Linkbusted. Article is actually here. Hopefully.

Fixed now, thanks.

One group of Americans never get sick or use the Dr, but know what they and their company pay for premiums and think this is a good deal, since the company might give them a raise.
One group of Americans get sick all the time, but use the emergency room. They can't afford the bills so look forward to the time the gov takes over so those annoying phone calls will end.
One group of Americans never get sick but have some sort of emergency procedure done and notice how much their co-pay is and look forward to the gov taking over.

One tiny sub-set of these groups go outside of the country and one tiny sub-set of THAT group needs medical assistance and can therefor compare the two systems. They are very vocal about NOT adopting gov medical care.

Being married to an Englishman, I've heard first hand repeatedly how much they just LOVE socialized health care. (Sarcasm.)

And, it seems, hospitals can be penalized for giving prompt treatment:

http://news.bbc.co.uk/2/hi/uk_news/england/suffolk/5237824.stm

Hat-tip (revealing a large bald spot and mostly grey hair where there is any) to Kate at Small Dead Animals.

When did initiatives to provide healthcare insurance for more Americans become the same thing as "socialized medicine"?

When those initiatives started to universally involve shifting the responsibility and authority of health management from individuals to society. For some reason, when that happens we refer to it as a process of "socialization".

Sahil,
It became "socialized medicine" when the people promoting universal healthcare insurance (Ms Clinton and others) keep referring to England and Canada as the models for their plans.

dr nic

Anyone want to provide sources that talk about how "those initiatives started to universally involve shifting the responsibility and authority of health management from individuals to society" or Ms Clinton's employment of England/Canada as models for her healthcare plans?

TO: Will Collier
RE: The Curse of the English Language

This seems to be a very obvious example of how one phrase "minimum wait" can be misunderstood by a good number of people.

Looking at it from the bright-side, one would take it to mean you would only have to wait 19 WEEKS before getting into the hospital.

However, as we realize here, one has to wait AT LEAST 19 weeks before even considering getting in to a hospital.

THIS is supposed to be the blessings of 'socialized medicine'? As proposed by Senator Hillary Rottum Clinton?

Hooooow niiiiiice.....

Regards,

Chuck(le)

P.S. I'm sure Will, southern gentleman that he is, will recognize the old, rude, joke about the term....

....Hooooow niiiiiice.

It's coming. The simple fact is, people are going to demand it, and you even have a lot of Big Business on board with it. It's a done deal.

It's either a choice between poor quality health care for all, but still at least some health care for all, or absolutely none for most people that is either quality of affordable.

At the rate things are going now, one day and night in the hospital will bankrupt a lot of people for life. That is, if their insurance companies will allow them to stay in the hospital that long.

Of course there are those lucky few who have really good, comprehensive medical insurance. Those are the ones that have to beg to be let go, they'll keep them in as long as they can to run every unnecessary test they can possibly run so they can milk their insurance for all it is worth.

If the medical, pharmaceutical, and insurance industries don't want "socialized" medicine, then by god they had better start becomming a little more social.

They won't though. They'll keep running the system into the ground, then cry when the car keys are taken away.

TO: PatrickKelley
RE: The System

"They won't though. They'll keep running the system into the ground, then cry when the car keys are taken away." -- PatrickKelley

Don't get me started.

The fact of the matter is that the high-priests of the medical industry, the AMA have a hold on the proverbial throttle; the medical schools. They manage the amount of medicine available by managing the number of providers.

But that's another, more specific, topical thread.

Regards,

Chuck(le)

Sahil,
How about this read down on the page for the Canada comparison.

dr nic

If socialized medicine is so universally awful, how come all the old people on Medicare seem to love it so much? I'll take a one or two-percent tax increase to put the rest of us on Medicare or Medicaid.

So would all the struggling and bankrupt pension plans, GM and Ford stockholders, most of the people making less than forty thousand a year, and many others.

And do the German, French, Norwegian, Finnish, Belgian, Italian, Japanese, Australian, or some other nations' plans have the same problems as Britain? I'd like to hear about more than just one problematic model. It's like someone proposes buying a car and all the neighbors say that cars are awful because that Yugo was a piece of shit.

