Thread: Purgatory: Health Care Board: Limbo / Ship of Fools.
To visit this thread, use this URL:
http://forum.ship-of-fools.com/cgi-bin/ultimatebb.cgi?ubb=get_topic;f=11;t=000757
Posted by RadicalWhig (# 13190) on
:
On the "Obama: Why so angry" thread, amongst a more general discussion of the levels of anger and division in US politics, there has been some discussion of Obama's health care reform plan. To avoid derailing that thread, I thought it might be a good idea to start a separate thread for the discussion of health care issues more generally.
What strikes me about Obama's plan is how very moderate and limited it is: it does not really amount to a "public health care system", so much as "increased regulation of a private health care system to make it a tiny little bit more fair". Nancy-Ann DeParle has talked about "reforming the health care market" and "building on the uniquely American employer-based system". To me, Obama's proposals seem like an absolute minimum for a civilised community. It still leaves a for-profit health system in place which (largely) ties coverage to employment.
There have been comparisons to the British NHS, which seems to be what so many Americans are (perhaps rightly) opposed to: a centralised system of direct State provision, with patients having very little choice.
The best health care system I have ever used is the French system: a single-payer system in which patients get maximum choice of care, while the bills are picked up by the State.
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.
My wife has a chronic, non-life-threatening, non-debilitating, but quite annoying condition which is easily treatable, but which if untreated can get worse and sometimes restrict her ability to work. In France, she was recieving weekly sessions of treatment at a local clinic; for this, we paid a small fee, almost all of which was reimbursed by the State. In the UK, she had to wait several months for a first treatment, and then was told that they would "see her again in a year"; this means that we have to go private, which is horrendously expensive in the UK because the private sector is squeezed out.
I would abolish the NHS in a flash; that is, I would gladly scrap the system of direct public provision in favour of a public single-payer system. In my opinion, that seems like the best way to ensure that universal free-at-the-point-of-delivery health care is provided while maintaining patient choice and high standards.
What is your view?
[ 21. June 2010, 17:34: Message edited by: Barnabas62 ]
Posted by five (# 14492) on
:
I can't compare the NHS to France, having never lived there. But comparing the NHS to the USA, where my family deals with health insurance as an issue quite frequently, I'm constantly shocked at how mis-perceived the NHS is there and also how many people think that the people least able (the sick, the disabled, the elderly) should be paying through the nose for care. When they can't, the results are catastrophic, not just for the patient, but for the society. Things that are easily rectified in a GPs office, or a minor treatment just don't happen as to walk through the door of a doctor's office without health insurance means you can be turned away. Many doctors wont' even accept "let me put that on my credit card" which I found truly amazing.
With 10 of the USA out of work, and therefore presumably without health insurance, and as this increasingly affects the middle class (by driving up their premiums, and also by their suddenly not having insurance through losing their jobs), I would have thought they'd be desperate to ensure at least some basic health care.
The NHS isn't perfect, but I'd never get rid of it. The stresses and strains and worry (and bills! Don't forget that all this private health care is paid for by companies that are basically there to decide what they're not going to cover, and your co-payments to keep you on your toes as the premiums aren't enough) of the USA system seem horrible to me.
Posted by Hawk (# 14289) on
:
quote:
Originally posted by RadicalWhig:
I would gladly scrap the system of direct public provision in favour of a public single-payer system.
Could you explain to me the difference between the two? I assumed NHS was single-payer.
And your description of the French system of making the patient pay up front and then wait to get partially reimbursed by the state doesn't seem that brilliant to me. Could you explain to me why this is better, or if there's any other reason why the French system is better? 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? Do you know any other details of how the French system works other than your personal experience as an end user?
In general, I love the idea of walking into a doctors and getting professional service and care without anyone once mentioning cost. It's a brilliant feeling, and it's available to everyone, rich, poor, citizen or illegal immigrant. The most pure example I know of the true purpose of a state, to serve its citizens. It might need reforming if its not as efficient as the French system you describe but it certainly doesn't need to be scraped. Perhaps just extended and expanded to pay for more things and more personnel so your wife can be cared for as she should be.
And I too am astonished, both at how flimsy and lightweight Obama's proposals are, and the corresponding excess of of vitriol his opponents have thrown at it. He really isn't doing much at all when you look at the details. Even if he gets the proposals through America will still have a frighteningly poor healthcare system.
Posted by joris2 (# 11137) on
:
quote:
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.
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?
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 ]
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.
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.
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.
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.
Posted by Hawk (# 14289) on
:
quote:
Originally posted by davelarge:
Would it be possible for someone to post a brief summary of the plan?
A brief summary? Almost impossible I'm afraid. The full proposal is still being debated, there are three versions of the bill and the debate is fighting to preventy itself being derailed by vast quantities of misinformation being posted by right-wing bloggers, newspapers and even republican politicians. This is the simplest summary of the House' proposal. But to get a good picture of what's going on you'll need to read a lot more.
[ 11. August 2009, 12:23: Message edited by: Hawk ]
Posted by ken (# 2460) on
:
quote:
Originally posted by Hawk:
It might need reforming if its not as efficient as the French system ...
The NHS is a lot more efficient than the French system. It is also a lot cheaper. We pay a lot less than they do, we get almost as much as they do. So we get more healthcare for our money.
The real losers are the Americans who pay more tax for their healthcare than we do and then pay as much insurance as the French or the Germans on top of that.
To put it crudely we are paying for 60% of a decent modern healthcare service and we are getting 80% of one. The Americans are paying 120% and only getting 60%
The French are paying for 100% of it and are getting what they pay for. Which is one reason they live longer than we do on average.
Posted by Honest Ron Bacardi (# 38) on
:
OK - some stats.
Total expenditure on health services by country:
UK - 8.4% of GDP
France - 11.0% of GDP
USA - 16% of GDP
OECD average - 8.9% of GDP
(source - OECD Health Data 2009)
Posted by Richard Collins (# 11515) on
:
quote:
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
Well put Ken. And I would suggest that it's mainly in primary care where this magical process occurs.
Posted by Clint Boggis (# 633) on
:
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....
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. I'm sure figures for health outcomes for those with good cover exist and those are the ones people with cover care about when comparing the US health with other countries. They don't mention them because they can't say "yeah, but if poor people get sick, who gives a shit?", even if they're thinking it.
Keep the NHS! It's one of the things which characterises this country: flawed, cheap and generally does the job while being misrepresented by the press. If we were willing as a country to spend more on heath care we'd get more choice and shorter waits but these are icing on the cake compared with a civilised system which provides cover for all - at a knock-down price.
.
Posted by Josephine (# 3899) on
:
quote:
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.
Provided that the insurance company hasn't decided to cancel your coverage or deny your claim.
We've got some experience of that. In fact, I dare say that most people who have ever had to use their medical insurance have that experience.
It boggles my mind how expensive our health care coverage is, and how little we get for it.
It also boggles my mind that so many people believe the things in the hysterical emails that are circulating the Internet.
I've called my senators and congresscritter. I've donated a small amount of cash to Move On to help fund the fight for health care reform.
The status quo is both unjust and unsustainable. We shouldn't tolerate it. It has to be changed. But the insurance companies -- which would cease to exist under a single payer plan -- have loads of money, and money buys power.
I don't know what else I can do.
Posted by New Yorker (# 9898) on
:
Just a clarification: Obama does not have a health reform plan. The House has one and there are several Senate plans floating around. What Obama is touting I am not sure since he admitted that he has not read the House plan.
Posted by Erin (# 2) on
:
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.
I linked to this in the other thread, and I think it bears relinking here. Denise Cortese, President and CEO of Mayo Clinic, talks about the current healthcare crisis and what we need to do to survive it. Some very good suggestions.
Posted by Amorya (# 2652) on
:
The key point of the NHS, for me, is to know that you will never be hit by a surprise bill for being ill.
The other year I broke my finger. Didn't realise at first, after a few days of pain I toddled off to the doctor's office, where they promptly told me to get myself down to the hospital. I jumped on a bus, sat in line at the waiting room, and after a few hours they gave me an X-ray, bandaged me up, and scheduled an appointment for next week for some physio.
I was a poor student at the time. If I'd had to pay anything, even if the cost was relatively small, I probably wouldn't have gone. "It's OK, my finger hurts, but I can deal." That's even if it was a system that refunded the cost later, because I would have hated the risk that I might not be refunded. Turns out that without treatment I would almost certainly have lost the use of my finger.
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. 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?
Amorya
Posted by davelarge (# 186) on
:
quote:
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.
I think that's a crucial point, and we've got to remember that (realistically speaking) there is no such thing as a perfect healthcare system. There will always be finite resources, people will always make mistakes (just because they are people), and everybody has to die sometime.
But for me, the clincher with public healthcare is that it makes it possible to invest (and that is the correct word, in my opinion) in preventative medicine. It makes sense that treating people when the issue becomes acute (and therefore urgent) is by far the most inefficient way go. But that goes against everything that an insurance company (who's main purpose is to make money for their shareholders) stands for: You don't pay out unless you have to.
Hawk - thanks for that link. I shall go and read it now.
Posted by five (# 14492) on
:
My cousin in the USA is, sadly a we-hope-former crystal meth addict. As a result, she is now HIV positive (it tends to promote hypersexual activity, while lowering the faculties of reason that say "condoms. Now THERE'S a good idea in this situation.") and has very few teeth. She detoxed in jail, and while we've supported her, she's for all intents and purposes uninsurable. Medicare and Medicaid provide some help, but the doctors don't seem as good as the ones my insured family members see and effective drugs and treatments for her HIV are effectively a joke beacuse they just aren't fiscally viable for her. (She's also unemployed, becuase who employs HIV positive addicts when there's 15% unemployment already, which there is where she lives.) Every time the family discusses her situation, my immediate reaction is that it just wouldn't happen on the NHS. With the drugs and treatment, she'd have the ability to try to get a job, rather than being ill all the time. She could at least be well enough to do community service and volunteer and keep busy, which would help keep her off the crystal meth.
She's a tragic case, the kind where it would be very easy for a lot of people to say "yup, it is ok to let her die." I can see that logic. But since she is alive, for her to have any hope of giving back to the community, she needs health care, which she just won't get at any level she can afford.
I wonder often if this sort of thing is how epidemics of AIDS and other diseases (not just sexual ones) can continue to spread quite rapidly. I remember tales of the early days of the epidemic where since people either couldn't afford blood testing or else didn't want it to appear on their insurance that they'd even been tested as it would raise their premiums to admit they'd engaged in risky behaviour so instead they'd donate blood and hope that if they were positive the clinic would call them when the clinic had tested the blood. It strikes me that this is no way to preserve public health, in so many ways and I wonder what implications it will have when and if swine flu or what comes next turns more virulent and fatal.
