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Politics : A US National Health Care System? -- Ignore unavailable to you. Want to Upgrade?

To: i-node who wrote (6434)	3/22/2009 8:33:30 PM
From: Lane3	1 Recommendation Read Replies (1) \| Respond to of 42652

But the fixed costs remain the same and just have to be borne by other hospital customers. That's true immediately, but over time the infrastructure shrinks to accommodate the reduced business. You end up with one fewer hospital and one fewer CT scanner. As I said, there is a natural limit to how much you can size down and still get economies of scale--you need a certain critical mass--but there will never be enough medical tourism to reduce customers by that much. You need to evaluate the system after it has adjusted to the change to determine the impact of the change. The transition period is too volatile. While reimportation isn't part of the "medical tourist" scenario, it IS part of the concept of moving health care costs out of the country where they are lower. I'm not a proponent of reimportation. But I think that price shopping is a wonderful idea. It reduces costs, keeps traditional facilities honest, and warms the cockles of my capitalist heart. A little competition never hurt any enterprise.

To: i-node who wrote (6434)	3/22/2009 9:29:58 PM
From: TimF	Read Replies (1) \| Respond to of 42652

While reimportation isn't part of the "medical tourist" scenario, it IS part of the concept of moving health care costs out of the country where they are lower. But that burden still ends up in the United States, borne by other drug consumers. Reimportation isn't really a case of some foreign country providing the good or service for less. Its American drug companies selling the same good, which cost them the same to produce, for less money because it gets routed through Canada. In effect all your doing is cutting the price, not cutting costs (in fact they would be marginally increased by moving the drugs around and having different middle men take a cut). Its not adding competition with someone else providing the good or service. Surgeries in other countries really are examples competition with someone else providing the service, with presumably lower costs. Its not just cutting the cost for/from the same provider. Also things like surgeries don't have the same level of economies of scale that drug production does, so there would be a greater possibility of reducing overall costs. Re-importation really is a separate issue, and comparisons or analogies to it just throw us off. For example, every major hospital is going to have a CT scanner; one fewer patients using it reduces the operating cost of the hospital only for consumables, which isn't much. If a significant portion of medical care demand went to medical care tourism, than you would have fewer hospitals, and fewer CT scanners in the US. In practice, since we already have the hospitals and CT scanners, and there is a lot of sunk cost in these things, it would take time before we would scale back, and fully realize the savings. Its not weeks, or months, its at least years, and maybe decades. OTOH its not like the demand would shift overseas that rapidly either. If it starts to shift, then those years or decades of adjustment can start as well. You don't get all the reduction in demand before any reduction in capacity starts.