[Winder]

We have been over this 100 times on this board, but the fact that some want to pay more and come here says very little about a comparison in quality. The fact that some will pay for a Mercedes does not mean the Ford isn't getting you where you need to go. We have more people traveling away to get care than coming in. Does this mean our care is worse than popular destinations like India, Costa Rica, Mexico, etc.?

So how many people traveled out of the country to get healthcare? Who are they? What did they travel for? How many people traveled into the country to receive healthcare? Who are they? What did they travel for?

I know two people who have traveled out of country for procedures. One went across the boarder at San Diego to Mexico to an American owned, profit seeking clinic for cancer treatment that is not allowed in the USA and the other went to Costa Rica for cosmetic surgery that she could have had done here for a lot less, but she wanted to spend 3 week recovering on the beach (and so nobody she knew would see her). Both of these people have lots of money. People who travel for medical typically are not the poor or the middle class. It is very expensive. When we look at where Americans are traveling for medical services we find that they are going to privately owned profit seeking clinics that are often owned and staffed by Americans.

People are free to pick between the Mercedes or the Ford, and the people who chose to buy Mercedes should not be forced to buy Fords for the rest of us.

[Nesster]

People are free to pick between the Mercedes or the Ford, and the people who chose to buy Mercedes should not be forced to buy Fords for the rest of us.

nothing in the affordable care act says a rich person can't travel out of country for their Mercedes. Or pay up for private care not covered by insurance in the USA.

[Rondec]

So how many people traveled out of the country to get healthcare? Who are they? What did they travel for? How many people traveled into the country to receive healthcare? Who are they? What did they travel for?

I know two people who have traveled out of country for procedures. One went across the boarder at San Diego to Mexico to an American owned, profit seeking clinic for cancer treatment that is not allowed in the USA and the other went to Costa Rica for cosmetic surgery that she could have had done here for a lot less, but she wanted to spend 3 week recovering on the beach (and so nobody she knew would see her). Both of these people have lots of money. People who travel for medical typically are not the poor or the middle class. It is very expensive. When we look at where Americans are traveling for medical services we find that they are going to privately owned profit seeking clinics that are often owned and staffed by Americans.

People are free to pick between the Mercedes or the Ford, and the people who chose to buy Mercedes should not be forced to buy Fords for the rest of us.

I guess I know more uninsured people, because I know several individuals who have traveled to Mexico and even as far as India for procedures ranging from coronary artery bypass surgery to cholecystecomies (gallbladder removal). Cost savings including air fare were thousands of dollars. Even in this country shopping for health care can produce considerable savings and as more hospitals make their rates available, it will make a difference where patients get elective procedures (and even semi-elective procedures) done.

[Winder]

I guess I know more uninsured people, because I know several individuals who have traveled to Mexico and even as far as India for procedures ranging from coronary artery bypass surgery to cholecystecomies (gallbladder removal). Cost savings including air fare were thousands of dollars. Even in this country shopping for health care can produce considerable savings and as more hospitals make their rates available, it will make a difference where patients get elective procedures (and even semi-elective procedures) done.

Were these State owned hospitals and clinics that they traveled too? Or were they profit seeking, privately owned clinics that did the procedures? I am not aware of any State owned (single payer) systems that allow for people from other countries to travel in and take advantage of the "free" health care. I can't go to Canada for free healthcare if I wanted to.

There are several American owned clinics operating in other countries that make good money flying people in for procedures. There is a hospital in Colorado (I would have to look up the name) that advertises abroad for customers and offers package deals for cash at a significant discount over what a citizen using insurance would pay.

[Rondec]

Were these State owned hospitals and clinics that they traveled too? Or were they profit seeking, privately owned clinics that did the procedures? I am not aware of any State owned (single payer) systems that allow for people from other countries to travel in and take advantage of the "free" health care. I can't go to Canada for free healthcare if I wanted to.

There are several American owned clinics operating in other countries that make good money flying people in for procedures. There is a hospital in Colorado (I would have to look up the name) that advertises abroad for customers and offers package deals for cash at a significant discount over what a citizen using insurance would pay.

