15 February 2010 
The President has invited Congressional leaders to the Blair House ten days from now to discuss health care reform. While the press has labeled it a summit, it has much more the feel of a televised debate, a kabuki dance played out for the cameras.
I am having difficulty understanding what the President is trying to accomplish with this meeting. Four possibilities are:
- If he thinks a Democrat-only deal is possible, then they’ll need to use the reconciliation process to try to pass a bill without Republican help. If the President can portray Congressional Republicans as uncooperative, he may be able to mitigate anticipated Republican process complaints from implementing a partisan two bill strategy. “I tried to work with Republicans, but they wouldn’t work with me. They left us no alternative but to use reconciliation to pass a new bill through the House and Senate on a majority vote.”
- If this is the primary purpose, then the meeting is not about the substance, but instead about Democrats trying to make Republicans look unreasonable to influence press coverage and public opinion, and to calm Congressional Democrats as they embark on a risky partisan legislative path. This is a cynical view of a potentially important meeting.
- If he thinks no Democrat-only bill is possible, and if he thinks no Republicans can be brought around to support a bill, then he may be looking to set up Republicans as the fall guy for his exit strategy. Liberals will be furious if the President, Speaker Pelosi, and Leader Reid abandon their efforts to pass legislation. If he can somehow shift the blame to Congressional Republicans, then at least he gets an election-year benefit from legislative failure.
- I don’t think this works because everyone knows that two Democrat-only legislative options exist: (1) the House could in theory pass the Senate-passed bill, or (2) the two bill strategy can be implemented using the reconciliation process. If the Democratic votes are there, either option works procedurally, even in the face of unanimous Republican opposition. If he cannot pass a Democrat-only bill through the Congress, it would again be because he could not hold 218 House Democrats and 50 (+VP) of 59 Senate Democrats. This procedural reality makes it hard to credibly blame Republicans for not getting a signed law.
- He may want to begin legislative negotiations with Congressional Republicans.
- If this is his goal he is going about it all wrong. The invitation letter sets up a structure of confrontation and nowhere mentions bipartisanship, inclusion, or compromise. The tone of the letter is horrible. It reads like an invitation to a televised debate rather than an attempt to find common ground. In parallel to the meeting, Speaker Pelosi and Leader Reid continue to work behind closed doors to build a Democrat-only substantive compromise and procedural path, causing key Congressional Republicans to suspect the Blair House meeting is either meaningless or a trap. Leader Reid scuttled a bipartisan Baucus-Grassley “jobs” bill compromise late last week, further undermining any remaining Republicans who might try for a compromise. If the President hopes in this meeting to foster bipartisanship on health care reform, he is setting himself up for failure.
- Yes, this perspective is skewed based on my partisan affiliation and policy views. Even if you believe the lack of bipartisan progress so far is entirely the fault of Congressional Republicans, that does not change the reality that Republicans are approaching this meeting convinced that it is a confrontation or a trap. Whomever you choose to blame for that, the setup of the meeting discourages anyone in either party who might be interested in building bipartisanship. I see almost no possibility that bipartisan progress results from this debate.
- He didn’t have a specific game plan when he announced the invitation, but he knows he performed extremely well when he sparred on camera with House Republicans a few weeks ago. He is recreating a similar environment, one even more favorable to his strengths. Whatever his goal, he knows that a partisan conflict in this environment will likely play in his favor on camera.
- This seems like the most reasonable explanation.
The President’s new proposal
The invitation letter from White House Chief of Staff Rahm Emanuel and HHS Secretary Kathleen Sebelius says the President will “post online the text of a proposed health insurance reform package.” House and Senate Democratic leaders have so far been unable to negotiate a compromise. What will the President propose?
- If there is a Pelosi-Reid-Obama substantive deal by the 25th, then it’s easy and ideal from the President’s standpoint. He can tell the Republicans, “Here’s the deal. I’ll tweak it for you to get your support. Otherwise we’ll pass it with only Democratic votes using reconciliation.” Democrats have so far been unable to close such a deal and round up 218 + 50 votes for it. I’ll give them a 3-5% chance of success before the 25th. It should be lower, but I think they deserve some credit for bull-headed perseverance.
- If there is not a Pelosi-Reid-Obama agreement by the 25th, then what will the President propose?
- Something midway between the House-passed and Senate-passed bills? If so, then Republicans can just reject it (easy for them, since they opposed both endpoints of that negotiation) and turn the focus back to disagreements between Pelosi and Reid. In the meeting Republicans could ask Congressional Democrats if they support the President’s new proposal and if they have the votes for it, and likely watch it break down in intra-party squabbling.
