In article ,
 Josh Hill  wrote:

> 
> 
> As far as I can tell, the problems with HSA's are that they work only
> for the middle class, and that nobody has ever heard of them.
   Work for upper, too. At least self-employed upper. There is no 
similar program available to the MCaid people and, unfortunately, the 
HSAs don't make any more sense for the poorer people economically than 
the regular policies


>
> > Also, who is going to 
> >pay for extra costs? The insurance company won't. 
> 
> Sure, the fees would be passed along to the customer in the end -- but
> the bean counters won't be thinking that, they'll be thinking they
> have to compete with the other insurance companies on price, and if
> they have to pay an extra $50 on a procedure to cover paperwork
> they'll either be cutting into their profit or pushing up their
> premiums and making themselves less competitive. So it's a case of
> making a market closer to ideal by breaking out some externality
> costs.

  Personally, I think you are largely working at the margins. MCare is 
always touted as using such a small part of their money for 
administration. That is because those touting are only looking at the 
money that CMS uses for research, overhead and keeping an eye on the 
Fiscal Intermediaries. The FIs (People like EDS, the Blues, etc) are the 
ones that do the heavy lifting such as processing and paying claims. 
When the money paid to the FIs are factored in, then eh administration 
costs are about the same. 

> 
> >    Which will then be cost shifted, people will leave the profession, 
> >will refuse to deal with the public option, all of which we are 
> >currently seeing with MCare. 
> 
> Yeah, except that the doctors that don't take Medicare have somewhere
> else to go, namely, privately-insured patients. And I don't see any
> evidence that doctors are leaving the system in the countries with
> universal health care. If anything, they're leaving it here, because
> of the increasingly overwhelming paperwork, the insurance company
> clerks, the malpractice suits, and the fact that GP's aren't paid
> squat anymore -- we'd rather send people to expensive specialists.
   last figures I heard, albeit about 5 years was that Canada was still 
a net exporter of physicians to the US. They are also having troubles 
with staffing as docs just get out, go to other options, retiring early, 
etc. Although, interestingly enough, I haven't seen anything that 
indicates there is much of a difference in rates of docs leaving the 
front lines. Seems, again, that each system is wearing out the docs, 
just in different manners. 
    Canada and the other places are all having their own problems, just 
a different set. 

> 
> >> Same difference, I think. If the pharmacy companies can't make money,
> >> they won't sell (or develop) the drugs.
> >
> >    Which is what I am concerned about. 
> 
> I'm not sure how much of an effect that would have in practice. We
> have some incremental patented drugs that are being sold for $1000 a
> dose when something costing $10 a dose works just about as well. The
> system is just plain broken. It cheaps out on some things, and spends
> exorbitantly for others.
> 

  Despite the Demonization of Big Pharma, medications only take up about 
10% of total healthcare expenditures in the US. Interestinly enough, 
this is EXACTLY the same percentage of total health care expenditures 
seen in Canada, Britain, Germany and the other government run systems. 
The Demonization of Big Pharma is BS politics. 

> >    Of course spending money on new pharmaceuticals is exactly where you 
> >get into trouble with rationing, "death squads", etc.
Actually pharm 
> >spending in the US (as a %age of total expenditures) runs less than 10% 
> >and is actually in line with the %age spent by most other western 
> >countries. We could zero out profit and marketing tomorrow for all pharm 
> >companies and it would only slow increases by a percent or two.  That 
> >may very ewll be offset by increases in morbidity and mortality because 
> >many of the new drugs do work. 
> 
> I'd find that more convincing if the pharmacy companies weren't making
> ridiculous profits and wasting vast sums on promotion. Sure, these are
> risks, but as things now stand we've essentially handed the pharmacy
> companies a sheaf of blank checks. Not a tenable situation.

     See above. Also the return on investment, profit margins, etc., for 
pharmacueticals runs about the middle of the pack of all industries. 
Another part of the Demonization that people studiously overlook. Part 
of the American obsession with taking out the most successful and 
shooting them. 

> 
> The GOP lost all its credentials as the party of fiscal prudence. They
> were worse than the Democrats ever were. But even if they hadn't been,
> they were the party that was always talking about reigning in
> government spending, right? About all they can do now is demagogue the
> fiscal stimulus (conveniently ignoring Bush's very Keynesian stimulus
> packages -- remember when he sent everyone checks?).

    I will agree that it lost all its credentials as a party of fiscal 
prudence. However, I would argue that they are certainly as bad as the 
Dems, but our worse situation is related to the synergism of both sides 
abandoning any semblance of responsibility. If you look at the unrelated 
earmarks in the Iraq bills for instance, you will find the GOP and Dems 
neck and neck in the amount of money they earmarked.

-- 
To find that place where the rats don't race
and the phones don't ring at all. 
If once, you've slept on an island.
    Scott Kirby "If once you've slept on an island"
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