The truth about America's "health-care crisis"...

[ilw]

Not really too bothered about saying how much i earn and stuff, so no offence taken.
basically works out at about 22% income tax. (annual wage just shy of 26k)

Other taxes: 17.5% VAT on lots of stuff and about £30 a month council tax
Don't receive any benefits/subsidies etc.

[j2k4]

Please allow me to back-track to my original point, which was the incredible mess made of the entire health-care system by the third-party-payer process, which has had the effect of removing the beneficial effect of competition from the health-care market.

I use as a prime example the process called LASIK, by which process miraculous eye surgeries are performed, and vision improved or restored.

A few facts:

LASIK surgery circa 1998 cost, on average, about $2200 per eye.

Ten years later it has dropped to the $500-$1000 range, even while the procedure itself has become more technically advanced, proficient, and safer than ever.

Here's the kicker:

LASIK surgery is rarely covered by insurance, and so is not subject to socialist "market" forces, which aren't capable (never have been, never will be) of slashing prices while simultaneously improving quality.

Bottom line:

You who favor a national health-care scheme are choosing to resign yourselves to a scenario by which costs are guaranteed to skyrocket, while quality-of-care remains an afterthought.

[ilw]

Please allow me to back-track to my original point, which was the incredible mess made of the entire health-care system by the third-party-payer process, which has had the effect of removing the beneficial effect of competition from the health-care market.

I use as a prime example the process called LASIK, by which process miraculous eye surgeries are performed, and vision improved or restored.

A few facts:

LASIK surgery circa 1998 cost, on average, about $2200 per eye.

Ten years later it has dropped to the $500-$1000 range, even while the procedure itself has become more technically advanced, proficient, and safer than ever.

Here's the kicker:

LASIK surgery is rarely covered by insurance, and so is not subject to socialist "market" forces, which aren't capable (never have been, never will be) of slashing prices while simultaneously improving quality.

Bottom line:

You who favor a national health-care scheme are choosing to resign yourselves to a scenario by which costs are guaranteed to skyrocket, while quality-of-care remains an afterthought.

Its a nice example, but since you have no idea how LASIK surgery costs have varied in a socialised health care system its a bit meaningless.
Why are costs guaranteed to skyrocket and why does quality of care need to remain an afterthought? whats the mechanism for guaranteeing this?

[j2k4]

Please allow me to back-track to my original point, which was the incredible mess made of the entire health-care system by the third-party-payer process, which has had the effect of removing the beneficial effect of competition from the health-care market.

I use as a prime example the process called LASIK, by which process miraculous eye surgeries are performed, and vision improved or restored.

A few facts:

LASIK surgery circa 1998 cost, on average, about $2200 per eye.

Ten years later it has dropped to the $500-$1000 range, even while the procedure itself has become more technically advanced, proficient, and safer than ever.

Here's the kicker:

LASIK surgery is rarely covered by insurance, and so is not subject to socialist "market" forces, which aren't capable (never have been, never will be) of slashing prices while simultaneously improving quality.

Bottom line:

You who favor a national health-care scheme are choosing to resign yourselves to a scenario by which costs are guaranteed to skyrocket, while quality-of-care remains an afterthought.

Its a nice example, but since you have no idea how LASIK surgery costs have varied in a socialised health care system its a bit meaningless.
Why are costs guaranteed to skyrocket and why does quality of care need to remain an afterthought? whats the mechanism for guaranteeing this?

Okay, I'll bite - give me the history of LASIK under the socialized scenario.

Costs skyrocket because the brake of competition is not applied; the service is available, the service is used, and the cost is born by the amorphous "third party", which has no "voice".

Those who have coverage are not bothered in the least about costs, and so are silent.

It's human nature, after all...you should have some familiarity with it.

The "quality-of-care" is guaranteed by the customer who shops for the best service, which decision is arrived at after due consideration of the cost/quality issues.

If you own a car, did you shop for the best you could afford, or buy the first thing you saw?

[The Flying Cow]

Whatever you Americans may think, (and there is no prejorative tone here), do NOT follow Europe's Health Care model.

Forget what the idiot Michael Moore, and I'm gonna quote Bush here, for emphasis, who needs to "get a real job", said, and please oh PLEASE do NOT go down that road.

Health care in the USA is millenia ahead of the European so-called "State-funded" ("National") health care system which is a failure. Tons are spent, and efficiency is not a result. There are waiting lists for 5 years ahead. I can debate endlessly the total chaos that it is, at least from experience of living among it in Europe.

