That Heritage Foundation chart, with the CBO’s preliminary scoring of the Senate’s health care bill.  (Hat Tip: Keith Hennessey)……

“Because the government (single payer) is best suited for the job. Witness the 29 other industrialized who use it successfully.”

One must be very careful when making international comparisons, especially because rankings are subject to individual methodologies, widely varying demographics and culture, and ideological bias (e.g. the WHO rankings are very poor in this regard). And if one is to draw any lessons from international experience, it is that a) public employment of medical personnel and ownership of facilities provides the worst care (and lowest cost GDP)…eg the UK. b) single payer insurance to private parties provides better care for higher costs, but the quality is not of the level that the average American finds acceptable (e.g. Canada); c) a mixed private and public insurance system (e.g. Germany) provides good care, but also costs the most (e.g. Germany) but still not as much as the US system. Depending on the year of comparison, the German system uses 11% of its GDP and the American system 14.5% (2005).

How and why the German’s get good results is not yet clear. Obviously they don’t have inner city drug cases and gunshot wounds; are less fat than Americans, etc., and I suspect that a system run by Germans is, per unit of output, going to be far more efficient than an identical system run by Americans. So, untill someone can show me more information, I remain agnostic on the issue.

“And witness the one who doesn’t. Us. Your private plan is and has been in place for decades and is a monumental failure.”

Actually that is not what has been in place for decades. Three decades ago government insurance was established. It has grown 20 fold and now about half of all medical dollars comes from the government (Medicare, Medicaid, VA, SCHIP, Public Health Clinics, University Clinics, County Clinics, etc.) . Prior to any government involvement medical costs rose 3.2% per year. Today it increases much faster.

So tar brushing private insurance is both inaccurate and dependent on what outcome you measure the whole system with.

“Exactly. It will not bankrupt the country. And we are treating and paying for the uninsured in the most expensive fashion possible. Preventative care is ignored. And preventative care saves dollars.”

Yes and no. We are treating some individuals less than we would under the proposed system. Currently those without insurance and who do not qualify for Medicaid (say the working poor) must be treated only for life threatening illnesses. To the degree they avoid treatment (or pay as they go) for other kinds of medical care is the same degree to which the new program will layer on additional costs.
(And preventive care is one of those old enthusiasms that have not been shown to save much at all.).

“And most importantly the proposed program LOWERS costs.”

I doubt it, at least not unless it imposes some very serious rationing. Putting millions on the public medical dole will cost more (about 200 billion a year when it gets rolling). The only way to cut costs is to either ration care through strict protocols, or cut reimbursement rates. As doctors are leaving medicare now, this approach does not seem promising.

Take a look at these two links. Excellent systems for a fraction of what we spend as a percentage of GNP and per person.

http://econlog.econlib.org/archives/2008/01/singapores_heal.html

http://content.healthaffairs.org/cgi/content/full/22/3/77

“and according to a ranking that includes a lot of outcomes that have nothing to do with the health care system, they have better outcomes.”

And that is a mighty big assumption. Actually it is a false assumption.

And there is no questions our administrative costs far exceed the rest of the world. And there is no question that catching disease early is far cheaper to deal with. See Deamonte Driver who racked up $250,000 in bills that could have been avoided with an $80 tooth extraction. And then he died.

Peace and good health to you as well.

So the crux of your argument is: 29 countries have single payer systems, they spend less and according to a ranking that includes a lot of outcomes that have nothing to do with the health care system, they have better outcomes. Therefore, the US should have a single payor system.

If it’s that easy for you, I commend you. Personally, I have a need to understand why that would be the case, whether the outcomes are better and which ones.

Having looked at those studies, I’m not sure I buy them. On fundamental principle, relative to where we are today, there are only 2 ways to save money.

1. Perform fewer services. It’s hard to believe this will be the outcome

2. Pay less for each service. It’s easy to believe this will be the outcome but that will come with a quality penalty in my opinion. If you choose not to believe that, we can agree to disagree.

You think that facts and studies are the answer, I want to understand why you believe the outcome you believe. I’m not big into reasoning by analogy since analogies are very challenging to line up. I’m more into how the fundamentals change and how that affects the outcome.

On the fundamentals, I believe:

1. More services will be used as the cost of services to people declines.

2. The government will strive to pay less for services but ultimately will fail because it will not be perceived to be acceptable in the US to have the public plan not cover what the private plans cover and therefore prices will continue to rise.

3. As a consequence, costs will increase in this country.

4. This will continue until costs rise to the point of being “unacceptable”. Like many other people, I believe this will happen more quickly if people pay for their own care and make their own price/quality tradeoffs as opposed to having the government make it once for all of us but again we may choose to disagree there.

The analogies of other countries are not important unless you can help me understand how they manage the root causes–number of services provided, quality of service provided (not quality of outcome by the way), and cost per service. Without that, analogies are inevitably apples and pears (or grapefruit).

I wish you peace and a long and healty life

Oh, and nothing personal Keith. I hope I didn’t offend you. Many great players end up stuck on lousy teams. In no way did I intend this to be a reflection on you.