A "Health Care Reform" bill has finally become law in late March, 2010, - a law with the Orwellian title "Patient Protection and Affordable Care Act". President Obama, his administration and nearly all of the Democrats in Congress have finally succeeded in getting a law to "reform" health care. Implementation of this law is now underway, and it will not be a quick and simple process. First of all, this one law is huge, over 2000 pages. Secondly, this law, although a valid law, was followed one week later by a law called the "Health Care and Education Affordability Reconciliation Act" which, among other things such as education, reconciles a few "differences" between the first law and another version. (See this web page for some explanations.) Of most importance however is that much of these laws' provisions are at least somewhat vague, requiring many specific rules and regulations to be defined and written at some later date, mostly by bureaucrats. It is also of note that all the provisions of these laws do not go into effect at the same time; instead they are to come into effect in a gradual manner over the next several years. Not until 2014 will the last of these provisions go into effect - almost two years after the next presidential election. Gosh, surely Obama is not "playing politics"! Nevertheless, if this "healhcare reform" is so necessary and wonderful, why could it not be fully implemented within one year, or two at the most? In any event, these laws are supposed to make the cost of "health care" more affordable. These laws are also to provde nearly everybody with affordable health insurance, without decreasing the quality and availability of health care. This web page points the reader to important information and data which relates to all of this. This includes information on the political aspects, but it primarily includes information on other aspects of "health care" reform and medical care, to include the cost and quality of medical care.
Some ongoing results and fallout from the "healthcare reform laws" will kept on this page.
Okay, let's get one thing out in the open right away. Before the bill's passage, it was clear to me that nearly every politician, commentator and pundit said that "we need health care reform", or "health care needs fixing". Even most conservatives said that "we need health care reform; we just did not need the 'reforms' pushed by the Democrats". Even most Americans seemed to be saying that "we need some kind of health care reform". Question: WHY ? I think nearly everyone would respond to that question by saying that our "health care system" is too expensive. It costs us too much money. Well, what is "too" much? What is "too" expensive? Many Americans seem to have few problems acquiring expensive things that they really do not need, such as a large expensive car or SUV, a big-screen high-definition television set, a full-featured iPhone, a one week vacation through the Caribbean on a cruise ship, and even a backyard swimming pool. And if they do not have enough money on hand to pay for those things, which they often do not, they are seldom reluctant to go into debt, either by borrowing money or by using credit cards. Families with credit card debts exceeding $5,000 are quite common these days. And yet when a family gets into financial trouble because of such spending, they seldom say things like "backyard swimming pools cost too much", "that large TV cost too much" and "that house cost too much". After all, those things are wonderful to have and they are often fun! Medical care is never fun. What male worker who finds extra money in his paycheck because of overtime or a year-end bonus says, "Hey, I can use that extra money to go to a doctor and get a routine physical exam to see if I am still healthy!" Hardly a single one. What female worker who finds extra money in her paycheck because of overtime or a year-end bonus says, "Hey, I can use that extra money to go to my doctor and get a mammogram to check for possible breast cancer!" A few will, but not many. (You could say that one reason for that behavior is that many workers have health insurance which they expect to pay for most of their medical care. However, they could still use that overtime or bonus money to take care of the copayment which most health insurance requires. So why not use it for that?) Nevertheless, if a person does get sick, except for some minor illnesses such as a cold, he or she goes and gets medical care; then when he or she finds out the cost he or she often complains that it costs too much. Good gosh, who wants to spend a lot of money for medical care, especially when medical care is never fun, and when that money could have been used for something fun, like a backyard swimming pool, a two-week vacation trip to Hawaii, or a much bigger and better television set? Well, there is no doubt that the cost of quality medical care in the United States is high. Even for American families who have spent their money wisely, saved some money, and who are not poor, these costs can be a burden if a family needs extensive and/or continuing medical care. However, as responsable consumers it helps to keep things in perspective. Our standard of living has risen over the past few decades, enabling us to buy more and better "things". But let's keep in mind that we also need to "buy" medical care, even though we hate getting medical care; even though medical care is not cheap.
