I have posted something similar before here, but am visiting boards (along with a few other from Tickerforums) hoping to bring attention to an issue that we think will be disastrous for the economy in the short to medium term, and which very few talk about. What we hope to do is get the medical reform proposed by Karl Denninger put in place before things get out of control (https://market-ticker.org/akcs-www?post=231949 ).

This will take a few minutes to read through, but I ask that you do and promise the threat here is real. First, I would ask that you just take a moment and look at this graph from the world bank. It shows the percent of America's GDP that is going into medical care.



Now I want to point out that where the graph starts (around 13% on medical care) is already higher than almost every other developed country in the world (can see them all at http://data.worldbank.org/indicator/SH.X...start=2000 ) and was high for the United States in 2000 by historic standards. Most those other developed countries today have socialist type systems for health care which should have naturally higher costs (arguments can be had between the two systems, but free markets are virtually always at least somewhat cheaper if there is competition). The trend is also not changing (the graph is a few years old). Last year we went past 17.8% of GDP on just healthcare which is insane by any historic or international standard (https://www.cms.gov/research-statistics-...rical.html).

Now let me ask two questions. 1. Do you think your income is increasing at the same rate as medical expenses? 2. Do you think this is a trend that can continue without major consequences?

What is Causing it?

Our basic problem is that the medical industry is treated completely differently than every other industry by the federal government. While other industries are all subject to anti-trust laws which force competition (and thus lower prices), the medical industry has not been subject to those same laws for a long time. It is not that those laws have been repealed, they simply have not been enforced on it in decades.

Let’s compare experiences. If you have a major purchase decision, like say a car, you look at multiple dealers or online. You look at what you are getting for your money and make the best decision. Since car dealers know you are looking between them, they try to keep the price of their cars down and make business decisions that allow them to charge less. Even if you don’t do that great of research, you probably end up spending less simply because the dealer must keep the price down as he or she knows many others are comparing and a reputation for high prices will hurt even among customers who do not look at closely.

Now let’s compare that to a hospital experience. Let’s say you are healthy right now and don’t need anything? Is there any easy way for you to go look up the difference prices for hospitals? Maybe Hospital A charges a little less for everything or Hospital B overcharges on many expenses. Of course, it is even more complicated than that because the hospitals have agreements with different insurance companies to charge different prices. What the hospital charges with one might be several times more than what charges it for someone on a different insurance or what is charges someone with none at all.

Now let’s say you get sick. You go to the hospital, they tell you everything you need, and you only get a final bill after everything is done. Now maybe Hospital A and Hospital B weren’t that different in cost, but maybe they were. Even if they weren’t, if they had to publish exactly what everything cost beforehand, they would have had far bigger incentives to keep prices down that they do now.

To put this in perspective, a women in Arizona was charged $83,046 for anti-venom at a hospital while it costs just $100 a dose in Mexico (http://www.nydailynews.com/news/national...-1.1152754) . While this is an extreme example, it’s indicative of our whole medical system.

I don’t want to get more into this here as I know this post is already getting long, but you see similar issues throughout the medical industry.

What Can You Do?

What we want to do is spread the word on things that would help our system. Karl Denninger has posted the following proposal https://market-ticker.org/akcs-www?post=231949 . What we are hoping for is that we can get this trending and force a new discussion away from the Obamacare/Republican Replacement plans, both of which are useless for addressing our issues.

One Final Thought: The Federal Debt Bomb

I would like to end with a series of graphs showing how this problem is effecting government spending. The only thing that these graphs show is what the Centers for Medicare and Medicaid Services spends each year and come straight from the Treasury (you can see the most recent full year on page 10 at https://www.fiscal.treasury.gov/fsreport...ts0916.pdf if you want to). Look at its growth over 16 years vs. the entire rest of the federal budget (which has also grown a lot). Note: After making these graphs I realized total government spending is somewhat higher than the number I used here as the federal government subtracts somethings along the way rather than putting everything it brings in as revenue and considers some things off budget (which effectively is used to distort true spending and debt). None the less, the graphs show the trend well enough and at most are just moderately ahead of where we are.










