quote:

---

Originally posted by RadicalWhig:
I would gladly scrap the system of direct public provision in favour of a public single-payer system.

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quote:

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Originally posted by RadicalWhig:
Coming back to the UK after living in France, the poor standard of the NHS system struck me. It is great that it is universal. It is great that there is no up-front cost. However, the quality and choice do inevitably suffer when compared to the French single-payer system.

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What do you mean by "single-payer system"?
Is the French system comparable to what I described of the Dutch system in the other thread?
 

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Posted by RadicalWhig (# 13190) on :
 
Five: I think we can agree that the present US system is the worst of all worlds, and that the NHS is superior to that. The Obama plan, while beneficial, seems not to go far enough; it keeps the insurance companies in place. Politically, given the power of corporate interests, it is probably as far as Obama can go.

I wouldn't want to get rid of the principle of universal, free-at-the-point-of-delivery health care. That principle is sacred. But, to improve how the principle of universal free-at-the-point-of-delivery health care is delivered, I would like to give serious consideration to the idea of having a public single-payer system (universal public health insurance) rather than a public direct-provision system in the UK.

On reflection, my "I'd abolish the NHS in a flash" comment was too hasty. I don't know for certain single payer is necessarily the best option. It does seems to work well in France and it does also appear to offer many advantages over both the American (corporate-led) and British (State-led) systems, so it ought to be seriously considered, but that's all. "I would seriously consider abolishing the NHS in a flash" would be closer to the truth.

There is some information on single-payer systems here. and here.

(OMG, it is past noon and I have done almost no work today. Right, I need to go and become a productive member of society for a few hours!).

[ 11. August 2009, 11:15: Message edited by: RadicalWhig ]
 

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Posted by Honest Ron Bacardi (# 38) on :
 
I have only had limited involvement with the French system, but my general impression is that yes - overall it delivers rather better than the British NHS.

However, it also costs a lot more I believe. 20% straight off all income, more if you are self-employed. I can't track the government contribution figures immediately, but the point I'm trying to make is that one has to compare like with like - if we are only prepared to expend an average of £x per head on health, we should not be surprised if another country spending £1.5x per head (say) gets a better service.

Also, you only get full reimbursement of charges under certain circumstances. Otherwise you have to fork out the difference yourself or carry insurance that will do that. This table claims to have current reimbursement rates.

I guess what I am driving towards is that a proper consideration would need to involve a full SWOT analysis of sorts. The risk is to pick one of the weaker points of one system and compare it unfavourably with another preferred system on that point alone. That would equally describe much American criticism of Obama's planned reforms.

But the inherent structuring of the French system around choice at the point of delivery, and single direct payment does offer considerable advantages, I agree.
 

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Posted by Horseman Bree (# 5290) on :
 
When Saskatchewan brought the beginnings of our present Medicare in Canada, back in the 1960's, doctors went on strike or left the province, the insurance industry went berserk, and the right-wing mouthies foamed away.

But then the doctors who stayed found that they were actually paid, unlike the previous situation of having to accept chickens or wait for loan arrangements or not get paid at all. People found that the system actually worked, and that they could all get in.

And the program developed across the country. Pearson was able to get Medicare through Parliament, despite being in a minority government.

We've now had a couple of generations of the service,and people are used to it.

The change has been that the right-wingers want to be "free" of taxes, even though our tax load is actually no worse than the US, and it includes paying for full Medicare. But some people don't want to pay anything for anything.

The last stats I saw showed that the US governments actually spend more per capita on health care than the Canadian gov'ts do, and then you add the cost of insurance on top of that. So whatever "system" it may be in the US, it is somewhere between 50% and 100% more expensive than the Canadian model - and we're by no means the most efficient!

And our outcomes tend to be better - lower infant mortality, longer lifespan....

And present communications make it easier to get your message out, however untrue or weird it may be.
 

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Posted by joris2 (# 11137) on :
 
After reading this
http://en.wikipedia.org/wiki/Single-payer_health_care
I think I understand.

The Netherlands have a mixed system where (very generally speaking) the short-term health-care is paid/reimbursed through the insurance-companies, and the longer-term health-care through a tax on income.
At first sight the cost seems about the same or slightly less than the French system.
We have freedom of choice where to get our health-care. The system is not (directly) state-controlled, but the government interferes a lot to try keep the cost down, sometimes with success, sometimes counter-productively.
 

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Posted by davelarge (# 186) on :
 
Being that I don't follow the details of US political debate, I don't really know the intricacies of what Obama is proposing. Would it be possible for someone to post a brief summary of the plan?

Many thanks.
 

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Posted by Hawk (# 14289) on :
 

quote:

---

Originally posted by davelarge:
Would it be possible for someone to post a brief summary of the plan?

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quote:

---

Originally posted by Hawk:
It might need reforming if its not as efficient as the French system ...

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quote:

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Originally posted by ken:
To put it crudely we are paying for 60% of a decent modern healthcare service and we are getting 80% of one

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quote:

---

Originally posted by Horseman Bree:
The last stats I saw showed that the US governments actually spend more per capita on health care than the Canadian gov'ts do, and then you add the cost of insurance on top of that. So whatever "system" it may be in the US, it is somewhere between 50% and 100% more expensive than the Canadian model - and we're by no means the most efficient!

And our outcomes tend to be better - lower infant mortality, longer lifespan....

---

quote:

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Originally posted by Clint Boggis:
I don't think anyone would try to argue that the US 'system' yields better outcomes overall but it almost certainly does for those with continuing good health who haven't reached their insurance payout limit.

---

quote:

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Originally posted by Amorya:
That's why I love the NHS. It's good enough, even if it's not absolutely super. It guarantees that however much of a mess I get into, I won't have to pay loads to sort it out.

---

quote:

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Originally posted by Hawk:
Could you explain to me the difference between the two [direct public provision & public single payer]? I assumed NHS was single-payer.

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quote:

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Originally posted by Hawk:
Is this the only reason why the French can treat your wife quicker and better, because you're paying for part of it? Or is their system of managing the service just less cumbersome and overstretched than the NHS?

---

quote:

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Originally posted by Hawk:
Do you know any other details of how the French system works other than your personal experience as an end user?

---

quote:

---

Originally posted by Amorya:
The key point of the NHS, for me, is to know that you will never be hit by a surprise bill for being ill. <snip>

It guarantees that however much of a mess I get into, I won't have to pay loads to sort it out.

---

quote:

---

Originally posted by Amorya:
That's why I love the NHS. It's good enough, even if it's not absolutely super.

---

quote:

---

Originally posted by Amorya:
But the thing is, we have private healthcare here too, if you want to jump NHS queues or whatever, and you can get insurance to cover it. Surely that's the best of both worlds?

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quote:

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Originally posted by Sober Preacher's Kid:
I disagree Og. Drugs have overtaken doctors as the most expensive part of medical expenses in total.
...

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quote:

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Originally posted by CorgiGreta:
New Yorker,

In light of your post, which correctly describes the status of the various plans, could you clarify the meaning of Mrs. Palin's reference to " Obama's [emphasis added] death panel". I can come up with only these options:

1. She is uninformed/misinformed
2. She is a liar
3. She is a demagogue
4. All of the above

Greta

---

quote:

---

Speaking of knocking the NHS, apparently it's drawing a hefty amount of flak from the opponents of healthcare reform.

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quote:

---

I think what scares a lot of people -- and, quite frankly, it scares the hell out of me, too -- is the idea that the government will just expand our current Medicare program instead of actually putting together some kind of logical system.

---

quote:

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Originally posted by RadicalWhig:
What is your view?

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I am scared to death and quite disappointed that there is actually a significant number of people who are opposed to any action concerning health care.

quote:

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Clint Boggis:
Why doesn't this settle it, even for the weakest minds?

---

Partisan politics mixed up with religious coercion.

To fix that problem, we need to rework our entire political system.
 

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Posted by Macx (# 14532) on :
 

quote:

---

Originally posted by Erin:
I think what scares a lot of people -- and, quite frankly, it scares the hell out of me, too -- is the idea that the government will just expand our current Medicare program instead of actually putting together some kind of logical system. US Medicare is probably the worst health plan out there, to be honest. They have price controls in place that literally do not even cover the actual cost of the services; there are more regulations to adhere to than the US tax code; they contract through regional carriers and fiscal intermediaries who all interpret Medicare requirements differently, which leaves you screwed if you are like my employer and have three different FIs and another three different carriers to deal with from one billing platform. If what ultimately comes out of all of this is expanded Medicare, I will be the first to take up arms against the government.

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quote:

---

Shouting down speakers who are attempting to engage in polite, rational discussion of an important matter is not a way to win people over to one's side, and I don't think it willl change the votes of very many, if any, politicians.

---

quote:

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Originally posted by Macx:
Wow! We agree. I'd just add that many of us that know what the Veterans Administration produces and it is . . . well, horiffic is being pretty gentle. When we think of the Government running healthcare, we think of VA healthcare for everybody. I think the vitriol ya'll are hearing comes from a suspicion that Obama wants to nationalize a bastard child of Medicare and the VA system & yup, that would be worth taking up arms over.

---

quote:

---

Originally posted by RadicalWhig:

quote:

---

Originally posted by Amorya:
The key point of the NHS, for me, is to know that you will never be hit by a surprise bill for being ill. <snip>

It guarantees that however much of a mess I get into, I won't have to pay loads to sort it out.

---

The same is true under a single-payer system.

quote:

---

Originally posted by Amorya:
That's why I love the NHS. It's good enough, even if it's not absolutely super.

---

But surely, even if something is "not absolutely super", we can do better. Why be satisfied with "good enough" when it comes to health care? And actually, for people with chronic but non-life threatening conditions, the NHS often isn't "good enough".

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Can we do better?

This single payer stuff sounds to me like the promises made when we privatised the railways: competition will provide better service and lower prices. What did we get? A bunch of companies who don't communicate, more late trains than ever before, and costly tickets.

If we had that kind of system for healthcare, while I know the cost wouldn't come into it, I can bet that you'd get some hospitals unable to get your medical history due to their system not being compatible with your GP, and you'd have to fill in a bunch of forms before you got any treatment. Multiple companies tends to breed inefficiency.

I seem to have a similar aversion to private industry controlling things that some vocal Americans seem to have to the government doing it.

Still, single payer would be far better than anything that requires health insurance. I know people in the States whose insurance refused to pay out for spurious reasons like "it was a pre-existing conition". As long as there's a guarantee that that kind of thing cannot happen, I'm happy enough

Amorya
 

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Posted by Sober Preacher's Kid (# 12699) on :
 
Since RadicalWhig has done a good job of explaining the differences between the NHS and the French system, I hope to clarify what the evil Canadian system does.

The NHS is unusual in that its a pure public provider and was designed and implemented as such from the beginning.

In Canada our system has had a different path since we have the deal with the Federal/Provincial power splits, but the long and the short of it is that the Beveridge Report was just as widely read here as elsewhere and the NHS was always held up in the formative years as the ultimate goal. We started out with a French-style system in the 1960's. The last great round of medicare reform was the Canada Health Act in 1984. This did two things:

1) Extra billing, aka Balance billing was banned. Until then it was a common practice in most provinces. In Ontario its removal prompted a Doctor's Strike.

2) Restrictions on the use of for-profit facilities means that most acute hospitals are non-profit. Long-Term Care facilities are more often for-profit, though non-profit homes are equally common.

The CHA bans private payment for publicly listed services, which means that Canada doesn't have a parallel private system (some minor exceptions, but they are curiosities).

All provinces (who actually run health care) have set up regional health authorities and in Ontario most doctors have moved to Family Health Teams. We've essentially implemented the NHS and didn't tell anyone. This has happened in the last 10 years.

For example, specialists are accessed by family physician referrals, including Pediatricians.

Health Networks have a particular focus on making sure complex cases like Mental Health get focused attention and management.
 

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Posted by CorgiGreta (# 443) on :
 
Erin,

It is Kaiser.

I suppose that I am biased since the extraordinary diligence of one their doctors saved my life a few years ago.

Greta
 

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Posted by Josephine (# 3899) on :
 
This article explains the Dutch and French systems, which seem to be less well-known in this country than the UK and Canadian systems.

I agree entirely with Erin's assessment of those who want to maintain the status quo.
 

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Posted by Macx (# 14532) on :
 
There is a difference between wanting to maintain the status quo and not wanting to see a program pushed through that the politicians haven't even read entirely yet.

There has got to be a third way, something that includes meaningful reform without perhaps also including free medical care for citizens of other countries illegally within our borders. Maybe a program that isn't run like the VA or loaded with pork for cronies.

Reform would be good, if it was good reform. Bad reform on the other hand, is what is being pushed by his highness of the very expensive bills.
 

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Posted by Timothy the Obscure (# 292) on :
 
Most liberal economists (Paul Krugman, for example) point to the French system as the best model in terms of value for money.

Most Medicare patients are very satisfied with their coverage. Medicare providers (of which I used to be one, when I was in private practice) are less so--the paperwork is overwhelming, and the bureaucracy (which is not civil servants, but contracted out to private insurance companies) is remarkably stupid and unresponsive.
 

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Posted by five (# 14492) on :
 
Most Medicare patients are satisfied with their coverage? That's news to me. Granted, it is anecdotal, but my stepmother and her friends, and my cousin would happily throw Medicare away if they could get better coverage elsewhere. My stepmother is lucky enough to be in the position where she's able to get health care through work (at 70, she's still working) but at least in our family Medicare (and even then it isn't "free" - without the supplements it seems next to useless from what I can make out) seems just horrible. Finding a doctor who will take it is a problem in itself, and the doctors that do take it seem to be of definitely lower quality and a bit more desperate for patients, which doesn't make anyone feel any better.
 

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Posted by CorgiGreta (# 443) on :
 
Here's a survey by an organization I feel is non-partisan.

Greta
 

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Posted by Moth (# 2589) on :
 

quote:

---

Originally posted by RadicalWhig:

But surely, even if something is "not absolutely super", we can do better. Why be satisfied with "good enough" when it comes to health care? And actually, for people with chronic but non-life threatening conditions, the NHS often isn't "good enough".

---

quote:

---

The British whinging about the NHS doesn't help either. It's easy enough to find examples of rude people and poor care in any system, but Brits do turn whinging into an art form! It's easy to put out scare stories which dampen the effect of the statistics, as most people don't understand or trust statistics anyway.

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quote:

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Originally posted by Macx:
If those politicians would have listened when they were politely written to, if they would have listened when they were politely spoken to, if they would have listened when they were spoken to a little harshly, if they would have listened when they were spoken to very harshly, it wouldn't have needed to come to that. If the shouting down doesn't get them to listen, perhaps a little violence & if they continue to abuse the people, they may very well encounter extreme violence.

---

The problem with this, of course, is when the ones writing, speaking, shouting and threatening violence are in the minority. What happens then, Macx, what happens then?

You claim to speak for "the people", when you're only speaking for the right-wing fundamentalist minority. What about all the people who are in favour of this? Should they get their weapons out to oppose you the same way you're threatening to oppose them? Is that what you want - politics reduced to the level of who has the most firepower?

Actually, having read your posts over the last months that's a really daft question. Of course you do.

It's a frightening attitude for your minority to have, though. What's next - overthrowing the government if your favoured candidate doesn't win at the next election? Setting up a quasi-military junta "for the good of the people"? Banning elections if the people can't even be trusted to vote for the "right" candidate? Suddenly you ain't got America, you've got Zimbabwe...
 

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Posted by Ricardus (# 8757) on :
 
IME, when the British moan about the NHS, they are generally comparing it to the French or German systems, and never to the American way.
 

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Posted by Hawk (# 14289) on :
 
I love how the British moan and whinge about everything. I feel sorry for the providers of course but it is certainly a stimulus. We are never happy and so things will always naturally strive to get better. The NHS is improving all the time. The moaning is natural to Britain but underneath it we are well aware of how lucky we are and if we’re not aware, we have the wonderful example of America to show us what the terrifying alternative is.

Personally, I’m not convinced that a single-payer system will turn us into the French. They might have better healthcare than us but I suspect the reasons are a lot more complex than single payer vs service provider. The points Amorya made about privatisation ring true in a British context. Correct me if I’m wrong RadicalWhig but a single-payer system seems mighty similar to privatisation of the NHS while the government pays the bills. And privitisation certainly hasn't made the trains more efficient or cheaper or better in any sense of the word. Private companies seem petty and squabling and too small to run things properly on a national level. I suspect the NHS would end up the same if single-payer was introduced. While money won’t hit us directly I sincerely doubt we will get the value for money that we’re getting now. Nationally, the cost will skyrocket. Private companies in competition doesn’t always decrease prices, the idea of natural market forces is a nice theory but often sticks in practice. What it does do is mean that suddenly a non-profit organisation becomes a profit-making organisation. The medical profession will have to make money, and the only way is to raise the costs, to make more money to pay for their managers, and their marketing campaigns to convince the consumer to go to hospital A rather than hospital B.

