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I think tort reform is a bit over-stated; but, I've been told by one of my friends that studied medicine abroad (and is a HUGE liberal) that in those other countries, healthcare is cheaper because "they don't have to worry about getting sued". I was a bit surprised by her comment. Generally, I'd view tort reform as minor in comparison to prodigious costs shifts and other distortions.

That's total utter BS!
If you sue an individual, how does that increase your cost of healthcare?
Doctors also carry malpractice insurance for that very reason, and that has nothing at all to do with health insurance premiums.

But tort reform applies to ALL torts not just medical.
So basically lets use this totally hypothetical example here.

Stu, you and your beautiful wife decide to buy your first house. 2 miles away is a DuPont chemical plan. Well life is going great, and you guys decide it's time to start a family. While your wife is pregnant you guys both start getting sick. You figure that it's just a bug that's going around and no big deal. However whenever your child is born, he's born with some unusual birth defects.

Not too long after the birth, your wife's condition worsens and eventually she dies. You feel that your health is actually getting worse too. You come to find out the DuPont plant has been ventilating toxic chemicals, which just happen to blow down wind to your house.

Now your wife is dead, your kid needs lifelong care, and you're in bad shape yourself.
Well you live in a tort reform state, and guess what.... You can only sue Dupont for 300k. After lawyer fees you might have half of that. 150k, guess that's the pricetag on the life of you, your wife, and son.

That's how tort reform works.

Not to mention a jury still has to rule in your favor. Additionally against a corporation (who is legally an individual) torts are your ONLY redress for wrongs. You can't throw DuPont in jail, so you sue them for punitive damages. You punish them by hurting them financially.

Create a public health insurance. If you don't have a job it is free. If you have a job it is paid by the employer.

Use the public hospitals to measure the costs of the different treatments. Treatments at private hospitals are then covered by the insurance if and only if they are in the same price range as equivalent treatments at the public hospitals.

i'm softening on the idea of universal health care. cold logic says poor people should just suck it up, but i don't want to defend this logic anymore. i am human after all.

as for this solution, it seems like it's on the right track, but only because it seems to be an attempt to create pseudo-competition. and there's an assumption that the cost of public hospitals should be the benchmark.

if the costs of the public hospitals are skewed in one direction or other, then it simply spreads the same distortion into the private hospitals.

maybe if this model was tweaked so that the lowest cost, best servicing hospitals, regardless of ownership, gets the most funding? say if people were given some amount X to spend on health care at whatever provider they wanted--like school vouchers. it creates incentives for hospitals to lower costs and provide better service without a central authority. maybe there is a system like this somewhere already?

Can't believe the Supreme Court even upheld this. Feel sorry for people living in the fascist dictatorship USA is becoming.

Can't believe the Supreme Court even upheld this. Feel sorry for people living in the fascist dictatorship USA is becoming.

Agree with this, but I think it's a different debate perhaps.

If you sue an individual, how does that increase your cost of healthcare?

The first thing we must acknowledge is that there's no such thing as "free" anything. ALL COSTS are shifted from someplace. Universal health care would not be free, nor would current taxes pay for such a thing. Addressing your comment per se, all costs, including law suits paid by insurance and not doctors, are shifted. Guess who pays... I wasn't one to believe that tort made any difference, but somehow my friend that studied in Europe was under the impression that medical expenses were cheaper there due MOSTLY to tort... there's no way this can be true, but I am cognizant that any expenses (including tort) will ultimately increase the input cost which eventually makes its way to the customer.... so if we say insurance will be paid by employer, for example, it's actually paid by the worker. Taxes paid by a corporation are actually paid by the customer. Real estate taxes paid by a landlord are actually paid by the tenant and so forth.... the person doing the paying is the one holding the bag. the one earning the money isn't (generally speaking)

Yeah don't want to derail the thread with a debate about that, just had to voice my displeasure about Obama "Care" or lack thereof & Dictator Obama.

Agree with this, but I think it's a different debate perhaps.