Posted by Og: Thread Killer (# 3200) on
:
At issue up here for us is costs, not who is funding it.
As long as the Doctors are the most powerful union in Canada, we will continue to plough more and more money into the system, without getting much better then the good system we have now. IIRC, labour eats up the largest portion of our costs now - not drug costs.
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. And, yet, we keep talking about reducing costs without getting at the root issue here.
We don't have the same reverance for Doctors as we had about 30 years ago, when they were regularly elected to Parliament along with the lawyers. But, nobody wants to fight them and I'm not exactly sure why.
Posted by Sober Preacher's Kid (# 12699) on
:
I disagree Og. Drugs have overtaken doctors as the most expensive part of medical expenses in total. As working-age people don't receive drugs under medicare except in hospitals or doctor's offices, that may be the only saving grace.
Actually, Canadian billing rates for physicians are significantly lower than US billing rates. The rock of the Medical profession meets the hard place the Ministry of Health.
Medicare actually does a good job of keeping billing rates in line.
Posted by RadicalWhig (# 13190) on
:
quote:
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.
The NHS is not a single-payer system. It is a direct public provision system. Care is delivered through public agencies, and the health care professionals are ultimately public employees.
In a public single-payer system, the hospitals might be provided by the State, local authorities, non-profit foundations, or private companies, while the general practitioners and other health care professionals would be essentially independent professionals with their own "cabinets". There would be a national, universal public insurance scheme which would cover everyone, and the individual would then be able to see the doctor or specialist of their choice, secure in the knowledge that the State insurance scheme will pick up the tab.
I think of it this way. Imagine you need lunch. The NHS is a soup kitchen. You turn up, you get what you are given, when you are given it, and you are bloody thankful (ignoring the fact that you have made a substantial contribution for it through taxes anyway). There are no condiments. BUT - you do get fed, you do get kept alive, and you don't have to pay for it up front. A Single Payer system, on the other hand, is like having your choice of restaurant. You go in, you choose what you want, and then, when it comes to pay, the universal public insurance scheme pays for you. You still get fed, you still get kept alive, and you still don't have to pay for it up front.
In practice, some Single Payer schemes do have a co-pay element. If I recall correctly, in France the state paid directly for 80% of my wife's treatments on her "carte vitale"; the other 20% we had to pay up front and then claim back on a private scheme. However, co-pays are not essential to the principle of the single payer system. The essential principle is that it is universal, publicly funded, but delivered through the patient's choice of competing providers.
quote:
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?
I think the difference is choice and directness. In the UK, if you want to see a specialist, you have to go to your GP, get a referral, and then wait for your number to come up. You will be given an appointment when it suits them. In France, you call up your specialist (it is normal for people, especially those with an on-going condition, to have a specialist of their choice on hand) and book an appointment to suit you. Is this just because there is more money in the system? No. It is because the system is more flexible, being designed around the patient's choice rather than the bureaucratic convenience of a public service provider.
quote:
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?
No. I have not studied the detailed inner workings of the French system. My only experience of it is 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.
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".
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?
No, not really. Firstly, because you in effect pay twice - once through your taxation for the NHS, then again through your private insurance. Secondly, because the costs of "going private" are so high - choice is not built into the public system (because it is a "single provider" rather than "single payer" scheme), and to get choice you have to go outside the public system at vast expense.
In The Orange Book: Reclaiming Liberalism, the Liberal Democrat MP David Laws makes a detailed proposal for replacing the NHS (National Health Service) with a NHIS (National Health Insurance Scheme) - essentially, replacing a direct public provision system with a single payer system. To me, he makes the case seem quite compelling and I cannot find any serious objection to it. Perhaps I'm missing something? Has anyone else read it?
Posted by Og: Thread Killer (# 3200) on
:
quote:
Originally posted by Sober Preacher's Kid:
I disagree Og. Drugs have overtaken doctors as the most expensive part of medical expenses in total.
...
Hmmm....I trust your local knowledge on this. I still think the doctor's union is making it expensive in total due to their unwillingness to let people settle where they want to practice and the very closed shop approach they have about people from other jurisdictions (Doctor trained in Ontario, practices in Michigan, can't work in Ontario).
Posted by CorgiGreta (# 443) on
:
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
Posted by Crœsos (# 238) on
:
quote:
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
Blogger Fred Clark recently had a long blog post about option #2 above. Actually it's mostly about how hard it is to find someone willing to simply come out and say "she's lying" in public discourse, usually tying themselves into pretzels to avoid the L-word.
Posted by Horseman Bree (# 5290) on
:
I moved over to The Real Live Preacher, and was interested to see this blog entry .
The second paragraph seems to be related to the discussion above, and the whole thing is not very far off.
Posted by barrea (# 3211) on
:
I can only speak as I find,and I have always found the NHS to be there when I meed it.
As I am now 82 I have to take lots of different tablets to keep me going and so does my wife.
We would never be able to afford them if we had to pay for them.
Everything that we get now is free including visits to doctors and treatments, operations and
tests etc.
We had to pay our National insurance payments every month while we where at work for many years but now when need it more the NHS is there for us.
I have nothing but admiration for our health system and for the many kind and gracious folk who work in it, including my own son who is a ITU nurse and my granddaughter who is a doctor and has been working for the NHS for 2 years. She is now on the way to Australia to spend 6 months in one of their hopitals
Our Grandson is in his last year at medical school and he should be working as a doctor in the NHS this time next year.
So please don't knock the NHS they are doing a good job.
I feel so sorry for the retired people of America who so often have to go without drugs and treatment that they really need just so that greedy people can make money out of private insurances that many people can't afford to pay.
Posted by davelarge (# 186) on
:
Speaking of knocking the NHS, apparently it's drawing a hefty amount of flak from the opponents of healthcare reform.
Posted by Honest Ron Bacardi (# 38) on
:
quote:
Speaking of knocking the NHS, apparently it's drawing a hefty amount of flak from the opponents of healthcare reform.
There must surely be some parallel universe these comments refer to. Surely nobody can get so much wrong at once.
Do American insurance companies refer to their claim assessors as "Death Panels" too?
Posted by CorgiGreta (# 443) on
:
I think that there is a good chanace that the angry protests may eventually work in favor of passage a plan along the lines of those proposed.
The public may well be forming a judgment that opponents of the plan are nasty radical extremists, if not a bunch of nut cases.
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.
If this public image of opponents of health reform becomes set in stone, more moderate opponents will face great difficulty in having their more informed, rational, and less stridently presently objections recognized.
Greta
[ 11. August 2009, 21:49: Message edited by: CorgiGreta ]
Posted by Honest Ron Bacardi (# 38) on
:
Precisely, CorgiGreta. I wondered aloud about that over on the other thread.
Any proposals must be critiqued and examined from every angle - that's how parliamentary opposition can be constructive. This surely represents failure of that model.
Earlier, Erin wrote: 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.
It's difficult to interpret all of what is being proposed from afar. But having spent an hour or two trying to understand it better, isn't that more or less what is being proposed?
Obviously I stand to be corrected on that. But if, as it seems, the current level of expenditure is proving painful for US businesses (wasn't this one of the reasons why it was American auto manufacturers teetering on the edge of bankruptcy?), any such plans risk crippling the economy. All this of course being over and above the iniquities already discussed elsewhere.
This sort of healthcare reform opportunity only happens once in a generation, I would guess. If the system needs root and branch reform, now would be the time to do it.
Posted by Hawk (# 14289) on
:
Thank you for your detailed answers RadicalWhig. I'm a lot more informed now.
Posted by Clint Boggis (# 633) on
:
From Davelarge's link:
"..Britain's healthcare as 18th in the world, while the US is in 37th place"
So which is better then? AND a lot cheaper!
Why doesn't this settle it, even for the weakest minds?
.
Posted by Martin L (# 11804) on
:
quote:
Originally posted by RadicalWhig:
What is your view?
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:
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.
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.
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:
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.
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. You just don't get it Corgi, the people are going to escalate until they are heard & the people don't want another Obama pork factory forced down their throats at the expense of their quality of healthcare.
Posted by Erin (# 2) on
:
quote:
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.
I see two problems here, though -- first, I can't find anywhere there is a proposal to expand Medicare, so it's probably better to actually understand the plan. Second, the right wing has put forth no alternative other than maintain the status quo. One has to be a clinical imbecile to believe that the current system is worth saving. As someone who works in the industry, trying to get reimbursement for services in an organization with one of the lowest overall costs and the best overall patient outcomes, I can honestly say that proponents of the current system are either too stupid to live or 100% pure uncut evil.
Posted by CorgiGreta (# 443) on
:
Medicare is not perfect, but there would be rioting in the streets if it were eliminated, and seniors were left at the mercy of private insurance companies.
I have Medicare Advantage, a Social Security plan admistered by a not-for-profit HMO, and I love it. I think that it is an ideal system since the with a non-profit HMO, the focus is upon medicine rather than upon the bottom line.
No paperwork. No bickering over claims. Huge choice of physicians. No profit-motivated tests and treatments or denials thereof. Strong emphasis on preventive medicine. Very affordable generic meds. No rationing panels. No underwriting panels.
Greta
Posted by Erin (# 2) on
:
Yeah, that's not what your providers are seeing at all. Unless the HMO is like Kaiser and running the organizations where you're getting your healthcare, non-primary care doctors and facilities get screwed ten ways to Sunday by Medicare HMOs.
Posted by Amorya (# 2652) on
:
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".
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
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.
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
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.
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.
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.
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.
Posted by CorgiGreta (# 443) on
:
Here's a survey by an organization I feel is non-partisan.
Greta
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".
I suspect many of us are afraid of letting the best become the enemy of the good. We think that the French system might well be better, but what we have now works OK, so why risk change? Almost nobody feels sure that change will be worth it, as it carries the risk of going horribly wrong.
Of course, there is an element of this in the debate in America. I can absolutely understand that those with good health care now are going to be very anxious about any kind of change. The idea of some government official rationing your health care is very, very scary. The fact that in practice it's not a government official, but a system with a lot of checks and balances is not easy to explain. As Josephine has explained before on this and other threads, those who have good health insurance and no long-term health problems think the existing system is great (which it is for them).
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.