Choice is a good idea but there’s already quite a bit of choice. You can pick which GP surgery you go to, within reason. Ideas to increase choice are already being floated in Parliament. Things are only going to get better in this regard. The NHS is great and could be better but I really think that scrapping it and replacing it with a single-payer system will be counter-productive, will increase costs and will just make everything more confusing for the patient. I hate buying a train ticket now as you have to pick between a hundred different train companies, each with their own website, times, prices and ticket types. It’s a nightmare and I can’t be bothered to research each one and find out which is best. Sometimes choice is a pain rather than a blessing. I would hate even more to have to do this every time I wanted to see a doctor or go to hospital. I like it being given to me by the system without having to worry about it. If there’s a problem with being given it, such as I’m not happy with the service or the delays then I’d like to have other free options on the table but all within the same public service, certainly not having to deal with a multiplicity of companies all vying for attention. It would be confusing, disorienting and far too much effort, especially when someone’s sick and can’t deal with it.
 

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Posted by Hawk (# 14289) on :
 

quote:

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Originally posted by Marvin the Martian:
Is that what you want - politics reduced to the level of who has the most firepower?

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quote:

---

It would be confusing, disorienting and far too much effort, especially when someone’s sick and can’t deal with it.

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quote:

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Originally posted by Moth:
...what we have now works OK, so why risk change?

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quote:

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The British whinging about the NHS doesn't help either. It's easy enough to find examples of rude people and poor care in any system, but Brits do turn whinging into an art form!

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quote:

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Originally posted by Josephine:
This article explains the Dutch and French systems, which seem to be less well-known in this country than the UK and Canadian systems.

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quote:

---

Originally posted by Hawk:
The points Amorya made about privatisation ring true in a British context.

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quote:

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Originally posted by JillieRose:
The question then becomes not 'Is that how the French system works in practice?' though that is an important thing to ask.

The question is, 'If we introduced this in Britain, is it what is most likely to happen?'

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quote:

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Originally posted by Hawk:
Correct me if I’m wrong RadicalWhig but a single-payer system seems mighty similar to privatisation of the NHS while the government pays the bills.

---

quote:

---

Originally posted by Hawk:
Personally, I’m not convinced that a single-payer system will turn us into the French. They might have better healthcare than us but I suspect the reasons are a lot more complex than single payer vs service provider.

---

quote:

---

Originally posted by RadicalWhig:

quote:

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Originally posted by Moth:
...what we have now works OK, so why risk change?

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The same can be said of any mess. Everything "works ok" if you have no knowledge or experience of something better. Good grief, even the "British Constitution" works ok to some people. If people were not prepared to "risk change" to improve on what "works ok", we'd still have slavery and child labour.

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quote:

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Originally posted by Og: Thread Killer:
Even the most right wing of governments up here did not try to break the Doctor's hold over who gets to practice where and for how much money.

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quote:

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Originally posted by CorgiGreta:
Erin,

It is Kaiser.

I suppose that I am biased since the extraordinary diligence of one their doctors saved my life a few years ago.

Greta

---

quote:

---

Originally posted by Alan Cresswell:
How is the cost determined in a single-payer system? As an example, if I had condition X and there were two local hospitals competant to provide the treatment for that I get that I'd be free to choose which hospital to go for. If hospital A charged £100,000 to treat me, and B charged £150,000 would I be allowed to choose the more expensive option on the expectation that that extra £50,000 was being translated into better service? Or, would the payer fix the price and expected level of service?

---

quote:

---

Originally posted by RadicalWhig:

quote:

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Originally posted by Hawk:
Correct me if I’m wrong RadicalWhig but a single-payer system seems mighty similar to privatisation of the NHS while the government pays the bills.

---

Um, not exactly. I think perhaps it is closer to a school voucher system (something that I'm not necessarily a fan of in education, but for different reasons) - some hospitals and other health care facilities will still be provided by the State or local authorities, alongside non-profit foundations and for-profit professionals (by which I mean your local doctor trying to make a living - the idea of a "for-profit hospital" is an anathema).

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quote:

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Originally posted by davelarge:
Isn't that roughly what the Conservatives were proposing with their Patient Passport?

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Err... ...well, yes, sort of... ...it seems a bit like it...

...oh dear, yet more evidence to support these baseless accusations that I'm just an Evil Wicked Tory in disguise.

(I'm not, you know.)
 

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Posted by Sober Preacher's Kid (# 12699) on :
 
My, what a lovely shade of Blue you are, RadicalWhig.
 

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Posted by Crœsos (# 238) on :
 
A blogger writes an account of her encounter with an actual "death panel":

quote:

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You have no idea what it’s like to be called into a sterile conference room with a hospital administrator you’ve never met before and be told that your mother’s insurance policy will only pay for 30 days in ICU. You can't imagine what it's like to be advised that you need to “make some decisions,” like whether your mother should be released “HTD” which is hospital parlance for “home to die,” or if you want to pay out of pocket to keep her in the ICU another week. And when you ask how much that would cost you are given a number so impossibly large that you realize there really are no decisions to make. The decision has been made for you. "Living will" or no, it doesn't matter. The bank account and the insurance policy have trumped any legal document.

If this isn’t a “death panel” I don’t know what is.

---

Government providing living will counseling on an as-requested basis = "death panel".

Insurance company pulling the plug on your treatment = "free market".
 

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Posted by Honest Ron Bacardi (# 38) on :
 
The "Death Panel" gambit sounds precisely like the sort of rhetoric that is liable to explode in your face at any time.
 

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Posted by Macx (# 14532) on :
 
You meant that as a joke right?

Put your hand in the box . . .
 

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Posted by Honest Ron Bacardi (# 38) on :
 
Your reference, alas, eludes me.
 

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Posted by davelarge (# 186) on :
 
In your defence, RadicalWhig, I think the patient passport was more about freeing up NHS money to be spent in private hospitals. This is probably too simplistic, but each individual could choose to take 'their money' to which ever provider they chose, and if the treatment cost more than 'their money' would cover, they would have to top it up out of their own pocket.

So it's not really what you were talking about. It was more about pandering to middle class foibles. You're off the hook
 

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Posted by Macx (# 14532) on :
 
Sorry Ron, Frank Herbert's Dune, the 1984 movie version. Scene where in the messiah is ordered to put his hand in a box that will generate pain & if he removes his hand, the "witch" will kill him.

quote:

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The "Death Panel" gambit sounds precisely like the sort of rhetoric that is liable to explode in your face at any time.

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quote:

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Originally posted by Hawk:

quote:

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Originally posted by Marvin the Martian:
Is that what you want - politics reduced to the level of who has the most firepower?

---

That's the American way. They founded a country on that principle.

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quote:

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Your post just struck me as the same brand of humor that brought us products such as this.

Of course it is entirely possible that you were serious.

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quote:

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Originally posted by RuthW:

quote:

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Originally posted by Hawk:

quote:

---

Originally posted by Marvin the Martian:
Is that what you want - politics reduced to the level of who has the most firepower?

---

That's the American way. They founded a country on that principle.

---

Yes, and we've decided every single political issue we've faced on this principle alone ever since one group of Englishmen won a war over another group of Englishmen in the late 18th century. Your country on the other hand has never, ever resorted to firepower to decide political issues. Except for the battles with the Luddites. And Culloden. And the Battle of the Boyne. And the English Civil War. And the Wars of the Roses. And Owen Glendower's defeat. And Simon de Montfort's little rebellion. And the Norman invasion. To name a few examples.

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quote:

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people such as scientist Stephen Hawking wouldn't have a chance in the UK, where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless

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quote:

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that he "wouldn't be here today if it were not for the NHS".

---

quote:

---

Originally posted by lady in red:

quote:

---

Originally posted by Alan Cresswell:
How is the cost determined in a single-payer system? As an example, if I had condition X and there were two local hospitals competant to provide the treatment for that I get that I'd be free to choose which hospital to go for. If hospital A charged £100,000 to treat me, and B charged £150,000 would I be allowed to choose the more expensive option on the expectation that that extra £50,000 was being translated into better service? Or, would the payer fix the price and expected level of service?

---

In France, the vast overwhelming majority of doctors all charge the same eg. a GP apointment is €22. I think it's about €30 for a specialist (normally you have to be referred by a GP or the Social Security / insurance won't pay). I think these standard rates are set by Government, although I could be wrong about that.

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quote:

---

Originally posted by Adeodatus:
A darkly funny episode in this debate is reported here today. The bit I especially like is the IBD editorial saying

quote:

---

people such as scientist Stephen Hawking wouldn't have a chance in the UK, where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless

---

Erm ... anyone spot the "mistake" here?

(For the record, Professor Hawking has said

quote:

---

that he "wouldn't be here today if it were not for the NHS".

---

---

quote:

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Originally posted by Alan Cresswell:
...but there's still a nice group of bureaucrats deciding what treatments the single-payer will pay for and how much will be paid.

---

quote:

---

Originally posted by Josephine:
If small businesses are truly the lifeblood of our economy, this aspect of our system should be front and center. I'm not sure why it's not.

---

quote:

---

Originally posted by Josephine:
You know, there's one aspect of the American system of having your insurance tied to your job that I've never seen discussed. That is, our system makes it far more difficult, if not impossible, for many talented people to start small businesses.

If you're self-employed, you have to buy your own insurance on the open market.

---

quote:

---

Originally posted by davelarge:

quote:

---

Originally posted by Josephine:
If small businesses are truly the lifeblood of our economy, this aspect of our system should be front and center. I'm not sure why it's not.

---

Because the loudest supporters of small businesses are also the loudest opponents of healthcare reform?

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quote:

---

Originally posted by Alan Cresswell:
[QUOTE]So, if the rates set by government (or, whoever) also apply to treatments (to cover cost of drugs, time in hospital etc in addition to actually seeing the doc) then the system has the customer choosing the person to see ... but there's still a nice group of bureaucrats deciding what treatments the single-payer will pay for and how much will be paid.

---

quote:

---

Originally posted by Josephine:
If you were truly supportive of small businesses -- including and especially the entrepreneur just getting started -- seems like supporting healthcare reform would be a no-brainer.

---

quote:

---

Originally posted by davelarge:

quote:

---

Originally posted by Josephine:
If you were truly supportive of small businesses -- including and especially the entrepreneur just getting started -- seems like supporting healthcare reform would be a no-brainer.

---

OK, I'm thinking out loud here, but perhaps both smallbusinessism and non-healthcarereformism are both manifestations of the conservatives' desire for small government. Small government means private provision of health services, and it means that small companies provide many of the services that the state would in other countries*, in an environment where regulation is minimal and the tax burden low. Therefore, the two derivative principles for which conservatives campaign aren't necessarily compatible with each other, but are manifestations of an overarching philosophy.

* Actually, primary health care would be a good example of this in itself. Wouldn't most doctor's clinics count as small businesses?

---

quote:

---

Originally posted by davelarge:
So, if I were to amend the highlighted portions of my previous post to be

"the conservatives' desire for minimal government welfare provisions"

and

"regulation of businesses is minimal"

would you agree?

---

quote:

---

Originally posted by Crœsos:

quote:

---

Originally posted by davelarge:
So, if I were to amend the highlighted portions of my previous post to be

"the conservatives' desire for minimal government welfare provisions"

and

"regulation of businesses is minimal"

would you agree?

---

Yes.

---

quote:

---

Originally posted by RadicalWhig:
Yes. Although baring in mind that "minimal regulation of business" tends to favour big businesses over small ones.

Those opposed to health care reform are not the ones who support small businesses; they are the ones who are supporting the "Walmartization" of the economy and forcing small businesses to go bust.

---

quote:

---

Originally posted by davelarge:
Wouldn't most doctor's clinics count as small businesses?

---

quote:

---

Originally posted by ken:
I doubt if oppostion to public health care in the USA can be put down to desire to keep big government out of the medical business. The US government, and US taxpayers are hugely involved in healthcare. More so than in many other developed countries, including the UK. And there is a huge amount of regulation as well. Again, mroe than most other countries

---

quote:

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Originally posted by Scot:
I think this is largely due to the mandate that insurance be provided through employers.

---

quote:

---

Originally posted by Alan Cresswell:
Plus, I could see the situation where providers look at a given treatment, say "we can't provide that service for that amount" and refuse to treat people ... which would be a disaster if repeated by all the providers in a given location.

---

quote:

---

Originally posted by Scot:
Fair enough, it's not a mandate. Employer-based insurance is, however, the norm in the US due to historical precedent, the tax code, and public expectations. I still maintain that it's the primary reason why most people are so astonishingly ignorant of the cost and limitations of their own coverage, let alone what will happen to them if they go outside of the employer-based system.

---

quote:

---

Originally posted by Scot:
I still maintain that it's the primary reason why most people are so astonishingly ignorant of the cost and limitations of their own coverage, let alone what will happen to them if they go outside of the employer-based system.

---

quote:

---

Originally posted by davelarge:
jlg, this all illustrates the fundamental problem: Insurance companies exist to make a profit. Their primary role is not to help people get (or stay) well.

---

quote:

---

Surely all reasonable people...

---

quote:

---

Originally posted by jlg:

I never received any revised statement indicating that they had debited any of the firms for the (obvious even to me) double-billing. So a roughly $6,000 procedure cost my insurance company $11,000.
...

---

quote:

---

Originally posted by davelarge:
jlg, this all illustrates the fundamental problem: Insurance companies exist to make a profit. Their primary role is not to help people get (or stay) well.

---

quote:

---

Originally posted by Scot:

quote:

---

Originally posted by davelarge:
jlg, this all illustrates the fundamental problem: Insurance companies exist to make a profit. Their primary role is not to help people get (or stay) well.

---

The two goals are not necessarily in opposition to one another. An insurance company that judiciously invests in keeping their clients healthy may well have reduced major claims and greater profitability. They may also have greater retention due to happier and healthier customers. Unfortunately our current quasi-private system doesn't encourage competition for end-users.

---

quote:

---

Originally posted by Scot:
RadicalWhig's screed notwithstanding, the potential for profit is an excellent motivation to provide exceptional service in an efficient manner.

---

quote:

---

In a non-profit corporation, the individuals doing the work are motivated by personal profit. Even in a governmental system, program budgets and individual compensation drive performance, however inefficiently.

---

quote:

---

Originally posted by Darllenwyr:
I would be interested to know how our American friends deal with chronic conditions such as type 1 diabetes, multiple sclerosis and colostomy. Am I right in understanding that the medical insurance providers will only foot the inevitable bills if your condition had developed after you took out insurance with them?

---

quote:

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Originally posted by Darllenwyr:
Let me see if I understand you, in Canada, it is something of the case that, those who are not fully healthy need not apply?

Chalk one up for a state-provided system of health care.

---

quote:

---

Originally posted by Dafyd:
In general, if you introduce opportunities for personal profit into a system that has been running without them, it becomes less efficient. The profit motivation tends to drive out other motivations.

---

quote:

---

Originally posted by Crœsos:

quote:

---

Originally posted by Scot:

quote:

---

Originally posted by davelarge:
jlg, this all illustrates the fundamental problem: Insurance companies exist to make a profit. Their primary role is not to help people get (or stay) well.

---

The two goals are not necessarily in opposition to one another. An insurance company that judiciously invests in keeping their clients healthy may well have reduced major claims and greater profitability. They may also have greater retention due to happier and healthier customers. Unfortunately our current quasi-private system doesn't encourage competition for end-users.

---

Part of the problem with this assessment, at least in regard to the current American health insurance system, is that most health insurance is provided through your employer.

---

quote:

---

Originally posted by Scot:
Personal profit is why they show up for work.

---

quote:

---

Originally posted by Darllenwyr:
I would be interested to know how our American friends deal with chronic conditions such as type 1 diabetes, multiple sclerosis and colostomy. Am I right in understanding that the medical insurance providers will only foot the inevitable bills if your condition had developed after you took out insurance with them?

What would be the position of somebody diagnosed with MS at age 48, who was then told that a curious episode that occurred when she was 16 was her first episode of MS? Would the insurers then say that this invalidated her policy? (I suspect that the answer to that will be 'Yes')

And what of the teenager who developes type 1 diabetes while still living with his parents? Presumably he will have to obtain his own medical insurance in due course? Will he be told that he will have to foot the bills for treating his diabetes himself? (Again, I suspect the answer is 'Yes')

I ask these questions because, in some way or other, they all touch me, my family, or my friends. I developed type 1 diabetes when I was 35, my wife developed MS two years ago, and my son was born with imperforate anus, dyspraxia, heart murmur, fistula from gut to bladder ...

