Thinking Citizen Blog — Victor Fuchs — Three Systems, Three Sets of Problems
Thinking Citizen Blog — Thursday is Health, Health Care and Global Health Policy Day
Today’s Topic — Victor Fuchs — Three Systems, Three Sets of Problems
Why are US health care costs so much higher than elsewhere? Well, answers Victor Fuchs, the health economist, there is the ratio of specialists to primary care physicians. Ours is 2 to 1 while it is about 50–50 in other countries. We have more standby capacity, less social support for the poor, higher incomes for physicians, more malpractice claims. In short, it’s complicated. The Fuchs/Emanuel solution is a voucher system funded by a value added tax. A topic for another time. Today, three sets of quotes from Fuchs — one set on employment-based insurance, one on Medicaid, and one on Medicare. I share them because they are models of efficiency — saying more with the fewest words possible. Experts — please chime in. Correct, elaborate, elucidate.
WHAT’S WRONG WITH EMPLOYMENT-BASED INSURANCE?
1. “Employment-based insurance, which covers 55% of Americans, is inefficient and inequitable.”
2. “It distorts labor markets, has high administrative costs and generates discontinuous coverage.”
3. “Because it is paid with pre-tax dollars, it providers a larger tax break to high wage than to low-wage workers.”
WHAT’S WRONG WITH MEDICAID?
1. “Medicaid and other programs for families and individuals with income below set limits cover about in 6 Americans. These programs require costly eligibility determinations, impose high tax rates on extra income of the recipients because the subsidies fall or disappear as income rises, and encourage evasion or avoidance of reported income.”
2. “Many who are eligible do not apply — some to avoid the administrative hassle or stigma and others because they expect their income to improve.”
3. “The programs also generate discontinuous coverage as eligibility changes.”
WHAT’S WRONG WITH MEDICARE?
1. “Medicare, which covers about 1 in 8 Americans, while popular, has fundamental flaws. It is an open-ended entitlement that does not consider the cost of technologies relative to their benefits.
2. “In an era of rapid technological change, that is a recipe for financial disaster.”
3. “Despite these programs, 15% of Americans have no health insurance, either they can not afford it or choose not to.”
FINAL QUESTION: What are the three best paragraphs you have ever read on health care in America or what to do about it and why?
http://sm.stanford.edu/archive/stanmed/2005winter/experts.html
http://www.nejm.org/doi/full/10.1056/NEJMp1200478#t=article
YOUR TURN
Please share the most interesting thing you learned in the last week related to health, health care or health care policy — the ethics, economics, politics, history…. Or the coolest, most important thing you learned in your life related to health are or health care policy that the rest of us may have missed. Or just some random health-related fact that blew you away.
This is your chance to make some one’s day. Or to cement in your mind something really important .
