Re: “Since it takes a considerable amount of time to increase supply (to train doctors and nurses…”

The Russians launched Sputnik in 1957, and then-president Eisenhower said we needed more scientists and engineers to catch up. Eleven years later, engineers were a dime a dozen and were being laid off. True, it takes more than 4 years to train medical personnel, but it’s been 15 years since Hillary tried to “fix” health care and who knows how many years since people have been saying we have a problem. It’s like not drilling for more oil because doing so will not have an immediate effect.

No wonder I flunked Econ 101. (I’m just kidding!) Actually, I deal with supply and demand issues every day in the business I’m in. We regularly adjust our prices accordingly. And, since many of the items we sell are imported from Europe, as well as other parts of the world, the value of the dollar against the various foreign currencies (especially the Euro) influences what we buy, how much we buy, and what our price structure might be. (Always with the next order cycle in mind.)

Healthcare is not your typical commodity. Since it takes a considerable amount of time to increase supply (to train doctors and nurses, to build new hospitals and clinics, and to develop and test new medical technologies and drugs), healthcare costs rise as demand increases
BUT remain high and continue to rise even when supply eventually expands. This unusual nature of healthcare as a commodity ensures that demand will always outpace supply.

I must also restate my position that our aging population is contributing to demand, and thus to rising healthcare costs. According to the U.S. Census Bureau, median age of the U.S. population has increased from 34.0 yrs. in 1994 to 35.5 yrs. in 2000 with a projection median age of 39.1 yrs. in 2035. Since we know older folks use healthcare services far more often than youngsters, and require more expensive therapies, treatments and surgeries in general, we can reasonably conclude that an aging population is impacting healthcare cost.

You wrote: “of course I can tell you why healthcare costs are rising rapidly. An aging population, use of new technologies and new designer drugs (gotta love some of the advertising!), administrative costs (each provider and each plan has its own set of rules, forms, etc.), excessive litigation, malpractice insurance, and supply and demand are among the reasons.”

Only partially correct. Econ 101 – things which drive the price of any commodity are – supply/demand, and things that artificially skew supply/demand. Of the items you cite, aging-population shifts specific demands without greatly changing the overall demand (e.g., old folks need more cancer screenings, but no longer need pre-natal care; children are about as costly as the very old in terms of market share), new technologies drive down the cost of old technologies, advertising can only stimulate demand to the degree it is affordable and is not wasted on that which is unaffordable (suggesting supply is fine), and similarly ‘designer drugs’ would not be developed were there no market for them. In any case, the average age of patients is not something we can control (unless you are suggesting we euthanize most of them – pretty soon us). Most of the items you cite as pointing to a health ‘system’ in crisis, only prove the opposite. Litigation does, indeed, sharply increase (skews) the cost of healthcare, but is small potatoes compared to what UHC will do. Malpractice insurance is dependent on litigation and, therefore, redundant.

You next wrote “There is also an overuse issue. ¶ … I happen to think prevention is the key to decreasing demand, and reign in costs.” Bingo on the first part, but then you contradict yourself. On the one hand, you recognize the overuse problem, yet then suggest preventative care as a solution to care abuse. I will accept your premise, for the moment, prevention can reduce the individual need for intensive care; but with the proviso this is a theoretical argument subject to testing. Fortunately, the test has already been done for us. Preventative care has been the near universal standard of care in this country for the past two decades. This is the same period (out of the last 60) in which American healthcare cost have risen most sharply. Clearly, something else is missing, and the something else must be cost-feedback to the consumer. Of the two, prevention has only a very slight impact on controlling costs whereas the impact from cost-feedback is huge. Ergo, it is allowing consumers to bear some (if not most) of the cost of their own care which is the ‘key’ to controlling cost; not prevention. Increasing the supply of doctors, nurses, hospitals and clinics can accomplish nothing until we first solve the problem of runaway demand, and, like the litigation/intervention comparison grossly dominates the situation. And, like the prevention solution, government has thrown every incentive conceivable at encouraging greater numbers of doctors, nurses, and para-meds for decades in a futile attempt at keeping up. Ditto for technology which was supposed to make the medical work-load less but, instead, creates its own demand. In the UHC scenario, luring more people into medicine satisfies the insatiable demand even less than does the current insurance-partnership model.

I have to give you some credit for recognizing supply side is not, in this case, the answer; though you did not articulate it very well or make the right connection.

One definition of insanity is doing the same [improbable] thing over and over expecting different results.

A. Though the effort is encouraging, we don’t want to simply answer your questions without some return on our own time and investment. That’s neither debate nor honest. At worst, that’s setting traps for others to step into; at best, it is ducking points you expect others to answer.

