What are people supposed to do if they get seriously ill?

[xjx388]

Let's at least have some intellectual honesty here as this has been explained to you over a flipping 30 page thread.

There is a distinction between 'cost-effective' and QALY, or quality adjusted life years.

As I mentioned to you at least three times, do a search on the New England Journal of Medicine site and see what you come up with before you use this argument again.

http://en.wikipedia.org/wiki/Quality-adjusted_life_year

And what are QALY's used for? Could it be to determine cost-effectiveness of a treatment? Let's see what your Wiki article says:

The QALY is often used in cost-utility analysis to calculate the ratio of cost to QALYs saved for a particular health care intervention. This is then used to allocate healthcare resources, with an intervention with a lower cost to QALY saved (incremental cost effectiveness) ratio ("ICER") being preferred over an intervention with a higher ratio.

Yup, that's what I thought.

 

[lomiller]

Sure. I'd be happy to. It happens all the time in UHC systems.

Umm Canada doesn’t have a single payer system for prescription drugs, they use an insurance system pretty much like the US does. All you are showing is a further example where this type of system breaks down.

That said, insurance for prescription drug coverage still makes a lot more sense than it does for medical coverage. If you want to guarantee access to all the expensive but marginally effective drugs out there, you pay extra for a better insurance plan.

 

[Tatyana]

And what are QALY's used for? Could it be to determine cost-effectiveness of a treatment? Let's see what your Wiki article says:

Yup, that's what I thought.

Yes, your bias scanning is showing.

Welcome to the world of evidence based medicine (again).







http://www.nejm.org/doi/full/10.1056/NEJMsb0911104
Comparative Effectiveness and Health Care Spending — Implications for Reform

Some clinical practices, once subjected to rigorous evaluation, have been found to be of no benefit, if not harmful.

Moreover, there is considerable variation in health care expenditures and a weak or even negative association between spending and outcomes, such as mortality at the regional level4 and quality measures at the state level.5

This evidence has been interpreted to mean that cutting back on these putatively useless or harmful services would simultaneously reduce cost and improve health.4,6 In contrast, several cross-sectional studies that have shown positive associations between spending and outcomes have been interpreted to show that more spending leads to better outcomes.7


http://www.nejm.org/doi/full/10.1056/NEJMp1007168

Legislating against Use of Cost-Effectiveness Information

QALYs provide a convenient yardstick for measuring and comparing health effects of varied interventions across diverse diseases and conditions. They represent the effects of a health intervention in terms of the gains or losses in time spent in a series of “quality-weighted” health states. QALYs are used in cost-effectiveness analyses (termed “cost-utility analyses” when QALYs are included) to inform resource-allocation decisions: the cost-per-QALY ratios of different interventions are compared in order to determine the most efficient ways of furnishing health benefits. In contrast, other health outcomes are generally expressed in disease-specific terms, such as incidence of cardiovascular events, cancer progression, intensity of pain, or loss of function. Though useful for measuring the effects of particular treatments, these outcomes do not permit comparisons among diseases and conditions or between treatment and prevention.3

 

[xjx388]

If the government got "out of healthcare" would there even be a health care system in the US?

Sure there would. It would be a system based more on free market principles than on government regulation.

 

[johnny karate]

Sure there would. It would be a system based more on free market principles than on government regulation.

Are you personally comfortable with free market principles determining whether you or your loved ones live or die?

 

[xjx388]

Are you personally comfortable with free market principles determining whether you or your loved ones live or die?

This is a strange question. I'm not comfortable with anybody or anything determining whether my loved ones live or die. Are you?

 

[DavidJames]

Deleted

 

[gnome]

Sure there would. It would be a system based more on free market principles than on government regulation.

Any particular government regulations that you think put counterproductive restrictions on the free market? Or is it just a sort of regulation bad free market good idea?

 

[johnny karate]

This is a strange question.

It's a perfectly valid question since you seem to be advocating for a free-market healthcare system.

I'm not comfortable with anybody or anything determining whether my loved ones live or die. Are you?

Of course not. But then again, I'm not the one advocating for a free-market healthcare system.