The first thing we must acknowledge is that there's no such thing as "free" anything. ALL COSTS are shifted from someplace. Universal health care would not be free, nor would current taxes pay for such a thing. Addressing your comment per se, all costs, including law suits paid by insurance and not doctors, are shifted. Guess who pays... I wasn't one to believe that tort made any difference, but somehow my friend that studied in Europe was under the impression that medical expenses were cheaper there due MOSTLY to tort... there's no way this can be true, but I am cognizant that any expenses (including tort) will ultimately increase the input cost which eventually makes its way to the customer.... so if we say insurance will be paid by employer, for example, it's actually paid by the worker. Taxes paid by a corporation are actually paid by the customer. Real estate taxes paid by a landlord are actually paid by the tenant and so forth.... the person doing the paying is the one holding the bag. the one earning the money isn't (generally speaking)

I definitely agree, it all gets paid forward.
However as far as I know just about everywhere in Europe still has a civil court system =)

But I've never heard of an MD going out of business due to litigation costs.
Many of the lecturers for my courses (my degree is legal studies) have all said they can count on one hand how many plaintiff verdicts they've seen in medmal cases.

N0where:
Pharma companies know they're selling 100% useless products. Statin drugs (that lower cholesterol) don't prolong life, or even do anything beneficial. The disclaimer right on every commercial reads "does not prevent heart attacks". Statin drugs are the MOST prescribed drug in the world.

Research shows:
1. There's no casual relationship between cholesterol and heart disease.
2. Statins provide NO NONE, not 1 iota of benefit at all to women, or anybody over 50. In fact in people over 50, and women, higher cholesterol leads to LONGER life.

2 things:
1) I don't disagree with you, but man you gotta have a citation in there somewhere.
2) None of what you say is related in any way to the point I was making.

That's total utter BS!
If you sue an individual, how does that increase your cost of healthcare?
Doctors also carry malpractice insurance for that very reason, and that has nothing at all to do with health insurance premiums.

But tort reform applies to ALL torts not just medical.
So basically lets use this totally hypothetical example here.

Stu, you and your beautiful wife decide to buy your first house. 2 miles away is a DuPont chemical plan. Well life is going great, and you guys decide it's time to start a family. While your wife is pregnant you guys both start getting sick. You figure that it's just a bug that's going around and no big deal. However whenever your child is born, he's born with some unusual birth defects.

Not too long after the birth, your wife's condition worsens and eventually she dies. You feel that your health is actually getting worse too. You come to find out the DuPont plant has been ventilating toxic chemicals, which just happen to blow down wind to your house.

Now your wife is dead, your kid needs lifelong care, and you're in bad shape yourself.
Well you live in a tort reform state, and guess what.... You can only sue Dupont for 300k. After lawyer fees you might have half of that. 150k, guess that's the pricetag on the life of you, your wife, and son.

That's how tort reform works.

Not to mention a jury still has to rule in your favor. Additionally against a corporation (who is legally an individual) torts are your ONLY redress for wrongs. You can't throw DuPont in jail, so you sue them for punitive damages. You punish them by hurting them financially.

This is a pretty extreme and nearly impossible example- I deal with the EPA every day and let me assure you these people are insane- you can"t take a leak outside without some ass hole bureaucrat showing up to sniff it.

The current system is basically this- You show up with a fever and a headache, Dr. sends you home with aspirin saying give it a week see if it goes away instead of running $40K in crazy tests. You turn up with some 1 in a million rare disease that cripples/kills you, now you are suing and even if you lose the Dr./ his insurance company is out a ton in legal fees, if you win there is serious millions in cost to be paid.

This isn't so much about the rare disease but the 999,999 ridiculous tests from the scared Docs that is the real cost.

I definitely agree, it all gets paid forward.
However as far as I know just about everywhere in Europe still has a civil court system =)

But I've never heard of an MD going out of business due to litigation costs.
Many of the lecturers for my courses (my degree is legal studies) have all said they can count on one hand how many plaintiff verdicts they've seen in medmal cases.

aren't hospitals usually sued not individual doctors? i'm not sure since i haven't watched HOUSE M.D. in a while.

anyhoo... http://www.nationalreview.com/agenda/230642/malpractice-litigation-and-cost-health-care/avik-roy

uh oh... http://www.nydailynews.com/opinion/obamacare-fail-tort-reform-malpractice-insurance-costs-crippling-medicine-article-1.452167 (according to this the avg premium for medical malpractice insurance for a N.Y. based neurosurgeon is 76k a year? whaaa?)

seems to be a rock and hard place situation we got here. yeah, it's a mess. or maybe these scamming docs are just making excuses?

Sneakers, you really piledrived this nail on the head.

2. No, there is not a free market for health insurance. If there was, we would all be able able to shop around -- across state borders. Yes, Stupid Governments again. They think they are the smartest and overregulate everything. In the end, no one can enter the market except those with really really deep pockets. Open the state borders to purchase/sell insurance, and prices would drop.