---

quote:

---

Originally posted by RadicalWhig:

But tell me, "Fellow Merkins", how would the proposals currently going through Congress help those with pre-existing conditions and a gap in their coverage? Would it make it easier or cheaper for them to get suitable insurance? Does anyone know?

---

quote:

---

Originally posted by cliffdweller:

quote:

---

Originally posted by RadicalWhig:

But tell me, "Fellow Merkins", how would the proposals currently going through Congress help those with pre-existing conditions and a gap in their coverage? Would it make it easier or cheaper for them to get suitable insurance? Does anyone know?

---

Yes, because it entails universal coverage. As explained above, the problem currently for self-employed persons or people working for small businesses is you aren't in a big enough benefits pool to bargain with the big insurers. Those businesspeople-- the ones least able to pay high costs-- pay the most for insurance, and run the constant risk of having their insurance cancelled if a dependent is diagnosed with some expensive, chronic condition.

By mandating universal coverage and making a public option available, Congress would basically create a giant pool that any American can have access to. Just like the large employers, they can offer one standard rate for everyone, since mandatory universal coverage insures there will be a large body of healthy customers to offset the unfortunate few with more expensive conditions. Basically, it puts every American in the same bargaining position as IBM or Microsoft.

---

quote:

---

Originally posted by RadicalWhig:

quote:

---

Originally posted by Scot:
Personal profit is why they show up for work.

---

Really? That's terrible.

In my experience, being paid is not the reason I go to work; rather, being paid enables me to go to work. The reason I do it is because it is interesting, sociable, worthwhile, challenging, and gives me a role, a status, and a purpose (that does not mean that I enjoy every minute of it, or that there are not bad days). Being paid means that I can afford to go to work. I don't think I'm alone in this. If it gets to a point where the only, or even the main reason you show up for work is so that you can get paid, you are in the wrong job and need to reassess your vocation.

---

quote:

---

Originally posted by davelarge:
jlg, this all illustrates the fundamental problem: Insurance companies exist to make a profit. Their primary role is not to help people get (or stay) well.

---

quote:

---

Originally posted by Scot:
Uh, good for you, I guess.

---

quote:

---

Originally posted by Scot:

quote:

---

Originally posted by Dafyd:
In general, if you introduce opportunities for personal profit into a system that has been running without them, it becomes less efficient.

---

What system are you talking about that has been running without the opportunity for personal profit? Employees of non-profits get paid, as do government employees. Personal profit is why they show up for work.

---

quote:

---

Originally posted by Clint Boggis:
Alan you're assuming that insurance business runs on fairly low profit margin. Are you just guessing? What kind of figures we're talking about - anyone?

---

quote:

---

Originally posted by Alan Cresswell:
I don't think "for profit" is a big issue in relation to insurance companies. You could also have "not for profit" insurance schemes, and I don't think there would be much difference (unless the profits earned by insurance companies are excessive). An insurance company has an income stream - premiums and investments on those premiums (if nothing else, a bit of interest on cash left in the bank). There are expenses - the money paid out for treament, wages to staff, costs of running offices ... and dividends to shareholders, or whatever way profits are paid out. The profits will be a very small part of the overall expenses. In a not for profit scheme, the overall expenses won't be much less.

---

quote:

---

Originally posted by Clint Boggis:

How much of the money they receive is spent on complex billing beaurocracy, arguing to avoid payouts, profit, legal cases, unnecessary medical tests.. [add your own non-health cost burdens] ? Can anyone point me to a simple breakdown?
.

---

quote:

---

Originally posted by cliffdweller:

quote:

---

Originally posted by Clint Boggis:

How much of the money they receive is spent on complex billing beaurocracy, arguing to avoid payouts, profit, legal cases, unnecessary medical tests.. [add your own non-health cost burdens] ? Can anyone point me to a simple breakdown?
.

---

I don't have the precise answer, but an anecdote from my personal experience may offer some clues.

My youngest has severe visual impairment. After years of having his treatment put off/ endlessly delayed by a bureaucratic HMO, we spent considerable time/effort "working the system" to get into the right plan and the right group with the right primary care physician (you wouldn't believe the number of ducks we had to line up) so he could be seen by a very well-regarded pediatric opthamologist in our area.

Here's the anecdote: a single doctor, working in a private practice. He employs a total of 5 different employees just to handle billing. Every insurance company has a different set of forms, a different set of rules, a different set of criteria, a different procedure for approval. He only needs two nurses and a single optometrist, but 5 billing clerks.

Within a very short time of seeing my son, the doctor was ready to move forward with his long-delayed surgery. Then began the real negotiation. It took around 4 months of intense negotiations by the billing staff to set up the surgery-- negotiating what hospital to use (the doctor maintains surgical privileges as 6 different hospitals since every insurance co. has a different contract), what anaestesiologist, every aspect had to be negotiated in advance before they got the green light.

So it takes 5 different highly skilled people to manage just the billing end of a single doctor's practice. That's insane. More people are working on the billing end then are on the medical end. One of the things reform can do is streamline all those disparate practices into a single uniform form and procedure.

---

quote:

---

The other thing is, he just tells a lot of whoppers now. Now, believe me, Rush Limbaugh and Sarah Palin are saying some things that are extremely off the charts untrue about the plan, but I just wrote down some of the things Obama said today which are whoppers.

He said everyone can keep their health care plan. Well, the CBO doesn't say that. Six million people are going to lose their plan. Preventive care saves money. That's not true. It's going to cost $90 billion a year. That's not true. It's probably going to cost twice as much when it's fully implemented. Government will be out of health care decisions.

He tells one thing after another, making it seem so easy. Well, believe me: This is not easy. It's going to take some sacrifices and some really painful cuts for people to get this system under control.

And often, when I look at him, I think he's over-promising, not as much as the other side, but to a significant degree.

---

quote:

---

The Senate Finance Committee will drop a controversial provision on consultations for end-of-life care from its proposed healthcare bill, its top Republican member said Thursday.

The committee, which has worked on putting together a bipartisan healthcare reform bill, will drop the controversial provision after being derided as "death panels" to encourage euthanasia by conservatives.

"On the Finance Committee, we are working very hard to avoid unintended consequences by methodically working through the complexities of all of these issues and policy options," Sen. Chuck Grassley (R-Iowa) said in a statement. "We dropped end-of-life provisions from consideration entirely because of the way they could be misinterpreted and implemented incorrectly."

---

quote:

---

Originally posted by Clint Boggis:
Going by the account above, if it's typical, I can't see how the actual medical and directly related costs could possibly account for over 70% of the total while there's such a dramatic imbalance between non-medical office staff and those actually delivering the service you want.

---

quote:

---

Originally posted by mjg:
David Brooks: ... Preventive care saves money. That's not true.

---

quote:

---

Originally posted by Alan Cresswell:
[...]OK, I'm not going to try and read anything written on blogs about the subject. But, I just don't understand how preventative care can't be less expensive?...

---

Looking at the context of the quote I'm wondering if he's looking very short term, currently they pay $X on treatment, next years bill they'll pay $X+Y on treatment (the people they haven't looked after till now will still get the disease) and pretreatment. In the future they'll end up paying $Z+Y with Z<X-Y, but who wants to spend for the future
Anyhow that's my first guess, the other possibility is he's arguing that care on 10 moderately ill people is more expensive than care on 1 seriously ill person, 1 corpse and and 8 still moderately ill and untreated people. To be honest my example (my gut tells me) has got too few serious cases to be realistic and too many to be financial realistic.
I disagree with 2, and think 1's worth the short time cost. But if I was emotionally anti-reform I might think differently.

[ 16. August 2009, 08:11: Message edited by: Jay-Emm ]
 

---

Posted by Clint Boggis (# 633) on :
 

quote:

---

Originally posted by Alan Cresswell:

quote:

---

Originally posted by Clint Boggis:
Going by the account above, if it's typical, I can't see how the actual medical and directly related costs could possibly account for over 70% of the total while there's such a dramatic imbalance between non-medical office staff and those actually delivering the service you want.

---

I understood the 70-90% paid by insurance companies to be the amount of their income that gets passed onto medical providers in claims. It doesn't necessarily mean that all of that money is spent on medical treatment, the practioners presumably include their administrative and other indirect costs within their bill to the insurance company. And, of course, the drug companies etc include costs over and above actually making and shipping their products in what they charge.

---

quote:

---

Originally posted by Alan Cresswell:
What conditions become cheaper to treat if left until they become serious? And, not just in direct medical costs; treating advanced illness involve longer periods of care, generally less comfort (quite often distinctly unpleasant treatments), considerable stress on patients and their family etc.

---

quote:

---

Originally posted by angelicum:
So it really depends on exactly what policies you're going to implement.

---

quote:

---

Originally posted by angelicum:
Take for example, statin, a cholesterol lowering drug. Some studies (mostly funded by the pharmaceutical company I bet) have suggested that every adult, regardless of actual cholesterol level should be on a low dose of statin and this reduces the lifetime prevalence of a myocardial infarction by X%. Now there would obviously be a cost to that implementation. Would the cost be higher or lower than what we currently do which is targetted cholesterol lowering plus the addition of whatever percentage point increase in disease that would result because of that?

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quote:

---

Originally posted by davelarge:
But fundamentally, keeping people healthy is (in my opinion) a morally better course than merely treating them when they are ill.

---

quote:

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Originally posted by Clint Boggis:
Some blogger concludes 'Obama tells whoppers' by stating something so clearly untrue (to anyone with a modicum of common sense) in a feeble-minded attempt to refute someone else's statements is - just weird. Idiot.

---

quote:

---

Originally posted by Alan Cresswell:

quote:

---

Originally posted by mjg:
David Brooks: ... Preventive care saves money. That's not true.

---

OK, I'm not going to try and read anything written on blogs about the subject. But, I just don't understand how preventative care can't be less expensive?

What conditions become cheaper to treat if left until they become serious? And, not just in direct medical costs; treating advanced illness involve longer periods of care, generally less comfort (quite often distinctly unpleasant treatments), considerable stress on patients and their family etc.

---

quote:

---

Originally posted by five:
An American doctor once told me that the annual check up was one of the biggest scams going.

---

quote:

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Originally posted by LutheranChik:
It's part of the collective nervous breakdown the right wing is having in our country at the moment.

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quote:

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Originally posted by LutheranChik:
Well, the latest is that the Obama administration is giving up on promoting a public option in its plan. This is very disappointing.
.

---

I'm still struggling to understand what the downside of the public option is for the everyday consumer. I get why the big insurers are worried (I couldn't care less that they are, but I understand it). But why is the average consumer simultaneously worried that government run (again, a misnomer) health care will be "too expensive" while simultaneously sure it will "drive the private insurance companies out of business"? If it does drive the privates out of business (and again, I highly doubt that would be the case) doesn't that just PROVE it can be done cheaper? Isn't that a win-win for consumers? If you have a lot of stock in Cigna, yeah, that's a problem but for the pitchforked masses-- what exactly are you afraid of???

[ 17. August 2009, 00:45: Message edited by: cliffdweller ]
 

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Posted by mousethief (# 953) on :
 
They're afraid of the lies that have been told them about the NHS and the Canadian system, as well as the bogeyman word "socialist".
 

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Posted by Sober Preacher's Kid (# 12699) on :
 
This may have been a tactic. Hillarycare failed. Lesson: Use a government plan as an initial bargaining position and compromise down to a universal private system. Not-for-profits that can't refuse customers would work. Given the huge political price that health reform carries, I think this was forseen by Obama's staff.

If I can think of it, they likely saw this long ago.
 

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Posted by mousethief (# 953) on :
 
Could well be.
 

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Posted by Sober Preacher's Kid (# 12699) on :
 
Given the result that Massachusetts wound up with, I think this is even more likely.

From a policy perspective, the key goals of a plan are:

1) Universal coverage regardless of health.
2) Security of coverage (no terminations due to adverse claims, derived from 1).
3) Provision of a minimum agreed standard of care and benefits.

None of this implies a government-run plan, i.e billing the US Government directly for services or expanding Medicare to include everyone. A universal private system would work, though it would have higher administration and non-medical expenses. If that's the price of universal coverage, so be it.

It's really window dressing but if it helps the medicine go down (not intended as a pun, but....), great.

But winding up the Right with a guv'mint option and then compromising to your real position is just smart bargaining.
 

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Posted by cliffdweller (# 13338) on :
 
agreed, sober PK. One of Pres. Obama's greatest strengths IMHO is that kind of savvy pragmatism. If it gets the job done, so be it.

[ 17. August 2009, 03:33: Message edited by: cliffdweller ]
 

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Posted by Macx (# 14532) on :
 
Sure, I am laughing while I say it but, yeah Obama is winning He had in mind to blow 9/10ths of his political capital, entrench his opposition while swelling their ranks with moderates all while inspiring defections in his vanguard . . . this early in his first year. Should be a lame duck by Christmas, tactically wow!

"The messiah is a failure", get used to hearing that, it is gonna be coming around on the guitar a bunch more times.
 

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Posted by New Yorker (# 9898) on :
 
I think it way too premature to say that "the messiah is a failure." Although I do want him to fail completely.

I don't think all this public option hype was a tactic since it has cost Obama political capital and the loony left will pull their admiration of him.

(The new bumper stickers may read:

"Obama: no longer a messiah; now just a politician!"

or

"From yes we can to well we tried!")

Anyway, my understanding of the Massachustes system is that it is bankrupting the State (or Commonwealth). Is this correct? This morning people are talking about co-ops. Yet, I hear that where this has been tried (in Washington State?) they have not really worked.

And at least some Canadians believe that their system is not working.
 

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Posted by Erin (# 2) on :
 
I wish that the right/anarchists/whatever you call yourselves would freaking stop with the "messiah" strawman. It's insulting and a goddamned LIE.

That said, I'm not sure what to think about him pulling the public option. On the one hand, I have way too much first hand knowledge of the suckitude that is Medicare. On the other hand, I have way too much first hand knowledge of the suckitude that is private insurance.
 

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Posted by tclune (# 7959) on :
 

quote:

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Originally posted by New Yorker:
Anyway, my understanding of the Massachustes system is that it is bankrupting the State (or Commonwealth). Is this correct?

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quote:

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Originally posted by Jason I. Am:

http://i4.photobucket.com/albums/y123/FistsOfCurry/5RkJK.png

---

 

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Posted by tclune (# 7959) on :
 

quote:

---

Originally posted by Macx:
Something that amuses me a bit about folks waving the MA banner as a success is an obvious factor MA doesn't have which many states do. That factor could very well be the chunk o' math that decides if such a program is viable or not in a state. I am of course, referring to illegals (and by extension non-taxpaying poly-generational wellfare families). MA isn't known for being a state with a huge population of illegals.

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quote:

---

Originally posted by Macx:
Something that amuses me a bit about folks waving the MA banner as a success is an obvious factor MA doesn't have which many states do. That factor could very well be the chunk o' math that decides if such a program is viable or not in a state. I am of course, referring to illegals (and by extension non-taxpaying poly-generational wellfare families). MA isn't known for being a state with a huge population of illegals. To put it in number terms, where the per capita GDP is higher there tends to be a lower percentage of illegals and folks on the dole. So if you have enough people (MA) paying in or some people (NY) paying enough in, perhaps you can fly a MA style health care plan. Cut that GDP in half, by say running the same program in WV (where it is unemployment more than illegals) or AZ (where the reverse is true) and now you are talking about running a program that can't possibly be funded outside of straight up robbing people with jobs to pay for insurance for the illegals/ folks on the dole.

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quote:

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Originally posted by Erin:
I wish that the right/anarchists/whatever you call yourselves would freaking stop with the "messiah" strawman. It's insulting and a goddamned LIE.

---

quote:

---

Because if we are willing to work for it, and fight for it, and believe in it, then I am absolutely certain that generations from now, we will be able to look back and tell our children that this was the moment when we began to provide care for the sick and good jobs to the jobless; this was the moment when the rise of the oceans began to slow and our planet began to heal; this was the moment when we ended a war and secured our nation and restored our image as the last, best hope on earth. This was the moment—this was the time—when we came together to remake this great nation so that it may always reflect our very best selves and our highest ideals. Thank you, God bless you, and may God bless the United States of America.

---

My bold.


 

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Posted by RuthW (# 13) on :
 

quote:

---

Originally posted by tclune:
MA just raised its sales tax from 5 to 6.25 percent to try to keep the books in balance. Nobody likes that option -- it's self-defeating to raise prices during a recession, but the states are hog-tied by their balanced budget requirements. MA will come out of this recession in good shape if it doesn't go on much longer, but it has been hard on everyone. The health insurance reform is not the major cause of that pain, though.