They were private clinics that deliberately catered to foreign clientele. These people paid cash for their procedures and were willing to travel because of the cost savings over the American system.

[Winder]

They were private clinics that deliberately catered to foreign clientele. These people paid cash for their procedures and were willing to travel because of the cost savings over the American system.

So, obviously a profit seeking private company can offer significant saving over our dysfunctional, bureaucratic healthcare system. Our system is a train wreck in many ways. It is full of perverse incentives that raise costs, reduce quality, and make care less accessible. All of this can be addressed without a single payer system.

[jeffkrol]

So, obviously a profit seeking private company can offer significant saving over our dysfunctional, bureaucratic healthcare system. Our system is a train wreck in many ways. It is full of perverse incentives that raise costs, reduce quality, and make care less accessible. All of this can be addressed without a single payer system.

Hmm.. what "savings"??? There is no "evidence" that the procedures were "cheaper"........maybe I just missed it.

[Nesster]

So, obviously a profit seeking private company can offer significant saving over our dysfunctional, bureaucratic healthcare system. Our system is a train wreck in many ways. It is full of perverse incentives that raise costs, reduce quality, and make care less accessible. All of this can be addressed without a single payer system.

This is true enough.

Reality, however, is that the big money private entities involved in health care, together with legalistically drawn regulations (we're talking about people's lives and health here, not to mention malpractice suits) etc ensure our system is dysfunctional - and that attempts to reform this system (which the Affordable Care Act addresses) towards greater efficiency are met with massively funded resistance. (Said massive funding comes from where? Our pockets of course, from medical costs...)

Without regulation, it is possible or even likely that costs could come down - however, we'd get a very segmented market where you get your pawn-shop clinics, your wal-mart clinics, and your Nordstrom hospitals. Besides, while having a heart attack, do you really want to be doing comparison shopping for your EMT and ER? Checking out ratings (which could be manipulated) and pricing? And what if there was a complication that completely throws off your computations? Yeah, I'd pick Moishe's Ambulance and Movers cause they are cheapest and have them take me to the local pawn-shop ER, where in exchange for fixing my heart I only need to donate one kidney and some bone marrow.

[Winder]

This is true enough.

Reality, however, is that the big money private entities involved in health care, together with legalistically drawn regulations (we're talking about people's lives and health here, not to mention malpractice suits) etc ensure our system is dysfunctional - and that attempts to reform this system (which the Affordable Care Act addresses) towards greater efficiency are met with massively funded resistance. (Said massive funding comes from where? Our pockets of course, from medical costs...)

Without regulation, it is possible or even likely that costs could come down - however, we'd get a very segmented market where you get your pawn-shop clinics, your wal-mart clinics, and your Nordstrom hospitals. Besides, while having a heart attack, do you really want to be doing comparison shopping for your EMT and ER? Checking out ratings (which could be manipulated) and pricing? And what if there was a complication that completely throws off your computations? Yeah, I'd pick Moishe's Ambulance and Movers cause they are cheapest and have them take me to the local pawn-shop ER, where in exchange for fixing my heart I only need to donate one kidney and some bone marrow.

We do have a problem with big money distorting they system, but they are using government regulations to distort the system. Bush's Medicare Part D cost the taxpayers $300 billion a year and made drug companies billions of dollars. These big money PACs and corporations use government to their advantage and to get access to public money. Giving government more power is essentially the same as giving more power to these super PACs and corporations. Who ends up writing these regulations and laws? There are 70 lobbyists for every sitting US Senator looking to buy special favors for their industry.

Is a segmented market bad? What does segmented mean? It simply means more choices and I don't think more choices are a bad thing. When the AMA came to power over our medical services they shut down more than half of all medical schools. Most of these schools trained healthcare workers who were going back into poor communities to work. Maybe the healthcare they were getting was not "Nordstrom" quality, but it was better than nothing, which is what these communities were left with after the AMA regulations were put in place.