If they opened the insurance market across state borders, you don't think all the insurance companies would find the states with the best (for them) requirements and operate from there? It's not a coincidence that all the credit card companies operate out of Delaware.

If they opened the insurance market across state borders, you don't think all the insurance companies would find the states with the best (for them) requirements and operate from there? It's not a coincidence that all the credit card companies operate out of Delaware.

Consumers would choose the insurance that fits there needs.

The other side of the coin is that for a company to have access to all 50 states, they must have an office in every state (minimum). Thus the reason for deep deep pockets when a company wants to go into any over-regulated artificially segmented market.
EDIT: as it is headed, the Federal government will have a 50-state monopoly, while the private-sector is regulated out of full markets (vs state-by-state).

As for scoffing at controlling all of the lawsuits (sniffles -> lawsuit)......
......Well, we are all now the proud shareholders of any lawsuits made to the Fed system (Obamacare). We will not be able to sue some rich company.....we will be suing ourselves everytime (as we are now the insurance company). But many will never understand the math. Debt does matter (private and govt).
Like a huge stormcloud feeding itself......s*** will start breaking.

2 things:
1) I don't disagree with you, but man you gotta have a citation in there somewhere.
2) None of what you say is related in any way to the point I was making.

how about an article? http://www.washingtonmonthly.com/features/2004/0404.brownlee.html

it's gotta be true, i read it on the internet!

seriously, people need to stop thinking doctors are benevolent, all-knowing wizards cloaked in their +1 healing white wizard robes but simply over-educated body technicians. call them on their bs, and educate ourselves!

However as far as I know just about everywhere in Europe still has a civil court system =)

She specifically talked to me about this. What she said was that due to healthcare being government owned and operated coupled with the fact that the government operates/presides over the court system, effectively when you sue, they just decide what they'll do or won't do.
In other words, you have a lot less legal recourse since they act as the judge and jury!!

She specifically talked to me about this. What she said was that due to healthcare being government owned and operated coupled with the fact that the government operates/presides over the court system, effectively when you sue, they just decide what they'll do or won't do.
In other words, you have a lot less legal recourse since they act as the judge and jury!!

big brother, indeed.

the rest of the world may think the American way of life is brutal and harsh, but damn it, the solutions for each problem in isolation just makes everything worse overall, imho.

i agree there seems to be problem with lawsuits and the cost of doing business for doctors, but i don't think that's government problem to fix, or that government (or intellectuals advising governments today) is smart enough to fix it, especially with more government.

this is pretty tangential, but the financial markets have this same problem in modern society with their ever-increasing complexity and government's desire (read: hubris) to control that complexity with disastrous results. Christmas Trees and the Logic of Growth by Mark Spitznagel

Einstein had it right when he said, “Problems cannot be solved by the same level of thinking that created them.” we need to pull back and let forces smarter than ourselves individually, namely market forces, to bring order to such complex systems.

difficult for the government to solve much.... and that's without the bribery. With the bribery, you can be assured that the solutions will make matters worse!

She specifically talked to me about this. What she said was that due to healthcare being government owned and operated coupled with the fact that the government operates/presides over the court system, effectively when you sue, they just decide what they'll do or won't do.
In other words, you have a lot less legal recourse since they act as the judge and jury!!

Isn't that why this country was founded in the first place, to avoid such things?
Police already have immunity, if doctors would get it I'd probably want to move to somewhere else.

Naw, it's unfortunate but just about all healthcare today IS big business. Big business is who benefits from "tort reform" and hurts your individual ability to have any kind of recourse should you be wronged.

As I said tort reform is a blanketed statement, it doesn't just effect medicine.

As I've said I don't believe that around here at least ( SWPA has a HUGE healthcare system, 2nd highest per capita elderly population in the country) MDs are being successfully sued.

To use my local health system UPMC (University of Pittsburgh Medical Center) as an example..
They're "non-profit", the largest employer in the county(2nd in all of PA), and also the largest private property owner, and have a near monopoly (of the 17 hospitals in the county that I can think of, UPMC owns 11). They own 6/8 within the city of Pittsburgh.

They don't pay taxes(non-profit, and considered "university property" so no property taxes ), but show quite a nice profit. 8 billion in revenue last year, with an "excess of over 250m".

The article you stated said successfully sued, but that doesn't say much. Successfully in went to trial? or successful in getting a settlement? I actually can't find data for 2011 sum of plaintiff awards for medical malpractice.

