1. IrvingSnodgrass - July 26, 1999 - 9:04 AM PT
It's been awhile since we had a health care thread around here. Share your thoughts on the state of health care, what you think of HMOs, your health care experiences, and any other related issues.
2. Ronski - July 26, 1999 - 9:05 AM PT
Good ideas to improve health care: Medical Savings Accounts and deductibility of insurance premiums.
3. msgreer - July 26, 1999 - 9:11 AM PT
Health care would be improved, opponents of Medicare and other government programs argue,if profit-driven market forces were allowed to work their miracles.
That premise can be tested by comparing for-profit and monprofit health maintenance organizations. A team of doctors conducted such a study and reported the result in the July 14 Journal of the American Medical Association.
The critical findings: For-profit spend more on overhead and provide a lower quality of care than non-profits.
4. msgreer - July 26, 1999 - 9:15 AM PT
cont.
The peer-reviewed study, "Quality of Care in Investor-Owned vs. Not-for-Profit HMO's," was conducted by four physicians: David U> Himmelstein, Steffie Woolhandler, Ida Hellander and Sidney M> Wolfe.
The doctors used reports from the National Committee for Quality Assurance's Quality Compass 1997, which included 1996 quality-of-care data for 329 HMO plans (248 investor-owned and 81 not-for-profit, representing 56% of the HMO enrollment in America.
5. msgreer - July 26, 1999 - 9:19 AM PT
cont
Unfortunately, fewer HMOs have reported such data in recent years. Nevertheless, the findings are valid until refuted. (An assessment of HMOs in the August Consumer Reports also favored the nonprofits.)
The study reported in the Journal affirms the belief held by many Americanss--including whose who believe in free enterprise--that for-profit companies pay investors and executives at the cost of providing treatment to patients.
">>>Spending on profit and administrative overhead was about 48% higher in investor-owned plans. (19.4 pecent versus 13.1 percent for non profit plans.)" according to the study.
6. msgreer - July 26, 1999 - 9:23 AM PT
cont.
A Journal summary added: "The percentage of revenues spent on medical and hospital sevices averaged 80.6 percent in investor-owned plans and 86.9 oercent in not-for-profit plans."
Critics of the sutdy will argue that doctors can't objectively evaluate the finaces of HMO's, which seek to limit doctors profit.
The numbers speak for themselves but, certainly, most doctors are qualified to assesss quality of care. The physicians' conclusion: "Investor-owned HMO deliver lower quality of care than not-for-profit plans."
No wonder the nation's biggest HMO's have sought congressional protection from lawsuits.
7. msgreer - July 26, 1999 - 9:29 AM PT
cont.
What did the docs learn about quality of care?
After examing all 14 of the National Committee for Quality Assurance's "Effectiveness of Care" variables, the doctors found that
investor-owned HMO plans had lower rates for all 14 indicators.
Worse, "the largest differneces in quality-of-care were in two indicators for patients with serious medical illnesses..."
Among the other tangible results:
"Medicare HMOs apparently encourage sick patients to disenroll and selectively recruit and enroll healthy individuals."
"The differences we observed in this study appea to be clincally significant," according to the authors. "For instnace, if all 23.7 million American women between ages 50 and 69 years were enrolled in investor-owned, rather that not-for-profit plans, an estimated 5,925 additional breast cancer death would be expected(based on our finding of a 4.8 percent difference in screening rates and previous estimates that biennial screening in this age group wuld result in 52 fewer
8. bubbaette - July 26, 1999 - 9:31 AM PT
HMO's are fine for healthy people. I like the emphasis on prevention and the ability to get routine things like pap smears with an HMO, but god help you if there's anything really wrong with you.
One of the differences that I've noticed between hmo and fee-for-service is that the doctor gives me more information about the condition or problem that prompted the visit. I've had a hard time squeezing info out of HMO docs in several situations.
9. msgreer - July 26, 1999 - 9:35 AM PT
fewer breast cancer deaths by age 80 yuears per 10,000 women screened)."
Despite such findings, the market trends are in favor of the for profits. The for-profits share of the HMO market is increasing, according to the July 17 Economist mag.
So much for depending on the market to guarantee quality and affordability.
One reason for the proliferation of for-profits, according to an Ernst&Young consultant quoted by The Economist, is their ability to offer large employers coast-to-coast networks and a variety of plans.
Ir's omportant to recognize the value the best HMO's have offered their clients. But it's also easy to envision a scenario in which the big,for-profit HMO's wuld someday consolidate and control the health care market.If that occurs, Americans won't need a study in a medical journal to tell them that the profit motive doesn't guarantee better health care.
They'll know it.
A special thanks to a friend at our local paper who is an editorial page editor.
10. Mazaska - July 26, 1999 - 9:41 AM PT
Good info, msgreer. Thanks.
11. CalGal - July 26, 1999 - 9:43 AM PT
Move the responsibility for health care and insurance back to the individual. I'm fed up with it being linked to employment. Utterly idiotic.
12. Ronski - July 26, 1999 - 9:59 AM PT
Comparing for-profit HMOs and not-for-profit HMOs is a little like comparing the socialism of the late USSR with the socialism of the late Tito's late Yugoslavia.
The current state of HMOs is not a product of free enterprise, it is a product of government intervention.
Looking for a way to give people something for nothing, Congress mandated in the 70s that most large businesses offer an HMO plan to employees. Before that, HMOs were a relatively small part of the health care landscape. Congress based this gamble on the success of Kaiser Permanente in Calfornia and a few other plans which had provided decent care and made money besides because they aggressively sought to enroll young, healthy people who did not actually use much health care. But as plans proliferated under the government's mandate, and the boomers aged, the problems HMOs now face was inevitable.
The comparison of for-profit and non-profit HMOs tells us little about how a truly free market in health care would work.
13. msgreer - July 26, 1999 - 10:10 AM PT
I believe the Kaiser program was a good one.
However, once more people enrolled in HMO's usually through their place of employment the HMO's changed also.
They re-wrote all the policies and put in force new standards for receiving all aspects of health care. They pleaded they had to or they would get wiped out financially.
Okay, but once a HMO begins to tell the individual what they will accept as "medically necessary" and what they will "accept" as what this service should cost (based on what similar procedures/check ups
cost throughout the country) they control what quality of care you will get.
This should be left to you and your doctor.
When an HMO plan gives financial incentives to doctors not to tell a patient all the care which is available to them for a certain ailment to keep costs down it is the consumer who is getting harmed. And the doctor who continues to get frustrated.