---

quote:

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Originally posted by cliffdweller:

quote:

---

Originally posted by Macx:
Something that amuses me a bit <snip> Cut that GDP in half, by say running the same program in WV (where it is unemployment more than illegals) or AZ (where the reverse is true) and now you are talking about running a program that can't possibly be funded outside of straight up robbing people with jobs to pay for insurance for the illegals/ folks on the dole.

---

Well since in states like CA and AZ the state is already covering illegals, only in the most expensive way possible (ER care), it's really gonna work out pretty much the same as now.

But it does illustrate how all our economic woes are inextricably intertwined. And thus is a good argument for immigration reform and a good guest-worker program.

---

Hehe, yeah. CA's state budget is a model for the rest of the country Problem is, the same people who are trying to cram an unpopular (in the United States, among United States citizens) Health Care plan down the throats of citizens are the same people who think amnesties are great for getting the legal family members of illegals to vote for your re-election, economy be damned.

The problem with talking about immigration reform is, it is a conversation we're going to need to wait at least 3 1/2 years to talk about in any kind of meaningful way. Maybe we could revisit tht topic of national healthcare after we accomplish immigration reform in some way that excludes sanctuary cities & includes felonies for aiding and abetting from the farmer that hires migrants to the district attorney that fails to deport illegals within his/her jurisdiction's jails. That, is a different topic though & likely to be discussed in Hell if it isn't floating around in Dead Horses.
 

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Posted by cliffdweller (# 13338) on :
 

quote:

---

Originally posted by Macx:
[QUOTE] Hehe, yeah. CA's state budget is a model for the rest of the country

---

quote:

---

Originally posted by Macx:
Oh, not at all. We're on the same page.

---

quote:

---

Originally posted by cliffdweller:

quote:

---

Originally posted by Macx:
Something that amuses me a bit about folks waving the MA banner as a success is an obvious factor MA doesn't have which many states do. That factor could very well be the chunk o' math that decides if such a program is viable or not in a state. I am of course, referring to illegals (and by extension non-taxpaying poly-generational wellfare families). MA isn't known for being a state with a huge population of illegals. To put it in number terms, where the per capita GDP is higher there tends to be a lower percentage of illegals and folks on the dole. So if you have enough people (MA) paying in or some people (NY) paying enough in, perhaps you can fly a MA style health care plan. Cut that GDP in half, by say running the same program in WV (where it is unemployment more than illegals) or AZ (where the reverse is true) and now you are talking about running a program that can't possibly be funded outside of straight up robbing people with jobs to pay for insurance for the illegals/ folks on the dole.

---

Well since in states like CA and AZ the state is already covering illegals, only in the most expensive way possible (ER care), it's really gonna work out pretty much the same as now.

But it does illustrate how all our economic woes are inextricably intertwined. And thus is a good argument for immigration reform and a good guest-worker program.

---

*Cough*

My favourite Republican, Mitt Romney said the problem of the poor and uncovered receiving expensive care motivated him to support health reform as Massachusetts governor.

I find this episode extremely illuminating as to which way the American health debate will unfold.

Oh, did I mention the Republicans have a mole in their midst?
 

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Posted by Macx (# 14532) on :
 

quote:

---

Originally posted by cliffdweller:

quote:

---

Originally posted by Macx:
Oh, not at all. We're on the same page.

---

Aack! Not even. Maybe just on the CA budget.

---

Little by little, you will be converted. It has already begun, there is no escape. . . . no turning back.
 

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Posted by Clint Boggis (# 633) on :
 

quote:

---

Originally posted by cliffdweller:

quote:

---

Originally posted by LutheranChik:
Well, the latest is that the Obama administration is giving up on promoting a public option in its plan. This is very disappointing.
.

---

I'm still struggling to understand what the downside of the public option is for the everyday consumer. I get why the big insurers are worried (I couldn't care less that they are, but I understand it). But why is the average consumer simultaneously worried that government run (again, a misnomer) health care will be "too expensive" while simultaneously sure it will "drive the private insurance companies out of business"? If it does drive the privates out of business (and again, I highly doubt that would be the case) doesn't that just PROVE it can be done cheaper? Isn't that a win-win for consumers? If you have a lot of stock in Cigna, yeah, that's a problem but for the pitchforked masses-- what exactly are you afraid of???

---

quote:

---

Originally posted by Clint Boggis:

quote:

---

Originally posted by cliffdweller:

quote:

---

Originally posted by LutheranChik:
Well, the latest is that the Obama administration is giving up on promoting a public option in its plan. This is very disappointing.
.

---

I'm still struggling to understand what the downside of the public option is for the everyday consumer. I get why the big insurers are worried (I couldn't care less that they are, but I understand it). But why is the average consumer simultaneously worried that government run (again, a misnomer) health care will be "too expensive" while simultaneously sure it will "drive the private insurance companies out of business"? If it does drive the privates out of business (and again, I highly doubt that would be the case) doesn't that just PROVE it can be done cheaper? Isn't that a win-win for consumers? If you have a lot of stock in Cigna, yeah, that's a problem but for the pitchforked masses-- what exactly are you afraid of???

---

Yes it's completely ridiculous isn't it? It's sad that people so stupid argue against their own interests. With a very little willingness to listen, some of them might understand and then their simple little faces would light up with the joy of discovery!

---

quote:

---

Originally posted by tclune:
The medical community talks as though they were driven by altruism, but chooses their practice based on where the money is. There is nothing wrong with that, but it does mean that we as a society need to make sure that the money is in the kind of care that we want to receive. The private system that we have simply doesn't (and, AFAICS, can't) provide that guidance.

---

quote:

---

Originally posted by tclune:
Other benefits are not obviously achievable simply by adding public option. For example, the big non-medical cost of the health insurance industry is wrapped up in the multitude of rules and regulations that each plan has that they will pay for. While incorporating a standard list of common coverage will massively lower the paperwork in the typical case (again, not requiring a public option at all), there will still be many circumstances where it will be unclear whether a particular procedure is covered by a particular insurance, and negotiations prior to treatment will still be the norm AFAICS.

---

quote:

---

Finally, the big deal that can only be addressed AFAICS by a single-payer system is health care reform -- shifting the rewards from the extreme bias we currently have for specialization back to a less expensive and more medically-effective emphasis on primary care will require a system that can dictate the rewards to the medical establishment. That idea sticks in the craw of many, but the alternative seems to me to be a continuation of the high-priced treatment of conditions that could and should have been prevented in the first place if there had been high-quality primary care.

The medical community talks as though they were driven by altruism, but chooses their practice based on where the money is. There is nothing wrong with that, but it does mean that we as a society need to make sure that the money is in the kind of care that we want to receive. The private system that we have simply doesn't (and, AFAICS, can't) provide that guidance.

---

quote:

---

Originally posted by Erin:
A big chunk of the costs would be ameliorated if payers just complied with the HIPAA transaction and code set requirements. They refuse, of course, because otherwise they would have no excuse not to pay, but it's been how many freaking years and we still have to pick up the phone and call them?

---

quote:

---

Originally posted by Josephine:
So Goldhill argues that we ought to buy our healthcare ourselves. Instead of paying an average of $12,000 per year to insurance companies on our behalf, if we were given that money, and required to stash it in a health savings account, and then use that to buy our routine health care, and used insurance only for truly catastrophic expenses, the system would become accountable to patients really, really fast.

---

quote:

---

Originally posted by New Yorker:
A glimpse into the future?

---

How horrible! Those sorts of decisions should be made by insurance corporations like God intended.
 

---

Posted by tclune (# 7959) on :
 

quote:

---

Originally posted by New Yorker:
A glimpse into the future?

---

quote:

---

Originally posted by New Yorker:
A glimpse into the future?

---

quote:

---

Originally posted by Crœsos:

quote:

---

Originally posted by Josephine:
So Goldhill argues that we ought to buy our healthcare ourselves. Instead of paying an average of $12,000 per year to insurance companies on our behalf, if we were given that money, and required to stash it in a health savings account, and then use that to buy our routine health care, and used insurance only for truly catastrophic expenses, the system would become accountable to patients really, really fast.

---

That seems to be nibbling around the edges rather than dealing with the main problem, which usually involves "truly catastrophic expenses" rather than routine health care. The financial incentive would still exist for the insurance company to dump the cancer patient or the patient with renal failure because they previously had acne.

---

quote:

---

Originally posted by Macx:
[QUOTE] Little by little, you will be converted. It has already begun, there is no escape. . . . no turning back.

---

quote:

---

Originally posted by tclune:
[QUOTE]While I would personally favor a single-payer plan, I think it is incredibly counterproductive to assume that those with a different view are stupid (if you're liberal) or evil (if you're conservative.) It is perfectly possible to have a different view from me and be neither (which either proves that I'm MOR or that I am both stupid and evil).

---

quote:

---

Originally posted by tclune:
[QUOTE]
The concerns about the public option are many. First, as Obama properly noted in his Colorado town meeting, is that the costs of a public option are not all borne in the open.

The example that Obama gave was the cost of capital and the related issue of how much money needs to be held in reserve to insure the viability of the insurance in the event of an unusual string of costly events. It is not waste or excessive profiteering that makes this a greater cost of a private company -- it is that the taxpayer is providing the insurance for the public option and not for the private option.

---

quote:

---

Originally posted by tclune:
[QUOTE]
Most of the benefits that one hopes to achieve with insurance reform can be achieved without a public option at all. Things like universal coverage, not dropping people when they get sick, etc. can be achieved through legislation that does not involve any public option.

---

quote:

---

Originally posted by tclune:
[QUOTE]
Other benefits are not obviously achievable simply by adding public option. For example, the big non-medical cost of the health insurance industry is wrapped up in the multitude of rules and regulations that each plan has that they will pay for. While incorporating a standard list of common coverage will massively lower the paperwork in the typical case (again, not requiring a public option at all), there will still be many circumstances where it will be unclear whether a particular procedure is covered by a particular insurance, and negotiations prior to treatment will still be the norm AFAICS.

Finally, the big deal that can only be addressed AFAICS by a single-payer system is health care reform -- shifting the rewards from the extreme bias we currently have for specialization back to a less expensive and more medically-effective emphasis on primary care will require a system that can dictate the rewards to the medical establishment. That idea sticks in the craw of many, but the alternative seems to me to be a continuation of the high-priced treatment of conditions that could and should have been prevented in the first place if there had been high-quality primary care.

---

quote:

---

Originally posted by Erin:

quote:

---

Originally posted by New Yorker:
A glimpse into the future?

---

No. In some ways it resembles the present, in that insurance companies today have people and groups that deny coverage for life-saving treatment every single day. Do you really not know this? Seriously: is it news to you that this happens every single day except maybe Sundays in this country?

---

quote:

---

Originally posted by cliffdweller:

quote:

---

Originally posted by tclune:
<snip>The example that Obama gave was the cost of capital and the related issue of how much money needs to be held in reserve to insure the viability of the insurance in the event of an unusual string of costly events. <snip>

---

How is this different than the current situation, when consumers pay for their own health care through private insurance, but also pay hidden costs through offsets for the care of the uninsured? We're already paying these costs, but shifting the uninsured into the insured ranks we should at least be able to lower those costs by shifting the uninsured to less expensive preventative care, rather than strictly ER.

---

quote:

---

Originally posted by cliffdweller:

quote:

---

Originally posted by tclune:

Most of the benefits that one hopes to achieve with insurance reform can be achieved without a public option at all. Things like universal coverage, not dropping people when they get sick, etc. can be achieved through legislation that does not involve any public option.

---

Sure, which is why Obama is now willing to give it up. But that alone doesn't show that including a public option wouldn't provide some additional benefit or cost savings.

---

quote:

---

Originally posted by cliffdweller:

quote:

---

Originally posted by tclune:

Other benefits are not obviously achievable simply by adding public option. For example, the big non-medical cost of the health insurance industry is wrapped up in the multitude of rules and regulations that each plan has that they will pay for. While incorporating a standard list of common coverage will massively lower the paperwork in the typical case (again, not requiring a public option at all), there will still be many circumstances where it will be unclear whether a particular procedure is covered by a particular insurance, and negotiations prior to treatment will still be the norm AFAICS.

Finally, the big deal that can only be addressed AFAICS by a single-payer system is health care reform -- shifting the rewards from the extreme bias we currently have for specialization back to a less expensive and more medically-effective emphasis on primary care will require a system that can dictate the rewards to the medical establishment. <snip>

---

I don't see how either of these is as an argument against a public option. All you've done is show that a public option is not a magic bullet that solves everything. No one is suggesting it is. But NOT having a public option doesn't solve any of these problems either.

---

quote:

---

Originally posted by New Yorker:

quote:

---

Originally posted by Erin:

quote:

---

Originally posted by New Yorker:
A glimpse into the future?

---

No. In some ways it resembles the present, in that insurance companies today have people and groups that deny coverage for life-saving treatment every single day. Do you really not know this? Seriously: is it news to you that this happens every single day except maybe Sundays in this country?

---

Well, at least now if your insurance company denies care those who are able can self pay. If the death panels come into being then that option is removed.

---

quote:

---

Originally posted by New Yorker:

quote:

---

Originally posted by Erin:

quote:

---

Originally posted by New Yorker:
A glimpse into the future?

---

No. In some ways it resembles the present, in that insurance companies today have people and groups that deny coverage for life-saving treatment every single day. Do you really not know this? Seriously: is it news to you that this happens every single day except maybe Sundays in this country?

---

Well, at least now if your insurance company denies care those who are able can self pay. If the death panels come into being then that option is removed.

---

quote:

---

Originally posted by New Yorker:
If the death panels come into being then that option is removed.

---

You know perfectly well it was the Republicans, and the people pullign their strings, ones who thought that idea up. Is nothing to do with Obama or the Democrats and you should be ashamed for perpetuating the lie that it is.

May you dream of Stephen Hawking tonight.
 

---

Posted by Crœsos (# 238) on :
 

quote:

---

Originally posted by tclune:
Here's the short form: You need to show some problem to which a public option is the answer. Failing that, there is no reason to even consider creating such a thing.

--Tom Clune

---

quote:

---

Originally posted by Crœsos:

quote:

---

Originally posted by tclune:
Here's the short form: You need to show some problem to which a public option is the answer. Failing that, there is no reason to even consider creating such a thing.

--Tom Clune

---

The public option is the counterbalance to mandated participation.
...
The problem here is that requiring people to buy insurance (or have it bought for them by the state if they can't afford it themselves) is essentially a huge bonus for private insurers for whom the economic incentive is to charge as much as possible for their services. The semi-market-based solution to this is to have a competitor motivated by something other than pure profit to keep prices somewhat in line. In other words, the public option. It's not the only solution to this problem, but it's the one that't currently seen as "politically workable" in the U.S.

---

quote:

---

Originally posted by ToujoursDan:
Using the car insurance example in California as a model, how does one deal with the fact that 25% of drivers in California [b]still[b] drive with no insurance even with that "low cost" option available?

New York Times: California's uninsured

In the case of car insurance you can give the person a ticket and take the car away.

Let's say the proposed healthcare bill forces everyone to buy insurance, or else. What is the "or else"? Most people don't buy insurance because they can't afford it. Are we going to start penalizing the poor or those in financial distress because they can't afford the costs of a mandatory private plan? What would that mean? Fines? Jail time? What happens to someone who shows up for treatment but whose mandatory insurance has lapsed or been cancelled for non-payment? Are we back to huge bills leading to bankruptcies again?

There has to be some kind of public fallback for those who do not, or can not afford to buy something on their own.

---

quote:

---

Originally posted by tclune:
I can see this as a problem if there were only one insurance company. But we have a wealth of insurance companies competing with each other, including many that are either non-profit (Blue Cross/Blue Shield) or are customer-owned (the various Mutual insurance companies). It still seems like a solution in search of a problem. I'd need a lot more reason to believe that the insurance companies are likely to engage in a conspiracy of price-fixing before I would find the public option at all compelling.

It is much easier for insurance companies to withold service from the expensive customers than to charge high prices -- you don't know that they'll stiff you on service unless you get sick and become an undesireable customer anyway, whereas everybody knows the cost of the insurance going in.

--Tom Clune

---

quote:

---

Originally posted by ToujoursDan:
I get it, but find this completely crazy.

Surely, it would be more efficient to just put everyone on a public plan than put together a bureaucracy to monitor and fine those who can't/don't buy a policy.

...

A tax funded option would make more sense.

---

quote:

---

Originally posted by tclune:

quote:

---

Originally posted by ToujoursDan:
I get it, but find this completely crazy.

Surely, it would be more efficient to just put everyone on a public plan than put together a bureaucracy to monitor and fine those who can't/don't buy a policy.

...

A tax funded option would make more sense.

---

I'm not sure about that. ISTM that one of the reasons that medicine got so absurdly expensive in this country was because the consumer wasn't paying for it. It was magically provided by the employer, and kept going up at an astronomical rate.