From these charts, I think we can very clearly tell one thing. The federal government cannot continue to afford ever increasing medical expenses. If we add in the interest paid on the debt every year to the expenses from the Centers for Medicare and Medicaid we are now up to over 4 out of every 10 dollars of the federal budget accounted for. That is leaving an increasingly smaller percentage for absolutely everything else the federal government pays for. The net result of that is that the federal government continues to borrow large sums of money to continue all the programs it wishes to.
That the federal government cannot afford these increases in prices any more than individuals or companies can presents us with one final worry, and it is the biggest of all.

Remember, that the federal government is also spending ever increasing amount of money on just interest on the debt. Right now, that interest is very light, but given the huge debt, is still hundreds of billions of dollars a year. Even a small increase in worry that the federal government will not pay back all its obligations will result in interest rates getting much higher much quicker (which means the federal government would have to borrow even more to keep up). In other countries where we have seen that happen and unless there is outside intervention (and there wouldn’t be anyone big enough outside to help the United States), interest rates on government debt go from relatively low to unaffordablely high in a very short period. At that time, it becomes virtually impossible for a government to borrow money. A change that massive would leave the United States instantly in the worst depression we have ever experienced. That is a future I do not see us having any chance of avoiding when we have medical costs going up at their current rates almost every year.

That is the future we are hoping to avoid. Please help us get Karl Denninger’s proposal trending. https://market-ticker.org/akcs-www?post=231949

seriously laughing my ******* arse off at tardism that's always displayed by THEE OSU....

if you honestly think you can stop that cash cow when the largest generation is aging into their 70s/80s/90s, you have serious lack of comprehension issues....

once the boomers finally die off and the money is siphoned along with it, she'll implode.....then your health care will be comparable to the rest of the world....

there's no fixing this one....

I think there is some jumping around here logically.

What's the problem with hammering the industry with the likes of Robinson Pattman? Medicare and Medicaid are the answer to that.

When you have the government essentially sitting between consumers and providers its difficult to keep things in line.

I think we may be seeing a major shift though in the near future, if Trump doesn't reverse course which I doubt he does. Here's to hoping that North Carolina Dental harolds the coming of a period of aggressive change for the positive.

(04-07-2017 11:46 PM)stinkfist Wrote:  seriously laughing my ******* arse off at tardism that's always displayed by THEE OSU....

if you honestly think you can stop that cash cow when the largest generation is aging into their 70s/80s/90s, you have serious lack of comprehension issues....

once the boomers finally die off and the money is siphoned along with it, she'll implode.....then your health care will be comparable to the rest of the world....

there's no fixing this one....

Except the problem is not primarily about the number of people receiving more medical care (that just compounds things), but price of those services (compare prices now to prices of the 80s, of the 90s, or of 00s vs. inflation). Exponential growth is a very nasty thing as things go from fine to way beyond affordable in a fairly short period of time and that is where we are at. If it was just boomers getting older, the trend would be far newer, rather than stretch back decades. Almost every aspect of the medical industry has prices going up far, far faster than inflation and has for decades with a few years off here and there. That will continue to happen so long as the anti-trust laws that have been key to keeping competition strong in every other industry are ignored here.

As things stand, we are not going to make it till past the boomers before things implode. Our real national debt increase last year was around $1.4 trillion dollars. The number you more regularly see quoted is because of things off the main budget balance sheet (like social security using trust fund interest, which has already been spent by the government years ago), but if you look at the actual amount of debt the government added straight from the Treasury, that's the number. At the absolute most we are talking a decade before things go to hell and I think that is highly optimistic.

HeartOfDixie, applying things like Robinson Pattman and Sherman Anti-Trust (old laws), is 90% of what needs to be done. There are a few new ones that will help, but the lack of basic anti-trust regulations being applied is the biggest issue and why the mess has made it to this level.

Not going to write a thesis but I'd suggest that a major reason for the increased cost of medical care is that there is now more of it.

