower prices. And benefit the providers by virtually eliminating their administration costs, and eliminating bad debts.
It dignifies the process for both the patient and the doctor whilst focussing the doctors on providing for patients rather than haggling about prices or squabbling with insurance companies.
And its already proven to reduce the cost of medicine in every other country in the world Ray. Which makes me wonder why Americans are so bent on proving that by fiddling with their current pile of poop that they can come close to achieiving similar results.
You see Steve still trying to make the point that cross state border competition of insurance companies would some how magically reduce insurance premiums. States with 20 insurance companies competing are actually doing worse in premium increases than in states with 1.... There's no evidence that any of the suppossed free market levers will actually have any significant effect.
And you want seniors and doctors to suddenly change the patient doctor relationship to the same kind of relationship that seniors have with the local grocery markets... Its not going to happen. You don't change a fundamental like that just by beleiving it will occur. If is resuilts one actually cares about, rather than ideology, than there are working models that already deliver efficiency and effectiveness beyond the US system, and also provide universality AND retain and even enhance the dignity of the relationship between doctor and patient.

Sounds a bit like communism to me.
The government sets the price and the doctors must accept it.

Or, the doctors say no and refuse to participate, those who do accept the price have long waits and those who do not treat the wealthy creating a have vs have-not state.
We see this already in Canada where patients routinely head to America for treatment, Doctors routinely leave the restricted markets of Canada for America. (I know of several eye laser doctors who left Ontario for Buffalo and Rochester)
I do agree this is not a traditional supply/demand type market, no doubt about that and Ricky's arguments do make some sense there, but to simply claim government can make such demands and have it work smoothly is a bit of a lark as well.

rickyp wrote:steve

Really? So, for example, there is no law to prevent a company from selling health insurance across State lines? There are no bare minimums and absolute maximums set by law?

How many insurance companies would you require to have effective price competition ocurring Steve?
3, 4 5 6 or more?
If you eamine the numbers of compsnies competing within a state there are plenty of states where there are plenty of competitors.
And yet, insurance costs aren't lower in those states.

And, by refusing to answer the question, you put the lie to your claim that the free market has failed. In order for that to happen, we would have to have a free market. We don't--so why do you keep erecting the SAME straw man, then burn it down repeatedly?

rickyp wrote:Steve I was aware of the sell out on drug reimportation by the Dems. I think it stunk. However I asked you what the Republican position was on drug reimportation...Becasue I can't find it anywhere. You'd think it would be a major plank in saving medicare. And its a free market solution....But no. Nothing in the plan is there?

So, Democrats oppose it and because Republicans aren't trumpeting it, they don't favor market solutions?

There are so many logical problems with your reasoning that it borders on psychological problems.

According to the National Committee to Preserve Social Security and Medicare
source:
http://my.firedoglake.com/peterr/2011/0 ... -to-phrma/

Well, they certainly seem a non-partisan, free market group. I mean, you can generally tell a non-partisan group because they attack Republicans on their front page!

Sorry, that's how YOU pick "non-partisan" groups.

I know, I know--you never said they were "non-partisan." Come on, I can list as many conservative lobbying groups and cite them as sources too.

Easy question: is the US medical insurance market a "free market?" If yes, then address the points previously made. If no, then please tell me when it was a free market and how costs have been impacted since the government got involved.

Try telling the truth--just once.

GMTom wrote:I do agree this is not a traditional supply/demand type market, no doubt about that and Ricky's arguments do make some sense there, but to simply claim government can make such demands and have it work smoothly is a bit of a lark as well.

Look at European systems, which are heavily regulated and do tend to have price-fixing. They tend to be more efficient than the USA (and Canada) and with similar or better health outcomes.

So I think it can work smoothly.

danivon wrote:

GMTom wrote:I do agree this is not a traditional supply/demand type market, no doubt about that and Ricky's arguments do make some sense there, but to simply claim government can make such demands and have it work smoothly is a bit of a lark as well.

Look at European systems, which are heavily regulated and do tend to have price-fixing. They tend to be more efficient than the USA (and Canada) and with similar or better health outcomes.