Anyway, I'm free to come over to the US and help out if you like. I'll bring my sister with her £40,000 cochlea implant and get her to explain how good the NHS can be. Her aftercare has been superb, and she doesn't go through her GP for it - just emails the team at the Royal Ear, Nose and Throat Hospital and they book her in to see them the next day. The NHS can really work when people want it to, just like any system.
Posted by five (# 14492) on
:
Moth,
You should also take your son as an exhibit. I think part of the problem in the USA is that to become a doctor requires seven years of education, not five, the four of that at undergraduate doesn't have to even be in a science if you take the core requirements for medical school entry as part of your distribution, and the tuition for ALL those years is expensive.
Tuition at medical school is expensive. Up to $75K a year, plus living expenses, plus whatever the previous four years of undergraduate cost you. You can buy a house for what it costs to qualify as a doctor, and not a bad house at that.
By contrast, though she was hardly living large, my sister in law did her medical degree actually as a graduate a couple of years back. Her tuition was the standard £3k per year, and the NHS paid for it. She did more medical education than US doctors get (four years, condensed into a year round programme rather than the standard five) and graduated with an overdraft of £300 since she lived in halls as a tutor while she did it. Every tutor in the university seemed to be in medical school!
So the NHS isn't just providing care, it is providing doctors.
Posted by CorgiGreta (# 443) on
:
More on seniors quite happy with Medicare.
Greta
Posted by JillieRose (# 9588) on
:
Okay, so maybe we have 'good as the enemy of best' in the UK. Then again, maybe not.
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.
And this is exactly why. We whinge and whine about the poor quality of care. Like that time I spent X hours waiting in Accident and Emergency because I had a...whatever.
And the newspapers going on about the crying shame when Person A doesn't get the same treatment as Person B, and the 'postcode lottery' for treatment, and such and such.
But I think the reason for that is: we don't know how good we've got it.
As for choice: can't you now go to any NHS hospital for your treatment/operation? So you can choose shortest waiting time/lowest bug rate/closest/the one near Aunt Maisie if you so desire. Yeah, the NHS needs some trimming. But in spite of our much-vaunted crappiness, we're still, what, 18th in the world?
I'm all for improving our efficiency. But even if there weren't a thing I could do about it, I'd take those odds.
Posted by Marvin the Martian (# 4360) on
:
quote:
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...
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.
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.
Posted by Hawk (# 14289) on
:
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.
Posted by JillieRose (# 9588) on
:
quote:
It would be confusing, disorienting and far too much effort, especially when someone’s sick and can’t deal with it.
Exactly. Back when my ME was really bad, I hauled myself down to the GP's surgery that I'd registered with after moving there, said 'Urgh' and attempted to communicate in some meaningful way my symptoms. And I was comparatively mild. I would hate to think how I would have coped if I had to choose between providers or whatever at that point.
I hate buying train tickets when I'm perfectly healthy. The same idea when I'm sick? Next to impossible.
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?'
(If the trains are anything to go by, the answer is yes.)
Posted by RadicalWhig (# 13190) on
:
quote:
Originally posted by Moth:
...what we have now works OK, so why risk change?
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.
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!
I'm not whinging! Have you seen me whinging? Whinging is negative. It complains but does not propose any alternative. I, on the other hand, am trying to start a transatlantic debate on the options of health care reform. My basic argument is that we should take neither Britain nor the USA for our models, but instead look to European countries for possible solutions. I argue this based on limited first hand experience of a system which, from the patient's perspective, seems to work so much better than the NHS. I'm not criticising the NHS or the people who work for it (insert obligatory tabloid comment about them all being bally heros here), but I do think that it is hindered by a severe structural flaw - public provision instead of public funding - which means that patient choice and quality tend, inevitably, to get squeezed out.
quote:
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.
Thank you, Josephine. I found that article very interesting.
quote:
Originally posted by Hawk:
The points Amorya made about privatisation ring true in a British context.
Yes, probably. We can't trust the British State to get much right these days. We can't expect to get the decisions right until we first get the decision-making processes right (which means, I hate to say it, fundamental constitutional reform).
If and when Scotland does become independent, and does get a proper Constitution which holds the government accountable, we can think about implementing health care reform in a new and flexible nation of 5m people, supported by a fledging civil service (tutored by some French ENA graduates) and a more open and accountable style of policy making. That would be so much easier and more likely to succeed than trying to introduce reform into a British State which has shown itself to be so tired, so incompetent, and so ossified, as to be incapable of reform.
quote:
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?'
Again, a fair point. This is the one real objection that I've found so far to the idea of an National Health Insurance Scheme. Single-payer is great in theory - and great in practice in France - but would it work well in Britain? I don't know. See my above comments about the dysfunctionality of the British State (I think the British State should be abolished!).
quote:
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).
I like the idea of making a (small, even token) up front payment - even, or especially, if that payment is actually made through a public insurance scheme. It establishes a customer-professional relationship which I find very refreshing in France, rather than the supplicant-authority relationship which I find so annoying with doctors in the UK.
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.
Indeed. Public health outcomes have as much to go with farming, transport and planning policies as they have with health services. The French are still overwhelmingly a nation of small towns; food comes from farms, not factories, and people can still walk to work, or to the local shops. Providing a healthy overall living and working environment is a part of the health-care process in which the State must be actively (and pro-actively) involved. Every public policy has a health implication. Cycle lanes are not just a road safety issue, they are a public health issue too. The Scottish Government is trying to tie these things together, but it is an up-hill struggle.
[ 12. August 2009, 11:27: Message edited by: RadicalWhig ]
Posted by Alan Cresswell (# 31) on
:
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?
The problems I see are that if the "customer" (ie: me) was allowed to choose based on expectation of service quality then there would be a strong temptation to go with the more expensive option and hence boost the overall costs. There would seem to be little incentive for the provider to keep costs down if they'd be met anyway.
On the otherhand, if the costs were fixed by the payer then there would be an incentive to the provider to keep costs down (to maximize profit) while maintaining good service (to attract more customers). But, there would need to be competant people within the payer organisation able to define both what minimum level of service would be expected for every treatment, and what would be a reasonable cost for that treatment. Which seems very beaurocratic to me. 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.
Posted by Moth (# 2589) on
:
quote:
Originally posted by RadicalWhig:
quote:
Originally posted by Moth:
...what we have now works OK, so why risk change?
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.
I'm not disagreeing with you. I'm putting fear of change forward as a reason why it's hard to get people to agree to what seems a sensible idea. Most people just find change far too stressful, so will put up with a situation that is not ideal to avoid it.
Personally, I quite like change, but experience teaches me that I'm in a small minority!
Posted by ken (# 2460) on
:
quote:
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.
Since when did right-wing governments try to break up wealthy people's clubs?
Posted by Erin (# 2) on
:
quote:
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
I get that, and Kaiser is a good one to have. Hell, I'm thrilled with my current insurance (granted, I was more thrilled several years ago, when I had 100% coverage at "very prestigious organization" and could see 10 specialists a day and never pay one cent). But Kaiser is an exception, not the rule. Most MAPs fight tooth and nail to keep every dime they have, insisting that the provider and patient jump through 800 hoops just to get an x-ray authorized, and then sit back for the rollercoaster ride that is the billing and reimbursement process. The only reason they pay at all is because the government says they have to, and even then they give you the attitude of a 13-year-old girl who's just been told to hang up the telephone.
God I want to strangle them just writing this. But seeing as how they're almost all administered by traditional insurance companies who routinely fight tooth and nail not to pay, their behavior is not surprising.
Posted by lady in red (# 10688) on
:
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. In the old days you used to pay up front and then get a refund, these days you hand a card over and it all goes through automatically. The Social Security pays 70% and then you take out (fairly inexpensive) insurance for the rest. People who are really poor get the full cost of their treatment paid for by the State. The 70% refund is based on the standard rates, and the amount your insurance will pay is also related to these standard rates. For example, my insurance pays for 100% of all standard consultation fees, prescription medicines and hospital costs and then up to fixed amount a year for optician, dentist etc.
Some very spiffy fancy-schmancy doctors that famous people go to charge more than the standard fees. If you want to see one of these, the Government will still only refund you 70% of standard rates so you will either have to pay the extra yourself or take out more expensive insurance.
In reality, most people are happy with the service provided by the doctors charging standard fees and don't bother with paying more to get fancier service. (Although I can see why you might - for example I am completely covered for staying in hospital on the ward, but I'm not sure my insurance pays for a private room.) But at any rate, the service you can get for Social Security + inexpensive insurance (you get can one that pays 100% of standard fees for about €30/ month) is already very good.
Posted by davelarge (# 186) on
:
quote:
Originally posted by RadicalWhig:
quote:
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).
Isn't that roughly what the Conservatives were proposing with their Patient Passport?
Posted by RadicalWhig (# 13190) on
:
quote:
Originally posted by davelarge:
Isn't that roughly what the Conservatives were proposing with their Patient Passport?
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.)
Posted by Sober Preacher's Kid (# 12699) on
:
My, what a lovely shade of Blue you are, RadicalWhig.
Posted by Crœsos (# 238) on
:
A blogger writes an account of her encounter with an actual "death panel":
quote:
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".
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.
Posted by Macx (# 14532) on
:
You meant that as a joke right?
Put your hand in the box . . .
Posted by Honest Ron Bacardi (# 38) on
:
Your reference, alas, eludes me.
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
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:
The "Death Panel" gambit sounds precisely like the sort of rhetoric that is liable to explode in your face at any time.
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.
Posted by RuthW (# 13) on
:
quote:
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.
Posted by Honest Ron Bacardi (# 38) on
:
quote:
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.
Well - it's also entirely possible I meant both.
RuthW - that does illustrate nicely how hyperbole renders a reasonable argument absurd. But any further comment on that is probably better on the other thread.
Posted by John Holding (# 158) on
:
quote:
Originally posted by RuthW:
quote:
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.
Strictly of course, all these except the "battles with the Luddites" are as much part of US history and cultural formation as they are of British history and cultural formation, since they all occurred well before the Declaration of Independence.
As for the "battles with the Luddites", in fact these affected a fairly small number of people in a fairly constrained part of the country. What looks today (from a PC perspective) like a major social uprising -- and was, to be fair, viewed by some of the authorities at the time in the same way -- really wasn't such a big deal at the time for most of the people living in the island. It's relatively recently that historians and analysts have given the Luddites the kind of profile they seem to have today.
John
Posted by Adeodatus (# 4992) on
:
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".
Posted by Alan Cresswell (# 31) on
:
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.
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.
Posted by Clint Boggis (# 633) on
:
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".
