The whole reason we have such a problem with health care in our country is because so few people have any sense of responsibility. The average US citizen demands that all health problems be fixed by someone else immediately and at a "fair price" (free), especially self-inflicted health problems. Any system that operates on the principle of people taking personal responsibility for any aspect of their lives will never work in the US; it would be sued into oblivion for its bias against irresponsibility.

There's some truth to that, but that's not a key driver in the big picture. Something like 60% of healthcare costs are billed during the last month or so of a patient's life. 60%!

Another key driver is using the ER as Urgent Care. Does the kid have a sniffle? Take them to the ER.

Lastly is the whole unnecessary tests thing that's happening. Doctors know they can get more revenue if they perform more tests. So, while they're certain enough of the diagnosis for any sane person who was actually paying out of pocket, since said patient isn't and it won't cost all that much they order three more Very Expensive Tests (including the Machine That Goes Beep) just to make doubly sure. A small portion of this is to avoid lawsuits - but a larger portion is to make money.

Obesity-related disease states are getting up there, though. My guess is that they'll be huge cost drivers for my generation and all subsequent generations.

Which is why I think the Singapore plan is such a great idea. It supplies the incentives for responsibility, savings, and rational care decisions which our current system, and every other form of socialized medicine I've seen implemented, sorely lack. I don't think their exact plan would work here. Our population is far more diverse, and there are a lot of entrenched interests which would lose power under it. However, I think it provides the best starting point I've ever seen.

I think having that as an option would be very good. With their current tax structure (which is significantly lower than ours), they can do this pretty easily. I believe my company has something very similar to this already, but with the very small amount of healthcare expenses that Amber and I have, it's simply not worth it financially right now.

What I would like to see at this point is some sort of a "normal healthy person" option. One that pays for normal physicals/wellness visits. Should cover the annual physical and normal testing (bloodwork, but not full body CAT scans and other nonsense), OB/GYN for women, yearly or twice yearly dentist, and optometrist. After that, office hours should have a $50 or so copay (not the $20 now), Urgent Care somewhere around $150, and ER around $500 (dropping to $250 if you're admitted). It should include "catastrophic" coverage for things like broken bones or other injuries.

Discounts would be given for being a non-smoker, within a healthy weight range (or body fat percentage), and having other healthy measurements (pulse, blood pressure, cholesterol, etc). That could drastically lower the costs for a decent segment of the population and encourage (financially) healthier behavior in the rest.

Ron you are mistaken on both accounts. see here:
http://ajrccm.atsjournals.org/cgi/content/full/165/6/750
Total health care costs in the United States (U.S.) reached $989 billion in 1995 and now exceed $1 trillion, 14% of the Gross Domestic Product (GDP) (1). Of this total, a disproportionate share is attributable to the care of elderly patients shortly before their deaths. According to Lubitz and Prihoda (2) and Lubitz and Riley (3), 6% of Medicare recipients 65 yr of age and older who died in 1978 and 1988 accounted for 28% of all costs of the Medicare program. In the same two years, 77% of the Medicare decedents' expenditures occurred in the last year of life, 52% of them in the last 2 mo, and 40% in the last month. Inpatient expenses accounted for over 70% of the decedents' total costs.

I think that it would come out to about 20% of all healthcare spending.

Also I have heard that the amount of unpaid for emergency room visits is very small compared to total spending. I cannot find the link but I think it is just a percent or two of total spending.

Floccina - you do realize that your links are for healthcare expenses almost 20 years ago, don't you? With the incredibly large increase in both drug costs (for brand drugs), end of life drugs, and medical tests available, I'm thinking your stats may be out of date.

I don't have a link to mine, but can say that they are only a few years old and coming from the Director of Pharmacy for an incredibly large hospital.

Even if my estimate of a month is off by a bit, it's not that far from the 1 year consuming 77% that you quote.

So, in terms of overall argument and the thrust of said argument - it's not wrong.

Now - that might change now as people have more lifestyle-created diseases (obesity leading to diabetes, joint problems, cholesterol, heart problems, etc.; smoking, and so on) and needing more maintenance meds earlier in life. However, off-setting this trend is the aging population along with discoveries that help prolong life just that much longer.

In terms of the ER spending, it's one of the driving factors. I'm not sure what you were trying to say as you used the word unpaid. If you're speaking of indigent care as it relates to using the ER as your doctor - you're right in that's it's a smaller percentage. However, if you're talking about paying customers, it's getting larger and driving costs up. Might not be incredibly significant now, but it's rising.