If your doctor is good enough he/she will tell you all your options. And some will even get on the phone to your HMO to get what he/she feels is necessary for your health.
This has proven to take too much time for the doctors to continue to do. They bring in specialist for this now.
ooppps.. got to run... beeped to the hospital. to be continued.
14. msgreer - July 26, 1999 - 10:12 AM PT
bubbaette
Re: message 8. This is what I am saying.
And it is far more complicated than what I just posted.
I look forward to continuing the discussion.
15. Ronski - July 26, 1999 - 10:24 AM PT
Perhaps I should add this: You could not *pay* me to enroll in any HMO.
Curiously, the approval rate of HMO care and U.S. health care in general was still pretty high the last time I looked. Also, some plans have reacted to complaints about denied coverage and the like by promising enrollees contiguity of care (seeing the same doctor) and that the physician will make the decisions (easier in in physician-run plans).
Although I don't ever want to be in one, HMOs are not the universal horror story that the press, politicians and some physicians often make them out to be.
16. JJBiener - July 26, 1999 - 10:48 AM PT
CalGal - "Move the responsibility for health care and insurance back to the individual."
This is not as easy as it sounds. In any group a few individuals will be high risk. The rest of the group will be moderate to low risk. When insurance is bought for a group the cost of the high risk individuals is spread out over the group making the insurance affordable for every one in the group. Without this mechanism, high risk individuals would not be able to afford insurance.
17. judithathome - July 26, 1999 - 10:54 AM PT
My son is one of those high risk individuals due to a pre-existing condition. He is self employed and uninsured. Last fall, he had a sort of stroke and ended up in ICU for 3 days. The cost of that stay was staggering. Luckily, he qualified for assistance and the hospital was a not-for-profit one. He's paying a monthly payment to them and they reduced the amount enough that he wasn't given another stroke when he read the bottom line.
18. Ronski - July 26, 1999 - 11:06 AM PT
A few words about health insurance. Health insurance is not so much insurance as it is pre-paid health care.
When you have health insurance and you go to a physician, you expect to pay a small amount (the co-pay) and the rest of the bill to be picked up by the insurance company.
This is like expecting that your homeowner's hazard insurance will expect you to fork over small co-pay, but will pay for whatever the rest of the cost is for say, painting your house. Or for your auto insurance to pay the bulk of your getting the car a tune-up, or oil-change, or having the belts replaced.
Only health "insurance" works the way it does, because it is not really insurance in the classical sense, which is insurance against calamity. Rather, it is pre-paid health care, and it is exists in the form it does because of government wage and price controls during WWII, which caused employers to give health plans in lieu of increased wages when competing for scarce, good workers.
19. Ronski - July 26, 1999 - 11:08 AM PT
Employees, of course, get these health benefits out of pre-tax income, while the self-employed must pay for health care out of post-tax income, thereby getting screwed.
If I may use that word in a family-oriented thread.
20. Slackjaw - July 26, 1999 - 12:39 PM PT
"But it's also easy to envision a scenario in which the big,for-profit HMO's wuld someday consolidate and control the health care market.If that occurs, Americans won't need a study in a medical journal to tell them that the profit motive doesn't guarantee better health care.
They'll know it."
Gosh, I'll bet that would slip right by the gang down at Antitrust.
21. Slackjaw - July 26, 1999 - 12:42 PM PT
"it is exists in the form it does because of government wage and price controls during WWII"
remember this post the next time you toe the libertarian party line and say path dependence doesn't underming market efficiency.
22. JJBiener - July 26, 1999 - 12:49 PM PT
Slack - Underming? Is this one Ming the Merciless' lieutenants?
23. Ronski - July 26, 1999 - 12:50 PM PT
Slackjaw,
Have I ever said that?
24. Slackjaw - July 26, 1999 - 12:54 PM PT
jeez, "g" isn't really even close to "e" on my QWERTY keyboard. How'd that happen?
So Ronski is our libertarian free marketeer who believes in path dependence?
25. Ronski - July 26, 1999 - 12:59 PM PT
Slackjaw,
As I recall, you've posted that all libertarians eschew charity, thinking it belittles the recipient, and you were wrong there. Just before you returned to a more active role in the Fray, we did seem to be talking about diversity in libertarian thought.
26. CalGal - July 26, 1999 - 1:03 PM PT
JJ,
"This is not as easy as it sounds. In any group a few individuals will be high risk. The rest of the group will be moderate to low risk. When insurance is bought for a group the cost of the high risk individuals is spread out over the group making the insurance affordable for every one in the group. Without this mechanism, high risk individuals would not be able to afford insurance."
In the first place, were everyone to buy their insurance directly, I am nearly sure prices would go down overall. Companies pay a premium for guaranteed coverage; in all *but* high risk cases, I believe, you could get the same coverage that a company gets you for less *than they pay for it*. (not what you pay)
Second, high risk individuals would be screwed--but then, they're screwed now, quite frankly, if they lose their jobs or want to switch jobs. So figuring out a solution for high risk individuals needs is always a problem. I see no reason why everyone else should be bound to solutions to protect high-risk people.
My preferred solution for the moment:
1) Tax health insurance benefits provided by an employer--the dollar amount paid, thankyouverymuch.
2) Eliminate the employer deduction for health care.
3) Make health insurance premiums 100% deductible.
4) Lower the deduction bar for medical expenses--currently at 7.5% of AGI--to 1% or eliminate entirely.
Government intervention would be required, obviously, to protect the individual from insurance company abuse (premium increase limitations, changing coverage, and so on). Also, I think subsidization is required for people with chronic long-term healthcare issues, as well as the working poor.
27. Amaxen - July 26, 1999 - 1:07 PM PT
Slackjaw,
Even if you buy the path-dependance theory, you don't really buy the QWERTY anecdote anymore, do you? That was discredited long ago. Perhaps this is an old debate.
28. Ronski - July 26, 1999 - 1:13 PM PT
For normal people who do not know what is being discussed here, a libertarian article on path dependence, voici:
link
Decide for yourselves whether government interference in the economy constitutes path dependence. And report back, SVP.
29. Slackjaw - July 26, 1999 - 1:36 PM PT
Ronski:
"As I recall, you've posted that all libertarians eschew charity, thinking it belittles the recipient"
Your recollection is completely wrong. I do not think charity belittles the recipient nor do I think libertarians in general (much less all of them) believe that.