If people have skin in the zipper, they pay more attention. And, realistically, making a universal plan paid for by taxes just has the same people paying, but not aware of the cost. Talk about crazy...

--Tom Clune

---

quote:

---

Originally posted by Crœsos:
Given that in situations where the patient has even less "skin in the zipper" (e.g. most other Western, industrialized countries) are nonetheless able to provide superior care at less cost than the U.S. system, I'm not sure your assertion follows. I can't picture a lot of people running off to get needless colonoscopies just because they're cheap.

---

quote:

---

Originally posted by tclune:
No, you missed the point. If one has a single-payer system, the government is controlling costs because they have the ability to do so and a strong incentive to keep their books in balance. That's not the system under consideration. The question that is being posed is, "How would adding a public option into the mix control costs?"

Single payer controls costs one way. Market systems control costs another way. Claiming that there can't be much of a market effect in a market-driven system because there isn't much of a market effect in a command system is just a non sequitur.

--Tom Clune

---

quote:

---

Originally posted by tclune:
The question that is being posed is, "How would adding a public option into the mix control costs?"

---

quote:

---

Originally posted by Honest Ron Bacardi:
Where exactly did this bizarre "death panels" stuff come from? How come nobody else has them?

---

quote:

---

Originally posted by ToujoursDan:
Let's say the proposed healthcare bill forces everyone to buy insurance, or else. What is the "or else"? Most people don't buy insurance because they can't afford it. Are we going to start penalizing the poor or those in financial distress because they can't afford the costs of a mandatory private plan? What would that mean? Fines? Jail time?

---

quote:

---

Originally posted by New Yorker:

quote:

---

Originally posted by ToujoursDan:
Let's say the proposed healthcare bill forces everyone to buy insurance, or else. What is the "or else"? Most people don't buy insurance because they can't afford it. Are we going to start penalizing the poor or those in financial distress because they can't afford the costs of a mandatory private plan? What would that mean? Fines? Jail time?

---

I suppose that this would be in the remit of the Death Panels. Wasn't it the Dead Kennedys who came up with Kill the Poor? I never thought I'd live to see such things in this country, however.

---

quote:

---

Originally posted by Honest Ron Bacardi:
The inefficiencies and iniquities of insurance companies are only part of it , surely. You still have all the issues of price gouging by the suppliers, unnecessary tests due to paranoia about getting sued/tort reform, and consequent insurance burden - to name but 3.5.

Where exactly did this bizarre "death panels" stuff come from? How come nobody else has them?

---

quote:

---

Originally posted by ToujoursDan:
I never thought I'd see a whole country lose its grip on reality.

---

quote:

---

Originally posted by ken:

quote:

---

Originally posted by tclune:
The question that is being posed is, "How would adding a public option into the mix control costs?"

---

Dunno. But as all the major developed countries that do it the mixed way have cheaper healthcare than the US, and better health outcomes, it obviously works somehow. France, Germany, the Netherlands and Japan all have mixed public-private systems with a number of competing insurance providers and all are cheaper than the US system.

They pay less than you do, and they get more.

Sounds like a no-brainer to me.

---

quote:

---

Originally posted by ken:
Being a bit of an old political hack and a conmspiracy theorist I assume that there is big money from somewhere behind the lies. But I have no real idea.

---

quote:

---

Originally posted by Josephine:

quote:

---

Originally posted by ken:
Being a bit of an old political hack and a conmspiracy theorist I assume that there is big money from somewhere behind the lies. But I have no real idea.

---

According to Wendell Potter, a former insurance company executive who has seriously repented of his former actions, your assumption would be entirely correct.

---

quote:

---

The practice is called "rescission" and Beaton's is not an isolated case. The House Energy and Commerce Committee found that the major private health insurers had rescinded the policies of approximately 20,000 people in a five year period, to avoid paying out approximately $300 million in benefit claims.

Appearing before the same committee, CEOs of the major health insurance companies stated that they would continue to use rescission, arguing that it is a necessary protection against fraud and abuse.

---

So while fighting 'fraud and abuse' the major private health insurers average 4,000 rescissions annually? Trying to be conservative I'll estimate they insure 50,000,000 people: .008%.

Even if you quadrupled the percentage the practice hardly seems out of control, which seems to confirm to what a seasoned insurance guy tells me: insurance regulators resolving conflicts typically err on the side of the consumer.

But ISTM this entire debate is shooting in the dark - IMO there's so much hyperbole being slung by both sides it's damn near impossible to really say what's going on.
 

---

Posted by mousethief (# 953) on :
 

quote:

---

Originally posted by mjg:
So while fighting 'fraud and abuse' the major private health insurers average 4,000 rescissions annually? Trying to be conservative I'll estimate they insure 50,000,000 people: .008%.

---

quote:

---

Even if you quadrupled the percentage the practice hardly seems out of control, which seems to confirm to what a seasoned insurance guy tells me: insurance regulators resolving conflicts typically err on the side of the consumer.

---

quote:

---

Originally posted by mjg:But ISTM this entire debate is shooting in the dark - IMO there's so much hyperbole being slung by both sides it's damn near impossible to really say what's going on.

---

quote:

---

Originally posted by mousethief:
Somebody has to look out for the consumer. God knows the insurance companies sure as hell don't.

---

Sigh.
 

---

Posted by Erin (# 2) on :
 
The right wing has gone off the rails. YouTube video of lunatic. I just don't even know what to say.
 

---

Posted by Josephine (# 3899) on :
 
Here is an interview with that same woman, apparently a few moments before the scene in the video Erin linked to.

She says she believes in Biblical values.
 

---

Posted by Crœsos (# 238) on :
 
Ironically enough, the "Heil Hitler" woman (that's how she's going to be known on the internet after this) is wearing an IDF shirt.

The only remaining question is how long before she gets an hour-long segment on Fox News?
 

---

Posted by mousethief (# 953) on :
 

quote:

---

Originally posted by Crœsos:
Ironically enough, the "Heil Hitler" woman (that's how she's going to be known on the internet after this) is wearing an IDF shirt.

The only remaining question is how long before she gets an hour-long segment on Fox News?

---

quote:

---

Originally posted by ToujoursDan:
So your fear of these so-called death panels (that haven't actually been proposed by anyone) comes from a song?

---

quote:

---

I never thought I'd see a whole country lose its grip on reality. But here it is.

---

quote:

---

.... at least as I read it, Section 1233 is not totally innocuous.

---

quote:

---

Originally posted by New Yorker:
Of course the House Bill does not mention "death panels" per se in the infamous section 1233, but even the left-wing Washington Post raised a concern over the DPs. Their columnist Charles Lane wrote:

quote:

---

.... at least as I read it, Section 1233 is not totally innocuous.

---

So even the left is concerned about the DPs.

---

New Yorker, you're getting lazy in your old age. The notion that any columnist who writes for the Post is per force a "left winger" will undoubtedly be news to Lane, Krauthammer, and Kristol while causing Novak to spin in his grave before he even gets into it. I sincerely doubt that you can find a single column from Lane that you would find to be to your left, let alone "left wing."

--Tom Clune
 

---

Posted by davelarge (# 186) on :
 
What? A news outlet that presents more than one opinion on an issue? Well I never!
 

---

Posted by Crœsos (# 238) on :
 

quote:

---

Originally posted by New Yorker:
Of course the House Bill does not mention "death panels" per se in the infamous section 1233, but even the left-wing Washington Post raised a concern over the DPs. Their columnist Charles Lane wrote:

quote:

---

.... at least as I read it, Section 1233 is not totally innocuous.

---

So even the left is concerned about the DPs.

Here is his whole column.

---

quote:

---

As it happens, I have a living will and a durable power of attorney for health care. I'm glad I do. I drew them up based on publicly available medical information, in consultation with my family and a lawyer. No authority figure got paid by federal bean-counters to influence me. I have a hunch I'm not the only one who would rather do it that way.

---

quote:

---

Originally posted by mousethief:
So you admit you know there are no death panels, and still you use that rhetoric to make some kind of rhetorical point.

---

quote:

---

Originally posted by New Yorker:
I admit that the phrase "death panel" is not in the bill but the concept to which the phrase refers is in the bill.

---

 

---

Posted by mousethief (# 953) on :
 

quote:

---

Originally posted by davelarge:
What? A news outlet that presents more than one opinion on an issue? Well I never!

---

quote:

---

Originally posted by mousethief:

quote:

---

Originally posted by davelarge:
What? A news outlet that presents more than one opinion on an issue? Well I never!

---

That's those liberals all over.

---

One might even get the impression that they think about things.
 

---

Posted by RuthW (# 13) on :
 

quote:

---

Originally posted by mjg:
So while fighting 'fraud and abuse' the major private health insurers average 4,000 rescissions annually? Trying to be conservative I'll estimate they insure 50,000,000 people: .008%.

---

quote:

---

It’s the 99th percentile, the people with over $35,000 of medical costs, who represent fully 22% of the entire nation’s medical costs. These people have chronic, expensive conditions. They are, to use a technical term, sick.

An individual adult insurance plan is roughly $7,000 (varies dramatically by age and somewhat by sex and location).

It should be fairly clear that the people who do not file insurance claims do not face rescission. The insurance companies will happily deposit their checks. Indeed, even for someone in the 95th percentile, it doesn’t make a lot of sense for the insurance company to take the nuclear option of blowing up the policy. $11,487 in claims is less than two years’ premium; less than one if the individual has family coverage in the $12,000 price range. But that top one percent, the folks responsible for more than $35,000 of costs – sometimes far, far more – well there, ladies and gentlemen, is where the money comes in. Once an insurance company knows that Sally has breast cancer, it has already seen the goat; it knows it wants nothing to do with Sally.

If the top 5% is the absolute largest population for whom rescission would make sense, the probability of having your policy cancelled given that you have filed a claim is fully 10% (0.5% rescission/5.0% of the population). If you take the LA Times estimate that $300mm was saved by abrogating 20,000 policies in California ($15,000/policy), you are somewhere in the 15% zone, depending on the convexity of the top section of population. If, as I suspect, rescission is targeted toward the truly bankrupting cases – the top 1%, the folks with over $35,000 of annual claims who could never be profitable for the carrier – then the probability of having your policy torn up given a massively expensive condition is pushing 50%. One in two. You have three times better odds playing Russian Roulette.

---

quote:

---

Originally posted by RuthW:
Having lots of healthcare insurers in California has not kept prices down. I spoke with the broker who found us our policy at work a while back just this morning -- he said that we were getting the best price possible for the kind of policy we have, and that the premiums would only go down if we got a policy that covered less stuff. The premiums are about to go up 11.35%; last year the increase was 14%. Hence my skepticism about competition between insurance carriers having any benefit for the consumer, and hence my belief that we need a public option.

---

quote:

---

Originally posted by tclune:
A public option just adds nothing positive to the mix.

---

quote:

---

Originally posted by RuthW:
The premiums are about to go up 11.35%; last year the increase was 14%. Hence my skepticism about competition between insurance carriers having any benefit for the consumer, and hence my belief that we need a public option.

---

quote:

---

Originally posted by davelarge:

quote:

---

Originally posted by tclune:
A public option just adds nothing positive to the mix.

---

It does have the potential to give the tax-payers' representatives more direct control over the costs. Does that count as one way of curbing the price of treatments?

---

quote:

---

Originally posted by aggg:
People don't have a problem with state controlled universal schooling so why not healthcare?

---

quote:

---

You're right Tom. But how can we find out where the money's going?

---

quote:

---

Originally posted by mousethief:

quote:

---

Originally posted by aggg:
People don't have a problem with state controlled universal schooling so why not healthcare?

---

On the contrary, many people (the vast majority right wing) have a problem with the public schools, and have their kids in private schools, or homeschooled, as a result. Largely it has to do with the teaching of evolution.

---

quote:

---

Originally posted by Martin L:

quote:

---

Originally posted by RuthW:
The premiums are about to go up 11.35%; last year the increase was 14%. Hence my skepticism about competition between insurance carriers having any benefit for the consumer, and hence my belief that we need a public option.

---

Thank you. My premiums have tripled in two years, simply because of price increase. Nothing to do with age, changes in condition, changes in coverage, or adding dependents. ...

---

quote:

---

Originally posted by Alan Cresswell:
Is it really the case that people lose their insurance (or, find they can only be insured by paying a significantly larger premium) if they contract an illness that has them in the hospital for a week?

---

quote:

---

Deception is not an incidental aspect of this medical care legislation, but is at the very heart of it.

---

quote:

---

As for those uninsured Americans who are supposedly the reason for all this sound and fury, there is remarkably little interest in why they are uninsured, despite the incessant repetition of the fact that they are.

---

quote:

---

No small part of our current medical care problems have been created by politicians who drive up the cost of medical insurance by mandating that insurance cover things that many people are unwilling to pay for.

---

quote:

---

Originally posted by New Yorker:
The government screws up a used car program, but we want it to run our health care?

---

quote:

---

Originally posted by Jason I. Am:
Tom, I'm feeling extraordinarily thick today. Can you explain (again) why the public option does no good where the single-payer option would? I can tell there's something to what you're saying, but I can't repeat the argument in an understandable way.

---

Single payer basically turns the medical industry into a governmental service. All medical services are paid for by the government and private insurance is, for all practical purposes, eliminated. There is some room for fudging on that. Medicare is usually seen as a model for single-payer in this country.

If it were extended to everyone, that would be what most folks would think of as a single payer system. However, there is supplimental insurace that is sold to Medicare recipients and the medical industry is not, strictly speaking, nationalized. Physicians can opt out of the system, but their patient base would be very small indeed.

The basic reality is that, if the government were essentially the sole entity that paid for all the core services, then the government could change the way in which services were delivered. We have evolved a very strange medical system because it is completely undirected. Essentially every physican in the US is a specialist. General practicioners and family medicine specialists don't really practice medicine, they provide referrals to the specialist that seems most appropriate for treating your condition.

As a result of this, physicians are massively overpaid for treating routine conditions, tests tht are unnecessary but lucrative to the specialist are routinely ordered, drugs are prescribed to justify doctor's appointments as often as to treat real diseases, etc.

We cannot watch television without being bombarded by ads for pharmaceuticals that only a physician can prescribe. The reason for this is that people ask their physician for the drugs that they see advertized on television, and the physician provides them whether there is a generic that would do the same job or not. A single payer system could eliminate that exhorbitantly expensive practice in one stroke.

Insurance companies have very limited ability to change medical practice -- unless they engaged in unlawful collusion to set prices with other insurance companies, they really couldn't restructure their fees to reorder medical priorities. A single payer system can accomplish those necessary ends.

It would be possible to create some sort of medical oversight board to set those priorities and allow individual private insurance companies to still sell the policies, but that would be a strange and inefficient system. The insurance companies would basically be providing no value and would be retained simply to subsidize the stock holders of the company.

An additional serious concern to my mind is malpractice reform. We have a system where doctors literally perform operations while drunk. If they kill or maim a patient, they are sued by the patient or their surviving spouse for many millions of dollars, and they continue to practice medicine.

This is just crazy. There is no reason why being victimized by a substance abuser with a scalpel should be seen as a winning lottery ticket, and no reason why physicians should not be forbidden from practicing medicine when they are found to be a danger to patients. I think that a single payer system could effrectively police physicians who have demonstrated for years that they are unwilling or unable to police themselves. If there is a real policing of medical practice, then there is an honest environment for allowing tort reform.

If you just add a public option, what you are doing is creating more insurance companies, but some of them are owned by the Federal Government. The stated rationale for creting this new and massive structure is to provide competition to the existing insurance companies "to keep them honest."

Not only does this rationale fail to adddress many of the things that need reforming, but I have seen no evidence that the current companies are particularly dishonest. They may not run their business the way that some people would want them to, but they are not obviously dishonest.

If one's goal is to change the way that care is delivered, simple competition for who provides the insurance is just plain irrelevant. If one's goal is to make sure that everyone can get coverage and will not be cancelled if they get sick or change jobs, a public option is unnecessary.

The real question in my mind is what value a public option has. The only objective thing that has been offered is to suggest that, if insurance companies are price gouging (something that I have yet to see any evidence for), a public option would require the insurance company to either stop that practice or go out of business. Lacking proof that price gouging is happening in the sale of insurance, I remain unmoved.

The other reason for demanding a public option is just perverse. As Rep. Maxine Waters said, she wanted to have a single payer system but was talked out of it on political grounds. She feels that if she doesn't get a public option, she will have "lost" on health care reform. She didn't offer any objective reason why a public option was a good thing, only a political reason that she gave up what she wanted and was unwilling to let the opposition get what they wanted. But polictical face-saving is an incredibly stupid reason to create a bureaucracy. If it doesn't do anything, let Rep Waters lose face -- it isn't that great a face anyway.