In the above paragraph I wrote that nearly everybody apparently thinks that health care costs too much. Well, there is no doubt that the total cost of quality medical care in the United States is high. And this total cost has been going up a lot for the past few decades. Some people may even understand that the cost of medical care should be higher today than it was many, many years ago. They just do not think that the cost should be as high as it is today. However, there are reasonable explanations for the large majority of the high cost of all medical care, and the increases in this cost. Not all of the increases, but a large majority. Below on this web page I point the reader to articles and opinions which provide more detailed information about "health care systems" and medical care, to include the total cost of medical care.
Our current "health care system", to include its costs, can be better understood if you first take into account what has happened to the United State economy over the past century, particularly during the last 50 to 60 years. During the past several decades, our standard of living has risen a lot. This despite the rise in the "cost of living" over the same time period. Therefore it is very worthwhile to understand exactly what has happened during this time period, and I discuss that in this paper. You really should read that paper if you want to have a solid background on this entire "health care" matter.
In the paper which I referred to above, I pointed out the huge changes in our economy during the past 50 to 60 years. Even after adjustment for inflation, our average incomes have risen a lot, and so has our standard of living. But then taxes have also gone up a lot. On the other hand, after adjustment for inflation, the cost of food has gone down. However, the major point was this: considering all the medical tests, treatments, equipment and drugs that are used today, at least 90 percent of them were not even available 60 years ago, perhaps as many as 95 percent! Another point made in that paper was that nothing in life is free, even medical care which helps us not only to stay healthy and to reduce suffering due to illness and disease, but also to live longer. Another point was that we need to be responsible with our money and our spending habits. Too many of us are irresponsible when it comes to spending money, at least some of the time. Many of us lead unhealthy lifestyes - eating too much, eating too many fatty foods and not enough nourishing foods; smoking; drinking; taking illegal drugs; not exercising, and so on. Despite that, too many of us think that we are "entitled" to certain things, such as a good job, a decent life, "affordable" housing, a comfortable retirement, and now even "affordable" medical care. Why a few politicians and pundits even say that just as we have a "right" to freedom of speech, a "right" to worship as we please, then we also have a right to medical care. What nonsense! What audacity! (By the way, when it comes to the poor among us, do not ignore the simple fact that the government had already provided them with Medicaid and SCHIP, so that the poor already had a reasonable "safety net". Of note is that these programs are in financial difficulties; what does that tell you about government programs?)
Have you read that paper which I referred to above? You should have. If you want more detailed information on medical care costs in the United States, this article on my web site gives a detailed discussion of those costs, with explanations and some data. You really should read that article. That article also discusses medical care in other countries, and gives some reasons why government involvement will be of no net value in the United States. With the exception of a few details, the bottom line to all of this is actually quite clear and simple, although not reassuring:
More than 90 percent of all the medical tests, treatments, equipment and drugs that are used today, perhaps as many as 95 percent, did not even exist 60 years ago! Since most of these do cure or alleviate sicknesses and diseases, and otherwise help keep us healthy and live longer, then when we do get sick or catch a disease we naturally expect to use these newer medical "interventions". The cost seldom prevents us from using these medical "interventions", although we do often complain about the cost. Now because there are much more of them today than there were 60 years ago, why then the total cost is of course much higher today. More and more medical tests, treatments, equipment and drugs will be developed in the years to come, thus enabling even more diseases to be better treated and people to live even longer, but again since there will be even more of these, why then the total cost can do nothing but increase! Unlike everything else in our lives, when something new and improved is developed with medical care, (even if many of us can not afford all of it), we do insist upon getting this medical care when we get sick or catch a disease. That is only human nature, given the value we place on our own lives and on our desire to avoid pain, suffering and death. This is quite different from other sectors in our economy. For example, except for those who are not very responsible with their money, we do not insist on buying a very large high-definition television set if we really can not afford it; instead we keep using a smaller television set that is not high-definition. Except for a few who are not responsible with their money, we do not insist on buying a very large house if we can not afford it; instead we buy a smaller house or even keep renting an apartment. Why today if you are very wealthy and in decent health, you can even go to outer space, and at least two wealthy people have already done that by paying the Russians over 20 million dollars for a trip to the International Space Station. Heck, the company Virgin Atlantic plans to provide sub-orbital spaceflights, with about 6 minutes of weightlessness in outer space, to the paying public within a few years. The cost per passenger is estimated at about $200,000. Of course very, very few people in the United States will do that, mostly because $200,000 is a heck of a lot of money. But then space flight is not something that cures disease, keeps you healthy and increases your lifespan. On the other hand, a kidney transplant, to include several years of necessary follow-up care and drugs, could cost as much as $200,000. If you need a kidney transplant to stay alive, would you want to spend that money? No, you would not. Instead you probably would expect "health insurance" or even the government to help pay for that huge expense. (By the way, it is worth noting that the actual price of a kidney transplant has come down over the years due to advances in medical technology and drugs, at least according to this article.)