Amaxen: I know that the Cato institute has a paper on the subject, and I know that any efficiency losses of QWERTY can't be larger than switching costs. But discredited may be a little strong. In any case, my mention of it was tongue in cheek.
30. Slackjaw - July 26, 1999 - 1:51 PM PT
anyway, libertarians may exhibit diversity on a great many things, but one of them is not the success of free market exchange.
31. Ronski - July 26, 1999 - 2:19 PM PT
Slackjaw,
I did not mean to imply that you believed charity belittled the recipient, quite the contrary.
But I do recall a Frayster telling a libertarian shortly after I joined the Fray that this was the libertarian position on helping others, and adding, "You people do not even know your own arguments."
I was pretty sure that that was you, but if it was not, my apologies.
More on path dependence tomorrow. But for now, is it "free market exchange" if the market has been circumscribed by price controls? If the government creates special consideration for one form of compensation (health care "insurance" for employees) but does not afford other citizens the same right?
I enjoy your posts, and I'm always learning.
G'night.
32. Slackjaw - July 26, 1999 - 2:50 PM PT
Heh, that last part sounds like something I might say, but the first part doesn't. I acknowledge that I may have said it in an effort to provoke someone, but it is not and never has been my actual belief about libertarians. Sorry for any confusion.
Naturally price controls are not free market institutions, as everyone knows. However, the statement that "it's this way because it used to be this way" is an expression of something that can undermine market performance. Even if the reason it got to be "this way" is the result of nonmarket forces, once those forces are lifted it's not supposed to affect market outcomes.
33. JJBiener - July 26, 1999 - 2:53 PM PT
CalGal - "Companies pay a premium for guaranteed coverage; in all *but* high risk cases, I believe, you could get the same coverage that a company gets you for less *than they pay for it*"
It doesn't work that way. Companies pay less because the risk is spread out over more individuals. The larger the group, the less the company pays per individual. There is no premium for guaranteed coverage. Full participation is required in many cases by the insurance company to mitigate their risks.
"high risk individuals would be screwed--but then, they're screwed now, quite frankly, if they lose their jobs or want to switch jobs."
Actually things are pretty good for us high-riskers right now which is why we get nervous when people want to muck with the system. We have COBRA to cover us between jobs and during waiting periods and we have Kennedy-Kassebaum to deal with pre-existing conditions. It isn't a perfect situation, but it is workable.
"1) Tax health insurance benefits provided by an employer--the dollar amount paid, thankyouverymuch."
No new taxes, thankyouverymuch.
"2) Eliminate the employer deduction for health care."
If an employer is providing health insurance to his employees, it is a legitimate business expense. Don't try to manipulate employer behavior by manipulating the tax code. It is a bad idea.
"3) Make health insurance premiums 100% deductible."
Doesn't this contradict #1?
"4) Lower the deduction bar for medical expenses--currently at 7.5% of AGI--to 1% or eliminate entirely."
I would have no problem deducting addition medical expenses.
34. JJBiener - July 26, 1999 - 2:53 PM PT
CalGal (Cont) - "Government intervention would be required, obviously, to protect the individual from insurance company abuse (premium increase limitations, changing coverage, and so on)."
Why would government intervention be necessary. Isn't this the kind of thing that is best handled through contract and free markets?
35. cigarlaw - July 26, 1999 - 3:04 PM PT
i have mixed feelings about hmos. i love mine, but they hate me --i signed up in january and they have paid out $1200 a month for medicine and are paying 20,000 for a wheelchair. on the other hand, watching 'eyes wide shut' reminded me of why health insurance should be illegal.
36. ranheim - July 26, 1999 - 3:29 PM PT
As one of the few M.D.s in these pages, I suppose that I must comment.
Please understand that following 9 years as an USAF Flight Surgeon in the '60s, I have been a small town (2000) general practicioner in LA (Louisiana). I work solo.
Personally, I have been fortunate. Both my wife and I are healthy; as are our three children. I have paid - non-deductible - for private health insurance with the highest deductible the company will allow me since 1972. Its a hell of a slug of money; and I am very thankful that there has not been one claim.
So, basically, I am out of the loop.
One of the primary reasons for leaving the USAF was the fact of all the lying that had to be done to get a job done. I don't believe a damned thing the government says. Neither do I believe big business - in this case : health insurance companies; pharmaceutical corps; hospitals - I, personally, see very little difference between profit and non-profit hospitals; the very big clinics; any other large organization in the field of medicine. Largeness promotes lying best as I can tell.
Some of the very worst statistics are about the young - do you want 30 and below? 40? With the exception of pregnancy, why does this group need insurance? They are in the healthiest years of their lives. True, should you have a "previous medical condition" you are in jeopardy. But, that small group will be jeopardy whatever the system.
Why does a male go in for a "check-up"? What do you expect me to find? There was a famous case in regard an USAF general in the '60s. As one of the USAF's "important" members, he was required to have an "executive physical". He received a "clean bill of health"; and fell over dead from a massive heart attack as he walked down the steps of a famous clinic. If females - the sexually active ones - see about an annual PAP Smear, what else do you NEED?
37. ranheim - July 26, 1999 - 3:50 PM PT
So what does a small town GP see in his office? Colds; sore throats; minor injuries; the worried well. What does a strep throat cost? My office fee is $25. Penicillin or Amoxil for a week will set you back $5 in my office; if you want a shot that will be your decision - I am not a 'shot doctor' - and will cost you another $10 or $15. 45 bucks max! That should be out of your pocket with no thought of an insurance company claim. "Meet my deductible" be damned! Its your insurance policy; not mine. And you expect me to fill in forms free of charge!
Blood pressure and diabetic patients spend about $2/day on medication; 2 - 4 visits to me yearly; lab work; equipment for home monitoring. That should be about $2 grand a year. In my way of thinking, that should be out of your pocket. Its when you start talking about laser treatment for a diabetic's eyes; kidney dialysis for same; open heart surgery; etc. that is when one uses insurance.
Accidents in the home; in sports; in auto accidents a part of the way we live in the USA. They cannot be planned by the individual. But, you can be sure your insurance company knows how much to charge you for your "share". That should not be a problem.
I don't like Nursing Homes! "I want you to do everything you can to keep mom alive." And I have seen STAGGERING sums of money spent when a family member utters that phrase. My wife and I have Living Wills. I'll come back as a ghost to haunt my kids if they hook me up to machines to keep me alive.