If socialized medicine is so universally awful, how come all the old people on Medicare seem to love it so much?

For the obvious reason: the old people on medicare will get more from the program than they'll have to put into it.

Anyone with an iota of sense can see the benefit of getting someone else to pay for your bennies.

This is also the reason they like Social Security so much- the government sends me checks because I'm old! Yipee!

I'll take a one or two-percent tax increase to put the rest of us on Medicare or Medicaid.

No, thanks.

I don't want to be on medicare or medicaid.

So would all the struggling and bankrupt pension plans, GM and Ford stockholders, most of the people making less than forty thousand a year, and many others.

Of course- they would love to pass the cost of their obligations onto someone else.

My questions are: "Why should I pay for someone else's healthcare?" and "Why should I pay for fuckups made by the people who run those bankrupt pension plans, Ford, and GM?"

Y'know, back in ye olde days, a company that screwed the pooch went out of business instead of attaching itself to the government teat.

And do the German, French, Norwegian, Finnish, Belgian, Italian, Japanese, Australian, or some other nations' plans have the same problems as Britain?

Well, Mrs. Clinton wasn't exactly pushing German, French, Norweigan, Belgian, Italian, Japanese or Australian healthcare as a model to emulate back in '93. I suspect the Clintons are at least shrewd enough to promote the best examples of something, instead of the worst.

I'd like to hear about more than just one problematic model. It's like someone proposes buying a car and all the neighbors say that cars are awful because that Yugo was a piece of shit.

Feel free to give an example of an efficient socialized healthcare system.

In Taiwan we have national health care. It's alright, but it always seems like:

a. you go to the doctor for EVERYTHING. Old people do it just for company!

b. The doctor wants you to return every three days (he gets paid by the visit, see, and not enough apparently) People are having to visit a dentist twice a week for 2 months even though the procedure was finished on the first visit (according to the US dentist examining my girlfriend.)

Lawyers: Taiwan's bar only has a pass rate of 2-5% (!) and doctors are rarely sued.

Result? Lots and lots of doctor shopping as there are tons and tons of quacks...some guy wanted me to get a hernia operation immediately despite it only being a pulled muscle.

It's coming. It's a done deal.

Historical inevitability? Now where have I heard that before? Ah, yes.

rosignol: actually, the French system of health care is generally regarded as quite successful (by European standards anyway). One reason for that might be that the French system is not really a socialised system; it's neither single provider (like Canada) nor single payer (French patients pay for their own care although the central government reimburses most large expenses). You could achieve the same effect in the US by getting everyone to open a Medical Savings Account and having the federal government underwrite them - which ISTR was the Republican counterproposal to Hillarycare.

rosignol: actually, the French system of health care is generally regarded as quite successful (by European standards anyway).

Mm. Didn't something like ~15,000 seniors die a few years ago in France because most of the doctors were on vacation during a heatwave or something?

And didn't the doctors in France go on strike back in June?

Yeah, that sounds like a great system. I gotta get me some of that...

It's coming. The simple fact is, people are going to demand it, and you even have a lot of Big Business on board with it. It's a done deal.

I think this bears a little more examination than y'all are giving it, even though it's wrong. It's not coming; it's here already. Here's how it works: poor people go to the hospital (the emergency room, if necessary) to get treated. They get billed. Both they and the hospital know they're not going to be able to pay, so no money is collected.

However, the hospital has to pay for itself somehow, so the unpaid accounts wind up jacking up the rates on everything, so that income is more closely related to expenditures. The result is that those who can pay wind up paying more, while those who can't pay little or nothing. This is effectively socialized medicine, but it's not anything like what you'd design if you were designing such a thing. Hilzoy maintains that it's more expensive by far than other kinds of programs that could be implemented, and that we pay more for less.

So, for now I'm granting that there may be a better solution, but I have no idea what form that solution ought to take. Certainly what we're doing now (what we're actually doing, not what people tend to think we're doing) isn't what you'd design in a sane universe, and measures to keep it from being that way all look mighty unpalatable to me. Who's going to turn away the poor kid with the broken arm? Or the uninsured guy with a kidney stone?