So, for once, if not twice, lets ignore Michael Moore's "Sicko" crap. Him and that clown Chomsky who suggested the twin towers were bombed by the Bush Administration need to be bombed.

"...but since you have no idea how LASIK surgery costs have varied in a socialised health care system..."

I'm not sure that kind of surgery even exists in a "socialised" model. Take the word of living through this. I have heard wonders about the American democratic format, and it is most definitely more successful than this crap I see for myself whenever I have the distasteful experience of venturing into a hospital here.

[ilw]

Okay, I'll bite - give me the history of LASIK under the socialized scenario.

Costs skyrocket because the brake of competition is not applied; the service is available, the service is used, and the cost is born by the amorphous "third party", which has no "voice".

Those who have coverage are not bothered in the least about costs, and so are silent.

It's human nature, after all...you should have some familiarity with it.

The "quality-of-care" is guaranteed by the customer who shops for the best service, which decision is arrived at after due consideration of the cost/quality issues.

If you own a car, did you shop for the best you could afford, or buy the first thing you saw?

i don't think LASIK is a good example, happy to discuss it if you want, but in the UK you can't choose to have it done on the NHS, you have to demonstrate that you need it done. You are of course free to pay to have it done... I think its currently about a grand per eye

i think overuse of a service (rather than the cost of providing a particular service for a single person) is what you're pointing to and i don't think that really happens with surgery as you can't volunteer yourself for surgery afaik. I'm sure overprescription does happen with drugs and antibiotics, especially ones for minor things like colds, but i just can't envision a scenario where use skyrockets


one system pleases all the people some of the time (and chooses the times based on how much they need it), and the other system pleases some of the people all the time (and chooses the people according to how rich they are)
Does that sound fair?


As for MisterSister, it really depends on what you measure, undoubtedly if you can afford it the US health care system is probably the best (or at least one of the top 3 in the world), but if you can't afford it, it is one of the worst of any developed nation in the world. Which is why when nations get assessed on averages the US sometimes loses to countries you might not expect like Costa Rica and Cuba

[4play]

From what i have read the price of lasik's really has not dropped considerably.

Also, there can be wide variation in what an advertised price will include. Beware of advertising that, for example, promises "LASIK from $500 per eye." Look for the fine print. Typically, only a few select people are actually eligible for LASIK at that price, because most eyes require more extensive correction or more follow-up after the surgery.

A leading industry analyst in 2007 said only 6.9 percent of conventional LASIK procedures cost less than $1,000 per eye. These procedures are performed with the less expensive options of bladed microkeratomes and conventional excimer lasers, not guided by wavefront analysis. Most customized wavefront procedures that also use laser-created flaps (IntraLase) cost from $1,000 to $2,500 per eye (see charts below).

source

im just curious j2k4 but would you not like the safety net of a national health service?

[j2k4]

i don't think LASIK is a good example, happy to discuss it if you want, but in the UK you can't choose to have it done on the NHS, you have to demonstrate that you need it done. You are of course free to pay to have it done... I think its currently about a grand per eye

LASIK is a perfect example, because the point is that it's price-per-procedure has dropped due to the fact it is not generally covered by insurance (here in the States, at any rate).

An easy surmise for this is it's status as an elective surgery.

i think overuse of a service (rather than the cost of providing a particular service for a single person) is what you're pointing to and i don't think that really happens with surgery as you can't volunteer yourself for surgery afaik. I'm sure overprescription does happen with drugs and antibiotics, especially ones for minor things like colds, but i just can't envision a scenario where use skyrockets

Your slip is showing, Ian.

Only a socialist mind-set would regard free access to elective procedures as threatening "overuse".

The market should be able to expand (or contract, as in the case of "buggy-whip" manufacturers) to accomodate the demand for service.

It is a medical procedure.

It is elective, insofar as it is a more expensive alternative to spectacles or contact lenses (which have also gotten cheaper over time; capitalism, again).

I'm pretty sure no LASIK provider would subject you to a procedure you didn't need, that is to say, if you weren't a candidate for, or wearer of, glasses/contact lenses.

one system pleases all the people some of the time (and chooses the times based on how much they need it), and the other system pleases some of the people all the time (and chooses the people according to how rich they are)
Does that sound fair?

What does "fair" have to do with it?

The price of LASIK (heretofore available to those who could afford it out-of-pocket) is dropping to the point those less-well-off can afford it as well, owing to a competitive situation created by the former.

You seem to want to advocate either of two scenarios:

1 - LASIK is (upon conception) made immediately available to the masses via government fiat, and at public expense.