All it needs now is for some right-wing blogger or other twister of facts (or Palin) to claim "this world famous scientist has been held captive for years by socialists!" and the simple drones would all accept it without question as the absolute truth.
.
Posted by davelarge (# 186) on
:
quote:
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.
Was that an intentional pun?
Anyhow, your point is obviously true. Under any system which uses public money, someone has to decide how that money gets spent. Personally, I like the model from Oregon because it seems to involve medical professionals and administrators in the process, and is relatively transparent. I'm sure the system's not perfect, but (as I said before) I don't believe that there is such a thing as a perfect system anywhere that resources are limited.
Posted by Josephine (# 3899) on
:
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. If you've got pre-existing conditions or major risk factors, you may not be able to buy it. And if you decide to go without, if you develop a long-term condition while you're without insurance, you may not even be able to get into a group policy later on -- gaps in your coverage change the normal rule that group policies can't refuse to cover pre-existing conditions. (Although, in this state, they can only refuse to cover for a fixed period of time; I don't know the rules in other states.)
I was running a successful small business when it became clear that my first marriage was going to end. I immediately began closing my business and looking for a "real" job, since, after the marriage ended, I would not be able to continue converage on my then-husband's healthcare through his job.
I know other people who dreamed of starting their own businesses, who I'm reasonably sure could have made it work, who couldn't because they would be unable to buy insurance.
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.
Posted by davelarge (# 186) on
:
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?
Posted by Crœsos (# 238) on
:
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.
Another factor is that in many cases you're also having to buy insurance for your dependents as well. A lot of people who might be willing to gamble on their own future good health are a lot less willing to do so with their kids.
Posted by Josephine (# 3899) on
:
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?
Why, though? Access to healthcare is a real barrier to starting your own business. Reforming healthcare removes the barrier.
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.
Posted by cliffdweller (# 13338) on
:
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.
Just as, in the US, there is a nice group of insurance co. bureaucrats decide what treatments they will pay for and how much will be paid.
death panels
At least with government bureaucrats there is some means of accountability every couple of years.
Posted by davelarge (# 186) on
:
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?
Posted by Crœsos (# 238) on
:
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?
I disagree with the premise that conservatives, in the modern sense of the term, have a "desire for small government". Most conservatives are in favor of increased military spending and they typically favor whatever wars are proposed, both examples of government at its biggest. They're also in favor of increased regulation, just so long as it applies to individuals (particularly regarding their sexual choices) and not businesses. In short, it's not big government they're opposed to, it's just a difference of opinion about which aspects of the goverment should be big. In the American paradigm it can usually be summed up as favoring government interests over individual liberty and favoring business interests over government interests.
Posted by davelarge (# 186) on
:
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?
Posted by Crœsos (# 238) on
:
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.
Posted by RadicalWhig (# 13190) on
:
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.
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.
Posted by cliffdweller (# 13338) on
:
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.
Yes. And an ironic choice of metaphor, given that in the past (they've recently cleaned up their act somewhat) Walmart's disgraceful track record on employer-provided health care forced so many of their employees into government funded programs for low-income families that it caused a significant strain on the system.
Posted by ken (# 2460) on
:
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
The paradox of the American system is that they pay the taxes, and they put up with the regulation, but they don't get what they are paying for.
quote:
Originally posted by davelarge:
Wouldn't most doctor's clinics count as small businesses?
Certainly in Britain. The largest category of doctors are the GPs, who are not employees of the NHS.
[ 13. August 2009, 17:18: Message edited by: ken ]
Posted by Timothy the Obscure (# 292) on
:
Some of it arises from pure ignorance--there was an incident at one of these "town meetings" a couple of weeks ago where a guy complained that the liberals were trying to create a government-run health plan and take away his Medicare. when it was pointed out to him that Medicare is a government-run health plan, he refused to believe it.
There's even less awareness of how insurance regulators operate, and what their effect is.
Posted by Scot (# 2095) on
:
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
You are exactly right, except for the first sentence. The American public is strangely oblivious to the vast amount of government involvement in our current health care system. I think this is largely due to the mandate that insurance be provided through employers. Most individuals don't realize what they are really paying or how the system works.
I'd prefer a truly open market in health care and I'd willingly accept a government-run or single-payer system, but right now we've got the worst of both worlds. We lack both the universality of a government system and the competitive advantages of a free market system.
Posted by mousethief (# 953) on
:
quote:
Originally posted by Scot:
I think this is largely due to the mandate that insurance be provided through employers.
Mandate? Is that the word you want? You can buy individual insurance plans in the USA. Further many, many employers don't provide insurance for their employees (most famously WalMart).
Posted by Scot (# 2095) on
:
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.
Posted by jlg (# 98) on
:
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.
Actually, this has been of problem in some areas of the US with OB/GYN services. As the malpractice insurance premiums went up and up, less doctors opted for this speciality (especially since it also comes with a basic inability to control your schedule).
If they did opt for it, many of them wanted to work where they could run what I call a "medical business" (as opposed to a medical practice) where they would have a much better chance of making a good profit with which to pay off their school loans and then 'live the good life'. That translates into major population center with decent average income and easy access to major (and prestigious - e.g. downtown Boston, not the suburban) hospitals.
Here in the Greater Boston area some years back there was a lot of press coverage about the number of hospitals which were eliminating their obstretics operations, leaving women to travel long distances to the now overcrowded remaining hospitals.
In rural areas of the US (especially with large areas of poverty and/or low population density), it has long been a problem to attract enough of even the basic services (some GPs, a pediatrician or two, a couple of OB/GYNs plus some sort of reasonable facsimile of a hospital).
Posted by mousethief (# 953) on
:
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.
Agreed.
Posted by jlg (# 98) on
:
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.
I think this is one of the biggest problems with the US system. It depends on the individual consumer to flag up problems, but that consumer really doesn't know squat about medical costs, much less how the insurance system works.
I noticed this (since I and my family don't use much medical care) when I had my gallbladder removed about ten years ago.
My surgeon simply accepted whatever payment he received from the particular insurer. He didn't bill you for the difference, he didn't argue with the various insurers/providers. This meant that he could run a tiny and simple office.
Nearly everyone else involved in the surgery I caught double-billing (i.e. once under the name of the individual,once again under the name of the Group Practice). I reported two or three of these by phone to my Insurance Carrier and received a simple Thank You for Calling Us with no further action taken.
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.
And they don't care?
The clear message I received was that it was too much trouble for the Insurance Company to pursue any particular instance of fraud. Maybe if I had come up with a lawsuit documenting many multiples of instances over a great number of years....
But it's "obviously" "not cost effective" "to pursue a particular isolated instance" "of what would be a tiny loss compared to the overall picture".
Meanwhile, these same insurance companies are refusing to cover diabetics or elderly heart patients or cystic fribrosis or multiple schlerosis or other "existing conditions". Why do I suspect that they get a nice cut from these double-billings for routine and one-time procedures?
Posted by davelarge (# 186) on
:
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.
Posted by RadicalWhig (# 13190) on
:
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.
Surely all reasonable people must be opposed, in principle and in practice, to the idea of for-profit insurance companies being the main means of funding health care. Those who are not so opposed must either:
(i) be doctrinaire libertarian capitalists with the intellectual sophistication of a teenage Hayek Society member; or
(ii) have a selfish vested interest in maintaining a for-profit system; or
(iii) be so stupid as to fall for the lies peddled by an unholy alliance of those in the first and second categories.
Sorry if this sounds a bit harsh, but really can there be any other reason to support private for-profit insurance as the main means of funding basic health care?
(I'm not including those who advocate a basic state-funded universal scheme with an optional private top-up - that is an entirely different matter).
Posted by Honest Ron Bacardi (# 38) on
:
quote:
Surely all reasonable people...
Well, there's the weakness of your plan right there, RadicalWhig. Reasoning requires a level of civility in discourse that is in distinctly short supply right now. Seriously.
Posted by Emma Louise (# 3571) on
:
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.
...
I don't think many people in the UK necessarily know how much medical procedures cost (I've never seen a bill, just turn up and have treatment etc.)
In the last few years I've also had my gall bladder removed along with a pregnancy that included ante-natal care (scans, midwife appointments, consultant) and a labour that involved induction, a 4 night stay, 2 attempts at a caesarean (and so the anaesthetist, surgeon, paediatrician, midwives and all the other bods there) as well as post-natal care.
I have always worked and always paid tax so I guess I've paid into the system, but if I was stuck unable to pay for a gallbladder operation the amount of pain that leaves is horrid - and for something so easily treatable. Similarly I hadn't "planned" a caesarean but having had quite a tough time post labour to have had a huge great bill to worry about as well would have been horrid.
Posted by Scot (# 2095) on
:
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.
RadicalWhig's screed notwithstanding, the potential for profit is an excellent motivation to provide exceptional service in an efficient manner. 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.
Posted by Crœsos (# 238) on
:
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. Thus it's only in the insurance company's financial interests to prevent long-term health problems that would occur before you change jobs or retire. Any money spent on preventing a problem that could be serious twenty years down the road (high blood pressure, high cholesterol, etc.) is pure loss for your present insurer and will only save money for whoever your insurer is twenty years from now.
Posted by Dafyd (# 5549) on
:
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.
If so, how come there is so little exceptional and efficient service around in the private sector?
I'm not saying that there isn't exceptional and efficient service around in the private sector. I've worked for a company that strove for it. My experience was that profit is a fairly low priority for companies providing such service. It kept us in business, but the real motivation was a combination of pride in our jobs, relations with our colleagues and customers, and looking down on our competitors who got away with doing less work for more money.
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.
There have been studies of this. 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. For example, to use an example of Michael Sandel's in his Reith Lectures, a nursery school introduced a series of fines for parents picking up children late. The reason was to reduce the burden on carers staying after hours to look after children. The fines had the effect of increasing the number of parents who picked up children late. Parents were now less motivated by embarrassment or a sense of responsibility to the carers.
I rather suspect (warning: unevidenced speculation follows) that the reason Radical Whig's experience was better in France than in the UK is that France is less profit-motivated as a society on the whole.
Posted by Darllenwyr (# 14520) on
:
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 ...
I dread to think how we would manage under the existing US system ~ I imagine we would not. All I can say is, "Be grateful for the NHS!"
Maybe I should point out that, if ever my wife has any problems with her MS, one phone call will see her booked in to see a specialist, generally the following day. If she is prepared to travel (and by this, I mean less that 40 miles, incidentally) she can generally see the specialist the same day. A word to the wise in the US; don't knock what you don't understand.
