I not operating under an assumption that the bill would solve the costs, other than that it must be one of the reasons for the bill to be introduced. (Other than preventing non-insurance with people who can't afford it.) I listed several things that are a direct threat to the health care system in the US, and I asked: what can be done.



HAHA. Did you really just use "I think you are wrong here, therefore you're not entitled to an opinion"? HAHAHA That's classic.

"So what?"?? You live in a society where a basic insurance package is $US 12,000 per year and you don't mind it going up? My insurance premium is $US 2,500 per year for me, my wife and two children.

And how prices go up? It's basic insurance economics, really. (And yes, it works the same in car insurance.) The decision to take insurance depends on the utility you get from insurance (your income minus the premium), versus the expected income of not insuring. (Your income times a probability to stay healthy, plus your income minus your medical costs when you get sick, times the probability to get sick). If U(I - pr) > U(I) * (1-P_sick) + U(I - C) * P_sick, you buy insurance. Otherwise you don't.
If I am a young, healthy person, and I make a sound decision between my expected health care costs and the insurance premium, I may choose not to take the insurance, especially if my income is around $US 35,000 and I would have to pay one third of that on health insurance. An older or less healthy person will see a large likelihood of medical costs in the next year (maybe based on the fact the person was hospitalized for three days last year, costing about $US 50,000) and will opt for insurance.
Only the relatively higher risks are taking insurance. (And the very risk averse.) This in turn raises the expected costs for the insurance company per insured person, which raises the premium. The whole cycle starts again from the beginning, with more people deeming themselves to healthy for the stated premium.

That said, there is something to be said to break the hold that both special interest groups and (insurance) companies seem to have on the health sector, and giving it back to the people who (might) need medical care in the future.



You might want to look into the field of HTA (Health Technology Assessment) if you really want to know. Looking at the additional costs of new technology per life years gained is a legitimate way of looking at health care, if only to keep a check on pharmaceutical companies ("You don't care? You want to pay anything as long as you get better? Fine, here's my drug. You can have it for $US 1,000,000. Daily." ), or to make a distinction between two types of new drugs. E.g.: www.ispor.org, the International Society for Pharmacoeconomics and Outcomes Research.

I really don't think that you, me and Aunt Em can make our own decision on what constitutes a cost-effective level of treatment. Especially not for those treatments for which I'm insured (large operations, expensive drugs, long term care plans). The problems I have (see my reply to LadyLorraine above) is that free markets don't work here. Buying a car (insurance) is different from buying medical care (insurance). I mentioned a lot in the above post, but the relevant one here is asymmetric information. There are many hidden factors that you and I don't know as a layman: most of the effects (How much does this help me?; Will it cure me, or only partly?; What are the side-effects?) are difficult to grasp even for doctors who struggle to keep up with the latest research (and Google-Fu skills don't help here, you need the entire power of the Cochrane Society or other meta-analyses behind you), costs in the health care sector are notoriously opaque with nobody being open about the true costs of a procedure or a drug (whole studies are done about this), uncertainty of future medical costs (What are the chances of getting an illness?; What does a certain probability mean? (which is difficult to grasp for most people); What are the effects of the illness?; or more fundamentally: What kind of illnesses can I even get?), all options of treatment (Does the doctor tell me everything, or am I only hearing what he wants to tell me because of his bonus from the pharmaceutical companies?; Are there really bonuses from pharmaceutical companies?; What kind of new treatments have only just been registered?; What kind of treatment have been approved in other countries but not yet here? - the whole "You need to see a doctor in order to see a doctor" problem).

The frontier of what constitutes cost-effectiveness should be part of a societal (political) debate, as it is in most countries in Europe, for two reasons: 1) I don't think an individual can make that decision and 2) it's not just YOUR money you're spending it's OURS (all insurees). Plus: it should NEVER be the sole criteria.



My concern is that these companies are apparently not taken to criminal or civil court. My answer is not to increase the dependency, I don't have an answer. I just threw it out there as an obvious problem that's happening right now. And what's worse: it's apparently already taken for granted.
The amount of data that needs to be kept, plus the difficulty of getting reimbursement is a genuine concern for providers, that needs to be addressed in any systematic change.



No, I don't think it's a problem, I noticed it's a difference in viewpoint. One that I found very interesting. Dutch doctors do have a default setting in saving lives, but they don't go as far as US doctors. At least academically, this is worth the effort of looking into.
As an example, in the Netherlands, patients with small brain tumors are treated with precision radiation, if they have up to ten tumors. More than 10, and the risk of brain damage is deemed to high. These patients receive a less invasive wide beam radiation. This is not "write them off" - it's "I want to save this patient, but I also want to prevent brain damage".
In the US, patients with 20 tumors or more are still treated, which is a very costly and time consuming procedure. They weigh the probability of brain damage much lower, but focus on survival (which could be a couple months extra). Is it better? Is it worse? I don't know, but I love to see it discussed, which might help the US to lower health care costs and might make survival longer in the Netherlands.

Progress comes not from merely taking a different viewpoint, but from a discussion of different viewpoints.

Society has to spread limited resources towards several millions of patients across the country (each of which are somebody's father, wive, son, granddaughter), many of them not suffering from a deadly disease. For that matter, those resources also need to be used for new roads (or repairs as I noticed while in California...), police departments - fire departments - military that needs funding, food that needs to be produced, etc.
There is only a limited supply of resources, and in order to allocate this fairly (and efficiently), you need to have criteria. Yes, personally I think that quality of life should be taken into account, at least partly.
And just like you I want a say in how my money is spent. But since it's rather ineffective to have everybody have a direct say, I am willing to give it in the hands of society, or by proxy it's elected representative(s).



As I said: I don't think the health care market can work as a complete free market, simply because the number of opportunities of market failures (despite the number of potential government failures) are huge.
I do agree with stopping to force employers to provide health insurance, and less power for special interest groups. Not sure I would want all restrictions on insurance companies gone, as there is a huge risk of this going wrong (privacy issues being one).


But let's make it clear: I'm not a US citizen, and I don't have any interest in interfering with the way you handle health care problems. My interest is partly academic, and partly a concern for the overall effects on the world economy if the system does start to present problems that spill over the borders of the national economy.