So I think it can work smoothly.

As I've said many times, "So what?"

If the Democrats were proposing the Swiss system, the French system, the Canadian system, or heaven forbid, the British system, we would have a known quantity with which to compare. They didn't. They created their own--without even understanding it (thus the waivers, the Pelosi statement about having to pass it to find out what's in it, etc.).

What Obamacare is not is a European plan. It's far worse--and more expensive.

So what? tom was asking if the idea of mandated pricing could ever work I was pointing at places where it does. What does that have to do with the Democrats?

Ricky:

ray

You yourself have recognized that RK has come down in price over the years. It's not covered by insurance but it is worthwhile


Yes. Because it has entirely elastic demand. By decreasing the price, practitioners increased the market for the procedure.
Appendectomy's are NOT something one can hold off on for a year or two.... RK certainly is...
If you can point to a place or time when modern medical services that a patient would consider essential treatment, became price sensitve you'd have more to support your arguement.

Ricky, since I'm a nice guy, I'll illustrate as nicely as possible how unfair your comment is. My argument is that price matters for some worthwhile procedures and certainly for some non-worthwhile procedures. But you've turned my word worthwhile into "essential". Either you flunk in reading comprehension or you flunk in honesty. Which?

Ricky:

The point is that the bargaining position between patients and doctors is not equal. A patient can shop, but for how long? Even if it isn't life or death there is a pressing need on the pateints behalf.

Well, there are many services that one needs that are pressing. Legal advice, plumbers, exterminators, etc. There also many example of uneven bargaining positions. In fact, an even bargaining position is a rarity because invariably there are information disparities in a transaction. However, these services do operate in markets which limits price. Yes, lawyers can be too expensive and plumbers too. But it would be a lot worse if the consumer didn't have to worry about the final bill.

(Pain is a pressing need...as any discomfort is...)

Most people over 50 experience some pain on a daily basis. Whether you decide to ignore it, take a pill, avoid stairs, get a cortisone shot, or have knee surgery is a function of pain level , and other personal attitudes. I'm just saying that price should be a component of the decision for the latter 2 options.

With much less knowledge on the side of the patient versus the doctor, and an industry that doesn't want to include price negotiation as part of the process (you need top ASK doctors for their pricing) everything is weighed against the consumer.

More likely they would took to an administrative assistant.

Fundamentally we need to look for a few different ways to control health care costs. Some element of the individual focusing on the cost equation is essential. Most people don't care when it doesn't come out of their pocket.

Stop distorting my words or I'll stop being a nice guy.

and Dan, you simply state your health care is better. I don't buy that for one second. As stated, your average is better than our average. But my insured care is better, we have among the best in the world for those who are insured. I am not exactly excited about getting lesser care. Your care runs smoothly, so what? I was at the DMV yesterday, it also ran "smoothly" it still sucked being there for over an hour. Oh yeah, it's run by the government!

ray

Ricky, since I'm a nice guy, I'll illustrate as nicely as possible how unfair your comment is. My argument is that price matters for some worthwhile procedures and certainly for some non-worthwhile procedures. But you've turned my word worthwhile into "essential". Either you flunk in reading comprehension or you flunk in honesty. Which?

Its unfair to point out that one of the instances in health care where we see price advertising (RK) is regularly price advertised is a completley optional procedure? Whether or not is worthwhile is irrelevant. Whether or not the demand is elastic is entirely relevant.I responded with a relevant point.
Please find another procedure for which you can find price advertising and for which pricesd have come down. You probably won't be able to, simply becasue the demand for otehr treatment isn't as optional or elastic. Worthwhile or not.
You flunk in comprehension.

ray
Well, there are many services that one needs that are pressing. Legal advice, plumbers, exterminators, etc. There also many example of uneven bargaining positions. In fact, an even bargaining position is a rarity because invariably there are information disparities in a transaction. However, these services do operate in markets which limits price. Yes, lawyers can be too expensive and plumbers too. But it would be a lot worse if the consumer didn't have to worry about the final bill.