The solution is simply stated: Get rid of the insurance companies, get rid of government involvment. Let patients negotiate a price with the doctor face to face.
It'll never happen because the current system is as intertwined as the staff of Aesculapius (or however you spell it) (You know, the rod with the snake wrapped around...). But, I live in fantasy world... :-)
Oh yeah, you'd have to get rid of all the lawyers too.

There are all kinds of reasons health care is down the tubes. It has been as big a drain on the economy for going on twenty years or more as gas prices are now. We just don't tend to notice it as much because it's been with us so long, and you never notice it until you or someone close to you needs medical care. Then you get it.

It has to be fixed. And it's sure not going to fix itself, it has to be brought kicking and screaming to it's own special operating room. It needs a massive transplant, and therapy, before it dies from massive internal hemorrhaging.

The magical, mythical "market" has never done anything for anybody but itself, until it is forced to. There are too many factors at work that want to milk that cow for all it is worth, and we the people are getting -well, sick of it.

The cost for transporting by helicopter my infant son with a heart condition to St. Louis was $15,000.

His initial three-week stay in the hospital was over $125,000. I have not seen the bill yet for his three-week stay in St. Louis, but I imagine it is a good bit more than that.

How much have I paid? A $250 deductible right off the bat. $200 for each hospital visit (four total). Deductibles for ambulances and the helicopter. Co-pays for doctor visits and prescriptions.

I'm deeply thankful our country has medical care as it is, because without Logan would not be here. I'm very fortunate that my medical coverage took care of so much of those astronomical bills. We're supposedly firmly in the middle class, and we had more in savings than the vast majority of Americans. Even so, the costs are huge, and I wonder what they will be next year--a $500 deductible, $400 for each hospital visit? How many people will be able to pay that?

Plus, if not for relatively recent legislation, I would have had to quit so that my could continue at her much lower paying job, and then hope that she never lost it, because an insurance company would not have covered Logan with a preexisting condition. Instead, she is working part time, and we are trying to get by as best we can for the moment (which isn't all that great, believe me). And yet we know that we've been pretty lucky.

I'm not arguing for socialized medicine, but the personal responsibility tack only goes so far. You might say, if we didn't think we were able to financially handle some kind of medical issue with a child, we shouldn't have had one to begin with. Fine. But congenital heart defects are found in 1% of births--never mind all the other complications babies can be born with. And as I said, we're supposed to be in the middle class. Given that situation, it's starting to look like only the uppers and upper middles can really risk having children, because everyone else faces a real risk of bankruptcy.

So let's not have England's socialized medicine. But what do you suggest as an alternative? Because for a great many of us, even with middle-class incomes and relatively good coverage, the current situation is not good, and it's only getting worse.

And please, spare me the paraphrasings of Churchill's democracy quote. Platitudes are not solutions.

Socialized medicine has worked real well for us here in Canada.

The government subsidizes education and healthcare. The most inflationary sectors of spending are ... education and healthcare.

Everyone is entitled to emergency room care, regardless of immigration status or credit score. ERs charge everyone double, since only half pay. And that half is subsidized taxes and increased costs passed on to consumers by business.

There is no health care crisis here, relative to other industrialized nations. We might as well elect someone to create one.

As Lein Shory's tale illustrates, part of the problem lies in that the question of what a procedure "costs" is almost meaningless, in the sense that it's impossible for a layman to anticipate and thus plan for. That's not just for emergencies, but even things you expect. Two more examples of my own. 1) Some years ago I had to have an angiogram, where they send a catheter up through an artery in your leg so they can look at your heart. I reported to the hospital in the morning, got a clean bill of health, was released that afternoon, and sent a bill for the list price: $17,000. Both my insurance company and the hospital told me to ignore it. That was just the first move in a standard negotiation process. In the end my insurance paid a fraction of that amount, and I paid a co-pay of about $300. 2) A friend of mine who is a nurse told me that if someone showed up at their hospital needing a procedure, had no insurance but plenty of money, and said, "Just tell me what it costs and I'll write you a check," their first move would be to discount the cost by about 85%.