As recently as 20 years ago, there were no effective therapies for psoriatic arthritis. Now drugs like Humira can cost thousands per year. Many of the newest cancer treatments cost tens of thousands. New radiological tests like the PET scan cost magnitudes more than simple x-rays, and multiples more than an MRI.

Nonetheless, some very good work has been done on this subject at Harvard Business School. Take a look at what Reggie Herzlinger (my accounting professor), Michael Porter and Clayton Christensen have done.

If that were all it was, it would simply be a case of us having to be more picky about we you used with this trend (or else it would still bankrupt us). It really is not the biggest thing though and technology has also served to reduce costs which is often forgot about (look at what it has done to so many other industries).

You cannot have prices on most things rise several percent a year beyond inflation forever. It mathematically is going to eat up increasing amounts of the budget if it does, but that is the shape we have been in for years and if it goes on too long, you are bankrupt.

edit: Even if you guys don't agree, I really do recommend reading the proposal I posted at the top. I think it explains things far better than I do.

(04-08-2017 07:27 AM)ohio1317 Wrote:  Except the problem is not primarily about the number of people receiving more medical care (that just compounds things), but price of those services

You're ignoring that the medical care needed by older people is a lot more expensive than that needed by younger people.

(compare prices now to prices of the 80s, of the 90s, or of 00s vs. inflation).

A better idea, lets not pretend there are only two inputs and we will compare the prices and the average age...

(04-08-2017 07:27 AM)ohio1317 Wrote:  

(04-07-2017 11:46 PM)stinkfist Wrote:  seriously laughing my ******* arse off at tardism that's always displayed by THEE OSU....

if you honestly think you can stop that cash cow when the largest generation is aging into their 70s/80s/90s, you have serious lack of comprehension issues....

once the boomers finally die off and the money is siphoned along with it, she'll implode.....then your health care will be comparable to the rest of the world....

there's no fixing this one....

Except the problem is not primarily about the number of people receiving more medical care (that just compounds things), but price of those services (compare prices now to prices of the 80s, of the 90s, or of 00s vs. inflation). Exponential growth is a very nasty thing as things go from fine to way beyond affordable in a fairly short period of time and that is where we are at. If it was just boomers getting older, the trend would be far newer, rather than stretch back decades. Almost every aspect of the medical industry has prices going up far, far faster than inflation and has for decades with a few years off here and there. That will continue to happen so long as the anti-trust laws that have been key to keeping competition strong in every other industry are ignored here.

As things stand, we are not going to make it till past the boomers before things implode. Our real national debt increase last year was around $1.4 trillion dollars. The number you more regularly see quoted is because of things off the main budget balance sheet (like social security using trust fund interest, which has already been spent by the government years ago), but if you look at the actual amount of debt the government added straight from the Treasury, that's the number. At the absolute most we are talking a decade before things go to hell and I think that is highly optimistic.

HeartOfDixie, applying things like Robinson Pattman and Sherman Anti-Trust (old laws), is 90% of what needs to be done. There are a few new ones that will help, but the lack of basic anti-trust regulations being applied is the biggest issue and why the mess has made it to this level.

That begs the question though, how can you when the 800lb gorilla is the government itself? The anti trust laws don't contemplate that situation.

(04-08-2017 10:25 AM)HeartOfDixie Wrote:  

(04-08-2017 07:27 AM)ohio1317 Wrote:  

(04-07-2017 11:46 PM)stinkfist Wrote:  seriously laughing my ******* arse off at tardism that's always displayed by THEE OSU....

if you honestly think you can stop that cash cow when the largest generation is aging into their 70s/80s/90s, you have serious lack of comprehension issues....

once the boomers finally die off and the money is siphoned along with it, she'll implode.....then your health care will be comparable to the rest of the world....

there's no fixing this one....

Except the problem is not primarily about the number of people receiving more medical care (that just compounds things), but price of those services (compare prices now to prices of the 80s, of the 90s, or of 00s vs. inflation). Exponential growth is a very nasty thing as things go from fine to way beyond affordable in a fairly short period of time and that is where we are at. If it was just boomers getting older, the trend would be far newer, rather than stretch back decades. Almost every aspect of the medical industry has prices going up far, far faster than inflation and has for decades with a few years off here and there. That will continue to happen so long as the anti-trust laws that have been key to keeping competition strong in every other industry are ignored here.