I am not a fatalist; but, close. And very independent. For many of you this may seem like a harsh view of things. But, there are surprizing numbers of people in my generation (I am 64) and older than I, who have very similar beliefs.
38. Amaxen - July 26, 1999 - 6:48 PM PT
Ranheim,
You touched a nerve when you talked about having to constantly lie when trying to get something done in the govt. It's why I left my job working as an economist for the commerce dept. I or a team I was on would do some interesting work with some of the data we had available, (time, about 1 month) only to have to rewrite it constantly so as to not antagonize some interest within commerce(net time: 9 months).The end result always threatened no one and enlightened no one.
Belief in path dependence was a virtual prerequisite, but while there, it seemed like every week brought another blow to the whole theory, especially as it applied to any sort of industrial policy or government intervention model of technology policy.
Getting back to your point, I believe that so much lying is required by the big HMOs, etc. because the industry as a whole is so closely tied to the government.
39. CalGal - July 28, 1999 - 9:53 AM PT
JJ,
Sorry I didn't get back to you sooner, the tech problems were annoying.
"Companies pay less because the risk is spread out over more individuals. The larger the group, the less the company pays per individual."
No, companies probably get a discount because they are bulk purchasers. Which is probably cancelled out by the fact that they pay a premium for guaranteed coverage.
"There is no premium for guaranteed coverage. "
I find that very hard to believe. An employer can hire someone with a high risk of cancer, or someone with diabetes. The insurance company has to charge the employer the same amount for that employee as someone with perfect health. Somewhere in that equation, someone is costing more money.
"Actually things are pretty good for us high-riskers right now which is why we get nervous when people want to muck with the system. "
No offense, but so what? When you go on and on about welfare mothers, do you care that they might be happy with that situation? Besides, it's only good for high-riskers who are employed at a corporation providing them benefits. And many times, that employee will have to stay at a job he hates simply to protect benefits because he can't get them elsewhere.
"No new taxes, thankyouverymuch"
Hey, no problem. Just pay taxes on the benefits you get. Right now, I believe corporations deduct some portion of the cost of their health care premiums? So your health care is subsidized by not only me (as if that's not sin enough) but anyone who pays taxes--including those who don't get that same benefit from their employment.
40. CalGal - July 28, 1999 - 9:53 AM PT
"Doesn't this contradict #1? (making insurance premiums deductible)."
Sigh. No. Because your company wouldn't be paying it any more. You would be. So companies wouldn't be getting the deduction, you would.
"I would have no problem deducting addition medical expenses."
Not until you're paying for all your insurance and given up your free ride.
"Isn't this the kind of thing that is best handled through contract and free markets?"
It's free market, with protection. Given that the government is mandating medical insurance, the companies are getting a lot of business. So it seems reasonable they get protections as well.
41. Ronski - July 28, 1999 - 1:36 PM PT
Re: Message #32 --
Not to beat this minor point into the ground, but while the lifting of restrictions should indeed return the market to normal, I have been arguing (and still do) that by taxing the health care of the self-employed and self-insured but not taxing the health benefits provided by businesses to their workers, the government is still intervening in the marketplace, picking favorites among different interests, and causing some people to subsidize (in effect) the health care of others. Not exactly laissez-faire. So the lifting of WW II wage and price controls did not return the market to its pristine state, by any means.
42. FreetoChoose - July 28, 1999 - 2:27 PM PT
Ronski
“Decide for yourselves whether government interference in the economy constitutes path dependence. And report back, SVP.”
Hey, this thread is mislabeled. I thought it was about the boring subject of HMO's, not about interesting stuff like path dependence.
Of course path dependence is possible. And it is plausible that government interference might cause path dependence. But your question appears to ask if government interference is synonymous with path dependence. It is not.
43. ranheim - July 29, 1999 - 5:47 AM PT
I am a member of the category "the great unwashed!" Unless it would take too long (or is too difficult) what in the world is path dependance? Sounds like following Indian tracks by Jim Bowie; or the Indians following Jim!
44. FreetoChoose - July 29, 1999 - 6:06 AM PT
ranheim
The link in Message #28 provides a decent introduction to the subject. While the entire article is worth reading, the first few paragraphs will give you a decent understanding of the concept. While the thrust of the article is to debunk the importance of the concept (thus some people may disagree with the conclusions), I don't think anyone will have serious disagreement with their description of the concept.
45. FreetoChoose - July 29, 1999 - 6:22 AM PT
ranheim
Here is a collection of articles and letters in Slate covering a tussle involving Krugman and Brian Arthur. While the central issue is increasing returns, the concept of path dependence is intertwined.
46. FreetoChoose - July 29, 1999 - 6:29 AM PT
Ronski
I agree. While there may be some element of path dependence, the continued asymmetric tax treatment by the government is very important. At a minimum, this should be addressed. I suspect that even if this occurs, inertia will be sufficient to cause many employers to continue offering group health coverage, but at least we will be free of the shackles that provide economic incentives for sub-optimal decisions.
47. FreetoChoose - July 29, 1999 - 6:31 AM PT
CalGal
“Given that the government is mandating medical insurance, the companies are getting a lot of business.”
???
Where and how?
48. alistairconnor - July 29, 1999 - 8:50 PM PT
Quote from "Today's Papers" :
>> USAT goes with a fresh survey of doctors and nurses that seems to show that insurance company procedures are inimical to efficient patient care.
(...) Basically, the HMO survey indicated that the doctors and nurses who took it aren't all that thrilled with insurers (...), but their attitudes are nuanced. For instance, respondents noted that they are frequently able to reverse an insurer's initial decision to deny a course of treatment, and they admit that the rise of managed care has probably led to an upswing in preventive medicine. The LAT headline is a wry one: HMOs PERFORM BEST FOR THE HEALTHY, DOCTORS SAY.
And crafty old Shuger passes, in the next paragraph, to a COMPLETELY different subject :
>> The WP reports on the Center for Responsive Politics' assessment of
the year in lobbying. Total lobbying expenditures for 1998 were 13
percent higher than the year before, with the total number of
clients up 21 percent over that time span. Top influence spender?
The insurance industry.
(Just in case anyone was seriously expecting any improvements in health insurance legislation.)
49. jonesatlaw - July 29, 1999 - 10:03 PM PT
Last year, I had a small accident doing some home repair. I got sawdust in my eye and was wearing contacts- Ouch. I went to the E-Room at the hospital associated with the University my wife worked for at the time. Quick dye job, some eye drops and away I went, feeling much better. My insurance was a self funded plan for the University, administered by a Mutual of Omaha subsidiary. Three threatening bills, and a half-dozen telephone calls and they couldn't conclude that they should pay the bill.