Posted by lily pad (# 11456) on
:
If it is anything like in Canada, you make sure that you find work that includes insurance as a benefit. I am about to start a new job and will have health insurance as part of a group plan so they can't refuse to treat my pre-existing condition.
Buying health insurance is almost impossible for those with chronic conditions. I did get a quote once and found the fee almost as high as my rent and medications for pre-existing conditions would not be covered at all.
Posted by Darllenwyr (# 14520) on
:
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.
Posted by Josephine (# 3899) on
:
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?
If you're trying to buy an individual policy, the answer is, yes. Pre-existing conditions are generally not covered. And, as you suspect, insurers will jump through all kinds of hoops to invalidate your insurance should you ever need it.
If you are on a group policy, the rules are different. There may be state-by-state variations; I'm not entirely sure. But, in general, if you have maintained continuous coverage (i.e., you have never been without health insurance), then a group policy has to cover your pre-existing condition. If there is a gap in your coverage, then they can refuse to cover the pre-existing condition for a limited amount of time (6 months, I think).
Depending on where you live and the details of your policy, your children may be dropped from your coverage when they turn 18, or 21, or 24. They may be able to stay on as long as they are full-time students, or until they reach a particular age, whichever comes first. After that, if they have pre-existing conditions, they're going to have to find a job that has a decent group policy.
When you're looking for a job, you're not supposed to ask about health insurance until they actually offer you a job, but that can be awkward if you know up front that, if they don't provide particular coverage, you can't take the job.
It's a bizarre situation we've got here. I don't know why anyone wants to keep it.
Posted by lily pad (# 11456) on
:
quote:
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.
In Canada, we have something like the NHS but many things that you have are not in our program, therefore we need to have supplemental health insurance.
We wait forever for specialists and for tests and we don't have enough doctors. We have no private system for those with insurance either.
People with manageable chronic health problems will generally try to work for government agencies or for bigger employers who offer group health insurance or at least one spouse will do so in order to have regular medications and medical supplies provided.
Our system works great for extremely sick people but is not so great for basic things.
Posted by RadicalWhig (# 13190) on
:
As someone above mentioned, a major problem with this whole "group policy" and "pre-existing conditions" thing is that it makes being self-employed or starting one's own business very difficult.
The case for either a state-funded universal single-payer scheme or a public-provided system like the NHS (I'm not sure which, but still mildly inclined more towards the former) seems stronger than ever.
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?
Posted by Scot (# 2095) on
:
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.
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.
Posted by Scot (# 2095) on
:
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.
I absolutely agree that the widespread provision of insurance through employers is one of the biggest reasons for the breakdown of the current system.
Posted by RadicalWhig (# 13190) on
:
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.
Posted by cliffdweller (# 13338) on
:
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 ...
The answer to both questions is, indeed yes, with one exception: if you find work for a large employer. It needs to be a large employer with lots and lots of employees in the benefits pool. In that scenario the insurer offers the employer a blanket plan that covers all employees for a standard rate. If the employer is large enough, bringing in a lot of business, the insurer generally will take all comers, even including pre-existing conditions, so as not to lose the contract.
But if the employer is a smaller company, the insurer will simply factor in the cost of caring for the MS or diabetic employee, and if their aren't enough healthy employees to offset the cost, they'll simply cancel the whole contract. This happened at a church I worked for when the custodian was diagnosed with prostate cancer.
At which point it will indeed be pretty much impossible for the MS or diabetic patient to fine private insurance unless they qualify for government assistance.
Note: California just cut funding for 1000s of children previously insured under our Healthy Families program.
Posted by cliffdweller (# 13338) on
:
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.
[ 15. August 2009, 01:30: Message edited by: cliffdweller ]
Posted by Sober Preacher's Kid (# 12699) on
:
In Canada, you can get a true Group Health Plan with unlimited prescription drug coverage for as few as 2 employees (thank you Manulife). With 5 employees you can get a quote from all the major carriers: Manulife, Green Shield, Blue Cross, Great-West Life and Sun Life.
On the personal side, there are really only 2 companies worth considering.
1) Your provincial Blue Cross plan.
2) Manulife.
Blue Cross plans vary by province. Many have "Guaranteed Insurability Options" for individual health plans.
In lily pad's case she would have to contact Medavie Blue Cross, the individual provider in the Maritimes. They offer GIO's for their health plans. They also have unlimited drug coverage. This sort of feature is usually backstopped by the provincial government.
The personal insurance market in Canada is a bit of a zoo. I sold this stuff and still breathe it.
I'm a bit disappointed with some of the offerings by the Ontario plan, Canassurance Blue Cross. They're undercapitalized and have gone nutty with their underwriting. I'd rather they improved their health offerings a bit but my suggestions were shot down.
You can take care of yourself with health insurance in Canad but it requires a good advisor and some money.
Disclaimer: I gave up my insurance business and my license so I took my dog out of that race.
Posted by Sober Preacher's Kid (# 12699) on
:
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.
Yes and no. Large employers like those usually employ benefits consultants to custom design their plans. Insurers don't pay any commissions on files that large, you pay a retainer to benefit consultant.
Also in many plans there is actually little or no insurance in their insurance. What I mean is that the policy is really a tax tool rather than an actual contract placing funds at risk. Many companies have predictable bills for low-cost, high-frequency claims like drugs. Thus they pay the costs directly through the plan without an insurance cap.
I used to sell this stuff. Been there, done that, got the training.
What Obama's plan would do is allow the revival of Community Rating, that is allow insurers to get away from individual risk rating. IRR is the heart of most complaints about health insurance. Community Rating means you accept all comers and charge a premium based on their pooled risk. The Obama plan would allow that system to work by providing a good supply of health participants.
The Blue Cross plans were founded on this principle, but it stopped working in the 1960's when other insurers with IRR cherry-picked the Blues' healthiest customers.
A Community Rated individual plan with subsidy for low-income earners would act like a universal plan without actually being government-run. I imagine this is what will eventually come to pass in the US.
Posted by Scot (# 2095) on
:
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.
Uh, good for you, I guess. Personally, I don't define myself by my job nearly that much. I care a lot more about my non-work roles, status, friends, and purpose. YMMV.
Posted by M. (# 3291) on
:
Can I ask a question- well, use my own experience as a case study?
A couple of weeks ago, I went to the doctor with a not-very-important thing - I had had a series of random swellings, on my foot, then my other foot, then my shoulder, then my elbow etc. No pain, no injury that I could remember. I thought they were probably unconnected and 'just one of those things' but went along to be reassured. The doctor discussed possibilitiese with me and eventually ordered some blood tests and asked me if I wanted my cholesterol level tested at the same time.
I could have had the blood tests done privately (I have medical insurance from my employer), but there is no point, my doctor's surgery provides a nurse, the appointment was made for a week later (could have been sooner but the date suited me). The results took a week and then I had an appointment with the doctor to discuss them (they were all perfectly clear and healthy, incidentally).
I have had the same doctor for as long as I have lived here - 21 years, so he knows my medical history. I have another issue my the doctor's surgery at the moment - it has just abandoned open surgery in the morning (for non-UK shippies, this is where you just turn up and queue to be seen. It worked well for me, I could turn up at, say, 8 am and be reasonably sure of being seen by about 8.45, so it minimised how late I was for work. Now I have to phone at 8.30 to secure an appointment for that morning).
I just wondered how this type of thing would be handled in other systems?
M.
Sorry, I should add that there is no paperwork for me at all - there was a form the doctor filled in for the blood test, to let the nurse know what tests were required. That was the only paperwork I saw at all.
[ 15. August 2009, 06:02: Message edited by: M. ]
Posted by Alan Cresswell (# 31) on
:
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.
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.
And, I'm not entirely sure that it would make all that much difference if the income from premiums and investments was replaced by direct funding from the tax payer.
The problem jlg outlined is that in any system where costs are charged to a payer then there will be some people who will inevitably try and charge more than they should. And, somewhere along the line it becomes more effort and cost than it's worth to identify and recover any overpayments. Most of us have probably had experience of something similar - personally I had someone claim I'd damaged their property reversing my car into it (I hadn't) but although my insurance company admitted they had a very weak case the claim was so small it was easier for them to simply pay up and write it off as a loss (in retrospect, I should have just paid myself as I lost more in extra payments due to lost no-claims and having to say I had a claim in renewing my insurance in the following years than I would have spent sending them a cheque ... but I didn't fully understand how the system worked at the time).
The only way I can see around the problem of medical practioners overcharging is to directly fund the practice. Which is, more or less, how the NHS works.
Posted by CorgiGreta (# 443) on
:
In the Kaiser model, there is no possibility of a doctor padding a bill. There are no bills other than standard minimal co-payments for a few services.
Kaiser is considerably less expensive than comparable plans from competitors.
This is probably attributable to the fact that all services (other than extreme emergencies or very rare referrals) are performed in house and/or the fact that Kaiser does not have to satisfy shareholders with ever increasing dividends. It is also possible that they are relatively more efficient, due to consolidation of services, procedures, and records within their facilities.
Greta
Posted by Clint Boggis (# 633) on
:
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?
I've been assuming that US health insurance is overall 'inefficient' in that the proportion of money from all premiums spent on actual necessary beneficial health costs for the patient is a long way short of 100%, but I don't know. I tried Googling a few days ago but gave up without an answer.
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?
.
Posted by RadicalWhig (# 13190) on
:
quote:
Originally posted by Scot:
Uh, good for you, I guess.
I didn't mean it in the "good for me" sense. I meant that assuming profit / payment as the main motivator - the reduction of our lives to a series of instrumental cash transactions rather than a more holistic social role and calling - is not only shallow and dehumanising, but will also result in poor quality service. People will work for cash, yes, but only when the boss is looking, or when they can't get away with slacking; they won't actually care. If you want people to care, then you have to think about things like pride, honour, fellowship, and reputation - these will motivate people even when no one is looking. The implication for health care is that a system with a "personal touch" based on on-going relationships is likely to provide a better incentive structure from high quality service than one driven primarily by the profit-motive.
Posted by Dafyd (# 5549) on
:
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.
Systems that function on volunteer contributions don't rely on the profit motive.
Government employees in the UK do not have the opportunity to increase their salary except as part of a general pay rise, or by changing jobs. So performance above and beyond the minimum standard to hold the job down isn't motivated by profit.