As things stand, we are not going to make it till past the boomers before things implode. Our real national debt increase last year was around $1.4 trillion dollars. The number you more regularly see quoted is because of things off the main budget balance sheet (like social security using trust fund interest, which has already been spent by the government years ago), but if you look at the actual amount of debt the government added straight from the Treasury, that's the number. At the absolute most we are talking a decade before things go to hell and I think that is highly optimistic.

HeartOfDixie, applying things like Robinson Pattman and Sherman Anti-Trust (old laws), is 90% of what needs to be done. There are a few new ones that will help, but the lack of basic anti-trust regulations being applied is the biggest issue and why the mess has made it to this level.

That begs the question though, how can you when the 800lb gorilla is the government itself? The anti trust laws don't contemplate that situation.

XACLY!

you cannot imagine the boon in health care facilities that have been built in my little po-dunk 'planned retirement community' over the last decade....I'd put Hattiesburg's expansion up against any municipality using only the 'eye test'....

Ohio, the Denninger proposal has some good points--pricing transparency, same price for all--but I have one question.

Why would any sensible person choose to be a doc or other health care provider under those rules?

And a follow-on question, with no providers, how are you going to have health care?

Back from work and will try to address points.

Bull_Is_Back,
No there are not just two inputs, but I can show why average age is not a huge factor in this in two ways.

The first is from the Treasury report. https://www.fiscal.treasury.gov/fsreport...ts0916.pdf (page 31) There are 4 areas of covered by the Centers for Medicare and Medicaid in it. From fiscal year 2015 to 2016, we saw the following percent changes in them, Grants to States for Medicaid up 11.95%, Federal Hospital Insurance Trust Fund up 5.4%, Federal Supplementary Medical Insurance Trust Fund up 13.87%, other up 14.3%.

Those are how much each program rose in a single year. Age is relevant and could increases costs, but we are not ageing even close to the level were we should have better than 10% a year increases in cost be the norm.

Next, look at the graph below (from the Market Ticker).



In this, you can see that Medicare (which by definition will be all older people) does not have significantly different rate of change than total health care changes. Side note: We did get a small drop in the year transition period to Obamacare, but that was always going to be short lived. The long term trend remains the same.





Owl 69/70/75, you are right that some of the incentives will be lost (this would remove a ton of money from the medical industry which would mean everyone in it would tend to get less), particularly over the short term. The things to keep in mind though are:
a) This is not something radical the United States would be experimenting with. You don't find many countries, 1st or 3rd world, who allow this level of noncompetitive behavior.
b) This is only putting into place the same type of restrictions virtually every other industries already face. While the transition would suck, this is not a plan that says don't make money. It simply in intended to make sure the competition is there to keep prices down (again, like everything else). Doctors and the like would still make what the market dictated, just without artificial barriers keeping prices up (if you started loosing too many doctors, the price for services would go back up some which would encourage more to enter the industry). The industry as it currently is formed might not be able to keep things as is, but...
c) The industry would adapt to changes. For decades, it has lived as an industry that is expecting to grow well beyond inflation and has made rules, practices and the like that fit that model. There would be hardships going away from that model for sure, but it would not take long for a new normal to be established and anything that would have to be changed as a result would be out of necessity.
d) Most importantly, whether we do anything or not, the current status quo will not keep. We simply don't have the money for it. Enforcing anti-trust laws on the industry would definitely cause a lot of pain, but it will be a lot less pain than if we wait until the system collapses as there is nowhere else to throw debt at.

HeartOfDixie,
The government would benefit more from than anyone. The huge size of Medicare and Medicaid let's them have more of a say right now in prices than others as they can negotiate with providers from a strong position, but they still live in a world where costs in the United States are multiple times that of costs for the same exact things in the rest of the world and where most parts of Medicare and Medicaid are increasing by well into the double digits every year. They also live in a world where the real deficit last year was $1.4 trillion. Enforcing anti-trust laws would radically reduce what they spend on health care and, as a result, would fix a lot of issues for them.