Yes, but in every one of these the demand is fairly elastic. You can choose whether or not to have a plumber renovate your bathroom. You can call in several for a quote. In a plumbing emergency ...well even then you can wait and call several plumbers while you wait.
Legal services have some unique pricing models (contingency fees for instance) in order to create a greater demand for the services.
Its really only the medical profession where there is a reluctance to discuss cost with the patient. Doctors like the concept of insurance becasue it removes from their day to day expericen the haggling and the being paid in goats and cows....

tom

and Dan, you simply state your health care is better. I don't buy that for one second. As stated, your average is better than our average. But my insured care is better, we have among the best in the world for those who are insured. I am not exactly excited about getting lesser care. Your care runs smoothly, so what? I was at the DMV yesterday, it also ran "smoothly" it still sucked being there for over an hour. Oh yeah, it's run by the government!

The point of this debate is the budget. And how to handle the budget deficit. Medical costs in the US account for 17% of your GDP. Costs for individual medical procedures are enormously expensive measured against the cost for an identical procedure anywhere else. and medical inflation continues to rise.
The point about discussing socialized medicine was specifically to illustrate how costs are maintained in other markets. Why countries like Japan spend only 9% of GDP, the UK 10% France 11% Canada 12% on health. Because the cost of services and procedures is less. And because the administration of the systems, the unproductive overhead, is much smaller.
Now you can quibble about quality, and you'd largely wrong BTW, but you can't ignore the fact that the current US system is incapable of being run as efficiently as any other system.
By the way, the percentage of Americans who are covered by insurance decreases every year. Why? Cost. So every year more people are being shut out of what you call " the best system in the world" . at what point does that become disturbing to you? (I'm guessing only if you or a family member are personally affected.)
A lot of employers are increasingly worried because their costs are increasing. And because a nation with two classes insured and uninsured begins crumble and also becomes more likely to spawn public disease out breaks and pandemics...
And the RK doctors who moved from Ontario to New York? You realize you picked a specialist who has never been covered under the insurance scheme unless doing cataract surgery...? They weren't running from socialism... They were never part of it.

More than 59 million Americans had no health insurance for at least part of 2010, an increase of 4 million from the previous year, the U.S. Centers for Disease Control reported Tuesday. While the worsening economic conditions did have a direct impact on the number of Americans with coverage, the situation also meant that a far greater number of Americans are forgoing needed medical care because of costs.



Read more: http://www.cbsnews.com/stories/2010/11/ ... z1OpfTqswR

Ricky:

Please find another procedure for which you can find price advertising and for which pricesd have come down. You probably won't be able to, simply becasue the demand for otehr treatment isn't as optional or elastic. Worthwhile or not.
You flunk in comprehension.

No I don't. You are not reading what I write. Whether I get a cortisone shot in my knee is optional. There is a demand curve. The level of pain is variable, and the demand is too. If it is excruciating, cost doesn't matter. But it can be mild, annoying, irritating, debilitating. Should I take an aspirin, stop playing tennis, get a cortisone shot or have a knee replacement? If knee surgery costs me $1 million I won't get it. If it costs me $10,000, I may depending on other factors; if it is free to me, then my cost will not enter into the decision.

Right now, I have a prescription for new knee braces to help me play tennis. I have below average insurance, so I would have to pay about 1/2 or $700 per brace. I'm thinking about it. If they were free, I would have had my insurance buy them 6 months ago.

RK is generally not covered by insurance. That's the reason why the prices have moderated or even come down. Practitioners have had to compete on price. You missed my point.

Ricky:

Its really only the medical profession where there is a reluctance to discuss cost with the patient. Doctors like the concept of insurance becasue it removes from their day to day expericen the haggling and the being paid in goats and cows....

That's exactly my point. Doctors don't want to have to discuss prices with patients. I am a consultant. I wish I didn't have to discuss prices with my clients either. But that's the problem. Cost has got to be a factor in health care decisions. The most important way for cost to be a factor is for the consumer to have skin in the game. I'm not saying there should be no insurance; and I'm not saying everyone should pay for everything. I'm just saying there should be some skin in the game for some procedures. There has to be some reflection of cost in the consumer's decision.