In fact, we're speaking rather loosely here. Profit is the act of returning money on an investment. Getting paid for my labour is not strictly speaking a profit. Now it doesn't particularly matter, but you're running the risk of lumping together rather different situations.
a) Employees receive a basic salary, and receive no financial motivation to do more than the bare minimum.
b) Employees receive a basic salary with a performance related review every year.
c) Employees receive a basic salary, plus on the spot financial bonuses for particular actions e.g. every customer complaint taken and dealt with within a particular period.
Now, by saying that employees in situation a are working for profit you're claiming that there's essentially no difference between a and c. If people are motivated to get paid at all, then they'll be motivated in just the same way by c. And that is quite wrong.
Posted by Doublethink (# 1984) on
:
The NHS runs on b, unless you are a doctor.
NHs services are already being tendered and in some cases being delivered by third sctor organisations. One noticeable effect is problems information sharing. That and that the people comissioning sevices and organisations don't always know enough about the specialism to make - what I would consider - sensible decisions.
Health economists reckon the introduction of the internal market into the NHS did a fair amount of damage - and it engenders a lot of admin costs.
It would be interesting to see the health outcomes of funding the NHS at 10% of GDP. I suspect we would reach French standards at that point.
Patient choice is a two-edged sword, I believe people should have health care planned together with their provider. But.
What about people who are clinically health anxious, what about people in first episdoe of psychosis who don't know they are ill, what about people who want a particular intervention because they have been convinced it works when there is no actual evidence it does - like homeopathy, what about people are only prepared to see a consultant specialist - regardless of actual clinical need, what about people who want quick-fix surgery (which won't overcome the problem in the long term) rather than to make lifestlye changes that will address the clinical problem ?
Posted by CorgiGreta (# 443) on
:
Clint,
I haven't had any success with Google either, but I recall reading some figures a few months ago. I wish I could remember the source, and I'll keep trying.
Nevertheless the numbers that stick in my mind are: private insurance spends between 70% and 90% of each dollar on actual health care. Medicare, on the other hand spends 97%-98% per dollar on health care.
There may have been some bias on the part of my source, but I doubt that any manipulation of the figures could refute a conclusion that administration and profit, not to mention hefty executive conpensation, consume a healthy portion of the private premium dollar. It may not be just profit, but it seems that there is major excess somewhere.
Greta
Posted by Alan Cresswell (# 31) on
:
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?
I don't know what sort of financial regulation there is in the US, but it wouldn't seem unreasonable if company profits are public domain. Whether the income from premiums and where that money was spent is available is another matter. But, if you can find an insurance company that's going to say how many customers they have (and, the big ones at least are likely to use that as an advertising line "bringing good health to 50million Americans" sort of thing) and can make a guess at the average premium paid per customer you might get an idea.
If CorgiGreta is right and 70-90% of insurance premiums fund patient care then that sounds about right to me. 90% seems high, as 10% doesn't seem much to pay staff and advertising, much less a profit return.
Posted by davelarge (# 186) on
:
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.
I think that the difference is not so much in whether there is the additional expense of paying shareholders, but one of attitude. A for-profit exists to maximize the bottom line, and the business that they do happens to have the happy collateral of helping people. A non-profit organization who's primary purpose is to help people, but which has to keep the books balanced is (I think) more likely to take a benevolent view of marginal claims and generally be 'nicer'.
Posted by Josephine (# 3899) on
:
I don't think any discussion of the health insurance industry is complete without the testimony of Wendell Potter, a former executive with Cigna who resigned after deciding that he could no longer, in good conscience, work for the industry.
Start here.
I've only just discovered his blog (available here).
Another source for facts that might be hard to find elsewhere is a sort of annotated bibliography for the movie Sicko. It provides many of Moore's claims about healthcare in the US, along with sources for those claims.
Posted by cliffdweller (# 13338) on
:
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.
Posted by Clint Boggis (# 633) on
:
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.
Thanks Greta, Alan and cliffdweller for your answers.
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.
The only 'good' point those in favour of the status quo would have is to ask about all those administrative and support staff who won't be needed any more - think of the massive unemployment!
.
Posted by mousethief (# 953) on
:
This is why my firm still employs three buggy whip makers.
Posted by mjg (# 206) on
:
David Brooks: Obama tells whoppers.
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.
And Palin vindicated?
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."
Posted by cliffdweller (# 13338) on
:
Oh, thank God. Now we have all been spared the horror of having an uncomfortable conversation. I mean, yeah, sure, not being able to get life-saving medical treatments is annoying, but having to think about death-- why that's just awful! Thank God we've been spared such needless suffering at the hands of heartless government bureaucrats.
Posted by Alan Cresswell (# 31) on
:
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.
Posted by Alan Cresswell (# 31) on
:
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.
Posted by Jay-Emm (# 11411) on
:
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.
Yes, I'm sure that's right: 70-90% is what insurance companies pass on and deem health spending, but there is another tranche of admin, support and billing staff costs to be covered too.
Overall we don't know the figures but it's likely to be well under half spent on medical and medically necessary costs. I'll be generous and guess 40% 'efficient'.
I too looked at that mjg link and immediately focussed on the line: "Preventive care saves money. That's not true."
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.
Don't they want to win the argument? It might get a round of applause from Obama haters but 98% of other adults will see through it. Maybe it's a typo or misquote that slipped though. Is there a 'not' missing? Those little things can end up making a big difference.
Jay-Emm may be right and they are looking at the extremely near future where it will be true for a short time but 'forget' to say they're being very selective of the facts to make a case only simpletons would accept. Or maybe they are seeing death as a cheap resolution.
I understood that in US health care, it's usual to get an annual check-up, while here in the UK it isn't. We don't do that as part of preventative care but presumably it's been deemed not cost-effective or has minimal effect on health outcomes. That's ok, it doesn't worry me because if I know that I need to, I can go to the doctor and get whatever tests or treatment I need with no bills.
ISTM that part of the US problem is that preventative care is good for those with health cover (including those annual checks which yield little benefit) but for those without cover, it costs so much that people either choose not to go or literally can't afford to. This exacerbates the divide between those with cover and the rest. Are there any figures comparing life expectancy between the two groups?
OF COURSE letting all those people who notice a pain or lump which might be the early stages of something nasty and getting it checked before it's too serious will benefit their health and their lives and save money overall. Everybody wins!
.
Posted by angelicum (# 13515) on
:
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.
Preventive health treats population in opposition to acute medicine which treats individuals.
So it really depends on exactly what policies you're going to implement. 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?
Or another example of preventive medicine - say everyone is encouraged to have yearly blood pressure checks with their GP. Some people with hypertension go on to develop strokes, heart attacks, etc. Not everyone does though, and some people carry on fine with high blood pressure. The medical guidance though would treat everyone with hypertension. Therefore the more cases of high blood pressure gets picked up, consequently more people are on drugs. Some of these people would be prevented from getting strokes, etc. Some people would get a stroke anyway. And some of these people would have never got a stroke in the first place. Is this more or less expensive than just treating the (expected) increase in stroke patients??
Posted by Antisocial Alto (# 13810) on
:
Widespread preventive care costs more because more people receive it, a lot of whom wouldn't have contracted a specific condition anyway.
"...many observers point to
cases in which a simple medical test, if given early enough, can reveal a condition
that is treatable at a fraction of the cost of treating that same illness after it has
progressed. In such cases, an ounce of prevention improves health and reduces
spending—for that individual. But when analyzing the effects of preventive care
on total spending for health care, it is important to recognize that doctors do not
know beforehand which patients are going to develop costly illnesses. To avert
one case of acute illness, it is usually necessary to provide preventive care to
many patients, most of whom would not have suffered that illness anyway."
(Quoted from a letter from the Congressional Budget Office director)
Posted by davelarge (# 186) on
:
quote:
Originally posted by angelicum:
So it really depends on exactly what policies you're going to implement.
Well, of course!
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?
How about a half-way house, where people in at-risk categories are allowed to take the drug, if they want it? That way, some of the unnecessary* treatment is removed, the cost lessened, but the people that are likely to benefit from the treatment still get it. The same can be said for your second example.
But in that example, isn't it better if people don't have heart attacks or strokes in the first place? Even if it does work out more expensive to minimize the number of occurrences of those conditions in the general population, isn't that a better outcome than treating the strokes etc after they have happened? It would certainly keep more people in work for longer, and potentially benefit the economy (and tax revenues) in that way. But fundamentally, keeping people healthy is (in my opinion) a morally better course than merely treating them when they are ill.
* in the sense that those people would not have gone on to have the condition if they had not taken the medicine.
Posted by angelicum (# 13515) on
:
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.
I completely agree. That's why I think cost-effectiveness/economics or big government/small govt should all come a very definite secondary to the discussion on health policy.
Posted by mjg (# 206) on
:
quote:
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.
David Brooks, arguably one of the more respected commentators around, pontificating on the PBS News Hour is summarily dismissed as a 'blogger'?
Weird.
Posted by cliffdweller (# 13338) on
:
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.
I guess if you can delay treatment long enough the patient just up and dies, which is really really cost-effective.
Posted by five (# 14492) on
:
An American doctor once told me that the annual check up was one of the biggest scams going. Apparently the results are deceptive as you have nothing to compare them against (apart from the last year, where if every category is marked "within normal limits" then you have no genuine measure to compare with, one shot blood pressure isn't particularly helpful (as many people get stressed and raise the blood pressure through just having the test done) and if nothing is found, you're often happily delusional that nothing can go wrong for rather a while.
Whether or not this is true, I have no idea, and I am not a doctor. Far from it! But his explanation made a lot of sense at the time.
Posted by Clint Boggis (# 633) on
:
I can't think where I got the idea he was a blogger. Sorry about that.
I was probably affected by the claim that more preventative care will result in higher costs. Does leaving problems until they're extremely serious and major action is required end up cheaper? It just makes no sense.
.
Posted by Josephine (# 3899) on
:
A fascinating article in the Atlantic. The author points out that we're not the true customers in the health care system; the insurance companies, Medicare, etc., are the customers. He looks at the problems this causes, and describes a way of making us the real customers, thus increasing quality and reducing costs.
It's a complete paradigm change. Worth reading.
Posted by Erin (# 2) on
:
quote:
Originally posted by five:
An American doctor once told me that the annual check up was one of the biggest scams going.
It depends, I think. I have a couple of chronic conditions that are controlled with medication and a family history of other unusual conditions, and the annual check-up is a good way to keep on top of them. We've been able to head off a couple of things that would have resulted in major surgery.
Posted by LutheranChik (# 9826) on
:
Well, the latest is that the Obama administration is giving up on promoting a public option in its plan. This is very disappointing.