So if you're not comfortable letting someone else determine if your loved ones live or die, how exactly do you think a free-market healthcare system works, if not in that way?

 

[BobTheCoward]

I'm not the one advocating for a free-market healthcare system.

So if you're not comfortable letting someone else determine if your loved ones live or die, how exactly do you think a free-market healthcare system works, if not in that way?

No one seller determines if I can or cannot have access to care. Terms are negotiated. It is up to me whether I choose to meet or not meet those terms.

 

[johnny karate]

No one seller determines if I can or cannot have access to care. Terms are negotiated. It is up to me whether I choose to meet or not meet those terms.

In a free-market system, if a health insurance company decides there's no profit in paying your medical bills, they'll do everything they can not to.

Negotiations don't factor in.

 

[xjx388]

It's a perfectly valid question since you seem to be advocating for a free-market healthcare system.



Of course not. But then again, I'm not the one advocating for a free-market healthcare system.

So if you're not comfortable letting someone else determine if your loved ones live or die, how exactly do you think a free-market healthcare system works, if not in that way?

Well, I throw it back the other way: Are you comfortable with a government agency crunching numbers and deciding that your or your loved one's lives are not worth saving?

In a free-market system, I decide how important healthcare is to me and my family. If I determine it's more important to me than smoking, drinking, movies, television, computers, music, owning a nice house, eating filet mignon, etc., then I budget for it accordingly.

Additionally, a more free-market based system will reduce costs. In the current heavily regulated system, Medicare, Medicaid and insurance plans incentivize performing more services. So, doctors and hospitals perform more tests and procedures in order to maximize revenue. A free market system, OTOH, incentivizes efficiency. Patients who are responsible for their own costs will not pay for unnecessary tests and procedures, which will force doctors to adopt more efficient practices.

For me, it all comes back to increasing personal responsibility. If more people had catastrophic insurance plans but were responsible for most of their day-to-day health costs, spending would come down dramatically.

Of course, a free-market system means that some people won't be able to afford the more expensive treatments. That's where charity care comes into play. If doctors were allowed to write-off the charity care they provide, I think that the uninsured would suddenly find themselves with a whole lot more options. As it stands now, doctors have to limit how much they provide.

 

[xjx388]

In a free-market system, if a health insurance company decides there's no profit in paying your medical bills, they'll do everything they can not to.

Negotiations don't factor in.

Why do you equate "free-market" with health insurance. Healthcare <> Health Insurance.

 

[DavidJames]

Ah yes, the Religion of the Free Market.

Libertopia, Heaven on earth.

 

[BobTheCoward]

In a free-market system, if a health insurance company decides there's no profit in paying your medical bills, they'll do everything they can not to.

Negotiations don't factor in.

Then you go to a doctor directly and negotiate a price. If you refuse to pay the price that is your choice.

The point is someone was trying to equate free market health care with someone else making a decision on your health care. That is not true. The decision is up to you to make the choice or not.

There are plenty of reasons to oppose free market health care. The "someone denies you access" isn't one of them.

 

[johnny karate]

Well, I throw it back the other way: Are you comfortable with a government agency crunching numbers and deciding that your or your loved one's lives are not worth saving?

UHC systems don't work that way. Other people have already pointed out the false equivalency you've made between the instances of people being denied certain treatments under a specific set of circumstances and people just flat out being denied treatment because an insurance company decided not to pay for it.

In a free-market system, I decide how important healthcare is to me and my family. If I determine it's more important to me than smoking, drinking, movies, television, computers, music, owning a nice house, eating filet mignon, etc., then I budget for it accordingly.

Unexpected catastrophes rarely adhere to a budget. What is your course of action if because of an unexpected catastrophe your medical needs exceed your ability to pay for them?

Additionally, a more free-market based system will reduce costs. In the current heavily regulated system, Medicare, Medicaid and insurance plans incentivize performing more services. So, doctors and hospitals perform more tests and procedures in order to maximize revenue. A free market system, OTOH, incentivizes efficiency. Patients who are responsible for their own costs will not pay for unnecessary tests and procedures, which will force doctors to adopt more efficient practices.