- The President could make concessions to Republicans in his proposal, even if they are only token concessions. In doing so he would risk angering Speaker Pelosi and Leader Reid, whose help he needs to pass a bill.
I am perplexed by the Emanuel/Sebelius commitment. The letter also challenges Congressional Republicans to offer their own proposal. Again, this makes sense if Team Obama is looking to embarrass Congressional Republicans for not having a unified substantive proposal transparently available to the public. I struggle to think of another context in which this idea makes sense for the President.
What should Republicans do?
I think that good policy is also good politics for Republicans. Even if they take the most cynical view of the Blair House meeting, I recommend they take the invitation at face value and attempt to participate constructively.
- Show up as invited.
- Focus your public comments on substance more than process. Republican leaders are spending too much time on a “start over” message. I would instead talk about why you oppose the House-passed and Senate-passed bills, and how you are open to any legislative process and solution that addresses those problems. Since the policy problems are core to the bill, you achieve the same effect, but you will be getting your substantive message out rather than looking like you’re bickering over process.
- The bills create a nearly trillion dollar entitlement program when we know that entitlement spending drives our long-term budget problem.
- The bills slow the growth of Medicare spending (a good thing) but then turn around and respend that money on a new spending program (bad).
- Health insurance would essentially become a governmental function, even without a public option.
- More decisions about the costs and benefits of various medical procedures and treatments would be pushed away from individuals and toward government officials.
- National health spending would increase. Health premiums would increase for most who have employer-based health insurance today. The cost control measures, weak as they were, have been further watered down to the point of irrelevance.
- The bills are filled with targeted benefits and carve-outs: especially the Nebraska and Louisiana Medicaid deals, exempting unions from the Cadillac tax, and carve-outs for certain Blue Cross / Blue Shield plans.
- Offer a wide range of substantive health policy changes (to current law, not to the bill), but do not feel obliged to have a single unified Republican proposal. It’s critical that Republicans step up and offer policy solutions, but they don’t have to be afraid of admitting that they are not unified as a party on those solutions. Different Members can push for different reforms: talk about medical liability reform, buying insurance across state lines, replacing the current law tax exclusion with a deduction or a credit, high risk pools, association health plans, health savings accounts and high deductible health plans. Republicans need to be aggressive in pushing positive policy ideas for health policy reform, even if they disagree amongst themselves. Embrace the differing views within the big tent, and use those differences to make your argument for an open amendment process.
- Hammer home that this should have been a legislative debate and process among multiple options, rather than a take-it-or-leave-it or option A vs. option B exercise.
- Aggressively push back on anyone who suggests this is “reform vs. status quo.” And push back on anyone who insists that reform must be all-or-nothing.
- When in doubt, shift the camera’s focus to your disagreements with Congressional Democrats, who will be a far easier opponent in a public snowball fight than the President.
When he announced this invitation the evening of the Super Bowl, the President bought himself nearly three weeks of breathing room. If the meeting fulfills my pessimistic expectations, I would expect a lot of partisan finger-pointing in the days following. Team Obama, Speaker Pelosi, and Leader Reid will then be back in the hot seat as they struggle to answer the question, “OK, so what are you going to do?”
(photo credit: No room at the inn by afagen)
I suggest there is a fifth possibility. Obama is between a rock and hard place when it comes to HC. One side wants complete government run health care and Obama, himself is of that ilk ("I prefer a single payer option"). The other side is the American public which is becoming more vocal about NOT wanting government involved in health care.
Obama is playing off the two sides and will support whichever side shows up best in the polls [2-3 days after Blair House].
The Republicans should make it clear to Obama that resolving the Federal debt by privatizing Social Security and Medicare is the number one priority.
Cato institute has a site in-progress. There's alot that can be cut, starting with the Depart of Education. Let's 86 the whole thing. http://www.downsizinggovernment.org/
I don't see why the focus is on insurance reform and not on provider reform. Healthcare providers are monopolists and earn economic rents. Physicians are the biggest gainers of any reform that further cements in place the guaranteed payment system whether public or employer provided. They will continue to benefit from the huge barriers to entry to the profession, education and training, (necessary) to earn economic rents. Economic rents are captured by monopolists when their compensation in the aggregate is above what would attract and employ that factor of production, physicians, to the healthcare system.
You've got to be kidding.