What percentage of healthcare is legitimate emergency service? How long would a "pawn-shop" ER be in business? People and family members have recourse when dealing with this activity. There is a practically new hospital between Nashville and Clarksville that is "well regulated" and just scored a 31 out of 100 on its quality of care. http://www.theleafchronicle.com/article/20120712/NEWS01/307120028/Gateway-ge...nclick_check=1

Look up all of the problems that our government managed Veterans Administration hospitals have had.
10 veterans test positive for hepatitis after colonoscopies - USATODAY.com
The VA has now sent letters advising 3,260 patients who had colonoscopies between May 2004 and March 12 at the Miami Veterans Affairs Healthcare System that they also should get tests for HIV, hepatitis and other infectious diseases.

Or maybe you missed the Walter Reed Army Hospital story. Soldiers Face Neglect, Frustration At Army's Top Medical Facility
Walter Reed Army Medical Center neglect scandal - Wikipedia, the free encyclopedia

Nobody has more frigg'n regulations than the Army. A good government ran hospital that is well regulated.

I don't buy the idea that regulations accomplish anything other than give people a false sense of security. There were regulations against what Madoff did. There were regulations against what Barclays did (and the FED knew about it since 2008). There are regulations against flying planes into buildings..... did it matter?

Or what about the regulations that all debt sold by banks has to be rated by a national rating agency? How did that work out? In 1975 Nationally Recognized Statistical Rating Organizations were established by the Federal Government, and all commercial debt that was sold had to be rated by one of the recognized companies (S&P, Moody's, Finch). Prior to this people looking to buy debt had to go to debt rating agencies and pay to have the quality of the debt determined prior to purchase. The ratings agencies worked for the buyer and had every incentive to make sure they accurately valued the debt. But after the government got involved this reversed and the rating agencies were working for the sellers, and debt sellers would shop agencies to find out who would rate the quality of their debt the highest. The government regulations did nothing to improve the quality of the debt or reduce the risk. If anything the regulations increased the risk in the credit markets and made the ratings agencies billions of dollars. The regulations gave investors a false sense of security.

[GeneV]

So how many people traveled out of the country to get healthcare? Who are they? What did they travel for? How many people traveled into the country to receive healthcare? Who are they? What did they travel for?

Google "medical tourism." It is a big industry now, with estimates of users around 750,000 and growing. Usually, the travel is for major surgery that is outrageously expensive here.

[GeneV]

Our system is a train wreck in many ways. It is full of perverse incentives that raise costs, reduce quality, and make care less accessible. All of this can be addressed without a single payer system.

Please give an example where that has been done successfully.

[Rondec]

We do have a problem with big money distorting they system, but they are using government regulations to distort the system. Bush's Medicare Part D cost the taxpayers $300 billion a year and made drug companies billions of dollars. These big money PACs and corporations use government to their advantage and to get access to public money. Giving government more power is essentially the same as giving more power to these super PACs and corporations. Who ends up writing these regulations and laws? There are 70 lobbyists for every sitting US Senator looking to buy special favors for their industry.

Is a segmented market bad? What does segmented mean? It simply means more choices and I don't think more choices are a bad thing. When the AMA came to power over our medical services they shut down more than half of all medical schools. Most of these schools trained healthcare workers who were going back into poor communities to work. Maybe the healthcare they were getting was not "Nordstrom" quality, but it was better than nothing, which is what these communities were left with after the AMA regulations were put in place.

What percentage of healthcare is legitimate emergency service? How long would a "pawn-shop" ER be in business? People and family members have recourse when dealing with this activity. There is a practically new hospital between Nashville and Clarksville that is "well regulated" and just scored a 31 out of 100 on its quality of care. http://www.theleafchronicle.com/article/20120712/NEWS01/307120028/Gateway-ge...nclick_check=1

Look up all of the problems that our government managed Veterans Administration hospitals have had.
10 veterans test positive for hepatitis after colonoscopies - USATODAY.com
The VA has now sent letters advising 3,260 patients who had colonoscopies between May 2004 and March 12 at the Miami Veterans Affairs Healthcare System that they also should get tests for HIV, hepatitis and other infectious diseases.