If what you are getting at though is that the federal government would not do this for the political blow back, I largely agree. Most who are competent in Congress in any kind of budget role know the current system isn't sustainable. Dealing with it though means going against a group donating huge to campaigns and probably means a drop of GDP of better than 10% for a year of transition. So instead of doing the right thing, they do the easy thing to make reelection easier. That is why we need public support to get this done.

(04-08-2017 04:38 PM)Owl 69/70/75 Wrote:  Ohio, the Denninger proposal has some good points--pricing transparency, same price for all--but I have one question.

Why would any sensible person choose to be a doc or other health care provider under those rules?

And a follow-on question, with no providers, how are you going to have health care?

ahhhhhh....there's that "incentive" thingy I'm so fond of....

Ohio, I agree with the elements that will enhance competition, like transparent pricing and one price for all. But the other 90% reads like an ambulance chasing lawyer's recipe for misappropriating every dollar he or she can from the medical profession. No sensible person would be a Doc under those rules.

Here's the basic formula that the leftists never seem to understand: Price (to consumer) = cost+ profit, where profit has to represent a reasonable rate of return compared to risk, in order to attract competent providers. This proposal drives price down, does nothing to reduce cost, and substantially increases risk. Therefore it necessitates a higher rate of return to attract providers at the same time it guarantees a lower rate of return.

We have the numbers and types of providers that we have today because of our current risk-reward calculus. Alter that calculus and you affect the provider pool. Alter it as negatively as this does and you dry up thst pool.

But you say other countries do it. Yes but their cost and risk structures are both lower.

People will pay anything to stay alive. We have a market driven by that.

(04-08-2017 07:52 PM)Claw Wrote:  People will pay anything to stay alive. We have a market driven by that.

You've kind of hit on why healthcare is different from virtually any other "free market" example. There are 4 or 5 reasons I can think of just off the top of my head that explain why the healthcare industry doesn't work well in a free market---

1) When you are seriously injured, the fastest care is the best care. There is no time or ability to comparison shop.

2) Its a life or death decision---nobody is interested in skimping there.

3) We dont pay the bill directly. A third party (insurance) pays. So, we shop for insurance, but we have a seriously reduced incentive to control costs during usage. Not to mention, the hospital industry makes it difficult to keep up with billing with patients being invoiced by multiple parties for the same procedure. It's a mess.

4) Hospitals don't post prices. Its not like there is a menu outside like a McDonalds. It actually very difficult to accurately comparison shop.

5) By law, hospitals must render and provide emergency care without regard to ability to pay. Those costs for indigent care are ultimately bourne by those customers who DO pay. The reality is we already are paying for many of the medical costs of the uninsured---we just do it indirectly. Those costs are going to be recaptured by private industry. They always are.

im sure there are more---that's just off the top of my head. Look, I believe in the free enterprise system as much as anyone. But we long ago have determined that its in the public interest that certain industries be allowed to operate outside of the normal "free market". The best examples are utilities. Its inefficient to have 5 or six gas companies building gas lines to every home. My feeling is we need to look at how we allow hospitals to operate. Because its so unique, its probably an industry that needs to be operated more like a giant utility. I think it makes sense to guarantee a reasonable profit in exchange for price uniformity.

(04-08-2017 09:26 PM)Attackcoog Wrote:  

(04-08-2017 07:52 PM)Claw Wrote:  People will pay anything to stay alive. We have a market driven by that.

You've kind of hit on why healthcare is different from virtually any other "free market" example. There are 4 or 5 reasons I can think of just off the top of my head that explain why the healthcare industry doesn't work well in a free market---

1) When you are seriously injured, the fastest care is the best care. There is no time or ability to comparison shop.

2) Its a life of death decision---nobody is interested in skimping there.

3) We dont pay the bill directly. A third party (insurance pays). So, we shop for insurance, but we have a seriously reduced incentive to control costs during usage. Not to mention, the hospital industry makes it difficult to keep up with billing with people being invoiced by multiple patied for the same procedure.