So how much does healthcare cost? Who can tell?

Half pay? Not in my ER... The collection rate where I work is less than 40%

EMTALA is the federal law that mandates that any patient that shows up to the ER must be seen and evalutated. Patients know it too, and show up for all sorts of non-emergent things (or they use us instead of their regular doctor, because we don't have a 5$ copay). If told they don't have an emergency, they write nasty complaint letters to the hospital that we have to spend time addressing. The amount of abuse of the ER is tremendous, and it's incredibly expensive.

On my last shift, I nearly wept at the number of people who showed up to my hospital with problems they'd had for weeks, months, or even years... not a single bona-fide emergency in the bunch.

Even so, we still have a better system than many socialized ones.

PJ O'rourke said it best: "if you think health care is expensive now, just wait 'till it's free"

Mad bikini blogger: even in a market based system there would be a need for insurance companies. The average individual is not able to pay the cost of extreme medical treatments, even if they were priced at something approximating a true cost. Most people don't have to pay for those types of procedures (or at least not often) but it's wise to plan for the possibility. Hence insurance that pools the risk among others.

I don't claim that our current medical insurance system is good or efficient. But insurance for health care makes sense in primciple, just like it does for automobile liability.

I still don't believe she'll run. The Dems have to know that conservatives who are disgruntled to the point of staying home and sulking in '08, would crawl across broken glass on their lips to vote against her.

If she runs, I'll bet she doesn't make it through the primaries. Still, it could be fun to see all the dirt come out of the closet if she does.

Insurance is designed to protect people against catastrophic events. Insurance covers most, but not all, forseable events.

Health insurance, however, has devolved into something that purports to cover every concievable malady and event. Consequently, it is just as expensive as having a zero deductible on your car covering any dent or malfunction.

Our society has to ask itself a fundamental question: Do we ask individuals to accept as much responsibility for their own, personal, affairs as possible or do we move down an ever enlarging path to total state control over our lives?

The problem is, as more and more opt to not accept responsiblity, costs will continously expand as politics will prevail over economics. Fights over what is covered will default to whatever is most sympathetic politically speaking and not necessarily cost effective or rational.

Example? A friend's 90 year old father elected to have heart surgery despite significant surgical risk. Why? He wasn't paying for it. Sadly, he died but not until he consumed a ridiculous amount of resources for a tiny possibility of a marginal improvement and extension of his life.

Would he have made the same choice if the money was coming out of his estate? Doubtful.

Ultimately, as in all socialist schemes, there will be more takers than providers. Society will grow weaker as ever more individuals shirk ever more responsibility.

Do we need as system to help those who cannot, really, help themselves? Yes. Is it difficult to construct a "fair" system. Certainly. Perfection is impossible. But the moment we are unwilling to make SOME hard choices is the moment we will not deserve to call ourselves either responsible or adult.

I'm just an IT manager (for a behavioral health insurance company no less) from New Hampshire, but to follow along Jag's point, it seems if Car Insurance was like Health Insurance, your oil changes would be covered and the garage would be billing the insurance company $500 for the service. You would just pay a $20 copay. Not much different than what an average oil change cost anyway (depending upon vehicle, of course!).

I agree with Mad Bikini Blogger, we need to pay out of pocket for normal, everyday outpatient services and have insurance for major medical/catastrophic illness.

TO: Craig
RE: Touching Upon Reality

"I agree with Mad Bikini Blogger, we need to pay out of pocket for normal, everyday outpatient services and have insurance for major medical/catastrophic illness." -- Craig

For a while, in the late 80s/early 90s, I dealt with health insurnace. I was one of the top agents in the country for my company. My especialité was a Hospital-Surgical policy that would cover anybody who didn't already have one-foot-in-the-grave, so to say.

NO EXCLUSIONS!

I had one client who had leprosy. Others had heart conditions. Or histories (over 6-months without treatment) of cancer.

This stuff sold like hot-cakes. And at reasonable prices.

Then the state came along and cut us off at the hip, using tax-payers money to subsidize the premiums.

The program folded overnight.