Subject to anti-trust laws? Physicians are already subject to anti trust laws. It is illegal for individual physicians to collectively work together to negotiate the prices of hospital services and mal practice insurance. Getting charged too much for mal practice? Too bad. Take it or leave it. Not getting paid enough to cover the costs of caring for your patient? Sorry!
Monopolies in the health care market? Hardly. What's going on is somewhat of a free market enterprise. The catch is that the prices of services are not transparent. Even if prices were transparent it's hard to compare and contrast effective buying power when you can't evaluate the quality of the services rendered.
Physician's are the biggest gainers? If you think that physicians will gain from more consistent underpayment of services rendered…..then sure physicians are the biggest "gainers". The general sentiment among US physicians are they they do not get paid enough for treating medicare and medicaid patients. In fact, many physicians will go onto claim that they LOSE money for each medicaid patient they treat. Why would any rational physician choose to lose money to treat patients? I don't know….compassion maybe? While the AMA supported Obamacare, many physicians were against reform because it doesn't cover the issue of physician underpayment.
Gouged for unnecessary care? Try med-mal reform….oh wait the lawyers have already bought out congress. Do unnecessary tests happen in the hospital? Yes. It's call SYOAM (save your own a** medicine). A guy have a rare 1/10,000 heart problem that can only be determined by CT scan? Okay then everybody who has chest pain (or even abdominal pain) should get a chest CT to rule out an aortic dissection.
If we have more people understanding the health care system then there will be a lot less people wanting to taking the shotgun to the physician.
Steven,
Of course, physicians are subject to the Sherman Anti-trust act just as lawyers and other professionals are not allowed to fix prices. I was referring to rent seeking behavior of individual physicians and for profit hospitals. These behaviors are reflected in the tendency of physicians to generate demand for their services in an already saturated market. Physician shortages are in areas where rent seeking is not possible. Each physician tends to be an individual monopoly as does each hospital. Hospitals compete not for patients but for physicians who bring patients. As a result their behaviors are cost increasing through overcapacity and physician demanded equipment.
You point out that Medicare and Medicaid are badly run as physicians and hospitals don't know when changes will occur and they face an uncertainty from accepting these patients. Many physicians have and even the vaunted Mayo Clinic has in some instances refused to accept these patients. This is more a lack of good analysis skills at Medicare and Medicaid and a lack of price transparency and price discrimination on the part of providers than deliberate underpayment.
Wow – not quite sure where to start there but your statement that a lack of price transparency isn't the reason for the Mayo pullout is coming out of left field. Medicare and Medicaid – especially Medicaid – don't reimburse at cost and force cost shifting to private payers. They are also incredibly poorly administrated and a never ending source of expense and headaches for providers attempting to interact with them. So not only do they not pay well, it is a pain to get paid. Medicare is the big issue of course because of its size, but as more and more primary care physicians refuse Medicare patients we might escape the program's bankruptcy because no one will take the insurance anymore. I realize that has a way to go with specialists and hospitals, but it didn't used to be a problem at primary care either.
Hi, I think that the lack of price transparency or the ability to properly price medical services is part of the problem. Because of wide variation of pricing for the same services provider to provider indicates an arbitrary pricing scheme by individual providers. As a result when Medicare and Medicaid look at median price some providers who are less efficient will have a shortfall. If price was actually determined through cost accounting then price variation would be lower and median price would be closer to average price.
Price transparency is part of the problem. Price variation among providers using the same factor inputs for similar services indicates a certain arbitrary pricing scheme. This indicates that cost accounting is not being used appropriately. All providers face similar factors of production and price variation should only follow the regional differences in cost of production but practice variation shows that different providers use the factors of production in varying quantities for similar outcomes. So, there are two problems that make price transparency difficult. In the first example we have arbitrary pricing and in the second we have a difference in the relative quantities of the factors of production to produce a health outcome. Both generate widely varying prices for the same services. It is hard for an insurer or Medicare or Medicaid to disentangle these prices and arrive at a rational median price. Some providers will be overpaid and some underpaid according to their costs of production.
Practice variation is just one example of how a cardiology practice in Elyria, Ohio can perform angioplasty's at four times the national average. see:
http://www.nytimes.com/2006/08/18/business/18sten…
This is the tip of the iceberg of monopoly behavior that is driving up our insurance rates. The root cause is a lack of regulation of physician and hospital compensation not greedy insurance companies. Physicians and hospitals should be subject to anti-trust oversight. It would be far cheaper for the federal government to educate and train physicians and purchase diagnostic equipment than for the federal government to be gouged over and over for unecessary care and tests at inflated rates and rates which vary provider to provider to defy even geography as an explanatory factor.