I got my revenge. No more than one month later, I awoke with the most terrible back ache I've ever had after falling asleep in my easy chair. Two days later, I'm in my GP's office where I discover that I have a dropped foot, and its off to the neurosurgeon. X-rays, MRI, and a little surgery and they're stuck with a $25K bill. I think it was the stress of dealing with that annoying woman that pushed my back over the edge. ;-)
50. Wombat - July 30, 1999 - 6:48 AM PT
What is a "dropped foot?"
51. CalGal - July 30, 1999 - 10:09 AM PT
FTC,
In my plan, which I was describing for JJ.
52. jonesatlaw - July 30, 1999 - 11:22 AM PT
Wabbit- pressure from a ruptured disk knocked out some nerves and I lost the ability to cotrol the muscles responsible for lifting my foot. I couldn't walk on the my heels, that's the test. It means surgery pronto, or you'll not get any of that control back. I have been lucky, and most of the nerves have recovered.
53. Wombat - July 30, 1999 - 2:02 PM PT
Jones:
That's "Wombat" to you, not "Wabbit." I was curious, since I have bad feet and a bad back. Not disk-related, though.
54. HardyHarHar - July 30, 1999 - 3:15 PM PT
Ronski,
In message # 18, you typed:
“Only health "insurance" works the way it does, because it is not really insurance in the classical sense, which is insurance against calamity. Rather, it is pre-paid health care, and it is exists in the form it does because of government wage and price controls during WWII, which caused employers to give health plans in lieu of increased wages when competing for scarce, good workers.”
Health “insurance” really is insurance, against the cost of emergency interventions. The whole idea of covering non-emergency therapy is that in the long-run, preventative medicine is cheaper than emergency medicine. I suppose you could argue that what most people call “health insurance” today is something different, I think what they mean to say is they are members of a health plan, or that they have health coverage.
55. HardyHarHar - July 30, 1999 - 3:16 PM PT
Ranheim,
In message # 36 you typed:
”As one of the few M.D.s in these pages, I suppose that I must comment…”
“Why does a male go in for a "check-up"? What do you expect me to find?”
Well, I’m not sure what kind of doctor you are, when I go in for “check-ups” my doctor checks my health vs. my risk factors; I get a chest x-ray once a year (I’m a former cigarette smoker,) he orders blood chems (cholesterol, so on…) and he checks my general health (vitals, changes over baseline…)
I personally would advocate a nation-wide check up for all men and women (voluntary, of course) at certain ages. I think the database created from such a policy would be incredibly valuable and anyway, everyone should have a set of “healthy-young” clinical diagnostics as a baseline to compare future tests to. What does it mean if my red blood cells are considered low at one time interval when I’m 35 and in the doctor’s office because of peripheral neuropathy, if my red blood cell count hasn’t changed since I was 20? If the doctor I’m sitting in front of has no “healthy-young” baseline data, what value is a test when I’m sick?
56. HardyHarHar - July 30, 1999 - 3:17 PM PT
I'm not sure what "“" is, it didn't appear in the preview box and I didn't use one keyboard for the first message and another for the second message?
57. HardyHarHar - July 30, 1999 - 3:30 PM PT
Ranheim,In message # 36 you typed:
"As one of the few M.D.s in these pages, I suppose that I must comment"
"Why does a male go in for a "check-up"? What do you expect me to find?"
Well, I'm not sure what kind of doctor you are, when I go in for check-ups my doctor checks my health vs. my risk factors; I get a chest x-ray once a year (I'm a former cigarette smoker,) he orders blood chems (cholesterol, so on,)and he checks my general health (vitals, changes over baseline.)
I personally would advocate a nation-wide check up for all men and women (voluntary, of course) at certain ages. I think the database created from such a policy would be incredibly valuable and anyway, everyone should have a set of "healthy-young" clinical diagnostics as a baseline to compare future tests to.
What does it mean if my red blood cells are considered low at one time interval when I'm 35 and in the doctor's office because of peripheral neuropathy, if my red blood cell count hasn't changed since I was 20? If the doctor I'm sitting in front of has no "healthy-young" baseline data, what value is a test when I'm sick?
58. hashke - July 30, 1999 - 4:01 PM PT
CalGal:
'What is a dropped foot?'
Eleven inches shorter than a dropped inch.
59. ranheim - July 31, 1999 - 5:50 AM PT
#56
Isn't it amazing what happens when two computers talk to one another : one speaking French; the other German. I am one of these old-timers who still listens to LP records on my hi-fi set. I buy 2nd hand LPs. One of my sources has a Mac; I have an IBM clone. Its amazing what turns up on paper when those two machines "talk" to each other. For you computer people, I am computer illiterate.
Back to medicine. As an intellectual project, having "routine" exams for all americans would produce a wonderful data base. But, do you have any idea what the cost would be? STAGGERING! UNBELIEVABLE!
The reason for this thread is HMOs. I don't participate. A little of both : I don't like the idea of socialized medicine + there are not that many patients in my area of rural Louisiana who are enrolled in an HMO. All of you know more of the inner workings of an HMO than I do. But, my understanding is that HMOs were formed to CONTROL the amount of money spent. Your suggestion would be outrageous in cost.
I, too, am an ex-smoker. Approximately one year after I quit, my brother (a member of a large clinic) arranged for me to have a CT scan of my lungs. I have done nothing since. I, too, have yearly lab exams consisting of sugar, cholesterol (good and bad), the new Prostate Specific Antigen, etc. However, I am 64. These tests would not be practicle for someone in their 30s. The debate within the field of medicine is at what age do tests such as the ones you and I have mentioned become monetarily feasible. And then we would have a fight : one accountant vs another.
Due to the lack of a personal data base + the fact is that a high % of the young are healthy, will keep your proposals on the sidelines until we have Utopia. My understanding of European socialized medicine is that they are not much further along than the USA in obtaining a data base such as you suggest.
60. ranheim - July 31, 1999 - 6:07 AM PT
As an addendum to post #59 I'll give you some figures for rural LA. It goes without saying that the cost in urban america would probably be close to double the figures below.
My standard office fee is $25; I would have to charge more for an extensive physical : say $35 - 40. A "Profile" locally includes the chemistries + complete blood count (CBC) : $85. PSA : $85. Thyroid "profile" : $75. Chest x-ray (2 views) : $100. I haven't done PAP smears in years; you women add on that cost. For men we are talking approximately $400 a year. Times - what is it now? - 260 million in the USA; one half too young for such an exam? I don't want to be the one who sets the age date should the above testing become mandatory.