--Tom Clune
 

---

Posted by Crœsos (# 238) on :
 
BTW, the commie pinkos at the RAND Corporation indicate that not only does VA care cost less than privately provided care, "VA patients are more likely to receive recommended care than patients in the national sample."

I'm sure the lack of 'death panels' in the VA is purely an oversight.
 

---

Posted by tclune (# 7959) on :
 

quote:

---

Originally posted by Crœsos:
BTW, the commie pinkos at the RAND Corporation indicate that not only does VA care cost less than privately provided care, "VA patients are more likely to receive recommended care than patients in the national sample."

---

quote:

---

Originally posted by tclune:
The basic reality is that, if the government were essentially the sole entity that paid for all the core services, then the government could change the way in which services were delivered.

---

quote:

---

Originally posted by Crœsos:
To a large extent it already is "run[ning] our health care". The U.S. spends more public dollars (that's tax money, everyone already knows the U.S. spends more total dollars) on health care per capita than that horrible British NHS that hunted down and killed poor Dr. Hawking.

---

quote:

---

Originally posted by davelarge:

quote:

---

Originally posted by tclune:
The basic reality is that, if the government were essentially the sole entity that paid for all the core services, then the government could change the way in which services were delivered.

---

But surely that logic extends even further if the government actually runs the provision of health services. I mean, if they directly employ the health professionals, manage the hospitals and clinics, and provide all the funding, then they have control over all the costs. From the point of view of cost reduction, that's got to be better than the indirect influence over the pricing set by private companies, even if the government is the sole purchaser.

---

quote:

---

Originally posted by Crœsos:
We've also already got examples of health care that's provided by government insurance (Medicare) or provided directly by the government (the Veteran's Administration). While the cost of both has been increasing, the rate of cost increase in both programs has been significantly less than cost increase of healthcare generally within the U.S. Add in to that the fact that participants in these programs are generally more statisfied with their service than those with private insurance, and I'd say we've got pretty good evidence that the U.S. government can do health care if it puts its collective mind to it.

---

quote:

---

Originally posted by tclune:
... However, there is supplimental insurace that is sold to Medicare recipients and the medical industry is not, strictly speaking, nationalized. Physicians can opt out of the system, but their patient base would be very small indeed.

---

quote:

---

Originally posted by tclune:
If it were extended to everyone, that would be what most folks would think of as a single payer system. However, there is supplimental insurace that is sold to Medicare recipients and the medical industry is not, strictly speaking, nationalized. Physicians can opt out of the system, but their patient base would be very small indeed.

---

quote:

---

Originally posted by davelarge:
OK, so when you say 'public option' you mean a government-run insurance scheme, not government-managed services?

---

quote:

---

Originally posted by prettybutterfly:

quote:

---

Originally posted by Crœsos:
To a large extent it already is "run[ning] our health care". The U.S. spends more public dollars (that's tax money, everyone already knows the U.S. spends more total dollars) on health care per capita than that horrible British NHS that hunted down and killed poor Dr. Hawking.

---

Do you have a source for this that you could send me? I've been having a similar discussion on this subject elsewhere, and this is an important point.

---

quote:

---

Originally posted by tclune:
But it is not irrational to imagine that many of the proponents are now aware of the situation and are taking a politically lower-risk strategy for effecting a single payer system. Personally, I find such tactics a despicable misuse of the democratic process. I prefer an honest debate. But that kind of dishonesty is certainly not unheard of in politics.

---

It might also help explain some of the shrillness of the opponents of a public option, if they fear it is the thin end of the single payer wedge.

Thanks for your explanations: I think I understand what's going on rather better now.
 

---

Posted by Crœsos (# 238) on :
 

quote:

---

Originally posted by Moth:

quote:

---

Originally posted by prettybutterfly:

quote:

---

Originally posted by Crœsos:
To a large extent it already is "run[ning] our health care". The U.S. spends more public dollars (that's tax money, everyone already knows the U.S. spends more total dollars) on health care per capita than that horrible British NHS that hunted down and killed poor Dr. Hawking.

---

Do you have a source for this that you could send me? I've been having a similar discussion on this subject elsewhere, and this is an important point.

---

You can get all the statistics from
the WHO. For example, you can see that that in 2006 the USA spent 19.1% of total government expenditure on health care, whereas the UK spent 16.5%. Further digging will get you actual figures.

---

quote:

---

Originally posted by Crœsos:
The U.S. spends more public dollars on health care per capita than that horrible British NHS that hunted down and killed poor Dr. Hawking.

---

quote:

---

Originally posted by Dafyd:

quote:

---

Originally posted by Crœsos:
The U.S. spends more public dollars on health care per capita than that horrible British NHS that hunted down and killed poor Dr. Hawking.

---

I fully expect you to find yourself cited as an authority attesting that the British government sent elite hit squads after the eminent scientist.

(Does Stephen Hawking really get all his medical treatment privately?)

---

quote:

---

Originally posted by ken:
... I'm not sure but I think Germany is the exact other way round - most doctors (like university teachers and Lutheran priests) are government employees, civil servants. But there are multiple health insurance schemes.

---

quote:

---

Originally posted by Dafyd:

quote:

---

Originally posted by Crœsos:
The U.S. spends more public dollars on health care per capita than that horrible British NHS that hunted down and killed poor Dr. Hawking.

---

I fully expect you to find yourself cited as an authority attesting that the British government sent elite hit squads after the eminent scientist.

---

quote:

---

Originally posted by Dafyd:
(Does Stephen Hawking really get all his medical treatment privately?)

---

quote:

---

Originally posted by IconiumBound:
Sorry to ring in late on this thread (p 6) but I wonder why the case for "death panels" hasn't been turned back onto the HMO's who regularly deny coverage even it means sentencing the subscriber to death? A relative, suffering from lukemia, was denied a bone marrow transplant by her HMO becuase, at age 70, she was too old to qualify. She died shortly after. Congressional hearings about two years ago heard testimony from a physician who employed by a leading HMO had the job of finding reasons to deny coverage. She resigned on moral grounds.

So.ISTM that we already have death panels and will probably continue to have them till a single payer legislation is enacted.

---

quote:

---

Originally posted by CorgiGreta:
Ruth,

The existence of a large number of carriers does not mean that the bulk of us have a wide choice when it comes to our coverage. Lots of companies offer coverage with just one carrier. Even the really large companies may offer only a handful of carriers, albeit with various plans.

Also, I am fairly certain that in most companies, the choice, if any, usually comes down to the same top four or five insurers. The result may not be a cartel or an oligopoly, but it would be fertile soil for one to grow and prosper.

I would guess that in a group as small as yours, the "choice" would be Blue Cross or nothing, but since I assume that you are in a liberal church group, perhaps it's Kaiser. Good on you if it is.

If your employer is trying to save himself or herself some bucks, you could be offered only a skimpy plan.

Greta

---

quote:

---

Senator Edward M. Kennedy, in a poignant acknowledgment of his mortality at a critical time in the national health care debate, has privately asked the governor and legislative leaders to change the succession law to guarantee that Massachusetts will not lack a Senate vote when his seat becomes vacant.

In a personal, sometimes wistful letter sent Tuesday to Governor Deval L. Patrick, Senate President Therese Murray, and House Speaker Robert A. DeLeo, Kennedy asks that Patrick be given authority to appoint someone to the seat temporarily before voters choose a new senator in a special election.

Although Kennedy, who is battling brain cancer, does not specifically mention his illness or the health care debate raging in Washington, the implication of his letter is clear: He is trying to make sure that the leading cause in his life, better health coverage for all, advances in the event of his death.

In his letter, which was obtained by the Globe, Kennedy said that he backs the current succession law, enacted in 2004, which gives voters the power to fill a US Senate vacancy. But he said the state and country need two Massachusetts senators.

"I strongly support that law and the principle that the people should elect their senator," Kennedy wrote. "I also believe it is vital for this Commonwealth to have two voices speaking for the needs of its citizens and two votes in the Senate during the approximately five months between a vacancy and an election."

---

quote:

---

Originally posted by New Yorker:
Watching Bill O'Reilly tonight who had the former President of the Canadian Medical Association, Brian Day. Dr. Day said that, in Canada, if you're having a heart attack the health care system would not pay for the ambulance to take you to the hospital. Is this true? Good God Almighty if it be true and keep that Obamacare far, far away.

---

Who do you think would pay for the ambulance if you had to go to the hospital in this country? The tooth fairy?

The only time I ever had to have one of my children transported by ambulance (she was having trouble breathing, and the urgent care clinic couldn't handle it, so they sent her to the children's hospital), our private insurance wouldn't pay for the ambulance. They decided it wasn't medically justifiable. (And I lost that appeal, too. Blasted government bureaucrats who care nothing for the life of a child. Oh, wait. They weren't with the government.)

At least on paper, we HAD insurance that covered transport by ambulance. Lots of private insurance companies don't even pretend cover it. Some of them cover a portion of it (often the first $500). Medicare doesn't pay for ambulances at all, nor does Medicaid. Are you absolutely certain that your insurance would pay for it?

And what does Obama have to do with health coverage in Canada anyway?
 

---

Posted by Leaf (# 14169) on :
 
But since we're on the subject of Canada ... I have some questions for New Yorker et al.

Do you really believe that all the other posters here from countries with universal health care are granny-exterminating death-panel-loving commie nazis (to borrow what appears to be the parlance of the debate)?

Doesn't the possibility exist in your mind that seemingly sane, intelligent, freedom-loving people would choose and support universal health care?

Does the fact that not one single non-American has sighed on this thread, "Gee, I wish we had the American system!" not light one tiny of doubt in your mind?

Are all us citizens of Canada, Australia, New Zealand, the UK, Europe, and Scandinavia really just that deluded?
 

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Posted by mousethief (# 953) on :
 
Leaf, you assume that for the right the debate is about health care. It's not. It's about Defeating Obama At Any Cost.
 

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Posted by Clint Boggis (# 633) on :
 
Another difference here. In Britain we have an ambulance service and it's free usually. I have no real idea how it's organised but if you need them they're there and you almost certainly won't get a bill.

I have heard of people being charged but I don't know under what circumstances.
.
 

---

Posted by Dafyd (# 5549) on :
 

quote:

---

Originally posted by Carys:
I think you'll find that Crœsos was being sarcastic.

---

quote:

---

Originally posted by New Yorker:
Watching Bill O'Reilly tonight who had the former President of the Canadian Medical Association, Brian Day. Dr. Day said that, in Canada, if you're having a heart attack the health care system would not pay for the ambulance to take you to the hospital. Is this true? Good God Almighty if it be true and keep that Obamacare far, far away.

---

quote:

---

Originally posted by Clint Boggis:
Another difference here. In Britain we have an ambulance service and it's free usually. I have no real idea how it's organised but if you need them they're there and you almost certainly won't get a bill.

I have heard of people being charged but I don't know under what circumstances.
.

---

quote:

---

Originally posted by Leaf:

Do you really believe that all the other posters here from countries with universal health care are granny-exterminating death-panel-loving commie nazis (to borrow what appears to be the parlance of the debate)?

---

quote:

---

Doesn't the possibility exist in your mind that seemingly sane, intelligent, freedom-loving people would choose and support universal health care?

---

quote:

---

Does the fact that not one single non-American has sighed on this thread, "Gee, I wish we had the American system!" not light one tiny of doubt in your mind?

---

quote:

---

Are all us citizens of Canada, Australia, New Zealand, the UK, Europe, and Scandinavia really just that deluded?

---

quote:

---

Originally posted by New Yorker:
I mean the press here and there spend all their time talking about how horrible it is, when it is not really that horrible. It does need some tweaking, but that does not mandate government run or provided healthcare.

---

If a fundamental overhaul of a system which is based on the wrong priorities and serves the interests of the wrong people counts as 'tweaking' then yes. Personally, I think that's stretching the definition of the word a bit too far.

And I notice you fail to comment on how misleading you talk show buddy was about paramedic services in Canada. But then, that's this debate all over, isn't it? Write a load of rhetoric using horribly distorted facts and playing on the prejudices of the listeners, then when your bluff is called move on to the next pack of lies without mentioning it. It's truly disgraceful.
 

---

Posted by Old Hundredth (# 112) on :
 

quote:

---

Originally posted by Clint Boggis:
Another difference here. In Britain we have an ambulance service and it's free usually. I have no real idea how it's organised but if you need them they're there and you almost certainly won't get a bill.

I have heard of people being charged but I don't know under what circumstances.
.

---

quote:

---

Originally posted by New Yorker:
The Canadian doctor meant that if you are having a heart attack and ring for the paramedics they won't come!

---

quote:

---

Originally posted by New Yorker:
One other thought before I depart. Here if you call an ambulance it comes to get you and then you or your insurance are billed. The Canadian doctor meant that if you are having a heart attack and ring for the paramedics they won't come!

---

quote:

---

Sort of like the way it is here when an insurance company denies certain treatment. You are still free to obtain the treatment and pay for it yourself. In socialized systems if you are denied, that's it.

---

quote:

---

Originally posted by Ricardus:

quote:

---

Originally posted by New Yorker:
One other thought before I depart. Here if you call an ambulance it comes to get you and then you or your insurance are billed. The Canadian doctor meant that if you are having a heart attack and ring for the paramedics they won't come!

---

Lies.

quote:

---

Sort of like the way it is here when an insurance company denies certain treatment. You are still free to obtain the treatment and pay for it yourself. In socialized systems if you are denied, that's it.

---

Lies.

---

quote:

---

Originally posted by New Yorker:
Sort of like the way it is here when an insurance company denies certain treatment. You are still free to obtain the treatment and pay for it yourself.

---

quote:

---

Originally posted by Ricardus:

quote:

---

Originally posted by New Yorker:
<snip>

---

Lies.

quote:

---

<snip>

---

Lies.

---

quote:

---

Originally posted by New Yorker:
One other thought before I depart. Here if you call an ambulance it comes to get you and then you or your insurance are billed. The Canadian doctor meant that if you are having a heart attack and ring for the paramedics they won't come!

---

quote:

---

Sort of like the way it is here when an insurance company denies certain treatment. You are still free to obtain the treatment and pay for it yourself. In socialized systems if you are denied, that's it.

---

quote:

---

We disagree stronly on this board, but I do wish each of you a great weekend.

---

quote:

---

Originally posted by New Yorker:
One other thought before I depart.

---

quote:

---

Originally posted by lily pad:
In Canada, the Federal Government gives money to the provinces for health care. What is covered or not is different in each province. It makes no sense but that is the reality.

---

quote:

---

Originally posted by New Yorker:
One other thought before I depart. Here if you call an ambulance it comes to get you and then you or your insurance are billed.

---

quote:

---

Originally posted by ToujoursDan:
From a psychological perspective it's fascinating. There is almost a childlike belief that a person's desire for something to be a certain way can triumph over the way things really are. That believing something is true deeply enough magically makes it true.

---

quote:

---

Originally posted by ToujoursDan:
From a psychological perspective it's fascinating. There is almost a childlike belief that a person's desire for something to be a certain way can triumph over the way things really are. That believing something is true deeply enough magically makes it true. I see so much of this driving the American political debate these days. It's like a piece of a Hollywood fantasy movie is playing a role in real life.

---

quote:

---

Originally posted by ken:
Here, if you call an ambulance, it just comes.

Why do you have a problem with that?

---

quote:

---

Originally posted by New Yorker:
One other thought before I depart. Here if you call an ambulance it comes to get you and then you or your insurance are billed. The Canadian doctor meant that if you are having a heart attack and ring for the paramedics they won't come!

Sort of like the way it is here when an insurance company denies certain treatment. You are still free to obtain the treatment and pay for it yourself. In socialized systems if you are denied, that's it.

---

quote:

---

Late that night, unable to sleep because of a splitting headache, I got up to take some strong headache medication. The last thing I remember was reaching up to the cabinet containing the pills. My wife then heard a crash as I hit the floor. I had collapsed and gone into a convulsion.

This is the point where we discovered just how fast and effective our health system could be. The complaints you hear directed at Canada's health system about waiting times for treatment are simply without foundation. As you will see from what happened next, my experience says quite the opposite.

The next thing I recall I was being carried downstairs by some fire fighters who responded to the 911 call and had made it to our house ahead of the ambulance. I was taken immediately in the ambulance to the Mount Sinai Hospital emergency. I drifted in and out of consciousness and don't remember much from that period, but a CAT scan done in the wee hours of Thursday, April 22 revealed a large mass in my brain.

---

quote:

---

Originally posted by tclune:
Hostly Hat ON

This post is wildly inappropriate. We do not attack the honesty or integrity of posters in Purgatory. Either take it to Hell or change your comment to the Purgatorial "Bollocks" or equivalent. A point may be full of crap, but the posters in Purgatory are not.