The cost of any technological improvements will also be borne by the public, and these will progress at a snail's pace; after all, it is not a necessary procedure.

The care and feeding of the "procedure" will further burden the already massively expensive National Health Care system.

2 - LASIK dies on the vine, because it's costs preclude universal availability, and if the poor can't afford it, the rich can't have it either.

From what i have read the price of lasik's really has not dropped considerably.

Also, there can be wide variation in what an advertised price will include. Beware of advertising that, for example, promises "LASIK from $500 per eye." Look for the fine print. Typically, only a few select people are actually eligible for LASIK at that price, because most eyes require more extensive correction or more follow-up after the surgery.

A leading industry analyst in 2007 said only 6.9 percent of conventional LASIK procedures cost less than $1,000 per eye. These procedures are performed with the less expensive options of bladed microkeratomes and conventional excimer lasers, not guided by wavefront analysis. Most customized wavefront procedures that also use laser-created flaps (IntraLase) cost from $1,000 to $2,500 per eye (see charts below).

source

There is a natural proclivity to maintain a level "profit-per-patient", but this is a by-product of the inprovements in technique and the ever-widening palette of procedures offered.

The providers are, to an extent, salesmen as well.

The costs of basic procedures have dropped, bottom line.

im just curious j2k4 but would you not like the safety net of a national health service?

I would prefer my "safety-net" consist of affordable health-care, and that my choices therein not be constrained by government/third-party-payer regulation and bureaucracy.

[ilw]

i think overuse of a service (rather than the cost of providing a particular service for a single person) is what you're pointing to and i don't think that really happens with surgery as you can't volunteer yourself for surgery afaik. I'm sure overprescription does happen with drugs and antibiotics, especially ones for minor things like colds, but i just can't envision a scenario where use skyrockets

Your slip is showing, Ian.

Only a socialist mind-set would regard free access to elective procedures as threatening "overuse".

The market should be able to expand (or contract, as in the case of "buggy-whip" manufacturers) to accomodate the demand for service.

i was just trying to understand what you meant by "Costs skyrocket because the brake of competition is not applied; the service is available, the service is used, and the cost is born by the amorphous "third party", which has no "voice"."
if that doesn't mean overuse of a service what does it mean?

one system pleases all the people some of the time (and chooses the times based on how much they need it), and the other system pleases some of the people all the time (and chooses the people according to how rich they are)
Does that sound fair?

What does "fair" have to do with it?

nothing i was just paraphrasing lincoln (?) to summarise the differences between the two systems. Neither is capable of providing a perfect health care system

1 - LASIK is (upon conception) made immediately available to the masses via government fiat, and at public expense.

The cost of any technological improvements will also be borne by the public, and these will progress at a snail's pace; after all, it is not a necessary procedure.

what costs of technological improvement are borne by the public? what in particular is slower to develop than in a captilist approach?

[j2k4]

Your slip is showing, Ian.

Only a socialist mind-set would regard free access to elective procedures as threatening "overuse".

The market should be able to expand (or contract, as in the case of "buggy-whip" manufacturers) to accomodate the demand for service.

i was just trying to understand what you meant by "Costs skyrocket because the brake of competition is not applied; the service is available, the service is used, and the cost is born by the amorphous "third party", which has no "voice"."
if that doesn't mean overuse of a service what does it mean?

Not overuse, surely.

In the third-party payer (one step from socialism) system, medicare/medicaid or insurance foots the bill for many of whom you would refer to as poor or needy.

The point is that medicare/medicaid and insurance are bureaucracies, and bureaucracies exist to perpetuate themselves, not to run a lean-and-mean service.

Overuse has nothing whatsoever to do with it.

one system pleases all the people some of the time (and chooses the times based on how much they need it), and the other system pleases some of the people all the time (and chooses the people according to how rich they are)
Does that sound fair?

What does "fair" have to do with it?

nothing i was just paraphrasing lincoln (?) to summarise the differences between the two systems. Neither is capable of providing a perfect health care system

1 - LASIK is (upon conception) made immediately available to the masses via government fiat, and at public expense.

The cost of any technological improvements will also be borne by the public, and these will progress at a snail's pace; after all, it is not a necessary procedure.

what costs of technological improvement are borne by the public? what in particular is slower to develop than in a captilist approach?

I think I explained the difference above - any system lacking a compulsion toward competitive pricing and practical economics quickly becomes onerously burdensome financially.


Medical care needs to function as a business, which necessity is antithetical to any government-sponsored endeavor.

That's a fact.