Meanwhile, the GOP and Big Pharma/Big Insurance have the peasants with pitchforks so riled up about "socialized medicine"...we have a church friend who's a lovely human being but whose emotions tend to override her IQ, who pays way too much attention to rightwing talk radio and spam e-mails, who's convinced that our neighbor to the north is putting Grandma out on an ice floe to die, practicing eugenics on sick babies, anesthetizing patients with seal clubs and Canadian whiskey and otherwise committing unspeakable crimes against humanity in the name of single-payer healthcare. It's part of the collective nervous breakdown the right wing is having in our country at the moment.
Posted by davelarge (# 186) on
:
quote:
Originally posted by LutheranChik:
It's part of the collective nervous breakdown the right wing is having in our country at the moment.
Oh, I think the right wing is fully in control of it's faculties. It's the everyday person who's having a breakdown induced in them by the right wing.
Posted by cliffdweller (# 13338) on
:
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???
[ 17. August 2009, 00:45: Message edited by: cliffdweller ]
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".
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.
Posted by mousethief (# 953) on
:
Could well be.
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.
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 ]
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.
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.
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.
Posted by tclune (# 7959) on
:
quote:
Originally posted by New Yorker:
Anyway, my understanding of the Massachustes system is that it is bankrupting the State (or Commonwealth). Is this correct?
No. MA is hurting from the recession, but less so than most states -- states just can't function in the black when so many of their tax-paying citizens are out of work. Their costs go up and their revenues go down, but the states are for the most part not allowed to run at a deficit, even during this sort of time.
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.
The health insurance reform has been a Godsend for many during this meltdown -- when people lose their jobs, the COBRA option has been a helpful stopgap, especially with the Federal government paying a substantial part of the cost during this emergency. But many folks have just plain run out of benefits -- they're no longer "unemployed" because they've been unemployed too long! Those folks are still able to get health insurance. This is a real safety net, as is the ability to get actual affordable insurance if you are self-employed or in a non-traditional job situation.
An awful lot of employers just plain don't offer insurance any more, but the people in MA are still able to get a reasonable plan. My daughter was one example, when she got back from working overseas and was working as a private contractor for the first year or so until she could land a job that she wanted with full benefits.
MA insurance does not refuse insurance to anyone, and the self-insured are not stuck in a pool of one for their rates and costs. The people can't be dropped for getting sick. The only folks who talk against the plan are ideologues who would be opposed to any plan. It isn't perfect, but it is better than any other state has to offer. My guess is that it will pretty much be what the federal plan ends up looking like if we get a federal plan at all. If not, I imagine that the rest of the country will try to move to MA.
--Tom Clune
[ 17. August 2009, 14:28: Message edited by: tclune ]
Posted by Macx (# 14532) on
:
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.
A problem with healthcare reform as the democrats/ leftists have advertised it, is that what could work in some states won't work in others. Where the demographics will sustain it and the people want it, I have no problem with the states passing MA style laws. Where the demographics won't sustain it and the people don't want it, nationalizing such policies seems not just draconian, not just to violate the 10th amendment, not just mindless of real economics, but foolish. Who's gonna pay the price in AZ, WV, MT, and LA (among others)? I haven't heard anyone on the left adress this.
This is why we have a 10th amendment. It wouldn't surprise me at all for Obama to go ahead and get some shaved down version passed in the hopes of regaining some face, just to have the whole shebang crapcanned via a 10th Amendment appeal to the Supreme Court and/or some other flavor of legal "states rights" revolt. Even if Obama "wins" at this point, he loses.
Posted by Jason I. Am (# 9037) on
:
As happy as I am having Obama in office, I'd be just as happy if Obama's legacy was to push through some sort of universal health care system only to be ousted in 2012. I believe Canadians have voted Tommy Douglass as the most loved Canadian of all time, in part for his contributions to getting their health care system in place even though it was political suicide for him in many ways.
Socialized medicine could be very bad if done incorrectly. The answer, however, is not free market health care. The answer is better socialized medicine. All those who complain about socialism and big government and government interference and governement incompetence often have trouble articulating what they really want instead.
The reason for that difficulty is best explained by this clever rant "against" socialized medicine:
http://i4.photobucket.com/albums/y123/FistsOfCurry/5RkJK.png
A consistent argument in that direction involves a lot more desocialization than most realize.
Posted by Kid Who Cracked (# 13963) on
:
quote:
Originally posted by Jason I. Am:
http://i4.photobucket.com/albums/y123/FistsOfCurry/5RkJK.png
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.
Macx, you don't know the half of it. Not only do we have few illegals, we have a lot of "legals" -- folks from New Hampshire who come down here to do our work and who pay MA taxes without being able to gain access to much of our social services.
I would urge every state to try to relocate next to NH. Their citizens are friendly and gullible -- the perfect neighbors...
--Tom Clune
Posted by cliffdweller (# 13338) 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. 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.
Posted by mjg (# 206) on
:
quote:
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.
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.
You'll be in better shape than California, where on April 1 sales tax went from 7.25% to 8.25% -- local taxes bring it up to 9.75% where I live.
In today's NY Times Paul Krugman likens the MA program to the Swiss system. He thinks it would be cheaper simply to extend Medicare to everyone, but will settle for "using regulation and subsidies to ensure universal coverage" as an improvement over the current situation.
Posted by Harperchild (# 14017) on
:
Just a short post to add my wholehearted appreciation of the NHS. I pay a very small percentage of my wage in NI contributions - nothing like the terrible amounts my American friends have to pay between jobs with adequate coverage. Every time a family member has a problem - from needing joint replacement or other non-urgent surgery, to treatment for an ongoing condition, to repairs after an accident -I expect to have to wait, or for specialists not to be available, or for there to be no NHS dentists, because I'm as susceptible as anyone else to what's said in newspapers, and 'statistics'...
And every time I've been amazed at the speed and professionalism of it all. I understand it may be better in some areas than others - maybe that's true in France as well?
I'm also stunned at how rude and ungrateful people are - people take it for granted and abuse the system; and yet it's STILL cheaper and more efficient. Good, huh?
Posted by Macx (# 14532) on
:
quote:
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.
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
If you think that's what I was saying in my post then you just weren't paying attention.
Posted by Macx (# 14532) on
:
Oh, not at all. We're on the same page.
Posted by cliffdweller (# 13338) on
:
quote:
Originally posted by Macx:
Oh, not at all. We're on the same page.
Aack! Not even. Maybe just on the CA budget.
Posted by Sober Preacher's Kid (# 12699) on
:
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?
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.
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???
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!
Imagine if there had been no police. People with money would pay private security firms to patrol their properties or accompany them for personal protection. Some would get together in gated communities with a guard to control entry. Ordinary people would either fend off burglars and muggers using whatever means they have available or risk injury, losing everything they own and death.
Then a new president proposes a publicly funded police force to share to cost and share the risk among everyone. The majority breathe a huge sigh of relief at the prospect, while the rich and the stupid and those who mindlessly loathe anything to do with government or authority which 'usurps' their personal responsibility shout it down and tell lies to scare or persuade the gullible.
I can't imagine a civilised country without a police force to protect the public but then I'm not one of the pitchfork-wielding arsehole faction. Doesn't the same logic apply to police and health care?
.
Posted by tclune (# 7959) on
:
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!
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).
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.
It is possible to structure a system where the cost of capital is essentially the same for public and private insurance entities. But being conceerned about this as a hidden cost of a public option and an overt cost of a private one is just a matter of honestly assessing relative costs and benefits.
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.
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.
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.
In all honesty, I can understand people opposing any public option and I can understand people opting for a single-payer system. What is considerably less obvious to me is what added value a new public option would add to our system.
--Tom Clune
[ 18. August 2009, 12:49: Message edited by: tclune ]
Posted by Josephine (# 3899) on
:
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.
The private system that we have doesn't provide that guidance. But David Goldhill (the author of that article in the Atlantic that I posted back a page or so) described a private system that probably could.
His opinion is that, as long as insurers are paying for virtually all healthcare, instead of patients, healthcare will respond to the needs of insurers and not of patients. So, for example, you get health care providers investing in IT for insurance billing, but not for patient records. It's almost impossible for patients to find out how much things cost. (Try it sometime, if you don't believe it.) And you've got high rates of hospital-acquired infections, which kill thousands and thousands of people, but which hospitals do almost nothing about. The patients aren't their greatest concern. In fact, if hospitals do their jobs too well, they make less money. It's a crazy system.
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.
Oh, and for the poor, he suggested that the government provide some or all of the HSA money, but leave it up to the poor to spend it themselves. It would cost the government less to do it that way, and it would have the effect of providing universal access to health insurance.
The article is worth reading. He may be describing what some folks have been saying they want: a uniquely American model with a minimal government role, universal access, and lower cost.
I wrote my senators and congresscritter, asking them to read the article, telling them that I consider it imperative to provide universal access to healthcare, and to decouple health insurance from employment. I know there are many ways to do that. I think the way described by Mr. Goldhill has merit (although I disagree with some of the details). It should at least be part of the conversation.
Posted by Erin (# 2) on
:
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.
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:
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.
I agree somewhat, but I honestly think the only way to get healthcare costs down is to have coordinated care amongst the physicians. Whether it be through the structure of the organization (Mayo Clinic) or the physicians just teaming up and getting it done (Grand Junction, CO), collaborative care is probably the single most effective way to manage healthcare costs.
Posted by Jason I. Am (# 9037) on
:
Josephine,
Would this be similar to the Social Security accounts idea that failed for Bush a few years ago? Or is there a difference to it that I'm missing?
Posted by Josephine (# 3899) on
:
Given that the health savings accounts are intended primarily for short-term needs, I think they wouldn't be invested, but would be kept in some form of cash equivalent. You wouldn't have to worry about a stock market crash wiping out your health savings.
Also, these accounts would be topped off or funded entirely by the government for the poor. I don't recall anyone saying about the privatized social security option that, if you didn't have enough income to put enough into your retirement account, that the government would put money in it on your behalf.
Posted by tclune (# 7959) on
:
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?
I'm not really up to speed on the HIPAA initiatives. But I am thoroughly familiar with the DICOM attempts at standardizing structured reports and using SNO*MED nomenclature to standardize reporting and speed payments.
The basic difficulty seems to be that it just shifts the nature of the game. Dermatologists offer facials and code the "treatment" in the way that gets reimbursed, etc. This isn't just an insurance company problem -- greed exists on all sides of this equation and complicates rational delivery of care.