As to those "few details" which I mentioned above, only two are worth noting here. The first one is "health insurance". The utility of health insurance as it relates to medical care is low at best, somewhat harmful at worst. This is especially true when you realize that there are many health insurance plans available today, and the insurance policies they offer differ from State to State due to thousands of State regulations. Health insurance makes our total "health care costs" higher, so a lot of this insurance is waste. The second one is the high cost of malpractice insurance and the practice of "defensive medicine" by doctors in order to avoid lawsuits. Most of this is unnecessary, so it is waste which adds to total medical care costs.
In the United States most people get nearly all their medical care by using health insurance. In fact, I note that "health care reform" legislation, as originally called, is now often called "health insurance reform", apparently due to the wishes of Obama and his administration. But the utility of "insurance" as it relates to medical care is low at best, somewhat harmful at worst. This report of mine gives details on this.
When it comes to all countries, it is often said that health care in the United States only ranks number 37 in the world. This ranking comes from the World Health Organization in a report which it published in 2000. This ranking, which the World Health Organization calls a measure of "overall health system performance", is very, very misleading. In fact, if you believe that this ranking is a measure of the "overall amount and quality of medical care", then this ranking is not true. A discussion and explanation of this can be found on this web page. (Let me give you a hint about this ranking: when it comes to what the World Health Organization calls "overall health system performance", the country which ranks almost right behind the United States is the country whose leader is - - Castro.) This pdf report includes the following about the World Health Organization Report: « This study bases its conclusions on such highly subjective measures as "fairness" and criteria that are not strictly related to a country’s health care system, such as "tobacco control". For example, the WHO report penalizes the United States for not having a sufficiently progressive tax system, not providing all citizens with health insurance, and having a general paucity of social welfare programs. Indeed, much of the poor performance of the United States is due to its ranking of 54th in the category of fairness ». The World Health Organization ranked France as the best in "overall health system performance". Concerning "health care" in other countries, I have done some research and I do provide additional information and data on this web page. Since I can read French, I do have some information here on medical care in France. Concerning "health care" in other countries, I have provided yet more additional information and data starting with these paragraphs on another web page of mine.
I have always been against any kind of so-called "health care reform" legislation, and I have already written about this on this web page. First of all, such legislation will definitely have a major impact on the health and medical care sector in the United States, which makes up a very large part of our economy - abount one-sixth. Second, such legislation will certainly cost the federal government, (taxpayers), a lot of money, and increase the federal deficit. The only unknown is how large this increase will be. Third, such legislation has no chance of "improving" our medical care and our overall health, let alone "controlling" the cost of medical care in a manner which benefits most people. (It may benefit a very few people, but at the expense of nearly all the rest.) Fourth, such legislation will contain much pork and "earmarks", with much of this being of value only to selected constituencies, certain politicans and some favored companies. Finally, despite Obama's repeated cries that there is "too much misinformation" out in public, the fact is that the "misinformation" of which he speaks is not at all the real misinformation that exists. Instead the misinformation that actually exists is a lack of real knowledge, good information and data on what is really going on in our economy, in the medical care sector of our economy and with the health of our population. On this web page I point the reader to articles which attempt to rectify this. Yes, there are many pages of information and data. But then keep in mind that the health and medical care sector of our economy is very large, varied, complex and constantly evolving. Also keep in mind that all the "health care reform" bills that had been finally proposed each contained over 2000 pages, not counting all the other legal documents to which they referred. The bill passed by the House in November of 2009 had nearly 2000 pages. The bill which was passed by the Senate in December of 2009 had over 2000 pages. The bill which finally became law in late March of 2010 has more than 2000 pages.
No matter what kind of economic system a country has, given some basic facts of economics, and the nature of medical care, human health and human beings, I do not think that the "free market" can help a lot in lowering total medical care costs. A report of mine gives my analysis of this. Nevertheless, despite what I consider to be some weaknesses of the free market and competition in the medical care sector, this does not then justify increased involvement by government.