So, cost rapidly becomes the factor that limits what one can do on a mandatory basis. $400 X 130 million is a very large figure!
BTW I pay for my yearly lab tests. Would those of you enrolled in an HMO be willing to pay out of pocket? Or would you want this to be a portion of your annual "dues"?
61. ranheim - July 31, 1999 - 8:41 AM PT
I forgot mammograms.
62. HardyHarHar - Aug. 2, 1999 - 9:21 AM PT
ranheim,
Certainly there is no need to annual physical examns for everyone, but at certain ages (14,21 & 30 for women? 16,25 & 30 for men?) the cost would not be as high.
But as I mentioned, the fact that younger people tend to be healthy is exactly the reason for examining them. To have a healthy-young baseline for future comparisons...
63. HardyHarHar - Aug. 2, 1999 - 9:25 AM PT
The reforms that are possible within the HMO system are really only nominal, anyway. The government will always be the main factor in determining what kinds of health services are available to the majority of Americans. HCFA, FDA & NIH have the largest impact on the direction our overall health sciences take, and they directly effect which services are made available to whom, at what cost and when.
64. JJBiener - Aug. 2, 1999 - 11:44 AM PT
Alistair - "Total lobbying expenditures for 1998 were 13
percent higher than the year before, with the total number of
clients up 21 percent over that time span. Top influence spender?
The insurance industry. (Just in case anyone was seriously expecting any improvements in health insurance legislation.)"
Think about. The media and politicians have made the insurance industry the latest demon. Politicians are threatening everything from expensive regulation which would put many companies out of business to complete nationalization of health insurance. What would you expect the industry to do? Sit on their hands and allow themselves to be carved up by a bunch of self-appointed Inquisitors? They are doing what they are supposed to. They are protecting themselves and their shareholders from those who would destroy them for political gain.
Let's not forget a few things. Insurance is legal and voluntary. Insurance companies have as much right as anyone else to participate in our legal system. Insurance companies are bound by contractual obligations just like any other individual or business. Insurance companies must ultimately satisfy their customers if they intend to survive and profit.
65. Ronski - Aug. 2, 1999 - 12:19 PM PT
JJ,
Are you of the suspicion, as I am sometimes, that statists are trying to cripple bit by bit the current mixed-economy system of providing health care, so they may one day declare that "the free market has failed" and impose fully socialized medicine?
66. bubbaette - Aug. 2, 1999 - 12:22 PM PT
Given that the U.S. spends a higher proportion of its GNP on healthcare than other industrialized nations yet covers a lower percentage of it's population, I don't think it's going too far to say the market has already failed.
67. CalGal - Aug. 2, 1999 - 12:27 PM PT
The market hasn't failed. The market isn't even really given a fair shot, since the true consumers aren't really exposed to the consequences of their decisions.
68. bubbaette - Aug. 2, 1999 - 12:44 PM PT
Well the market as it evolved was a system of employer-provided health insurance (for those lucky enough to get it). I take it the real market as you define it is the consumer paying the provider directly for each service provided?
69. CalGal - Aug. 2, 1999 - 12:49 PM PT
"Well the market as it evolved was a system of employer-provided health insurance (for those lucky enough to get it). "
I could be wrong, but I believe the government kicked the market in this direction?
The real market should be the consumer paying for his or her own insurance--which would entail them paying for the services provided a great deal, yes.
70. HardyHarHar - Aug. 2, 1999 - 12:51 PM PT
Whether or not the "market" has failed, depends entirely on your perspective. Yes, in some other countries they spend less on health, per capita, but you have a 24 month waiting list (England) for a total hip replacement....gee, try going 24 months with a hip that doesn't work (since you'd be put on the waiting list only after reaching a point where such an intervention was medically necessary, try 36 months, to be more realistic, from onset of worst symptoms to surgery.)
71. JJBiener - Aug. 2, 1999 - 12:55 PM PT
Ronski - There is no doubt in my mind that the statists are setting the stage for fully socialized medicine. They are using all of the time honored techniques: misinformation, stereotyping, demonization, predictions of disaster, etc.
An example of misinformation is the statists substitute the number of people who have insurance for the number of people who have access to health care. The implication is that unless a person has insurance, they are unable to obtain any health care. This ignores the fact that there are free clinics, government run hospitals, doctors who donate their time, for-profit and non-profit hospitals which donate resources and bedspace, pharmaceutical companies who donate medicines, and laws that require emergency rooms to treat patients regardless of their ability to pay. The result is that virtually everyone has access to some form of health care. Of course if this were widely known there would be hard to justify making massive changes to the system.
If anyone would like examples of the other techniques I would be glad to provide them.
72. bubbaette - Aug. 2, 1999 - 12:55 PM PT
The problem with individually purchased health insurance at this time is getting into a large enough risk pool. Self-purchased health insurance these days is pretty adverse-selecting and the cost is beyond the means of most folks making a middle-class wage, much less the low income folks who are least likely to have employer-provided insurance.
It seems to me that in order to make a true market system, you'd pretty much have to start from the bottom up and re-design.
73. HardyHarHar - Aug. 2, 1999 - 12:56 PM PT
The government, in doing just about anything, is reacting to an outside influece. Who would have had anything to gain by pressuring government to pressure corporations to provide health insurance to workers?
Bubbaette,
In my opinion a "free" medical services market would entail individuals paying for their surgery, cholesterol check, whatever... and no, a "free" market would never work, and is not desireable.
74. Ronski - Aug. 2, 1999 - 12:59 PM PT
Cal is correct. We have not had an free market in health care since the 40s, at least. We have a mixed market, which advocates of more government control mistakenly call, or, perhaps in some cases, willfully misrepresent, as a "free market."
75. CalGal - Aug. 2, 1999 - 1:01 PM PT
"The problem with individually purchased health insurance at this time is getting into a large enough risk pool. "
Sigh. If *everyone* were purchasing their own insurance, why would it be any different from, say, car insurance? As an individual purchaser, why am I not getting screwed by not having a large enough risk pool?
"Self-purchased health insurance these days is pretty adverse-selecting and the cost is beyond the means of most folks making a middle-class wage, much less the low income folks who are least likely to have employer-provided insurance."