4) Hospitals don't post prices. Its not like there is a menu outside like a McDonalds. It actually very difficult to accurately comparison shop.

5) By law, hospital must render and provide emergency care. Those costs are ultimately bourne by those customers who DO pay. The reality is we already are paying for many of the medical costs of the uninsured---we just do it indirectly. Those costs are going to be recaptured by private industry. They always are.

im sure there are more---that's just off the top of my head. Look, I believe in the free enterprise system as much as anyone. But we long ago have determined that its in the public interest that certain industries be allowed to operate outside of the normal "free market". The best examples are utilities. Its inefficient to have 5 or six gas companies building gas lines to every home. My feeling is we need to look at how we allow hospitals to operate. Because its so unique, its probably an industry that needs to be operated more like a giant utility. I think it makes sense to guarantee a reasonable profit in exchange for price uniformity.

I actually agree with this. the issue is incentives to keep enough people in the health care professions. There are a few ways I think it could be done. For example, teachers in NC can participate in a loan forgiveness program if they stay in state. I'm not saying every doctor should get free schooling at all but I do think where could be some incentives for them. Maybe a tax break of some kind. IDK... just spitballing here.

Sent from my SM-J700T using CSNbbs mobile app

Something needs to be done because my future daughter-in-law is going to med school and has absolutely no plans to treat patients. She's going straight into research at the urging of her father, a MD currently treating patients and two MD Grandfathers who either still see patients or retired within the past year and a half.

Adopt what the Buckeye wants and the only people going into treating patients will be those too stupid to get hired to do research.

(04-08-2017 07:27 PM)Owl 69/70/75 Wrote:  Ohio, I agree with the elements that will enhance competition, like transparent pricing and one price for all. But the other 90% reads like an ambulance chasing lawyer's recipe for misappropriating every dollar he or she can from the medical profession. No sensible person would be a Doc under those rules.

Here's the basic formula that the leftists never seem to understand: Price (to consumer) = cost+ profit, where profit has to represent a reasonable rate of return compared to risk, in order to attract competent providers. This proposal drives price down, does nothing to reduce cost, and substantially increases risk. Therefore it necessitates a higher rate of return to attract providers at the same time it guarantees a lower rate of return.

We have the numbers and types of providers that we have today because of our current risk-reward calculus. Alter that calculus and you affect the provider pool. Alter it as negatively as this does and you dry up thst pool.

But you say other countries do it. Yes but their cost and risk structures are both lower.

The transparent pricing (and single pricing) is to me to me admittedly the biggest aspect by far. You get that and we are 80% of the way there. If we could get that today, I would take it and run.

With that said, I do support the rest and think much of it is needed and large parts are just there to ensure the competition is legitimate (although neither myself not the author of it would ever be confused as liberal; Denninger has actually been credited as a founder of the Tea Party according to some sources, although not something he proudly proclaims given it shifted focus).

I get what you are saying and I am not trying to hide from negative consequences we would have to go through in the short term. This is a plan that would mean substantially less money in the medical system, which over the short term will negatively impact most working in it as well as the broader economy (given that it is better than 17% of GDP, the impact would be huge). Further, somethings that now receive a lot of money simply couldn't be justified anymore after the transition. This would likely hurt some research and we would have fewer people entering the medical profession for a time (with many others leaving). That is not something I can deny, but it's necessary because we have let things get this out of hand. If we had made these changes 20 years ago, when the percent of GDP we spent on healthcare was far less, the negative consequences would have been far fewer as the correction we would need would be far less.

With that said though, industries grow and shrink all the time and having the medical industry shrink is a good thing, not a bad thing long term. The higher profit in medicine has attracted a huge amount of people to the industry over the past couple of decades. If the the profit drops, that will reverse and it will shrink back some as both people and money shift to other industries. That would be hard, but it wouldn't be a bad thing any more than people switching from other industries to technology was a bad thing. Or to go an older example, with people switching from farming to industrial work (similarly hard, but similarly a good thing long term).