If we don't have the providers screaming bloody murder then there is no effective healthcare reform.
Republicans should focus on individual responsibility. Insurance isn't the solution, it's the problem and primary cause of high costs. Eliminating insurance and having individuals negotiate with physicians directly would reduce cost and offer no new impediments to either improved health care or entry to the health care profession. Insurance should be used only for catastrophic health care needs. Whole Foods has an excellent workable model that, with some government funding of overdrawn health care savings accounts, could offer universal health care and lower costs.
Why do people keep talking about insurance reform. Individual responsibility (privatized health care) is what will solve our problems, not improved traditional Health insurance.
Ed, Health insurance doesn't cause high healthcare costs anymore than fire insurance causes building replacement costs to rise. The problem is with providers. See what Maryland has done.
http://www.thehealthcareblog.com/the_health_care_…
Maryland has transparent pricing, no price discrimination and open enrollments for all insurance customers. Insurers can't skim the cream in Maryland. Here is an example of how healthcare can be reformed at 0 cost, change regulation. Easy, clean and you eliminate economic rents.
I think Ed is on the right track. A great example of this is Lasik surgery. If you consider the advances in technology, efficacy, better outcomes, AND lower costs, it's all due to market forces for an out-of-pocket procedure. Granted, it's an elective surgery, but consider the colonoscopy my wife is undergoing in March. Without insurance its $750 bucks. In a manner of speaking, it too is elective. I would bet if thrown open to the market, the cost would eventually drop in half, with valet parking to boot!
One certainly doesn't submit a claim on their homeowner insurance for a leaky faucet. Indeed, cut the co-pays and coverage of the routine diagnostics, unless you want to pay extra for them.
I would like to see the tax advantage of buying healthcare moved from the employer to the employee. If the employer would up the pay to the tax-equivalent to the employee and let the tax credit and the insurance stay with the employee, no matter where he went or what he did.
Before you let the "market" forces run free, you need to have price transparency. It's hard to judge if the health care is "worth it" if you don't know how much it's going to cost you.
Also, most people cannot effectively evaluate what a particular procedure is "worth" to them. Lasiks is a clear cut cut example (pun intended) where you know exactly what you are going to get with the money you pay. Do you know exactly what is going to happen if you decided not to get a heart stent? Even the doctor won't know exactly what's going to happen! There are probabilities and complications but everything is variable. It's hard to price a moving target.
Health care and Social Security should depend on individual responsibility. Both are funded by pay-as-you-go and will collapse or cost so much that the country will become a socialist state. Even then, we will have great problems as is well known in Europe where some of their Social Security programs are in deeper trouble than ours. Ours is one of the better off, but still will require increased taxes, reduced benefits or increasing the age of retirement. Within a very few years 2 people will be supporting one on Social Security. The same finance plan, if you can call it that, is what funds Medicare. That needs to stop very soon. US Goverment pays $704B in medicare support as best I can tell The overhead of local, state, federal governments and insurance companies and collection agencies is transparent evidence that the money is not well spent. Eliminate tax on retirement savings and health care savings, require people to make those savings payments to their OWN accounts (or else they are taxed) and we can dig our way out of financial disaster that appears looming in the not too distant future.
Our government and all the libs will worry about the poor so, the government would simply cover overdrafts of health savings accounts but require the individual to repay by removing the periodic deposit from pre-tax earnings — sort of like SS now..
Where are suggestions along these lines for Republicans to submit? How could any politician argue with this. It delivers universal coverage, improved health care and reduces insurance companies profits. This should be wonderland for libs and progressives — unless there is something else in their agenda I have missed.
"but do not feel obliged to have a single unified Republican proposal."
I don't want the Republicans to try to "improve" the existing bills. I worry that they will try to prove that they can be bipartisan and forget good sense. Your advice is excellent. Hope they are listening.
Obama is hoping to recreate the House Republican retreat atmosphere and stacked the deck a bit to be sure. Paul Ryan emerged from the last event as a rising star, he has offered a plan and yet he is not on the invite list. If he was really interested in hearing Republican ideas he knows Ryan has offered them. He doesn't want to go toe to toe with him though on national television.