No, the cost is not beyond the means of most folks making a middle-class wage. Low-income is a different matter that could be handled with tax credits. But it's not beyond the means of the middle-class. Figure $200/month for a family of 4, $2000 deductible.
That's not what they're getting now? Too bad. If they want what they're getting now, they can pay taxes on it.
I think I posted on the CalGal plan ten or twenty posts back.
76. HardyHarHar - Aug. 2, 1999 - 1:02 PM PT
JJ,
In concluding a list of examples in which people get free health care, you wrote:
"Of course if this were widely known there would be hard to justify making massive changes to the system."
This is not true, the reasons for making massive changes to the system are as numerous but they almost all flow back to the cost of providing the care. Sure, anyone can stagger into an ER and get looked at but it saves everyone money if the people who are going to the ER for check-ups, births and drug & alcohol related ailments had some form of health plan that would allow them to get non-emergency help first.
77. JJBiener - Aug. 2, 1999 - 1:02 PM PT
Hardy - Don't forget to mention the distortion in pricing caused by a single payer. When I was there, I needed a box of medical supplies. That box of supplies would have cost 3-4 times as much as I paid in the states for the exact same thing. By going to a doctor and getting a prescription it would fall under National Health and the government would pay the inflated cost without question. The supplies were also of demonstrably poorer quality as well.
78. Ronski - Aug. 2, 1999 - 1:02 PM PT
I'm not sure I understand Hardy's first paragraph above, but no one pressured the government into pressuring businesses to offer health plans to employees. Government intruded into the economy with wage and price controls in the 40s, and businesses responded by offering health plans in far greater numbers than they ever had before in order to protect their ability to compete for workers. The system was created by government bungling, not in order to please some interest group.
79. bubbaette - Aug. 2, 1999 - 1:05 PM PT
I don't know where you're getting your figures for self-purchased health insurance. Back in 1993 when I went back to school full time, I thought about extending my employer-provided health insurance under COBRA at 102% of the actual cost for Blue Cross/Blue Shield (which was a non-profit) at the state employee group rate. The cost for my own single coverage was about $210 per month.
80. Wombat - Aug. 2, 1999 - 1:06 PM PT
The system was created in World War II to attract and retain workers in an extremely competitive job market.
81. CalGal - Aug. 2, 1999 - 1:06 PM PT
I don't know all the history, but I thought the custom of providing employees medical insurance began as union demands. I'm not sure how it moved over to non-union shops.
82. JJBiener - Aug. 2, 1999 - 1:08 PM PT
Hardy - I also mentioned places other than emergency rooms which provide the services you mentioned to the poor for free. The problem is that many of them are run by private, charitable and religious organizations and therefore fall outside direct government control. The statists want to nationalize all of these efforts and have government control everything.
83. HardyHarHar - Aug. 2, 1999 - 1:09 PM PT
Yes, those familiar with Ghetto insurance would be comforted by the $200/month figure for a family of 4...
You get injured and the neighborhood tough comes into your home and hits you till you quit complaining.
84. CalGal - Aug. 2, 1999 - 1:10 PM PT
Oh, okay. Competition. That makes sense.
Bubba,
"Back in 1993 when I went back to school full time, I thought about extending my employer-provided health insurance under COBRA at 102% of the actual cost for Blue Cross/Blue Shield (which was a non-profit) at the state employee group rate. The cost for my own single coverage was about $210 per month."
First off, COBRA is expensive. In general, companies pay a bit more for each person than an individual would. I spelled out the reasons for JJ a while back. Second, I'm quite sure that the policy you would have purchased would *not* have been a $2000 deductible policy. It was probably quite a bit more than that.
And since the company was paying $210/month for you, you were getting $2400/year in benefits that you weren't being taxed on. So if you had the choice in your *own* life, you'd probably opt to pay $65/month for a $2000 deductible policy and pocket the rest.
85. Ronski - Aug. 2, 1999 - 1:11 PM PT
As for the assertion that a free market could not work in health care, the fact is that it did work, relative to the advances of medicine available at the time and relative to the state of the economy at the time, before government intruded into this area.
The free market can provide food, clothing and shelter. There is no reason why it cannot provide health care. Those who cannot afford proper health care can (and were, historically) helped by a wide variety of religious and industrial charities, and by a medical professional ethic which pretty much dictated that as much as a third of a physician's time was to be spent helping the poor.
There is a role for government in the public health, when coercive measures are needed to protect society, such as forcing TB sufferers to take their medications, and the like.
That said, I do not expect any wholesale return to the free market in health care. It will not happen; at least, not for decades.
86. bubbaette - Aug. 2, 1999 - 1:11 PM PT
Another thing about the current system that I find highly ironic -- docs figure their charges based on the availability of health insurance and what the insurance companies figure is "reasonable and customary". Physicians then inflate their bills so that they can get paid what they actually think they should make for a given proceedure after the insurance company decides on the percentage it agrees to pay. Big insurers, such as Blue Cross, have enough market power to negotiate substantial reductuions in charges. The uninsured patient doesn't have that market power and acutally end up paying more for the same service because they don't have insurance.
87. HardyHarHar - Aug. 2, 1999 - 1:11 PM PT
Ronski,
But even your explanation begs the question, what prompted our government to install wage and price controls? What has our government ever done, just out of the blue? There is always some external stimuli, isn't there?
88. CalGal - Aug. 2, 1999 - 1:12 PM PT
I posted the specifics of the CalGal plan a while back, Message #26, but here it is again:
"My preferred solution for the moment:
1) Tax health insurance benefits provided by an employer--the dollar amount paid, thankyouverymuch.
2) Eliminate the employer deduction for health care.
3) Make health insurance premiums 100% deductible.
4) Lower the deduction bar for medical expenses--currently at 7.5% of AGI--to 1% or eliminate entirely.
Government intervention would be required, obviously, to protect the individual from insurance company abuse (premium increase limitations, changing coverage, and so on). Also, I think subsidization is required for people with chronic long-term healthcare issues, as well as the working poor. "
89. JJBiener - Aug. 2, 1999 - 1:14 PM PT
Bubbaette - What CalGal is referring to is sometimes called catastrophic care insurance. It only pays for hospitalizations and such. It doesn't pay for doctors visits, medicine, etc. Those come out of your pocket. What you were looking at probably covered those things and had a $250 deductible instead of a $2000 deductible.