A better writer than I am writes about our "health care system" and "health care reform" in this article on the web. I agree with most of his points. Not all of them, but nearly all. He does emphasize some very important points about our medical care which I have covered in my own writings, but which almost nobody else seems to recognize, let alone openly acknowledge.
My comments and opinions on some political aspects of "health care reform" in the United States are given on this web page. These are comments and opinions which, for the most part, were written before the final "health care reform" bill became law. (Actually two laws.)
Comments and opinions on the effects and fallout of the "Healthcare Reform Laws" are given on this web page. These are comments and opinions which were written after the final "health care reform" bills became laws.
A number of comments, articles, and opinion pieces appear in the news and on the Internet which, in one way or another, call for some sort of "health care reform", or simply comment on it. I have found some of these to be particularly misleading and/or incorrect. In these pages on my web site I reference those articles, comments and opinion pieces and then I show where they are misleading and/or incorrect, and I explain why.
The economist and social commentator Thomas Sowell has written many very short articles which relate to this "health care reform" business and medical care. I have found these articles to be easy to read, very informative and to the point. The are definitely worth the read. Below I provide links to the appropriate articles, starting with the oldest ones at the top. In order to best understand Thomas Sowell's writing, it is better to read the oldest ones first. (NOTE: Each article may appear in a new window when you click on the link for the article. To then get back to this page, just close the new window.)
As of early November, 2009, a chapter in Thomas Sowell's book titled "Applied Economics: Thinking Beyond Stage One" was available on this web page. The title of the chapter is "The Economics of Medical Care", and it is worth the read. Unfortunately, as of December 26, 2009, the full chapter was no longer available on that web site. Only the first two to three sentences of parts of each chapter are available. In order to read all of the parts, you must subscribe to "Investors' Business Daily", or at least get a "free" trial subscription. As for myself, I dislike these so-called "free" trial subscriptions. It is too easy to forget that most of them will automatically end up charging you money as a full subscriber unless you take specific steps to avoid that. In this particular case, I recommend that you buy Thomas Sowell's book. It is available from Amazon for just over 10 dollars.
I recently bought the book and read the chapter on "The Economics of Medical Care". It goes into more detail about various aspects of economics as they apply to medical care, many of which were briefly discussed in some of Thomas Sowell's many articles which I referenced above. It does not, however, mention the important fact that the major reason for the total increased cost of medical care today, as a percentage of GDP, is because today there are many more medical tests, treatments, equipment and drugs available today than there were in years past. I do disagree with Thomas Sowell about one thing in the book. He claimed that there was an economic benefit to the advertising done by drug companies, and although he does not say it, it appears to me that he is talking mostly about the advertising that is done for the benefit of consumers, such as in popular magazines and on television. He says: « The most wonderful drug ever created will help no one's medical condition unless it becomes known. Advertising does that.» . Well, I would expect doctors to know about any drug or medicine, whether brand new or old. After all, doctors are supposed to know what drugs are available for different medical conditions, and they are supposed to keep up with the latest drugs and medicines available. Drug company sales representatives do visit doctors frequently, giving them information on their drugs, to include brochures which describe the drugs in some detail. Also of import here is that only licensed doctors can prescribe drugs; ordinary consumers can not; consumers can only ask their doctor for the drug. (One relatively new drug which has been heavily advertised on television, and still is, was prescribed for me by my doctor over one year ago. I had not mentioned that drug to my doctor. And yet he knew about it, and he thought that it might help me with one of my medical conditions, so he wanted me to take it. I first rejected his suggestion because given what I had seen and heard about this drug during commercials, I did not think it would help my medical condition, given what I knew about the latter. However, I eventually gave in and allowed the doctor to give me a prescription and then I took the drug. By the way, this drug did not help me. In fact, I suffered one of the "rare" side effects, which thankfully was cleared up after I did further research and then stopped taking this drug. Note that in this particular case the doctor did not at all need me to know about the existence of this drug, from advertising or otherwise, but that I later did my own research on this drug after I suffered the side effect.)
Just a few days before his inauguration as President, Obama said, "We are five days away from fundamentally transforming the United States of America". And by gosh, he meant it !
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