The point here is that, as one grizzled individual informed me, Major Medical insurance programs are looked upon as a 'blue sky project', by doctors. He was in real estate. He specialized in medical facility properties.

He said he could trace the rise of health care costs to the proliferation of major medical insurance policies. I suspect there was also something to do with the change of medical care from a 'charitable' to an 'industrial' approach.

Regards,

Chuck(le)

Contrary to some of the above statements, the vast majority of Americans have insanely generous healthcare benefits, which is a huge part of the problem. People have an appalling sense of entitlement to healthcare, and are unaware of the costs. There is no consumerism.

When my company recently switched policies, people were grumbling that the copay went up from $15 to $20. Boo-hoo, I was offended -- my brother and sister are both doctors. My 44 year old sister, who spent 3 years away from her husband and kids to go to med school, is still a resident, forced to pull all-nighters and 35-hour shifts.

A doctor is typically the most skilled and expensively trained and educated person most people transact personal business with. But people who'd thoughtlessly hand over $40 to a bartender every happy hour think they can eat up an hour of a doctor's time and shouldn't have to pay anything for it. That's absurd.

My sister-in-law and two first cousins are doctors. I admire their work. I don't begrudge them pay commensurate with their work.

But when the university I work for sprang a new $250 deductible per person on us this year--in addition to co-pay and other increases--I didn't think "boo hoo to the rest of you, people in my family are doctors, and they work hard." I thought, "Wow, we may be looking at close to a $1000 pay cut." And there are folks where I work trying to provide for their families on a single income. That kind of increase is not easy to deal with (unless, of course, you don't get sick, which I haven't found to often be a choice).

It's fine to talk in the abstract about inflationary sectors and costs relative to other industrialized nations. But I don't go to the emergency room to hang out, and I don't blithely hand $40 to a bartender while whining about giving $20 to a doctor--and yet it was brought home to me in a very real way how in an instant one whom I consider to be a fairly responsible person (myself) could suddenly be facing financial ruin.

Now maybe I'm just a single anecdote, and everyone else is a whiner and abuser of the system. But I don't think so.

I propose implimenting Nationalized Entertainment, like free concerts, movies, cd's, dvd's, gameboys, books, magazines etc so that income earners can spend all their disposible income on necessary things like personalized health care insurance while contributing a tax base which helps those who truly need society's assistance.

As a self-employed person I pay my own health insurance and would rather spend the $400 a month for that rather than spending $350 bucks to see a 2 hour Madonna concert, or buy countless CD's, DVD or go to the movies or buy $60 gameboys, or $4 magazines etc. Add up the monthly cost to entertain oneself and one can see how much money is spent on luxuries one assumes they can afford while insisting they cannot afford the necessary cost of items such as health care.

My priority to be responsible for myself and my family not enriching those who entertain me while they attempt to tell me that I cannot afford health care.

Perhaps universities could stop paying tenured Professors high salaries to work a mere 9 hours a week plus 4 months free paid vacation along with having paid assistants to help them work?

Lein Shorty unfortunately you work in an industry which is immune to helping people like you.

Another problem with Universal Health Care is that the next generation of under-populated 20-somethings are not going to be happy about paying more than 50% of their income to support a bunch of aging baby-boomers who believed Big Government Daddy would be there to pay for their old age luxuries particulary when those 20-somethings have been indoctrinated by their baby-boomer Professors to believe the best way out of a bad situation is to abort and/or euthanize costly problems.

The Great Society who partied for the last 4 decades is going to awaken with the worst hang-over they have ever experienced in their lives. What is more frightening is that it will be those feminists who encouraged aborting their replacements who unfortunately are going to scream the loudest making everyone else's hang-over all the more profound.

What comes around goes around; Karma can be a nasty thing if used selfishly.

syn,

Never mind.

And my name's not Shorty.

One funny thing is how the US automaker execs have begun calling for socialized medicine -- so as to reduce their own costs, for free. (And since they're chronically unprofitable, I guess they won't experience the increased corp income taxes the system might necessitate, ha).

Imagine socializing healthcare -- a highly successful market where the big problem is meeting huge consumer demand with constrained resources -- and hence high prices. Perhaps instead we should socialize the AUTO industry, that value-destroying quagmire full of greedy incompetents who consistently show an amazing lack of foresight and inability to serve the market.