90. Ronski - Aug. 2, 1999 - 1:16 PM PT
Cal,
Businesses began offering on-site health care more than a century ago, usually by having a nurse or physician on sites (factories) that were large enough to warrant them. It made good business sense to keep workers healthy. But the modern idea of employee health plans was a product of wage and price controls in WW II. Unions liked the idea, as well.
91. CalGal - Aug. 2, 1999 - 1:18 PM PT
Bubba,
"Big insurers, such as Blue Cross, have enough market power to negotiate substantial reductuions in charges. The uninsured patient doesn't have that market power and acutally end up paying more for the same service because they don't have insurance."
It's not the uninsured patient. Heavens, everyone is so used to getting full coverage they forget the rest. It is everyone who pays the full price of an office visit (many people who have insurance do this, you understand). If everyone were paying for their own insurance, they would start to act like consumers. All the problems you describe are caused by the fact that the majority of the insured are not acting like consumers.
92. HardyHarHar - Aug. 2, 1999 - 1:19 PM PT
I keep getting too far behind the current posts for my answers to fit into where they belonged, but:
JJ,
The government has no interest in taking over for charities and clinics that provide care for free, at least I've never seen anything that led me to that conclusion. The point is, medical services reform has already helped a lot of people and I think further reforms will continue to do so.
Ronski,
The days of a doctor doing houscalls for a bushel of apples sure is cute, but if you think that your average indigent ever got looked at you're crazy. I know people, of a certain age, who claim to have had their tonsils removed by the tonsil guy who would show up in town every-so-often and he used a wire loop, that tore the tonsils out, swiftly. What, are we supposed to mark our calendars, hoping the appendix guy shows up in time for little Billy? We've progressed past the point where individual doctors can provde the standard of care on their own, unless we lower the stanard.
93. Ronski - Aug. 2, 1999 - 1:19 PM PT
Hardy,
The Government sought these controls in a misguided effort to keep down the costs of fighting the Nazis. It seemed like a good idea at the time to government bureacrats responsible for procurement, although I suspect there were some classical liberal economists who warned of negative consequences.
94. Ronski - Aug. 2, 1999 - 1:22 PM PT
Hardy,
On the contrary. By some standards, we now have an excess of physicians in this country. Earlier in our history, and in fact until quite recently, we had shortages of physicians, largely because doctors controlled their numbers with the help of a coercive government.
95. bubbaette - Aug. 2, 1999 - 1:24 PM PT
Cal
I think there are enough causes of the cost of health care to make all involved into bad guys. Many people with insurance demand to see a doc for every ache and sniffle, creating a larger demand than if they had to pay for those office visits out of their own pockets. Medical technology becomes available at a cost and all those insured demand access to (for example) the MRI because it must be the latest and the best. Docs practices invest in an MRI and have to prescirbe its usage in order to make their investment back. Insurance companies have to make a profit. (and there's been a huge trend of non-profits going for-profit after receiveing decades of tax breaks) Phamaceutical companies come up with drugs of marginal utility and then have to advertise like hell to develop a market for them which, in turn, ups the number of dr. visits by patients seeking a scrip for the pill they heard advertised. It's a vicious cycle with no easy answers or single villians.
96. JJBiener - Aug. 2, 1999 - 1:32 PM PT
Bubbaette - What is the point in making them villains to begin with?
97. JJBiener - Aug. 2, 1999 - 1:36 PM PT
Hardy - "The government has no interest in taking over for charities and clinics that provide care for free, at least I've never seen anything that led me to that conclusion."
Read the Clinton Care plan. That is exactly what it would have done. That is also what statists are calling for by demanding that everyone have health insurance and have the same access to the same medical resources regardless of their financial status.
98. Wombat - Aug. 2, 1999 - 1:47 PM PT
Ronski:
You are being a tad disingenuous in harking back to the "good old days" and for that matter criticising the US health care "system" as it was set up by the 1940s. The "system" was no doubt adequate until the quantum advances in treatment and technology of the 1960s and 70s that prolonged life and enabled treatments for conditions that were previously fatal.
I would hate to have to return to a time when people would have to make a choice between letting a child die, selling their house, or hoping that a charity or friends, family, and neighbors would be willing to assist them.
At present our "system" is both expensive and inefficient, with bureaucrats in a position to make medical decisions, mountains of paperwork administered by semiliterates, and discontented doctors and patients.
I would suggest a state-based single payer system, treating company contributions and individual and family deductibles as taxes, to be collected once a year. It would be interesting to see how much cash that would generate, and how that would translate into services provided. There would no doubt have to be a rationalization of doctor fees, but at least they would only have to deal with a single fee structure, instead of the multifarious structures they have now. An added incentive might be picking up the tab for malpractice insurance.
99. CalGal - Aug. 2, 1999 - 2:04 PM PT
"I think there are enough causes of the cost of health care to make all involved into bad guys. "
Actually, I think you can link most of it back to the consumer--who isn't acting like a consumer. Take the employer out of health care, for starters. And make all you folks who get health insurance through employment pay taxes on it. Watch just how quickly you'd decide you could get it cheaper elsewhere.
Once you take the employer out, there are two ways to go: turn insurance over to the individual, using the government to protect his rights, or go single payer.
Ain't no way, no how, this country is going single payer. This is not a country that supports making it worse for most in the interest of making it better for some.
100. Ronski - Aug. 2, 1999 - 2:10 PM PT
Disingenous? Not at all.
The purpose of health insurance should be to make it possible for people *not* to ever have to choose between the life of a child and paying a mortgage. That is what catastrophic insurance is for, and it is relatively inexpensive. What is expensive is the kind of "insurance" we have now, which is pre-paid health care, subsidization of the insured by the non-insured (through the inequitable tax structure), and excessive demand by persons who mistakenly think neither they nor anyone else is paying for visits to the doctor (or physician's assistant, or nurse practitioner). There is no call coming from me to make people "hope" a charity will bail them out. There are numerous safeguards against such rolling of the dice available in free market health care, or would be.
And while the startling advances in medicine such as organ transplants are expensive, remember that modern medicine also saves many millions of dollars due to similarly startling advances in preventive medicine. Blood pressure medication is way less expensive than long term nursing care for stroke victims. If you can avoid kidney failure through diabetic medication, you will also not need a kidney transplant, and we are developing better and better medications. A more bureacratized system is sure to damage the R&D of drug companies, and sure to end up in greater rationing than exists now.
To the extent that we subsidize food, shelter and clothing for the destitute, we may also want to subsidize health care to the same degree, but that is a far cry from the nationalization of medicine, which any single payer system would represent, imo.