Originally Posted by Greedy,Greedy,Greedy
Huh? That showed a complete lack of understanding of the system today.
Just to note, today, there are many people pushing on healthcare costs - insurance companies negotiating contracts, governments and businesses with large healthcare expenses, consumers who have to choose among insurance plans. There are relatively few plans that cover "everything", and the few with extremely broad coverage are very expensive.
In the absence of sophisticated negotiators like insurance companies, there is a very good argument our prices would be significantly higher, since the provider would have disparate negotiating power. Providers are severely limited - building a hosptial is expensive, and hospitals are sine qua nons for much health care. Plans that tried to do it a different way (see Harvard Pilgram Health in Mass.), building up their own lower cost clinics where they could controll prices, ultimately failed because they could not compete with the quality of the Boston teaching hospitals (though they had a good run with an alternate model, which did have a lower price for a while).
By the way, you don't have to look to economic theory to see some of the savings insurance negotiations get you. Compare jurisdictions where there are few insurers and many hospitals and jurisdictions where there are many insurers and few hospitals - in the later case (e.g., Massachusetts), healthcare costs are higher. Here, as a matter of fact, one healthcare system has so much bargaining power that plans cost less which exclude that system - they are available and a few people choose to give up that care and get lower cost healthcare. They also miss a lot of key specialists.
So, silly banana argument misses the banana boat. It's all a work of fiction that bears no resemblance to how healthcare is paid for.
Now, I can spot some huge problems in the incentives. For example, if a hospital has a large capital investment in a piece of equipment, like an MRI, the hospital needs to use the MRI. Today, everyone has bought their own MRI, as well as a slew of other radiology equipment. You have no swagger without PET and CAT as well. However, the best care is not always to do an expensive radiology test; there are many unnecessary tests done. There are also systems for catching unnecessary tests - but the hospital has to buy and invest in these. If you are a hospital CFO, will you spend money to buy a system that will reduce the profit you make on big capital investment?
There have been several attempts to deal with this issue, but one of the things Obamacare will do is cause medicare and medicaid reimbursement rates to be paid in part on outcomes rather than on itemized tests etc. that are run. That is huge, and it deals with the system as it exists, not as some Randian banana dealer imagines it exists.
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