Cite please.

For me, it all comes back to increasing personal responsibility. If more people had catastrophic insurance plans but were responsible for most of their day-to-day health costs, spending would come down dramatically.

Even the strongest sense of personal responsibility cannot account for every unexpected catastrophe. What is your course of action if because of an unexpected catastrophe your medical needs exceed your ability to pay for them?

Of course, a free-market system means that some people won't be able to afford the more expensive treatments. That's where charity care comes into play. If doctors were allowed to write-off the charity care they provide, I think that the uninsured would suddenly find themselves with a whole lot more options. As it stands now, doctors have to limit how much they provide.

Ah, so I have my answer. If someone's medical needs exceed their ability to pay for them, their fallback position is to rely on the charity of others. Sounds like a pretty shaky system. What are the guarantees that it would be effective?

 

[johnny karate]

Why do you equate "free-market" with health insurance. Healthcare <> Health Insurance.

Because most people can't afford to pay for medical care directly. That's why they have health insurance.

 

[DavidJames]

The point is someone was trying to equate free market health care with someone else making a decision on your health care. That is not true. The decision is up to you to make the choice or not.

No, the decision is up to the provider to decide if they want to treat you. The customer can only decide to buy if the provider is willing to sell.

Unless you are saying the customer can force the provider to provide a service.

 

[johnny karate]

Then you go to a doctor directly and negotiate a price. If you refuse to pay the price that is your choice.

I've never heard of anyone refusing to pay for life-saving medical treatment. Usually, it's that they can't pay for it.

The point is someone was trying to equate free market health care with someone else making a decision on your health care. That is not true. The decision is up to you to make the choice or not.

Yeah, that's pretty much nonsense. If I can't afford the cost of life-saving medical treatment, and my insurance company decides not to pay for it, at what point was it my decision to not get that treatment?

There are plenty of reasons to oppose free market health care. The "someone denies you access" isn't one of them.

I disagree.

 

[xjx388]

UHC systems don't work that way.

Of course they do. Are you telling me that NICE doesn't decide which treatments the NHS will cover based on cost-utility computations using QALYs?

Other people have already pointed out the false equivalency you've made between the instances of people being denied certain treatments under a specific set of circumstances and people just flat out being denied treatment because an insurance company decided not to pay for it.

I've never heard of an insurance denial based solely on the fact that they just don't want to pay for it. Ins. cos. use cost-effectiveness measures just as much as NICE does. And people can appeal insurance decisions as well. It's not a false equivalency.

Unexpected catastrophes rarely adhere to a budget. What is your course of action if because of an unexpected catastrophe your medical needs exceed your ability to pay for them?

Catastrophic insurance, charity care, family help, etc. If you still can't pay for it then you don't get the treatment. How is it different in a Single-Payer system?

Let's try an example. Let's pretend that Mr. X's wife is diagnosed with metastatic breast cancer and given all the standard treatments to no avail. She is given 3 months to live, if she's lucky. However, there is a new drug that is widely available throughout the world, but their country's Single-Payer system has decided that the cost/QALY ratio is too high to approve it's use. Therefore she must come up with the cost of the treatment on her own. What should she do?

Cite please.

Which part would you like citations for? I tell you what, I'll cite as soon as you cite for this:

In a free-market system, if a health insurance company decides there's no profit in paying your medical bills, they'll do everything they can not to.

Negotiations don't factor in.

Even the strongest sense of personal responsibility cannot account for every unexpected catastrophe. What is your course of action if because of an unexpected catastrophe your medical needs exceed your ability to pay for them?

Then I suffer and die, I assume. What happens to people in Single-Payer systems who are denied life-extending cancer drugs that they can't pay for. I'm sure they suffer and die as well. We can't meet everyone's needs all the time, can we?

Ah, so I have my answer. If someone's medical needs exceed their ability to pay for them, their fallback position is to rely on the charity of others. Sounds like a pretty shaky system. What are the guarantees that it would be effective?

Again, what are the alternatives in Single-Payer systems? Are you saying that everyone's needs are covered 100%? Then why do so many people die of cancer and heart disease in those systems?