Epic indeed - you've even got duplicates of quotes/responses in there. :lol:
I think this has grown beyond my ability to make a sensible reply to all of it. So just a few points.
There may be 37.9 million immigrants in the US, but most of them have health insurance, so they are not counted. the 9.6 million figure is for all non-insured immigrants, not just illegal immigrants.
The RAND experiment is fascinating, but it seems to show two things that I think are important, and one that I think is obvious. The obvious one is that making people pay directly for their health care decreases use. No kidding. I definitely want my money, no matter what, and I'm sad to lose it.
What is different is that the commodity itself is not an *incentive*. I only want heart surgery if I have a heart problem. If I don't have that, you can promise me the a thousand of the best-quality heart surgeries in the world, and I won't take any of them. Equally, I don't want insulin, I don't want antidepressants, I don't want a hip replacement, I don't want an MRI, and I definitely don't want a hospital bed. Anyone who does want these things without medical need should be strongly discouraged from "purchasing" them, no matter what the system.
The non-obvious things are: when the price incentive was included, both non-necessary *and necessary* treatment went down. That is to say, people were opting out of important treatment to save money. While in superlibertarianland this is an unmitigated good (people get to choose - their money or their life!), for the rest of us, that means crappier health care. People aren't good judges of their medical needs, and delay costly examinations and treatment when they shouldn't, resulting in worse, and often less economically efficient, outcomes. What could have been treated with a bottle of pills or a minor surgery today, takes expensive medical firepower tomorrow. As the report says:
Second, once a patient entered into the system for treatment, their costs were about the same. That means that people are not weighing whether or not to get procedures. They're weighing whether or not to see a doctor at all. In addition to the serious problems with self-diagnosis, this does not get at the fundamental cause of health care cost increases. To quote the report again:
-Jester
I think this has grown beyond my ability to make a sensible reply to all of it. So just a few points.
There may be 37.9 million immigrants in the US, but most of them have health insurance, so they are not counted. the 9.6 million figure is for all non-insured immigrants, not just illegal immigrants.
The RAND experiment is fascinating, but it seems to show two things that I think are important, and one that I think is obvious. The obvious one is that making people pay directly for their health care decreases use. No kidding. I definitely want my money, no matter what, and I'm sad to lose it.
What is different is that the commodity itself is not an *incentive*. I only want heart surgery if I have a heart problem. If I don't have that, you can promise me the a thousand of the best-quality heart surgeries in the world, and I won't take any of them. Equally, I don't want insulin, I don't want antidepressants, I don't want a hip replacement, I don't want an MRI, and I definitely don't want a hospital bed. Anyone who does want these things without medical need should be strongly discouraged from "purchasing" them, no matter what the system.
The non-obvious things are: when the price incentive was included, both non-necessary *and necessary* treatment went down. That is to say, people were opting out of important treatment to save money. While in superlibertarianland this is an unmitigated good (people get to choose - their money or their life!), for the rest of us, that means crappier health care. People aren't good judges of their medical needs, and delay costly examinations and treatment when they shouldn't, resulting in worse, and often less economically efficient, outcomes. What could have been treated with a bottle of pills or a minor surgery today, takes expensive medical firepower tomorrow. As the report says:
Quote:On the other hand, the HIE showed that cost sharing can be a blunt tool. It reduced both needed and unneeded health services. Indeed, subsequent RAND work on appropriateness of care found that economic incentives by themselves do not improve appropriateness of care or lead to clinically sensible reductions in service use.
Second, once a patient entered into the system for treatment, their costs were about the same. That means that people are not weighing whether or not to get procedures. They're weighing whether or not to see a doctor at all. In addition to the serious problems with self-diagnosis, this does not get at the fundamental cause of health care cost increases. To quote the report again:
Quote:In addition, cost sharing may not address the principal causes of cost growth. Cost sharing cuts expenditures by reducing visits but has little effect on the cost of treatment once care is sought. If, as is widely believed, cost increases are driven by treatment expense and new technologies, cost sharing can contribute to reducing costs at each point in time but may have little effect on the overall rate of cost growth.Amen. The problem is that health care is getting more and more expensive, per person, per treatment, per anything. THAT is what needs solving.
-Jester