--Tom Clune. Purgatory Host
Hostly Hat OFF

---

quote:

---

Originally posted by New Yorker:
One other thought before I depart. Here if you call an ambulance it comes to get you and then you or your insurance are billed. The Canadian doctor meant that if you are having a heart attack and ring for the paramedics they won't come! ...

---

quote:

---

Originally posted by tclune:
Hostly Hat ON

This post is wildly inappropriate. We do not attack the honesty or integrity of posters in Purgatory.

---

quote:

---

Originally posted by ToujoursDan:

It's this moral and intellectual laziness that really gets to me.

---

quote:

---

Originally posted by Hawk:

quote:

---

Originally posted by ToujoursDan:
It's this moral and intellectual laziness that really gets to me.

---

I think that's the most frustrating part of the whole situation. This complete unquestioning swallowing of the most blatent barefaced lies while facts and extensively researched information are scoffed and sneered at and rejected out of hand.

It is a common human trait unfortunately. Terry Pratchett, in one of his treatises on the human condition (The Discworld books), wrote that there is a type of person who won't believe the sky is blue if presented with a sworn affidavit signed in triplicate by a line of priests and scientists, but will happily believe anything whisperered to them by a stranger in a pub.

Unfortunately, like attracts like and by natural gravitation the Republicans seem to have gained a monopoly on this type of person.

---

Oh sure, all you coastal elites believing in things like "the sky"! The so-called 'sky' just a wild conspiracy theory spun by out-of-control leftists!

(Please note that while 'the sky' is a falsehood spun by a shadowy conspiracy to further a nefarious agenda, I in no way consider it 'a lie'. )
 

---

Posted by Otter (# 12020) on :
 

quote:

---

Originally posted by Hawk:

quote:

---

Originally posted by ToujoursDan:

It's this moral and intellectual laziness that really gets to me.

---

I think that's the most frustrating part of the whole situation. This complete unquestioning swallowing of the most blatent barefaced lies while facts and extensively researched information are scoffed and sneered at and rejected out of hand.

---

You sure this post wasn't meant for the Zeitgeist thread?
 

---

Posted by Sober Preacher's Kid (# 12699) on :
 

quote:

---

Originally posted by RadicalWhig:
I'm confused about the Canadian system. Some posters refer to "in Canada". Others say, "in [Province]". Which parts of the Canadian system are federal and which are provincial? To what degree does the level of care and cover (and costs) vary from province to province?

---

quote:

---

But the Scriptures have something to say about people who look at the poor and say, "Go on your way. Be warmed and fed."

---

quote:

---

Originally posted by New Yorker:
I do not think anyone (or at least not many) on my side of the debate want anyone to die for lack of care.

---

quote:

---

Originally posted by RuthW:

quote:

---

Originally posted by New Yorker:
I do not think anyone (or at least not many) on my side of the debate want anyone to die for lack of care.

---

You're wrong, because people are dying for lack of care every day and people on your side of the debate can't be bothered to even propose a solution.

---

quote:

---

Originally posted by New Yorker:
On the contrary, the GOP has proposed solutions but the press doesn't bother looking into them and the Democrats don't need GOP support so they are DOA.

---

quote:

---

Originally posted by Hawk:
[QUOTE]Originally posted by ToujoursDan:
[qb]

It is a common human trait unfortunately. Terry Pratchett, in one of his treatises on the human condition (The Discworld books), wrote that there is a type of person who won't believe the sky is blue if presented with a sworn affidavit signed in triplicate by a line of priests and scientists, but will happily believe anything whisperered to them by a stranger in a pub.

Unfortunately, like attracts like and by natural gravitation the Republicans seem to have gained a monopoly on this type of person.

---

quote:

---

Originally posted by tclune:
Unfortunately, I suspect that any proposal that means-tests Medicare benefits would be DOA anyway. I think that it needs to be done, but I don't think that very many congressmen from either party would actually vote for it unless they were planning on retiring anyway.

--Tom Clune

---

quote:

---

Originally posted by New Yorker:

quote:

---

Originally posted by RuthW:

quote:

---

Originally posted by New Yorker:
I do not think anyone (or at least not many) on my side of the debate want anyone to die for lack of care.

---

You're wrong, because people are dying for lack of care every day and people on your side of the debate can't be bothered to even propose a solution.

---

On the contrary, the GOP has proposed solutions but the press doesn't bother looking into them and the Democrats don't need GOP support so they are DOA.

---

quote:

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As for people not getting as much "choice" as they want in the NHS, I personally can't work out what choice it is that people want.

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quote:

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Originally posted by New Yorker:
This thread has dropped to page 2. I don't know that it should be revived but I did want to answer Josephine.

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But the Scriptures have something to say about people who look at the poor and say, "Go on your way. Be warmed and fed."

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Yes they do. And, as an RC I have a strong belief that one's charity towards the poor and less fortunate will be reviewed on Judgment Day. I do not think anyone (or at least not many) on my side of the debate want anyone to die for lack of care. We just don't like the plans being formulated by the Democrats. Health care reforms? Yes. The current House plan? No.

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quote:

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We have the best system in the world already. We can see whatever doctor we want, whenever we want, and we can have whatever treatment that we decide, together with our doctor, that we want. It's great! But if you let the Democrats have their way, they'll take all that away. There will be long, long lines for any kind of treatment. And what's worse, you won't have any choice about what doctor you see or what treatment you get. You will have government bureaucrats making all your medical decisions for you -- and we know that's bad, because the government will be sure to make decisions that kill all the old folks and and everyone with disabilities. People like the littlest Palin boy and Steven Hawking and your own grandmother won't have a chance.

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quote:

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Originally posted by tclune:
Just curious -- do people thinkt hat Sen. Kennedy's passing will increase the likelihood of getting a health care bill passed, be the final nail in its coffin, or have no effect?

--Tom Clune

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quote:

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Originally posted by Luigi:
Just listened to the TR Reid interview - worth listening to. For me the NHS has always been excellent. Don't really understand what so many Americans are petrified of.

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quote:

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Originally posted by New Yorker:
This link should work.

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Originally posted by Croesus:
The main argument against means testing is that programs for poor people tend to be poor programs. One only has to look at the common American perceptions of Medicare (which serves all senior citizens regardless of wealth) and Medicaid (which is geared towards poorer Americans). The former is seen in a fairly positive light, while the latter is villified as unjustified handouts to shiftless layabouts. It should also be noted that it has historically been much more politically feasible to cut Medicaid than it has Medicare, largely because of this disparity in popularity.

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Originally posted by Crœsos:
The idea that a system can be supported if 63% of the population is working age (18-65), according to Census Bureau estimates for 2005, but is horrendously unsustainable if only 57% of the population falls into this category, as estimated for 2035, when the youngest of the Boomers will be at least 70, seems counterintuitive. Perhaps tclune can explain why those particular six percentage points are the critical ones?

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quote:

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Originally posted by tclune:
[QUOTE]
Adding a lot of people into a health insurance program just seems to be making the problem worse. The idea that folks will have to get insurance isn't a problem for most folks. But the government is going to be helping a lot of them to pay for the insurance under any of the plans that have been discussed. Where will that money come from?

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If I hadn't been involved in this process as long as I have and to the depth as I have, you would already have national health care.

...

It's not where I get them to compromise, it's what I get them to leave out.

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Originally posted by cliffdweller:
I don't know if I'd say "most folks" don't have a problem getting insurance-- 45 million seems like quite a lot of folks to me.

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Originally posted by tclune:
No, I can't. But that is because you have posed the question in a way that fails to capture the problem. It is simply not the case that Social Security was doing fine in 2005.

If you actually want to understand the problems that Social Security is facing, you can consult the Social Security Agency itself. No-one can accuse them of over-hyping the problem.

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quote:

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Originally posted by tclune:
Many respectable economic evaluations will show a considerably worse problem. Also, the SSA FAQ fails to include the most recent forecasts from the economic collapse, which move the date that the trust is exhausted up by more than a decade (if memory serves) from their much-quoted 2037. Here's their FAQ. BTW, their assertion that benefits will continue to go up each year has already been given the lie. This week a two year freeze on SS COLAs was announced.

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Originally posted by tclune:
(And yes, you are right that MediCare is a bigger train wreck. But they are both massive problems with no good answers in sight.)

--Tom Clune

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quote:

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Originally posted by tclune:

quote:

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Originally posted by cliffdweller:
I don't know if I'd say "most folks" don't have a problem getting insurance-- 45 million seems like quite a lot of folks to me.

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I failed to communicate my point. I didn't mean that most folks have insurance, but that most folks don't have a problem with the idea of insurance reform that requires everyone to get insurance. Sorry for the confusion.

--Tom Clune

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Originally posted by Crœsos:
As for the question of COLAs, no one ever promised that "benefits will continue to go up each year".

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quote:

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Originally posted by tclune:

quote:

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Originally posted by Crœsos:
As for the question of COLAs, no one ever promised that "benefits will continue to go up each year".

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Maybe you're saying something that I'm misunderstanding, but the very first question on the FAQ I linked to says: "No, there are no plans to cut benefits for current retirees. In fact, benefits will continue to be increased each year with inflation." That was what I was responding to in my post, and my twisted little mind tends to distort the bolded text into something that says that benefits will continue to be increased each year.

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Originally posted by tclune:
As to the COLA being an inflation index, that's just intellectually dishonest. It has NEVER been that, no matter what the claim. It has always EXCEEDED the cost of living index AFAIK. The notion that inflation has been negative this year is also dishonest, if your major costs are medical and heating. Indeed, the reason the COLA has been so much higher than the inflation index is precisely because the things that seniors spend most on have routinely exceeded the inflation index.

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Originally posted by tclune:
Even if all of that is wrong-headed, it doesn't explain how the SSA has been able to see into the future enough to say that no COLA will be needed for TWO years. That was done because of monetary problems, which is the point I was raising as to people's anxiety levels with the government's management of the retirement programs.

--Tom Clune

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quote:

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Originally posted by Crœsos:

quote:

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Originally posted by tclune:
Even if all of that is wrong-headed, it doesn't explain how the SSA has been able to see into the future enough to say that no COLA will be needed for TWO years. That was done because of monetary problems, which is the point I was raising as to people's anxiety levels with the government's management of the retirement programs.

---

Given that the freeze is a projection and not a plan set in stone at this point, I'm not sure what your objection is. It certainly seems ridiculous to accept (as you seem to) that the Social Security trustees can predict the performance of the U.S. economy through at least 2037 but can't predict inflation in 2010. Either you accept that the SSA can make economic predictions or you don't.

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Originally posted by romanlion:
As a means of tying the SS news back to the thread topic, two things about social (in)security are clear...

Any CEO/CFO that managed an employee retirement fund in the way that SS is managed would be run through and hung in the square.

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quote:

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Originally posted by romanlion:
As someone totally opposed to the idea all I can say at this point is thank goodness for Barack Obama!! We all knew he was a rank amateur, but his lack of political skill surprises even me.

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quote:

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Originally posted by tclune:
No, that is not the only set of choices. I may also mean what I said -- that whatever the ability of the SSA to predict the economy, they are eliminating the COLA for reasons that are based on the fact that they are going broke.

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quote:

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Originally posted by tclune:
The SSA is very near to the time when it will be taking money out of its trust instead of adding it. That money buys more T bills than even the Chinese do. When they stop doing that, we are going to be in big trouble. Slowing that day of reckoning down is undoubtedly a high priority for the government, and that seems to me to be what is being done.

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Originally posted by romanlion:
Only Big Brother could steal 6%(+/-)* from you for retirement for your entire life and leave you with ZERO value should you die prior to reaching the ever higher age for benefits.

---

Whereas you can still spend money in private savings if you're dead? The fact that you can't take it with you is more a function of Grim Death itself rather than some government conspiracy. I guess your heirs would miss out. If only Social Security paid survivor's benefits. Oh wait, they do!
 

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Posted by tclune (# 7959) on :
 

quote:

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Originally posted by Crœsos:
The 'trust fund' was proposed by Alan Greenspan in the 1980s to deal with the retirement of the Boomers. It was never meant to be a permanent institution and was supposed to expire around the same time the last of the Baby Boom generation does. Despite apparent notions to the contrary, the Boomers will eventually die.

---

quote:

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Originally posted by tclune:

quote:

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Originally posted by Crœsos:
The 'trust fund' was proposed by Alan Greenspan in the 1980s to deal with the retirement of the Boomers. It was never meant to be a permanent institution and was supposed to expire around the same time the last of the Baby Boom generation does. Despite apparent notions to the contrary, the Boomers will eventually die.

---

Ah, I understand! This situation that the SSA describes as a "big financial problem" is by design! And since the trust fund will be exhausted before the last boomer even retires, I presume part of the plan is for them to die before that, too. Death panels live! That certainly puts my mind at ease...

--Tom Clune

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quote:

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Originally posted by Crœsos:
Only if we assume that the last boomer (born ~1962) won't retire until she's 75 years old (in 2037). And quite frankly, if you assume that the Baby Boom generation is going to work ten years longer than is assumed in the Trustees' Report, then you've just restored solvency. Problem solved!

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quote:

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Originally posted by RuthW:
Eliminating tax breaks for companies who offer health insurance to their employees and instead giving $2300 per person ($5700 per family) to people to buy health insurance is insane. Have these people even looked at what health insurance premiums are these days? This proposal would make things even worse than they are now.

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quote:

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quote:

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Originally posted by romanlion:
As someone totally opposed to the idea all I can say at this point is thank goodness for Barack Obama!! We all knew he was a rank amateur, but his lack of political skill surprises even me.

---

I'm coming around to this view (from the other side of the street) with great reluctance. I had high hopes that a Democratic president with a Democratic congress would really be able to accomplish things that needed doing. And Obama is clearly the smartest man in the room, whatever the room. I was really hopeful that Dems would retake power and actually govern. I was even hoping they'd push through a strong single-payer health care system that would be able to revamp our totally broken health care and restructure Social Security for the long haul.

Now, I will be amazed and appreciative if they just manage to push through a Massachusetts-style universal health insurance plan. It's really disappointing.

--Tom Clune

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quote:

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Originally posted by Luigi:
Tom - are you saying that Obama is a very capable guy but the institutions and vested interests and power bases are so strong even though the democrats won power that it looks as if Obama's oponents could probably wreck anything of any worth?

Or are you saying the democrats aren't supporting him effectively?

Or are you saying that America is in many respects ungovernable - the only people who can govern effectively (the Republicans?) are those who want to leave virtually every vested interest alone in the name of free markets?

Or something else?

Luigi

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quote:

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Originally posted by Crœsos:

quote:

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Originally posted by romanlion:
Only Big Brother could steal 6%(+/-)* from you for retirement for your entire life and leave you with ZERO value should you die prior to reaching the ever higher age for benefits.

---

Whereas you can still spend money in private savings if you're dead? The fact that you can't take it with you is more a function of Grim Death itself rather than some government conspiracy. I guess your heirs would miss out. If only Social Security paid survivor's benefits. Oh wait, they do!

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quote:

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Originally posted by Luigi:
Tom - I get the distinct impression that whilst you think that Obama mishandled the health care debate you also think a well-informed debate is virtually impossible. Whilst the alternative you suggest may have been better you appear to think that it may well have hit problems as well.

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Originally posted by Luigi:
When I look at the USA and see the power and the vitriol of the right wing media

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quote:

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Originally posted by New Yorker:

quote:

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Originally posted by Luigi:
When I look at the USA and see the power and the vitriol of the right wing media

---

Can we please get over this? Sure there is "power and vitriol" on the right, but there is just as much "power and vitriol of the left wing media" as well. I suggest that it does little to advance the health care discussion and quite a bit to impede it.

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quote:

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Originally posted by Crœsos:
One of the main things wrong with most American news media is what is colloquially known as "Shape of the Earth: Opinions Differ" Journalism, wherein any controversy is reported as some sort of insoluable problem where both sides have a point. Sometimes this is the case, but sometimes it isn't. Sometimes it does a disservice when you revert to "both sides are equally at fault in this controversy". Sometimes the Earth really is round, and you should just say so.

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quote:

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Originally posted by ken:
US healthcare costs twice as much per pill as some other countries. Public provision pays the same prices as private.

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quote:

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Originally posted by New Yorker:

quote:

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Originally posted by Luigi:
When I look at the USA and see the power and the vitriol of the right wing media

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Can we please get over this? Sure there is "power and vitriol" on the right, but there is just as much "power and vitriol of the left wing media" as well. I suggest that it does little to advance the health care discussion and quite a bit to impede it.

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quote:

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Originally posted by New Yorker:

quote:

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Originally posted by Luigi:
When I look at the USA and see the power and the vitriol of the right wing media

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Can we please get over this? Sure there is "power and vitriol" on the right, but there is just as much "power and vitriol of the left wing media" as well.

