DoD spends about $45B/yr on healthcare, for 8 million people. That of course doesn’t include their enrollment fees, deductibles, co-pays, or additional payouts through MediCare, etc.

My reading indicates

1) Tricare covers 9.2 million people, not 8 million.
2) It’s exclusive of Medicare (ie, military retirees are dropped from Tricare at age 65, when they become eligible for Medicare).
3) Tricare has no copays, deductibles, or enrollment fees.

If I’m wrong about any of these, I’ll be happy to be corrected. But, as far as I can tell, none of the things you “added” to jack up its apparent price, actually apply.

And while the military certainly suffers from being high risk, one would hope that active duty personnel are in better shape than most of us and have less expenses related to being overweight, malnutrition, etc.

I think the fact, that active duty military (though not, necessarily, their families or retirees) are more fit than the general population, is more than made up for by their higher risk of life-threatening or debilitating injury, PTSD, …

And you expect administrative costs to increase as the the group size increases

I wouldn’t expect the administrative cost per enrollee to rise. You’re familiar with the concept of “economies of scale,” right?

You are right, though, that the doctors in Tricare earn less than their colleagues in civilian life (though more than their non-medical counterparts). So one wouldn’t expect nearly as dramatic saving from a civilian version, which would be comparable to the UK’s NHS. The latter, I’ll point out, spends $2760/person/year. (Irrelevant, I realized, because nothing done in any other country could possibly be relevant to this country.)

Anyway, the point was not to suggest Tricare as a model for revamping the entire US healthcare system. Rather, it was a rebuttal of your claim that the US government couldn’t possibly deliver quality healthcare at a reasonable price.

Fargus,
It’s not that I want you to do your own research, it’s that I don’t have an infinite amount of time to post links to the billions of articles online regarding the excesses of the Federal Government. Nor do I want this to get into a discussion of why it’s really ok (or isn’t ok) how much we spend on education, housing, social services, national defense, public transportation, energy, space exploration, agriculture, research, infrastructure, communication, legislation, the judiciary, etc. ad infinitum. I want to stick the point.

So far, none of the arguments from Jacques are relevant, let alone convincing.

TRICARE does not appear to support Jacques’ hopes of cutting down costs by any substantial margin. DoD spends about $45B/yr on healthcare, for 8 million people. That of course doesn’t include their enrollment fees, deductibles, co-pays, or additional payouts through MediCare, etc. And while the military certainly suffers from being high risk, one would hope that active duty personnel are in better shape than most of us and have less expenses related to being overweight, malnutrition, etc. We don’t have age breakdowns and breakdowns on who’s eligible for Medicare, but we can make some assumptions using U.S. averages.
If there’s 8 million people covered, about 1.25 million of them are eligible for Medicare. These people spend about 2:1 compared to non-Medicare recipients, so we can add about $7.5B the that $45B number giving us $52.5B, which again doesn’t include fees, deductibles, co-pays. Obviously this is hard to estimate, but if we conservatively say $500/pp/anum, that gives us another $4B, for a total of $56.5B for these 8M people, or slightly over $7000/pp. US avg. per capita is just under $8000/pp.

Also, what are the cost benefits of healthcare at a military facility? The doctors and nurses and administrative staff their are just paid their standard G-whatever wages, right? At least any that are government employees. These will be substantially less than the salaries of private sector hospitals, which also artificially decreases the military cost. Now, I suppose you could move all health workers into the public sector and pay all healthcare professionals G-whatever wages, but if you think that’s going to increase the quality of healthcare, keep dreamin’.

I suppose a savings of 12.5% is significant, but as I’ve said, I would expect this group of people to be in better shape, and I think I’ve been conservative on my estimates. And you expect administrative costs to increase as the the group size increases, so if the size increased by the 40x necessary to cover the entire US pop, it’s hard to believe that the cost wouldn’t rise significantly over that $7000/pp.

Random Questions:
Does the admin cost of Medicare include things like rent, land purchase, building construction, etc.? Or do those expenses come from other parts of the Federal Budget? I expect the answer is the latter.
What did these other countries spend on healthcare before they went to their socialized systems?
Why are infant mortality rates so much higher in these countries?

And, once again, should you attempt to justify public sector, please refrain from the “everybody else does it” responses. They add no value whatsoever to the discussion. If that’s all you’ve got, you’ve got nothing. If you have specific details on how, why, and how much, you’d expect to save in the U.S. on a public-sector plan, then please provide them.

I’m out.

Europe and Canada are not the United States … the system we propose to install is not identical to theirs.

They’re not Australia, Japan or Korea, either.

For that matter, Sweden is not Germany, France is not Iceland, … etc.

Each of of the two-dozen countries has its own peculiarities that makes it different from the rest.

And their healthcare systems are not identical either.

Still, one ought to be able to learn something from examining their experiences, no?

Furthermore, that they deliver health care more cheaply, as measured against GDP, ignores the question of what they deliver (quality/quantity) compared to the US.

I’m not ignoring that. There’s lots of comparative data, on healthcare outcomes in industrialized countries. By some measures, the US fares quite poorly, compared to the others. Overall, though, the healthcare outcomes across the industrialized world are pretty much comparable. The only discernible difference is that the rest of the industrialized world achieves those outcomes a lot more cheaply.

I guess to be precise I should say that I don’t care if you or anyone else can afford health care and reject the notion that I am responsible for anyone’s care but my own.

Really?

You don’t care whether the guy sitting next to you on the bus has antibiotic-resistant TB? You don’t care whether the kids in your child’s class are vaccinated? You don’t care whether your co-worker drops dead of a heart attack, in the middle of your joint project?

Sure you do.

To pick an analogy, you subsidize free public education, through high school, for all your neighbours. Not only that, but you mandate that their kids actually attend school.

Why?

One need only look back to what the country was like, before the advent of universal public education. Most of the population was illiterate, fit only for the most menial of occupations, and everyone was poorer, as a result. You can’t run a prosperous, modern industrial society, without an educated workforce. So you are (or ought to be) more than willing to make the public investment in human capital, which is required for you to be able to enjoy the fruits that our technological society provides.

The argument for ensuring that your fellow citizens are not too sick, to be productive members of society, runs pretty much the same way.

Jacques is holding up data points in his argument, in pointing to other industrialized nations with relevant experience in the area of health care. Those data points could be reasonably examined to see if those experiences could and should be applied to the United States. What’s unequivocally not legitimate, however, is to reject those arguments out of hand because you insist without any evidence that everything the government does is bad (and you have the temerity not just to assert it, but to demand that it be taken as the default position, assumed to be true unless someone else does your homework for you). What’s not legitimate is to equate your rejection of Jacques’ arguments based on the fact that it’s really hard to hear with your fingers shoved in your ears so hard, with Jacques’ rejection of your “argument” that whatever you say needs to be presumed to be true, and that you can’t condescend to provide any evidence to back it up.

It’s getting ridiculous.

If the experience of other countries with the “public option” is, for some inexplicable reason, irrelevant, perhaps their experience is relevant.

Good to see your blog back in action again, Jacques

I had planned to blog Strings 2009 in Rome (from which I’ve just returned). Alas, Italian efficiency intervened …

If any of my regulars wants to know why I offer a high degree of deference to Jacques, it’s because he’s undeniably a very smart man, no matter our disagreements on some political questions and policies…

And the reason why you haven’t, is because it doesn’t.