American lifestyle habits are simply not a large driver of our increased health care costs.
You are correct that by itself our lifestyle is not enough to drive costs. It is the combination of our lifestyle and expectation level towards heathcare that drives costs.
For example, all the extra testing doctors do for liability reasons that is 2.4% of spending:
http://content.healthaffairs.org/content/29/9/1569.abstract
Or how our special snowflake mentality makes us overtreat for conditions like cancer:
http://www.kaiserhealthnews.org/sto...philadelphia-cancer-patients-overtreated.aspx
and many other diseases. Thanks to our "the customer is always right" approach to healthcare that becomes more and more disconnected from the real costs a third of our healthcare spending is waste:
http://www.washingtonpost.com/blogs...necessary-health-care-two-charts-explain-why/
Americans just being fat and unhealthy isn't the problem. The fact that our fat asses demand so much from the system when the inevitable sh*t hits the fan is what is expensive.
What's interesting is that the ACA directly attacks hospital readmissions, which as you said IS a large contributor to our costs.
Presumably that makes you happy, right?
Sure. I am a rational person. I can probably list a half dozen changes that were good that are part of the ACA. But that doesn't mean I like the ACA. The damage it is doing is far greater than the benefit. The things I like about the ACA could be done without the mandate and other parts I dislike, but that would have required a Congress that wasn't lobbied to death by an insurance industry that does a lot of political spending.
Seeing as how the ACA shows our Congress is bought and paid for, I just wish they would have done nothing instead of create the love letter for the industry (or more exactly the largest insurance companies in the industry) that the ACA is.
That's not really in line with the facts either. The growth of medicare and medicaid spending has been markedly lower than the growth of private health spending for a long time now. That's pretty much perfect logic for how our spending would be lower with single payer.
And it is also perfect example about why innovation, and honestly top talent going into the medical field, would be gone in the system you want. The reason Medicaid and Medicare payments are so low compared to private insurance companies is because they PAY LESS.
They pay less for the same procedures, they pay less for new innovative procedures if they pay at all, they never pay for anything close to an elective procedure and they prevent Medicare and Medicaid patients from getting elective procedures on the side so the standard of care stagnates.
There is a reason that Medicaid participation rates are so low, and that Medicare participation rates are dropping. Those doctors that do participate are leaving less available slots open for Medicare and Medicaid patients and more slots for private insurance patients that pay the bills. Or maybe the doctor quits taking insurance all together and moves towards a 1%er concierge practice, thereby separating access to the best medical talent from the average American.
Here is the great article that talks about slotting, reimbursements and the temptation to just say "screw it" and go concierge:
http://www.kevinmd.com/blog/2012/09/blame-patients-long-wait-times.html
What's funny is that Medicare, Medicaid, and every private insurance company already has a board like the IPAB, the ACA just makes it so the IPAB can actually function. Strangely, innovation soldiers on.
It soldiers on because no single board has enough leverage to control the industry. Even if Medicare decides a procedure is not worth coveraging, if enough private insurances decide to support the procedure there is enough ROI on the R&D to make it available to the public.
You combine that power together, or give the insurance companies a convenient reason to cede power like with the IPAB, and suddenly it is this board of bean counters and not the best minds in medicine that is defining what is the acceptable level of modern patient care and what is the best results we can get for patients that can't afford to pay for everything with cash.
Again though, if you think the idea that Medicare and Medicaid having a board that looks into the utility of medical procedures will destroy innovation in this country that means our system for innovating requires no critical assessment of the merits of what they create. That's a shit innovation system.
No, there is a critical assessment of merits but that isn't happening with the bean counters that run Medicare and Medicaid. Now private insurance companies assess the innovation on their own and decide to pay or not pay based on the data and not budget projections. But with the existence of a more centralised panel like the IPAB, now one group will set standards for the whole industry.
I don't see how you don't get the disconnect here.
Innovation happens in medicine because someone or some company expects to make money off that innovation. In order for them to make money, there has to be some way for them to be compensated above and beyond what the current level of care costs. Otherwise, why innovate? That is typically the practical reason for heath care costs to rise each year.
The problem is that innovation happens in bursts, not continuously. For five years it is done one way, then a new million dollar machine is released and then from that time forward the new standard of care costs 20% more to account for the machine costs. Averaged over a long period or across the entire industry it looks continuous, but really in each segment costs due to innovation are closer to stairs than a hill.
This doesn't work for a bureaucrat panel of beancounter that wants healthcare spending to increase at certain and steady x% intervals each year that they can budget for. So instead of assessing the merits of the new standard of care, it is thrown out and what we had was good enough end of story. Medicare and Medicaid have done this for YEARS. No reason to think the IPAB will be better or different, the motivation to control costs via beancounters is the same.
Oh and in the case of Medicare if you publically try to push the standard of care yourself as a physician via advertisements (aka push the old people to expect more so they push Medicare to pay more) get ready for a Medicare audit or two. Those always cost thousands of dollars even if you are 100% by the books, like an IRS audit. The priority becomes controlling costs, not the best patient care possible.
You and other progressives can pitch one fit after another that doctors should go into medicine to help people and not for the compensation, or that companies should innovate to push the standard of value in care and not just for their own profits. Call the system shit, call the doctors greedy, call the drug companies evil.
But all the temper tantrums in the world won't change facts-
A more consolidated system around the IPAB panel will HAVE TO cut medical profits to contain costs which will stifle innovation and over a long time will send America's greatest minds into finance/law/IT/whatever instead of medicine which lowers the potential quality of care for us all.
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