Perhaps if most doctors didn't have their heads up their asses, and treated people like people, then there wouldn't be this problem. I'm willing to bet probably 7/10 who've ever been to ANY doctor will say:

Their MD was arrogant.
Their MD didn't listen to them.
Most older patients are simply put on medications without knowing why, or what they do.

Granted I'm only a paramedic, but I think I know a little something about healthcare. It's for exactly this reason I'm constantly encouraging those close to me to find new doctors. The things I hear are literally absurd to me. I don't actually even have a PCP for this reason. I haven't found one that actually listens to what I'm saying, rather then just doing their own thing. If I ever have anything I need medically (which I haven't, or I've been able to take care of on my own) I would go to an urgent care.

2 things:
1) I don't disagree with you, but man you gotta have a citation in there somewhere.
2) None of what you say is related in any way to the point I was making.

Ask and ye shall receive!
1)Studies:
http://www.trialresultscenter.org/study7914-MRFIT.htm (low cholesterol diet study)
No significant decrease in death due to lowering cholesterol.

http://www.ncbi.nlm.nih.gov/pubmed/7968073 (study on statins)
No significant decrease in death due to lowering cholesterol via simvastatin.

http://www.trialresultscenter.org/study8315-Minnesota-coronary-survey-(Frantz).htm
No significant change in death due to lowering of cholesterol.

http://www.trialresultscenter.org/study6751-JUPITER.htm
Statin v. placebo, no significant change.

There's plenty of evidence out there, feel free to look.

i'm softening on the idea of universal health care. cold logic says poor people should just suck it up, but i don't want to defend this logic anymore. i am human after all.

as for this solution, it seems like it's on the right track, but only because it seems to be an attempt to create pseudo-competition. and there's an assumption that the cost of public hospitals should be the benchmark.

if the costs of the public hospitals are skewed in one direction or other, then it simply spreads the same distortion into the private hospitals.

maybe if this model was tweaked so that the lowest cost, best servicing hospitals, regardless of ownership, gets the most funding? say if people were given some amount X to spend on health care at whatever provider they wanted--like school vouchers. it creates incentives for hospitals to lower costs and provide better service without a central authority. maybe there is a system like this somewhere already?

The model I suggested gives the hospitals plenty of reasons to be cost effective. Public hospitals are normally cheaper than private hospitals. Mostly due to lower salaries which at the public hospitals are controlled by the state. You create competition by making the success rates public available and by giving people free choice when they have to pick hospital.

All in all a very effective way of lowering the costs of medical care.

Here is a link that looks at the costs of health in the US and compare to other nations.Exhibit 9 is very interesting.

http://www.kff.org/insurance/snapshot/oecd042111.cfm

Ask and ye shall receive!
1)Studies:
http://www.trialresultscenter.org/study7914-MRFIT.htm (low cholesterol diet study)
No significant decrease in death due to lowering cholesterol.

http://www.ncbi.nlm.nih.gov/pubmed/7968073 (study on statins)
No significant decrease in death due to lowering cholesterol via simvastatin.

http://www.trialresultscenter.org/study8315-Minnesota-coronary-survey-(Frantz).htm
No significant change in death due to lowering of cholesterol.

http://www.trialresultscenter.org/study6751-JUPITER.htm
Statin v. placebo, no significant change.

There's plenty of evidence out there, feel free to look.

Like I said, I already agree with you. Citations are nice for people who haven't looked this stuff up on their own!

eta: nawhead - medical malpractice insurance is as crazy expensive as you pointed out.

seriously, people need to stop thinking doctors are benevolent, all-knowing wizards cloaked in their +1 healing white wizard robes but simply over-educated body technicians. call them on their bs, and educate ourselves!

+a lot

Another big problem here is that CME isn't catching doctors up fast enough. Most doctors you see have relatively up-to-date knowledge...from when they went to med school.

+a lot

Another big problem here is that CME isn't catching doctors up fast enough. Most doctors you see have relatively up-to-date knowledge...from when they went to med school.

.. In some other country!

Steppin Razor - a few things
You could argue that there should be limits on these things in terms of insurance coverage, but gl drawing a line.

Well there's the rub. Deny a 98yr old his 5th heart and you're a death panel. How do you tell a guy, 'sorry time for you to die now'? But then who in his/her right mind thinks it makes sense for that 98yr old to get a heart because he can afford it and is next on the list?
I don't have the answer, only that I don't want to live to decrepitude so I'll be passing on those things.

why would a drug company advertise a drug that they know docs won't prescribe? Docs know HPV exists, the ads are used to get YOU to suggest to your doc that you take it instead of another branded drug if you have HPV. How's that different from a Pepsi ad?