Sorry Shory I apologise for my mistake.

Yeah yeah, never mind and keep leading yourself down the road to serfdom but when you arrive please don't cry tears of emotional blackmail about the misery everyone else has brought upon you because you demanded Government rescue you from your own responsibilities.

What we have forgotten is that Freedom and Democracy is hard work, requires responsible behavior from every individual who is capable of meeting their own needs; none ever said it was easy.

When everyone considers themselves entitled to each and every need then those who truely have need for community assistance will be plundered because of those who refuse to help themselves.

If everyone is riding the collective wagon who will be left to carry the heavy weight?

What I have learned in my 44 years of living is that the more responsibility I place upon myself ensures that I will be less a burden on everyone else.

Shory if you are in dire financial straights over $1000 less because your deductible is a new $250 then you need to increase your skills beyond the employment comforts of the Ivory Tower; an industry immune from the real world environment.

I deeply regret having mentioned I work for a university, for I should have expected that those with an all-consuming hatred for public institutions and those who work in them would glom like a magpie onto the mere mention of a public university, where, the assumption goes, no one works hard and everyone is little better than a panhandler.

Since when did I demand government rescue me from my responsibilities? You seem to be demanding that a strawman rescue you from your rhetorical ones. I only asked for suggestions of solutions.

Yours, that I just need to work harder, is asinine. We do not live in Somalia, where it it truly every man for himself. Were we all rich, we could pay for all our medical care in its entirety, and not worry about insurance companies at all. But we're not, unfortunately, and as one who isn't I am most glad that the eeeeeevil government(s) passed laws against rejecting people for preexisting conditions--and I suppose you oppose that, because in your view anyone who cannot earn and save enough to afford any catastrophic health condition a child may be born with ought not have children--a policy that will rather quickly send our society the way of the Shakers.

Jon,
I have a few examples of other systems. I live in a border city with Canada and I work in the healthcare system. We see quite a few Canadians who cross the border to pay out of pocket here because its faster. The wait time to get an angiogram after a positive stress test there is so long, many people die of heart attacks before they can get to their appointment.
In a more personal example, my in-laws are from Denmark. When my husband was in high school, his father went in for elective colon surgery. During the surgery, colon cancer was found as an incidental finding. He then underwent successful treatment of his cancer. The doctors told him that if this cancer had been found six months later, he likely would have died. My father-in-law freely admits that the only reason he beat his cancer is that he was living here, because the wait time for that elective surgery in Denmark is longer than six months. In fact, it is one of the reasons that my in-laws decided to apply for American citizenship.

dr nic

Same here, Dr. Nic. Many Canadians vacation in my area, and show up in my ER having had GI bleeding (complete with bona-fide melena) for months.

It's amazing that it's faster in many cases to wait until your vacation, come to an ER in the United States, and get your endoscopy the same day, intead of wading through the Canadian system.

Lets talk for just a minute about some of these remarks..."The people on Medicare love that program because they get so much out of it and put nothing into it." That's not even close!

All the people on Medicare have worked for 30-40 years and paid into SS the same as everyone else. All those years they worked and paid into that program someone else was using it. That how that system works. They also pay almost 100.00 per month for medicare part B and another 50.00-80.00 per month for part D (prescriptions) on top of that they paid for supplemental health ins. from AARP or some place with is an average of about 150.00 per month. Then there are all the co-pays that their part D of medicare doesn't cover on prescriptions, which can go into the hundreds of dollars a month...I'm sure you can do the math and figure that it is not anything close to a free program.

Yes, it is going to go broke one day with the increasing cost of healthcare? But, why is there such an increase in healthcare? We can look to our health providers for the cause of that. Most physicians are so damn afraid of a med-mal suit that they all practice defensive medicine. Defensive medicine is driving our healthcare into the ground. Its the reasons your co-pays keep going up and why your employer can no longer afford premiums. Until we either have better tort laws in this country to protect drs. from frivalous lawsuits, or we have an NHS this is only going to get worse.