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Originally posted by Timothy the Obscure:
Yeah. The Nation versus Fox News.

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quote:

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It was just a year ago that Barack Obama accepted the Democratic nomination for president. He was on top of the world, with 80,000 star-struck fans in Denver believing that he could deliver the change he promised.

One of those promises involved the medical system. “Now — now is the time to finally keep the promise of affordable, accessible health care for every single American,” he asserted in the Denver stadium, to wild applause.

“If you have health care — if you have health care, my plan will lower your premiums,” he added. “If you don’t, you’ll be able to get the same kind of coverage that members of Congress give themselves.”

It seemed simple enough. And almost no one, at least on the Democratic side, seemed to question his goals.

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quote:

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Your claims here seem to be more a matter of ideology than history.

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Originally posted by Honest Ron Bacardi:
Which claims, mjg? (Just trying to follow your argument)

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quote:

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Originally posted by Josephine:
This article makes the point that making sure everyone has medical insurance isn't good enough. Most people who go bankrupt as a result of medical expenses have insurance -- or at least, had it when the medical expenses began.

I think the only thing that will ensure access to health care for everyone is some form of single-payer system. But if we can't get that, a public option is the least-worst of the remaining choices. I'm afraid we won't even get that -- although I like Olympia Snow's idea of a trigger. Maybe we could get that past the lobbyists. Maybe.

---

quote:

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Originally posted by Sober Preacher's Kid:

Obama even compared his plan to Auto Insurance legislation. Hehe, I made that comparison before his speech.

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quote:

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Originally posted by Sober Preacher's Kid:
Before anyone jumps up an says that Obama's plan won't work in the US, remember, it is currently found in Massachusetts.

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quote:

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Originally posted by tclune:
The problem with the way we're proceeding is that he has not come out and said as much.

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quote:

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Reforming what doctors do will be the more contentious issue, and I suspect we are going to have to wait until the current system actually collapses before we can address it.

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quote:

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Originally posted by mjg:

quote:

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Reforming what doctors do will be the more contentious issue, and I suspect we are going to have to wait until the current system actually collapses before we can address it.

---

It's difficult for me to imagine a collapse: could you expound a bit?

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quote:

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Originally posted by tclune:
I saw a chart of its growth over the last decade and a half -- the blink of an eye. It has grown in that time period from something like 5% of our GDP to something just shy of 20% of GDP if memory serves.

---

quote:

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Originally posted by tclune:
we continue to push medical care up the expense ladder without regard to whether or not we are gaining any medical benefit thereby.

---

quote:

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Originally posted by Hiro's Leap:

quote:

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Originally posted by tclune:
I saw a chart of its growth over the last decade and a half -- the blink of an eye. It has grown in that time period from something like 5% of our GDP to something just shy of 20% of GDP if memory serves.

---

Something like this?

---

quote:

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Originally posted by Hawk:

quote:

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Originally posted by tclune:
we continue to push medical care up the expense ladder without regard to whether or not we are gaining any medical benefit thereby.

---

I don't doubt this is the case but I'd be interested in any examples. In what situations do doctors prescribe expensive drugs or treatments that are unnecessary or no more effective than cheaper alternatives?

I would have thought this sort of natural market slide would have been curtailed by some kind of national advisory body like the NICE in UK. Or are all doctors in USA completely independent and able to prescribe whatever they like - whether it increases observable health benefits or not.

---

quote:

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Originally posted by Hawk:
In what situations do doctors prescribe expensive drugs or treatments that are unnecessary or no more effective than cheaper alternatives?

I would have thought this sort of natural market slide would have been curtailed by some kind of national advisory body like the NICE in UK. Or are all doctors in USA completely independent and able to prescribe whatever they like - whether it increases observable health benefits or not.

---

quote:

---

Originally posted by New Yorker:

quote:

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Originally posted by Timothy the Obscure:
Yeah. The Nation versus Fox News.

---

More like CBS, ABC, NBC, NPR, CNN, MSNBC, Washington Post, and NY Times v. Fox News and Washington Times.

---

quote:

---

Originally posted by mjg:

quote:

---

Originally posted by tclune:
The problem with the way we're proceeding is that he has not come out and said as much.

---

In this respect the guy is an interesting case study: he's either ignorant or disingenuous.

---

quote:

---

"Our proposal would change incentives so that providers will give patients the best care — not just the most expensive car — which will mean big savings over time," Obama said.

The government already has a Medicare Advisory Commission, but its advice on cost-cutting is often ignored by lawmakers. The president's plan would give teeth to the recommendations by requiring Congress to approve or disapprove them as a package, much as it did with the military-base-closing commission.

"What we want to do is force Congress to make sure they're acting on these recommendations to bend the cost curve each and every year," the president said.
(Source: NPR)

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quote:

---

[Pablos-Mendez plotted] a graph that related expenditure on health per head to gross domestic product per head for all countries. The correlation was extraordinarily close.
[...]
Pablos-Mendez saw inevitability in his graph. Attempts to limit health expenditure do not and cannot work. I thought back on a graph I saw years ago in Paris: it showed the straight line of inexorably rising health spend in France, and all the way along the line were arrows indicating failed attempts to limit the spending. Or I think of Tony Blair squirming in that famous television interview and committing on the spot to increase Britain's health spending from 7% of GDP to 9%.

---

quote:

---

Originally posted by RuthW:
Individual doctors' profits are not substantially higher than they were 20 or 30 years ago; they're not gouging patients any more than insurance companies are. They're very well paid, yes, but no more than they used to be. It's the whole structure of medicine that's the problem, the sheer number of specialists we have and the work they do. We're going to need more people in general practice and geriatric medicine and fewer in most specialties, because the inflated costs are coming from patients being referred to specialists they don't need to see who conduct unnecessary tests and procedures. We're going to have to even out the pay so there isn't such a big incentive for people to opt for specialized fields instead of general practice. And we're going to need a different philosophy, a different approach. This NPR story describes a "collaborative, wellness-oriented approach" some folks in Minnesota are taking, which sounds to me like the direction we should be going.

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quote:

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Originally posted by tclune:
While the wellness idea makes sense, the notion that doctos aren't making noticeably more than they were 20-30 years ago in relative dollars just doesn't hold up. Yes, it is true that family practicioners are pretty much standing stil. But most specialties have done considerably better than that.

---

quote:

---

Like it or not, the individual doctor really is the problem. The problem with healthcare reform is that very few people are willing to acknowledge that immutable fact.

---

quote:

---

Originally posted by RuthW:
Got some numbers to back that up? I looked up what radiologists make these days, and it looks like what my dad made in the early 80s plus inflation.

---

quote:

---

Originally posted by Hiro's Leap:
I'm a big fan of the NHS and the efficancy of public health care versus private, but it's not the only answer. We simply expect more and more.

---

quote:

---

[...] doctors' salaries aren't a large enough chunk of health care spending in the United States to make a difference. According to [health care economist Uwe] Reinhardt, doctors' take-home pay (that is, income minus expenses) amounts to only about 1 percent of overall health care spending, or about $26 billion. That's a drop in the ocean compared with overhead for insurance companies, billing expenses for doctors' offices, and advertising for drug companies. The real savings in health care will come from these expenses.

---

quote:

---

Originally posted by Dave W.:
According to an article in Slate doctors are paid far better in the US than elsewhere, but ...

quote:

---

[...] doctors' salaries aren't a large enough chunk of health care spending in the United States to make a difference. According to [health care economist Uwe] Reinhardt, doctors' take-home pay (that is, income minus expenses) amounts to only about 1 percent of overall health care spending, or about $26 billion. That's a drop in the ocean compared with overhead for insurance companies, billing expenses for doctors' offices, and advertising for drug companies. The real savings in health care will come from these expenses.

---

---

quote:

---

Originally posted by Crœsos:
Can't find the source on it right now, but I came across an assertion that as recently the early 1990s the typical 'cut' an American health insurance company would take of the pool of premium money they were administering was ~5%. This represents adminstrative expenses plus profits (for those insurers who aren't not-for-profits). As of today the typical number is around 20%. I have a hard time believing that the business of insurance has become four times more inefficient in the past decade and a half.

---

quote:

---

Originally posted by Hiro's Leap:

quote:

---

Originally posted by tclune:
I saw a chart of its growth over the last decade and a half -- the blink of an eye. It has grown in that time period from something like 5% of our GDP to something just shy of 20% of GDP if memory serves.

---

Something like this?

---

quote:

---

Originally posted by tclune:

quote:

---

Originally posted by Crœsos:
Can't find the source on it right now, but I came across an assertion that as recently the early 1990s the typical 'cut' an American health insurance company would take of the pool of premium money they were administering was ~5%. This represents adminstrative expenses plus profits (for those insurers who aren't not-for-profits). As of today the typical number is around 20%. I have a hard time believing that the business of insurance has become four times more inefficient in the past decade and a half.

---

If you can find the source, I would be quite interested in reading it.

--Tom Clune

---

quote:

---

The total amount Americans pay their physicians collectively represents only about 20 percent of total national health spending. Of this total, close to half is absorbed by the physicians' practice expenses, including malpractice premiums, but excluding the amortization of college and medical-school debt.

This makes the physicians' collective take-home pay only about 10 percent of total national health spending.

---

quote:

---

Originally posted by Clint Boggis:
Any long term cost savings may be too late to help his political career as things like cheaper treatment and better outcomes due to treating health problems early are benefits which build up over more than three years.

---

quote:

---

She has been married to Lewis Preston Sutton, Jr. for 30 years and he works two jobs to take care of her while she battles Meniginoma - a cancer that is usually slow growing with benign tumors. Unfortunately, that is not the case for Sutton.

"I said I've always been different and I wouldn't have this cancer thing be any other way. I accept it," she said. "It has to follow my personality."

She went two months without possible life-saving medications because her insurance wouldn't cover it, another example of abusing the working poor, she said.

"How in the world can it take so long to find out (whether they would cover the medicine or not) when it could be a matter of life or death?" she said. "It is almost like, in a way, committing murder."

She eventually received the medication, but the cancer is taking a toll on her strong will and solid frame. Her thin black hair is brittle from the drugs and chemo treatments. She has had brain surgery twice -once on Jan. 29, 2007, and again on Jan. 11, 2008.

---

At least she didn't have to deal with some government bureaucracy or 'death panel' that would just needlessly delay lifesaving medical treatment.

[edited for subject-verb agreement]

[ 15. September 2009, 17:58: Message edited by: Crœsos ]
 

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Posted by Josephine (# 3899) on :
 
According to a new study, you're 40% more likely to die if you don't have health insurance. That means 45,000 people die each year as a result of being uninsured.

If you're a parent, and you have kids that are too old to be covered on your insurance, but too poor to buy their own insurance, and working at jobs where insurance isn't provided for them, that's really scary. Maybe more scary for me than for them.
 

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Posted by Albertus (# 13356) on :
 

quote:

---

Originally posted by Crœsos:
Crystal Lee Sutton, whose struggles to unionize her workplace were the basis for the film Norma Rae, has died. She spent her last years fighting the other battle American workers often have to deal with, getting her insurance to pay for her medical treatments.

quote:

---

She has been married to Lewis Preston Sutton, Jr. for 30 years and he works two jobs to take care of her while she battles Meniginoma - a cancer that is usually slow growing with benign tumors. Unfortunately, that is not the case for Sutton.

"I said I've always been different and I wouldn't have this cancer thing be any other way. I accept it," she said. "It has to follow my personality."

She went two months without possible life-saving medications because her insurance wouldn't cover it, another example of abusing the working poor, she said.

"How in the world can it take so long to find out (whether they would cover the medicine or not) when it could be a matter of life or death?" she said. "It is almost like, in a way, committing murder."

She eventually received the medication, but the cancer is taking a toll on her strong will and solid frame. Her thin black hair is brittle from the drugs and chemo treatments. She has had brain surgery twice -once on Jan. 29, 2007, and again on Jan. 11, 2008.

---

At least she didn't have to deal with some government bureaucracy or 'death panel' that would just needlessly delay lifesaving medical treatment.

[edited for subject-verb agreement]

---

quote:

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Originally posted by Albertus:
But you're probably happy with that, and think that sub third world health care for a large number of your fellow citizens is a price worth paying to keep those company bonuses healthy?

---

quote:

---

Originally posted by Josephine:
According to a new study, you're 40% more likely to die if you don't have health insurance. That means 45,000 people die each year as a result of being uninsured.

If you're a parent, and you have kids that are too old to be covered on your insurance, but too poor to buy their own insurance, and working at jobs where insurance isn't provided for them, that's really scary. Maybe more scary for me than for them.

---

quote:

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Originally posted by Josephine:
Albertus, I think your irony detection meter needs to be recalibrated.

---

quote:

---

Originally posted by Josephine:

quote:

---

Originally posted by Albertus:
But you're probably happy with that, and think that sub third world health care for a large number of your fellow citizens is a price worth paying to keep those company bonuses healthy?

---

Albertus, I think your irony detection meter needs to be recalibrated.

---

Um, yes, oops. . That is what happens when you jump into a discussion at a late stage without reading what's gone before. My only defence is that, as ken said, there are plenty of people out there who could say that sort of thing in all seriousness.
I wonder whether Norton have a product i could buy to help me in future?

[ 21. September 2009, 10:13: Message edited by: Albertus ]
 

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Posted by Imaginary Friend (# 186) on :
 
So, didn't someone suggest that opposition to the health care reform bill was largely from spiteful Republicans who want to make sure Obama didn't get his way? According to this article, there is a lot of money being spent by Big Pharma, the insurance industry, and others in defence of the status quo.

If you'll excuse the pun, it's sickening.

[ 01. October 2009, 17:38: Message edited by: Imaginary Friend ]
 

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Posted by Jason™ (# 9037) on :
 
I've missed the last few pages of this thread, so I apologize if this has already shown up here, but if you haven't seen it, take a look at this cartoon explanation of "Why We Need Government-Run Universal Socialized Health Insurance".

For me, it says everything. I haven't heard anyone say anything that comes close to convincing otherwise.
 

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Posted by Clint Boggis (# 633) on :
 
It seems to be happening - Happy Christmas to 30 million people with no health care!

The anti health care lobbyists seemed to have managed to water down a bit. Have the changes demanded to get it through made it more expensive and less effective than originally proposed or is the answer rather meaningless because it's predetermined by your political position?
 

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Posted by Martin L (# 11804) on :
 

quote:

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Originally posted by Clint Boggis:
...or is the answer rather meaningless because it's predetermined by your political position?

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Not only that, but it tells us exactly who watches which cable news network!

I think they should have gone much farther. The video clip to which Jason linked is neat, and explains how many services are already managed by the government. I loved the comparison between a government-run fire department and a government-run health care system.

I do think we need to figure out how to put an end to "incentives" given to encourage votes.

[ 24. December 2009, 18:33: Message edited by: Martin L ]
 

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Posted by Sober Preacher's Kid (# 12699) on :
 
I wondered when this thread was going to turn up.

Indeed, Merry Christmas to my dear neighbours, who may finally taste the joy of real health care.

Part of me though just can't believe it. I'm on record in this thread as saying that the important thing is that everyone gets covered and therefore gets access to care, and I'm agnostic as to the actual method used.

If this works out, as it seems it just did, this really is the biggest change in American social policy since the 1960's.

Did Obama just manage to do that which evaded every President since Harry Truman?
 

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Posted by cliffdweller (# 13338) on :
 

quote:

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Originally posted by Sober Preacher's Kid:

If this works out, as it seems it just did, this really is the biggest change in American social policy since the 1960's.

Did Obama just manage to do that which evaded every President since Harry Truman?

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quote:

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Originally posted by sharkshooter:
Whereas the Premier of a Canadian province went to the USA for surgery recently.

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quote:

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Originally posted by cliffdweller:

quote:

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Originally posted by sharkshooter:
Whereas the Premier of a Canadian province went to the USA for surgery recently.

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America does have some of the best health care in the world... for those who can afford it.

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quote:

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Originally posted by cliffdweller:

quote:

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Originally posted by sharkshooter:
Whereas the Premier of a Canadian province went to the USA for surgery recently.

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America does have some of the best health care in the world... for those who can afford it. Luckily for the Premier, Canadians have excellent insurance.

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quote:

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Originally posted by Sober Preacher's Kid:
...
It's a lie that Canada doesn't have two-tier health care. We do, it's just the private clinics are in the States.

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quote:

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Originally posted by ken:
A parable about US healthcare politics with reference to Big Macs, shedloads of wonga, and going to Canada for medicine, just like Sarah Palin does

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quote:

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Originally posted by New Yorker:
...Shouldn't we know what is in it before it passes?

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quote:

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Originally posted by sharkshooter:

quote:

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Originally posted by New Yorker:
...Shouldn't we know what is in it before it passes?

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Where's the fun in that?

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