I know why they do it. I'm suggesting that health care should not be a parallel of the soda industry. That this might be the kind of thing we hold apart from the rest of the stuff that gets bought and sold.



There's a lot more to comment on but I'm too lazy to quote everyone.

I think Stueyskid's example of his kid situation is not a derail at all. I love real world examples (not to say I'm happy you got bills because I feel for you). It's hard to tell someone to their face 'tough shit' after you hear their story.
The only thing I'd add to it is, most people on Medicaid don't game it. Most of them are dirt poor. Furthermore, there are a lot of people who don't qualify for Medicaid because they make too much, yet are still poor by most people's definitions. Imagine if Stueyskid made $10-15K less than median. Too much for Medicaid, but makes those bills that much worse.


On tort reform: I read naw's article where they play games with the numbers. They don't tell you how much is actually awarded+spent on lawyers. No they give a number that includes 'cover your ass' tests. Who figured out which tests are CYA and which ones are real? Callin' BS on that one.
Ultimately, malpractice insurance is pretty high and can't help but be a factor in costs at the doctor's office. However, it seems to me that medical malpractice insurance is a rather lucrative business to be in. According to nawhead's article, 2-3% of physicians face a lawsuit. 100% of them pay for insurance every year. Malpractice awards would have to be astronomical to dent that cash cow.

As nawhead alluded to, how can you tell the difference between CYA tests and BS tests? For me, I realized when I went to the doctor for a sore shoulder and he ordered an MRI, and when I said 'is that really necessary?' he replied, 'I don't practice sloppy medicine. You don't want me to practice sloppy medicine, do you?'. You get a mixed bag with doctors. They aren't the noble, looking out for you above all saints most people believe them to be. So nawhead, you an I are 100% in agreement that

seriously, people need to stop thinking doctors are benevolent, all-knowing wizards cloaked in their +1 healing white wizard robes but simply over-educated body technicians. call them on their bs, and educate ourselves!

The inherent problem with government is as Stueyskid pointed out - bribery (to use his term) drives government action. The nonsense in government is built when one company or industry carves something out for themselves, then others do, then some contrary player tries to plug the dam, then tries to get their own hole in the dam, ad nauseum. If we had representatives who held the interests of the people above the interests of the moneyed, government would be barely noticeable, just sticking in a regulation or rule here and there to prevent problems down the line.
But just because government has problems doesn't mean we're better off getting screwed by companies directly.


Last thing is about 'free health care'. People who support a governmentally directed system (which can have private companies operate within it) realize it costs money. Nobody is saying it doesn't, and nobody is saying it shouldn't. We all spend money on health care. We should. Our money is not being spent well, it's not being spent fairly, for the good of many, or at good value. If government can assure that those things are more true with them than without them, then bring it. We're all spending money anyway it might as well be spent better than it is now. And if I spend into a system and am healthy but my tax money goes to defray Stueyskid's child's birth, good. I'm fine with that. If I can help, I'd be happy to. And a government system allows for that. Maybe when I'm sick, Stueyskid Jr or someone else's Jr can help with my tab. Cumbayah

Well there's the rub. Deny a 98yr old his 5th heart and you're a death panel. How do you tell a guy, 'sorry time for you to die now'? But then who in his/her right mind thinks it makes sense for that 98yr old to get a heart because he can afford it and is next on the list?
I don't have the answer, only that I don't want to live to decrepitude so I'll be passing on those things.

this really is a difficult question.

i have nothing insightful to add other than needs more Milton Friedman! (hearing this man break down assumptions i never even thought to question, didn't even know was possible to be questioned, is revelatory to me.)

On tort reform: I read naw's article where they play games with the numbers. They don't tell you how much is actually awarded+spent on lawyers. No they give a number that includes 'cover your ass' tests. Who figured out which tests are CYA and which ones are real? Callin' BS on that one.

it's a mess for sure. but i think it can be simplified by considering whether the alternative of tort reform results in a better outcome for the ordinary person. and i think what we have now is a lesser of 2 evils.