Personally I don't much like it when such a large percentage of the people in our country go without medical care and needed medications .
Where is the solutions? Also, visit Dr. Crippens blog he will tell you about the NHS in the UK. He admits it is terrible but atleast ALL the people have coverage. It is false that peole have to wait so long for emergent medical care and seeing specialists or surgeries. They get classed by their GPs. Some get put into a 2 week referral which means they have to be seen by a specialist within 2 weeks. It is the cases where the GP has determined you are not emergently ill have to wait so long. Really not much unlike what goes on here in the USA many times. I received an intial appt. with a GI specilist for 6 months out. I was working and had excellent ins...Didn't make any difference. Only when my PCP called the GI personally did that appt. get moved up..I also have friends in Canada who tell me they wouldn't trade their NHS for our screwed up system for anything in the world.

Ahh, health care - my love. Some of you have it kind of right, some of you have it completely wrong. I have worked in the value equation of health care field for a few years now and we all need to quit pointing fingers. It is the summation of actions taken by the individual actors, all reasonably taken, but when added together cause problems. Those problems are:

Paying doctors for doing procedures instead of managing their patients health. We do acute things very well and quickly .. and this would disappear overnight in a nationalized system ... but poorly on chronic diseases which drive most of the cost increases.

Insurance paying for office visits and a big chunk of Rx and other small procedures. There is no health insurance anymore, it is a prepaid healthcare system.

The federal government programs do not pay the cost of providing care. This is Medicare and especially Medicaid. So this cost shift goes to commercial payers, increasing their costs to provide health benefits.

Americans do not get much physical exertion and coupled with the push for lowfat diets created an interesting "perfect storm" of high carb foods creating sugars the bodies cannot burn off - hence the diabetes explosion. Non-controlled diabetics are worse than cancer for costs.

There is some defensive medicine practiced in response to some malpractice law situations and this varies by state.

New medical facilities open up and immediately work to fill up their space, driving utilization for services and increasing the overall spend on healthcare.

What to do:

Improve the flow of medical information to the appropriate healthcare providers.

Modify the payment system to incent providers to manage your health not just do things.

Create consumer driven situations HRA's, HSA's in order to make consumers, all of us worry about what we spend and just pay out of pocket for the small stuff. Tie in a large deductible plan for the big stuff - that for which insurance should really be intended.

Create incentives for individuals to pay smaller premiums if they don't smoke, watch their weight, etc. Within the incentives work to provide upfront preventive care that has real paybacks to long term costs.

It won't be easy, and it won't fix it overnight. But the government solution is a terrible one. The government helped create this mess, the government getting more involved in delivering care would make it worse. Thank the AMA for not graduating more doctors - more doctors mean more patients and more costs due to higher utilization. Get more info out to everyone so they understand better how to spend health care dollars. The computer could actually help us here - now we can track performance and costs more accurately.

The next time you make comparisons as to how you stack up against "socialized" medicine, do it with those countries that have it right. You are the highest per capita spender in the health care and roughly 40 million of you have no protection. Comparing this little fact to how it's taken care, for instance, in Finland and Sweden, you lose.

"You are the highest per capita spender in the health care and roughly 40 million of you have no protection."

The fact that we are the highest per capita spender doesn't mean its wasted. Americans spend tons of money, much out of their own pocket, for "healthcare" that is cosmetic or supplemental in nature. The fact that 40 million may not have coverage also is less than meaningful. Most of these people have the means to acquire private health insurance or are young and chose to forgo it. They may be wrong to make that choice but it doesn't mean they are deprived of coverage.
Of the balance of uncovered persons, most (unfortunately) go to ERs where they get (subsidized) acute treatment. Yes, some with chronic diseases are uncovered and don't get treatment. But when you have to wait six months in many countries, might die in the process of waiting, how is that "superior" to the American system?
I don't know how Finland or Sweden manage their healthcare. I imagine if their system is superior, cost effective as well as comprehensive, it will be embraced here.
Funny, I don't hear the raves about those countries experience coming from Hillary or other government monopoly advocates.

I wonder why?

Maybe because they have almost completely confiscatory tax rates.