Read Ezra Klein's reaction to the guest list:
"This seems like too many people to get anything done. And where are the good-faith folks who'd actually have something interesting to say? Ron Wyden's not on there. Jay Rockefeller's not on there. Even Olympia Snowe's not on there. They've left off the people who know the most about the subject and would be likeliest to cut a deal. Obviously, that's not an accident:"
This is not a serious effort to reform health care and in my opinion the President is likely to have this backfire. Recent polls show the public prefers the Congress start over as the Republicans have suggested. The continued focus on health care while unemployment and concerns over the economy are high may show bull-headed perseverance, it also is completely tone deaf. The Republicans would do well to heed your suggestions participate constructively. They benefit by the fact the President continues to drag health care through the second year no matter what happens at this debate.
“In other states, when a patient who doesnt have insurance pays out-of-pocket, hospitals frequently charge him prices that are far higher than the group rates that private insurers have negotiated. In Maryland, by contrast, uninsured patients are charged the fixed rates that everyone pays.” – That’s from the Maryland article referenced above. I find this statement unbelievable. Rush Memorial Hospital in Chicago announces on its web site that if you pay cash when you go into the hospital you get a 50% discount. Doctors frequently do that also.
Insurance is an expensive overhead and a method of wealth redistribution. Why should I be in a pool where my money is paying for someone’s pregnancy? Why shouldn’t a doctor be much happier if he doesn’t have to deal with insurance companies. I know that for many doctors a whole “insurance administrator” person could be eliminated from the office staff. That goes for dentists also. The insurance knowledge by healthcare support people is not cheap.
There is no fix for insurance. Insurance for planned medical care is not insurance, but a pool for wealth distribution and in that form should be eliminated.
Insurance should be for catastrophic health problems only. Otherwise, people should pay for their own health care. They can do that if they are allowed to save with pre-tax dollars and the fund belongs to the individual — the government cannot get its hands on the money. [The same solution applies to Social Security.]
I await real solutions to our healthcare “issues”. A real solution will drastically reduce the role of “insurance” in my health care future, offer universal coverage and lower costs. It can be done.
A 50% discount for cash. But from what price? If that price is from the hospital chargemaster then the individual is probably still paying more than other payors. And who has $50,000 allocated to healthcare, isn't that the role of catastrophic coverage?
Health insurance is not the problem is provider price discrimination. Again the Maryland example speaks volumes. A highly skilled commission, sensitive to provider needs replaces all of that administrative overhead and prevents insurers from closing enrollment and benefiting from insuring a relatively healthy sub-group of the Maryland population. Large insurers like Aetna tend to have a good cross-section of healthy and sick so their loss ratios tend to be in the high 70% to low 80% range. A cream skimming HMO might have a much lower loss ratio. Maryland makes all insurers have a relatively high loss ratio but they have a lower cost of doing business in Maryland as a result.
I have a big problem with government price controls. What happens when the Maryland commission prices something too low? Do the doctors just accept it? Why do you think a commission isn't political? For instance, a progressive commission might prefer lower costs to support the poor to remunerative rates for hospitals and doctors.
There are price comparison sites available in some markets for health. Here's one for
Chicago:
http://www.leslieslist.org/low-cost-testing.php?e…
The 50% is a well known price cut for not having to deal with insurance, government or charity. If you have gone to the hospital lately and been changed $200 for a styrofoam cast then you know they charge with the market will bear. If you were paying out of pocket and complain you might have found their price was soft. We did and they lowered it. That is what we have found in New York City, Pittsburgh, Chapel Hill, and now Austin. Through a combination of daughter in college sports and our own needs, we have been through the hospital mill in all 4 of those sites. They will negotiate. Why they all seem to do business that way is not clear to me, but that's what we've seen.
Rush Memorial Hospital in Chicago says right on their web site that if you pay in cash up front, you get a 50% discount. You can look at Leslie's list and see many of the other hospitals in Chicago.
You mention $50,000 allocated to health care.a bill that size would definitely fall into the catastrophic health care insurance scheme. All planned health care should be paid for out of pocket. That would include colonoscopies, child birth, annual checkups, pap smears, breast X-Rays, Chest Xrays, and dental care. When the costs of these items come out of your own pocket you get more interested in the keeping yourself maintained.
With the proposed health savings accounts, you would still be paying, but there wouldn't be an insurance [or government] middleman taking money from you and raising premiums and telling you what is and is not covered. I see no downside at all to removing most insurance companies and government from the health care picture.
I generally agree that catastrophic insurance and an HSA works when you're employed and it works when you're not suffering from a chronic ailment. An Accountable Care Organization or ACO can lower the costs of managing a chronic ailment and this is where a traditional policy would be appropriate. So one size cannot fit all.