But just because government has problems doesn't mean we're better off getting screwed by companies directly.

again, i think a lesser of 2 evils. but there's an assumption that being "screwed" by the government is better because it results in less upfront costs as the system stands now. you've acknowledged that you're aware there are hidden costs when government gets involved based on your reply further down, so the real question is which system can be more efficient, based on both upfront and hidden costs.

further, we should consider the results for the economy as a whole when private enterprise engages in an activity for profit vs government engaging in the same activity w/o a profit motive. profits by businesses are not just shoved under a mattress. that money is used to fund new business, new employment, either directly or indirectly (through being saved in banks, which in turn loan out that money to other businesses).

already linked this video in this thread already, but it remains relevant. Milton Friedman on why soaking the rich won't work.

conversely, what does government give back to the economy? government creates nothing. it saves nothing. it merely spends.

it's been said that capitalism is the worst economic system, except all the others that have been tried.

needs more Milton Friedman!

Last thing is about 'free health care'. People who support a governmentally directed system (which can have private companies operate within it) realize it costs money. Nobody is saying it doesn't, and nobody is saying it shouldn't. We all spend money on health care. We should. Our money is not being spent well, it's not being spent fairly, for the good of many, or at good value. If government can assure that those things are more true with them than without them, then bring it. We're all spending money anyway it might as well be spent better than it is now. And if I spend into a system and am healthy but my tax money goes to defray Stueyskid's child's birth, good. I'm fine with that. If I can help, I'd be happy to. And a government system allows for that. Maybe when I'm sick, Stueyskid Jr or someone else's Jr can help with my tab. Cumbayah

i agree now that it should be government's role to preserve the minimum safety and health of its citizens, just like defense spending. so now the question for me is how best to do that, and for that, i want to contemplate improva's response (he's ahead of the curve again, as always).

The model I suggested gives the hospitals plenty of reasons to be cost effective. Public hospitals are normally cheaper than private hospitals. Mostly due to lower salaries which at the public hospitals are controlled by the state. You create competition by making the success rates public available and by giving people free choice when they have to pick hospital.

All in all a very effective way of lowering the costs of medical care.

Here is a link that looks at the costs of health in the US and compare to other nations.Exhibit 9 is very interesting.

http://www.kff.org/insurance/snapshot/oecd042111.cfm

i like the idea of hospital report cards and consumer choice. i really think there's a need for something like that. is there something like this already in Europe?

that OECD reports paints a grim picture, but i don't think anybody's questioning that the U.S. already has the most expensive health care in the world.

so here's a great interview that breaks down the OECD report from 2009: http://www.pbs.org/newshour/rundown/2011/11/why-does-healthcare-cost-so-much.html

cliff notes:

Why is it more expensive? What's worse?

uses a lot of expensive diagnostic tests, such as MRI and CT scans, and performs a lot of interventions where it is not always clear-cut whether the procedure is necessary or not -- tonsillectomies, knee replacements, and so on

countries where there is a greater stress on controlling costs, and different tort law rules, there are fewer such interventions.

[ed: very big obstacle for the U.S., and personally, i don't think it should be changed.]

primary care system is weak for poor/unisured populations. diabetes, asthma or difficulties in breathing (COPD) should not need to be treated in hospital

Infant mortality - 6.5 deaths per 1000 live births, is well above the OECD average of 4.4

[ed: i agree this is a disgrace for the U.S. being like a 3rd world country]

What's good about the U.S. health care industry?

Some of the health care provided by the VA, and indeed in the private sector, is probably the best in the world.

cancer care ... Your chances of living five years after being diagnosed with breast cancer, or cervical cancer, or indeed several other cancers, are better in the United States than almost anywhere else in the world.

What can we learn from other countires? What can be done about it?

No countries have brought down costs -- health care costs are rising everywhere (with the occasional year-to-year variation), so the real issue is whether other countries are providing good quality care at lower costs than the United States. A few things are common to the high-performing health systems:

* An emphasis on primary care, to ensure that most care takes place outside of (expensive) hospitals

* A system which encourages use of (cheaper) generic drugs, when there are alternatives to expensive brands

* Tight regulations of prices and fees, for at least those services that are paid for by public programs

* Adherence to clinical guidelines, so that excessive use of expensive diagnostics or unnecessary health care is prevented

[ed: i think Obamacare will help in primary care visits, and i think that's great. the excessive diagnostic tests probably won't change. as for generic drugs, my health plan encourages the use of generics, so i don't understand this issue that well. as for price regulation, that doesn't seem to be a goal of Obamacare, and i need to read up more on it, but right now i don't agree with price regulation (or the theory itself) as i see that as inherently inefficient. so i think aggregate costs will probably go up as they are now.]