Or maybe you missed the Walter Reed Army Hospital story. Soldiers Face Neglect, Frustration At Army's Top Medical Facility
Walter Reed Army Medical Center neglect scandal - Wikipedia, the free encyclopedia

Nobody has more frigg'n regulations than the Army. A good government ran hospital that is well regulated.

I don't buy the idea that regulations accomplish anything other than give people a false sense of security. There were regulations against what Madoff did. There were regulations against what Barclays did (and the FED knew about it since 2008). There are regulations against flying planes into buildings..... did it matter?

Or what about the regulations that all debt sold by banks has to be rated by a national rating agency? How did that work out? In 1975 Nationally Recognized Statistical Rating Organizations were established by the Federal Government, and all commercial debt that was sold had to be rated by one of the recognized companies (S&P, Moody's, Finch). Prior to this people looking to buy debt had to go to debt rating agencies and pay to have the quality of the debt determined prior to purchase. The ratings agencies worked for the buyer and had every incentive to make sure they accurately valued the debt. But after the government got involved this reversed and the rating agencies were working for the sellers, and debt sellers would shop agencies to find out who would rate the quality of their debt the highest. The government regulations did nothing to improve the quality of the debt or reduce the risk. If anything the regulations increased the risk in the credit markets and made the ratings agencies billions of dollars. The regulations gave investors a false sense of security.

I think there are clearly two issues with our health care system: (1) cost of care -- this includes for procedures, imaging tests, and medications. Because of the high costs, people without insurance coverage struggle to get by and often end up as dead-beats, just totally unable to pay for the health care that they use. Doctors own stock in out patient surgery centers and in radiology centers and heavily refer to these, cherry-picking the patients who have insurance that pays well, while sending those with poorly paying insurance elsewhere. The lack of centralization actually increases costs. (2) lack of coverage -- this is the issue that "Obamacare" attempts to address, albeit in a round about way (penalizing those who don't have health care and giving subsidies to those who are on the poorer end of things). I personally would have liked to see a single payer, government run system as compared to the current plan, but we get what the politicians can get passed, not what is best for the country.

There is no comparison between the VA system and how folks with Medicare get treated. People with Medicare get the same coverage (sometimes better) as those with private insurance, in the same hospitals, with much the same doctors.

[Wheatfield]

I don't think you "get it". In every industry where free market "profit motive" is allowed to work we get lower prices. The competition pushes out higher priced competitors.

So why is it that America pays hugely more for health care than Canada, doesn't have anywhere nearly as good coverage, and overall has poorer health care (your scare citations are all well and good, but they don't represent the facts very well)?

[Wheatfield]

Were these State owned hospitals and clinics that they traveled too? Or were they profit seeking, privately owned clinics that did the procedures? I am not aware of any State owned (single payer) systems that allow for people from other countries to travel in and take advantage of the "free" health care. I can't go to Canada for free healthcare if I wanted to.

That's only because you can't leave your country. Americans coming over the border for health care is actually pretty common.

[GeneV]

I think there are clearly two issues with our health care system: (1) cost of care -- this includes for procedures, imaging tests, and medications. Because of the high costs, people without insurance coverage struggle to get by and often end up as dead-beats, just totally unable to pay for the health care that they use. Doctors own stock in out patient surgery centers and in radiology centers and heavily refer to these, cherry-picking the patients who have insurance that pays well, while sending those with poorly paying insurance elsewhere. The lack of centralization actually increases costs. (2) lack of coverage -- this is the issue that "Obamacare" attempts to address, albeit in a round about way (penalizing those who don't have health care and giving subsidies to those who are on the poorer end of things). I personally would have liked to see a single payer, government run system as compared to the current plan, but we get what the politicians can get passed, not what is best for the country.

There is no comparison between the VA system and how folks with Medicare get treated. People with Medicare get the same coverage (sometimes better) as those with private insurance, in the same hospitals, with much the same doctors.

Good summary. I would also add the problem of poor/over utilization. Some of this is to avoid litigation, but much of it is just because our system lacks proper organization. Tests are ordered that are not necessary. (My recent MRI, for example) Levels of care often don't match levels of need. Some of the level of care issues are caused by payment patterns of insurers, including those of last resort.