Question: Let's imagine that Obama genuinely wants to find a good health care proposal that addresses the 4 questions he raises at the end of his letter. What could he propose that would not be viewed unfavorably by the right?
Should it not be on TV? ("Behind closed doors!")
Should it be on TV? ("It's a trap!")
Should he put forward his own proposal? ("He's shoving it down our throats!")
Should he not put forward his own proposal? ("Where are his ideas? Where is his leadership?")
Should he request Republican proposals? ("They're only seeking to embarrass Republicans!" says Keith)
Should not request Republican proposals? ("He's not interested in hearing opposing views!")
Should dictate which Republicans be invited? ("He didn't even invite Snowe!" says Keith)
Should he leave the door open for 4 invitees of the Republican's choosing? (This is in fact what he did. If the Republicans want Snowe there, they should invite her.)
Keith leaves no room for the possibility that Obama is genuinely interested in quality legislation to resolve the health care problems he clearly identifies at the end of the letter. I'll ask again:
If Obama genuinely wants a bi-partisan dialogue on health care, what could he possibly do that wouldn't be seen as a trap or disingenuous by the Republicans? Is there any way for him to accomplish an actual dialogue on this issue? How?
Take it off TV, have it done privately and agree to start over.
Yes, he can. He could appoint a Conservative to head the panel and charge him with solving the health problems.[Recall Ghandi's advice to the Hindu mans whose son had been killed by an Muslim]. He could state the problems in a very short list:
1. Universal care without bankruptcy as a possibility
2. Improved health care; continue leading the world in health care research and results
3. More doctors (US has too few).
That would shock everyone and offer possibility of real improvement.
Well, Barack, do you feel lucky?
So much debate,
Why does the US not copy France or Sweden or Germany or Japan.
I think they have better health care than the US.
No – they don't. And not even France's model is maintaing any sort of cost containment anymore.
The US system is by far the most successful intreating sever acute issues – it is the place of service for the world who can get her. Also, somewhat surprising to me when I read this is that we do more preventative screening that the nationalized systems as a percentage of the population. Most of our bad outcomes data is a lifestyle issue than a statement on the quality of care. The US is sedentary and fat. A very dangerous combination.
The ' take-it-or-leave-it, or option A vs. option B exercise" sounds like the same game plan the Motion Picture & Television Fund tried to execute when it sought to close its hospital and long term care unit by redefining its historic charitable mission. What happened when it threatened to evict its ill and elderly patients in a surprise, shock and awe mover? Not so surprisingly those patients who were about to be dumped into other facilities , and their families, pushed back on a number of fronts. Now, over a year later, Mr. Katzenberg and the MPTF board find themselves in an embarrassing and uncomfortable position. Entertainment industry support for keeping long term care open is vocal and growing. The CEO was forced to resign, and more resignations are on the horizon. There is rumor of dissension on the Board. At least one Board member resigned early last year with integrity intact while others dug themselves into an untenable position. So goes Hollywood, so goes the nation. Or maybe it's vice versa.
Either way there is a lesson to be learned in trying to blitz through an ill-conceived plan without dialogue.
Doctors have been able to carve out profitable lines of specialty service because there is no price transparency to their customers. If you eliminated third party payers and required everyone to purchase their own private health insurance coverage and contemplated what the true cost of service is, we might see an entirely different response to private ortho hospitals and other surgery centers. Right now the real cost of any significant surgical procedure to a patient is effectively zero – so why not consume? Of course the private providers also do a very high quality job, in fact much higher than their hospital competitors in the few real quality metrics that exist for public consumption – much more need to be done in published consumer literature on cost and outcomes too.
Nowhere in any of the discussions have I seen an average cost analysis. How much does it cost to be a human being? What percentage of the average income in the US (the private average income, not the government average) should be put aside to pay for all of that person's medical costs of his lifetime? 1%? 5%? 8% 12%? What are those numbers? I have never seen them. I do know that paying premiums for insurance throws money into a pool which is used for other people's health care. I do know that insurance costs money to have, to sell, to manage, and to partake of [doctors have to deal with insurance companies]. If individuals paid doctors and hospitals and labs directly, price transparency would naturally arrive and most ordinary procedures would be well understood by the public.
$36K is the averate as of 2006. On average, how much of the $36K is necessary to cover that person's medical needs over a lifetime? Anyone have a good reference on that?