B. No one here said there aren’t problems with the current state of healthcare, we said:

1) the left is grossly overstating the issue, the better to increase the reach of government

2) there is no such thing as a ‘system of healthcare’ (unless you are talking about things like Medicare, Medicaid, SCHIPS, HMOs, &c) for you to ‘reform’

3) UHC and other state-run systems are the opposite of what is needed if your objective is to make healthcare more: affordable, accessible, and first-rate

4) the ‘unaffordable’ argument is bogus because we can all afford something

C. “those people” are doing quite well even without the handouts, and as people have done for centuries without the benefit of modern medicine

You are convinced our ‘poor’ suffer horribly because they lack the same high level care you or, maybe, Bill Gates gets. Think for a moment and then answer this. How much better is the care even our poorest American recieves than that of his grandparents? Nobody dies here today from diseases like chicken-pox or TB which, a century ago, devastated poor and rich alike. No child here, suffers from a lack of access to basic care or immunizations. Even our poor can line up for free flu vaccines virtually unknown when I was a kid. Advances in medical care are fueled by profit, making them temporarily out of the reach of those who cannot yet afford them (but soon will). It is the trickle-down effect here that really matters; not disparities. The rich getting Cadillac care pushed my level of care from bicycle to SUV within my lifetime, and that of poor people from pedestrian to rapid-transit in the same period. Without the rich getting their ‘extras’, mine would be stuck at the 1950s level of care. So, if it takes the rich getting better care than me and I getting better care than the poor such that we all benefit, what’s your complaint?

What is up with that ‘Wagoner guy’ is he is taking the lead (and the heat) in speaking for all the other carmakers. That’s because he represents the largest carmaker now asking Congress for a bailout. I don’t know why you single out Wagoner, especially; they are all pulling the same stunt (getting others to pay for their failures). Had not government offered a bailout to the mortgage industry, it’s less likely Wagoner &Co would be begging one for themselves (hey, guys, the handout till is open, let’s get ours before someone slams it shut!) Though to be fair, it turns out most of these failures are the direct result of government skewing of the auto-market and unconscionably bad union deals (also abetted by government in 1990s). So, to answer your question, Mr. Wagoner finds himself in the unenviable position of going hat-in-hand to the same people who put them in this position in the first place to bail them out. In both cases (demands made on carmakers and the bailout), it is the consumer and taxpayer who ends up paying for it.

Okay, you figured out the economy is in trouble. What’s your solution to getting it back on its feet? Ours is less government a) let it fall (the industry will be healthier for it), b) less government interference in markets, plus c) some well timed tax-cuts where it stimulates the economy most. Key to fixing any problem is figuring out what actually caused it in the first place. Too many liberal solutions to problems ignore causes, preferring to band-aid problems than admit liberalism had any part in causing them.

Remember our discussion on Myers-Briggs last year? It “feels” to me that John Ross, like your friend Harry appeared to be, is an “NF” (Intuitive Feeler) personality type as opposed to “ST” (Sensing Thinking). You stated then that, “The key is to defend your position against any and all attacks by any and all reasoning,” and I agree. The problem is that the personality types “reason” differently. Basically, NFs “go with their gut feeling” and STs rely on logical thinking. Also, I keep forgetting my own advice: For a liberal, the issue is not the issue; the revolution is the issue, and revolution means overturning the existing order of things. I suspect that Mr. Ross’ real goal WRT health care is to change the current system just for the sake of changing it. Whether that change produces a positive result is immaterial; good intentions are what matter, as you pointed out, because it makes the “feeler” feel good.

BTW, since you mentioned numbers and have experience in political campaigns, I thought you might be interested in “The Case of The Uncounted Ballots” http://www.lagriffedulion.f2s.com/elec2000.htm

I CARE, so I’m going to side with John on this one. It’s what I feel that’s more important than what some person who actually studies the issue says.

And right now, I feel like having another beer.

Didn’t you read post 98? “But the point is there’s an incredible amount of information out there. The more you read, the more confused you get. And then you find yourself right back where you started.”

This is officially about feelings and emotions, which avoid all these unpleasantries.

So, do you prefer your peanut butter to be crunchy or smooth, or your economy socialist or capitalist? One opinion is as good as another.

No evidence? See http://www.netmba.com/econ/micro/supply-demand

I happen to think the Cowboys should have beaten the Steelers.

As long as all we’re discussing is opinions, because looking at facts and their underlying assumptions are too hard to do, I thought I’d just toss out another opinion or two.

I happen to think prevention is the key to decreasing demand, and reign in costs. However, not only does the individual have a role to play. Corporations and the government also have a role to play in promoting healthier living. (If I’m Eli Lilly and Co., I’d much rather keep you hooked on Prozac!) Why do citizens of the other advanced nations in the world enjoy better overall health than we do while spending half as much per capita on healthcare? Of course the answer is lifestyle. I don’t have time to go into all the differences between their lifestyles and ours. I have relatives who live in Sweden. The Swedish people in particular take a healthier, more balanced approach to living. Here, most of us, or at least most of the people I know, spend more quality time with the people at work than with spouses and children. Talk about being married to the job! Work less, play more. Platitudes for sure. But if you value health and well-being, it’s a good prescription.

We could also work to increase the supply of doctors, nurses, hospitals and clinics. But there isn’t any concrete evidence to support THAT as a method of reducing cost. Where I live there’s been talk about actually consolidating and closing some healthcare facilities (much to the public’s dismay) because they are a drain on the local system. (Too many empty beds.) If we could induce more young people to become doctors and nurses some might end up moonlighting as bartenders and cocktail waitresses – my work in the liquor business provides all the evidence I need to conclude that we’ve been drinking an awful lot lately! Why is that?