The drop in medical personal wouldn't be a continuous thing either. While lower prices would initially mean less profit and force people out, once the industry shrunk to its new equilibrium, prices would stabilize at their market value. If the industry kept loosing doctors or other personal for a time, any shortage would result in increased prices (and thus profit, as cost hasn't changed) which would attract more people into the market (until it is once again at equilibrium).

If we end up with an equilibrium where it feels like there are too few medical personal, we would need to reevaluate various laws and incentives yes (I'd start with the college education aspect first actually) to find a way to make cost (for the provider) or price rise a bit.

(04-08-2017 09:26 PM)Attackcoog Wrote:  

(04-08-2017 07:52 PM)Claw Wrote:  People will pay anything to stay alive. We have a market driven by that.

You've kind of hit on why healthcare is different from virtually any other "free market" example. There are 4 or 5 reasons I can think of just off the top of my head that explain why the healthcare industry doesn't work well in a free market---

1) When you are seriously injured, the fastest care is the best care. There is no time or ability to comparison shop.

2) Its a life of death decision---nobody is interested in skimping there.

3) We dont pay the bill directly. A third party (insurance pays). So, we shop for insurance, but we have a seriously reduced incentive to control costs during usage. Not to mention, the hospital industry makes it difficult to keep up with billing with people being invoiced by multiple patied for the same procedure.

4) Hospitals don't post prices. Its not like there is a menu outside like a McDonalds. It actually very difficult to accurately comparison shop.

5) By law, hospital must render and provide emergency care. Those costs are ultimately bourne by those customers who DO pay. The reality is we already are paying for many of the medical costs of the uninsured---we just do it indirectly. Those costs are going to be recaptured by private industry. They always are.

im sure there are more---that's just off the top of my head. Look, I believe in the free enterprise system as much as anyone. But we long ago have determined that its in the public interest that certain industries be allowed to operate outside of the normal "free market". The best examples are utilities. Its inefficient to have 5 or six gas companies building gas lines to every home. My feeling is we need to look at how we allow hospitals to operate. Because its so unique, its probably an industry that needs to be operated more like a giant utility. I think it makes sense to guarantee a reasonable profit in exchange for price uniformity.

Most of those things you listed are big issues though and reasons we have prices rising faster than anyone can afford to pay (governments, individuals, companies). Without getting into everything, biggest ones are:

1. When you are seriously injured there is not time to compare, but that's why things need to be set-up so the price is the price regardless of whether you come in with insurance A, B, or none at all. There is too much potential to hit you right here without that protection.

2. You can't price compare beforehand and that's a huge issue. Hospital, doctors offices, etc should have to post prices (that are the same for everyone, no matter how you pay) that are easy to compare. Higher price areas would inevitably get fewer customers and which would be compounded by having a reputation for high prices.

Ohio, agree totally that transparent pricing is a major step. There is one major problem in that this isn't like buying a car where adding a particular radio is the same every time. No two surgeries are exactly the same and if you don't make allowances, then no Doc will take on a high risk patient. This can be handled, but it would have to be incorporated into the system. Also, what happens if they cut in and then find a problem that wasn't anticipated. Those things happen.

As for the same price for everyone, sounds great but there is a big problem. It doesn't cost the Doc the same to treat an insured patient as it does an uninsured one. Why? Because there's a risk of nonpayment with an uninsured that doesn't exist with an insured, and that risk carries a considerable cost. Bismarck and other universal systems handle that by making everybody insured.

As for everybody spending money to keep from dying, that's why our system costs so much. Costs incurred in the last three years of life more than make up the difference between our costs and single-payer and single-provider costs. Those systems simply don't pay those costs and let you die. Bismarcks don't pay those costs either, but they let you pay them, or buy insurance to pay them.

Ways I see to cut costs:
1) No-fault malpractice like Sweden. Their system also gets victims paid faster and does a better job of identifying bad docs and getting them out of the system.
2) If we do Bismarck, do like France and pay for med school for anyone who agrees to work on the "free" side for a salary for ten years.
3) Open up more slots for NPs and PAs to perform more procedures. If we do Bismarck, insurers on the "free" side, in particular, would have clear economic interests to pursue this.