One thing that would be easier to include under a single-payer system is criminalizing many of the more egregious acts of some physicians. Theft is theft, even when it's done with an insurance claims form. Private insurance has absolutely no incentive to prosecute these frauds. That is kind of counter-intuitive to me, but empirically it is clearly the case.
The amount of medical fraud appears to be very substantial. We don't discuss that in these debates because the opposition would kill whoever questioned the integrity of any doctor. Can any politician survive an ad campaign that pits his integrity against that of the men and women in white lab coats? But that's an image problem, not a reality of medical practice.
We need to root out both incompetence and fraud in medicine to get control of the practice. Neither of these is addressed at all in our current system. We need a single point of entry to go after this sort of thing, but the politics is that raising the issue is a guaranteed loser for whoever does.
--Tom Clune
[ 18. August 2009, 13:53: Message edited by: tclune ]
Posted by New Yorker (# 9898) on
:
A glimpse into the future?
Posted by Crœsos (# 238) on
:
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.
Posted by Crœsos (# 238) on
:
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?
No, that's a glimpse of the present. If you don't believe that care is routinely denied by private insurance companies now, you are so far out of touch with reality that there is no real basis for discussion until you get up to speed on how medicine is actually practiced.
--tom clune
Posted by Erin (# 2) on
:
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?
Posted by Josephine (# 3899) on
:
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.
Did you read the article I linked to?
No, I didn't think so. Try reading it.
Posted by cliffdweller (# 13338) on
:
quote:
Originally posted by Macx:
[QUOTE]
Little by little, you will be converted. It has already begun, there is no escape. . . . no turning back.
Aack! My eyes! My eyes! The horror!
Posted by cliffdweller (# 13338) on
:
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).
Absolute. But neither Clint nor I said that. We simply expressed our difficulty understanding both the logical inconsistencies of the conservative argument, and the motivation of some of the protesters.
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.
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 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.
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 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.
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.
Posted by New Yorker (# 9898) on
:
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.
Posted by tclune (# 7959) on
:
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.
I'm afraid I don't understand the equivalence you are trying to draw here. If we have universal coverage, of any flavor, there will be no shifting of payment from uninsured to insured. However, because insurance companies have to maintain a reserve of money in the event of a statistically unusual run on services, cost of capital will apply in either case. The cost of that reserve can be overt, as with a private company's costs, or hidden, as when Uncle Sam provides the deeep pockets to cover anomalous events. If the private company has to pay for the reserve and a public option can simply dip into the public treasury as needed, then there is an artificial advantage built into the public option. Obama's point seemed to be that the private insurers ought to have access to the same capital funding mechanisms that a public option might have, to provide a level playing field for evaluating which operations were actually achieving economies through efficient operation.
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.
No, but the burden of proof is on those who are arguing for some large new government program. If it offers no known benefit, why would we do it? That's the point -- there is no gain that I can discern from the "public option" idea. I can see advantages to a single payer system, but I just don't see why a public option would add any advantage that we couldn't achieve without creating this new monster. So, what is it that creating this monster is going to do for us that we can't get without it? Saying that there might be such a thing isn't going to cut it. You need to identify what the advantage is (or at least is hoped to be).
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.
You still haven't come to grips with the basic point: If you can achieve all the advantages that you are after without creating a new and huge governemental entity, it seems overwhelmingly obvious that you shouldn't create the huge governmental agency. If a public option doesn't provide a benefit that you seek, while a single payer system would, then again you have not got any reason to adopt a public option.
Unless you're just a fan of large bureaucracy, showing no benefit is the same as a reductio on the assertion that we should create one. If you want to argue that we need this option, you have to establish that there is something of value that we can't get without it. That's not a very difficult point.
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
[ 18. August 2009, 15:57: Message edited by: tclune ]
Posted by ToujoursDan (# 10578) on
:
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.
Says whom? There aren't these kind of "death panels" in any proposed bill and the public option doesn't mean that those who have the ability to pay out of pocket lose the ability to do this.
Furthermore, there isn't a single country with nationalized care, like the NHS or Medicare Canada or Australia that does anything like this.
It's nothing more than something people have made up. It doesn't exist. It isn't being proposed. It's fiction.
Posted by Erin (# 2) on
:
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.
Really? I haven't read that, would you mind pointing me to your source?
Posted by ken (# 2460) on
:
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
The public option is the counterbalance to mandated participation. Health care for catastrophic situations is something that a) you don't know if you'll ever really need and, unless you're incredibly wealthy, b) you couldn't save up for even if you knew in advance you'd need it. Given this, the obvious solution is some sort of risk pooling, with everyone paying in and those "lucky" souls who get cancer or banged up in a car accident being the ones to draw on the pooled resources of the group.
The problem with a program that isn't allowed to turn anyone away is that the incentive is for healthy folks to save their money by opting out and only joining at the last minute if they need the service. One solution to this problem (the current one in the U.S.) is simply to make it so that you can't just join up at the last minute. The problems inherent in this "die in the gutter" approach are more or less why there's a health care debate in the U.S. at the moment, so I won't go into them here. The other solution is to simply mandate that everyone participate in the system. 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.
Posted by RuthW (# 13) on
:
Quit with the references to "death panels." No one has proposed such a thing.
Robert Creamer gives three reasons why we need a public option, one of which is practical and makes sense and two of which are entirely political:
1) If the government is going to require everyone to buy health insurance, it has to provide a public option, because otherwise they're requiring everyone to buy something from private entities that have no incentive to keep costs down because there is not enough competition among them. As he says, "Once government requires you to purchase a product, it has to provide some means to guarantee that the price is fair." The two ways to do this are for government to regulate prices -- fat chance getting that through Congress, given the insurance industry's pull -- or for government to provide a public option.
Something I'd add to what he says is that this could work the way California's low-cost car insurance works. The state requires all drivers to buy car insurance, and most people just buy insurance directly from private companies. But if you're poor enough, you can buy it through the state, which processes the applications and then randomly assigns people to private companies -- if you want to sell car insurance in California, you have to accept a share of low-income drivers. Premiums are set in each county to cover the costs of losses and admin.
2) The health care bill is going to get passed chiefly on the strength of votes by Democrats, and about 100 Democratic Representatives have said a public option is a must-have.
3) The public option is symbolic for the progressives, who are the only people who are going to get passionate enough to rise up in opposition to the loud voices on the right opposing health care reform.
Posted by tclune (# 7959) on
:
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.
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
[ETA: The political reasons listed in Ruth's post seem much more honest than this turkey of an argument. I saw Rep. Waters discuss why she would be damned before she'd give in on the public option. She never mentioned any virtue to the option at all. Rather, she said that she had wanted the single-payer option, and gave in on that because of political pressure. So she wasn't going to give in on this, too. But a stupid position is not worth defending. If she had fought for the single-payer system, it would have been a fight with substance. This is just a fight to insist that if she isn't going to get what makes sense to her, then the other side isn't going to get what makes sense to them. It is idiocy.]
[ 18. August 2009, 17:57: Message edited by: tclune ]
Posted by ToujoursDan (# 10578) on
:
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.
Posted by tclune (# 7959) on
:
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.
MA deals with this by requiring people to submit a form disclosing their insurance when they file their income tax. If they don't, they are fined a significant amount of money (although less than the cost of buying insurance.) If they can't afford insurance, there isn't a problem -- the state has a fund to provide coverage or a subsidy for those who needs-test as not having sufficient funds to buy it. We still do not have 100% insurance coverage, although it's pretty close (over 90%, but I forget the exact figure.)
There are people who are allowed to opt out. If you are a Christian Scientist, for example, you don't have to buy insurance. But, except in the case of people with a "note from their doctor," youare required to either get insurance or get fined. If you don't file income tax, you face other problems if you're caught...
--Tom Clune
Posted by ToujoursDan (# 10578) on
:
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.
When I look back at my own life, my bouts with poverty came quickly and unexpectedly when I lost a job and had to make decisions on what I had to pay for first. Putting a roof over my head and keeping the lights on were much more important than something nebulous like insurance. The thought that the state would further penalize me for being in such a position seem pretty cruel.
You'll never get universal coverage if the onus is on the individual to dig into their own pocket and buy a plan. If you don't have universal coverage then all the problems in the current system, with the uninsured showing up at the emergency room and their costs being borne by the insured, return.
A tax funded option would make more sense.
[ 18. August 2009, 18:13: Message edited by: ToujoursDan ]
Posted by Crœsos (# 238) on
:
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
While it may be true that there is a "wealth" of insurance companies nationally, thanks to the U.S.'s federalist patchwork of state laws the private health insurance available to many Americans is essentially offered by either a monopoly (Alabama's biggest insurer controls 83% of the market) or a cartel.
Details on the insurance markets in individual state can be found on this openly pro-reform website. National report here [PDF].
Posted by tclune (# 7959) on
:
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
Posted by Crœsos (# 238) on
:
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
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.
Posted by tclune (# 7959) on
:
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.
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
Posted by Darllenwyr (# 14520) on
:
A couple of points: First, on the logic that has been advanced, "Death Panels" should exist in a number of countries with publicly-funded health care, this one among them. No such panels exist, nor is there any suggestion that they should. However, there has been plentiful evidence in this thread that such panels, albeit covertly, already exist in the wonderful US of A. Will those who insist that Death Panels are the inevitable consequence of public health care kindly look at reality and stop daydreaming (or should that be day-mareing?)
Second, somebody please tell me exactly what I have missed? I see repeated complaints that the shortcoming of the NHS is that you have to queue for treatment ~ you cannot get anything done immediately. Aside of the fact that this is a gross over-simplification (ie, just plain wrong most of the time), can somebody tell me how having to negotiate with your insurer to obtain permission to proceed with treatment before doing so is in any practical way different from joining a queue, in so far as it introduces a delay? From what I have seen on this thread, the delays introduced by insurance companies far exceed anything caused by waiting lists in the UK today.
And, before anybody complains about that last remark, yes, I know that the UK has had its share of horror stories about excessively long waits for treatment. But therein lies the point ~ they were horror stories. In other words, they represented extremely unusual occurrences.
Posted by Crœsos (# 238) on
:
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
Actually I was responding to your assertion that the reason U.S. healthcare is so expensive is because people will get a whole bunch of tests and operations they don't really need because the cost is covered by insurance.
The point about the public option has already been answered at least twice: it provides a reasonably-priced competitor to largely monopolistic private insurers so that mandating participation doesn't turn in to a huge handout to insurance companies.
Posted by Honest Ron Bacardi (# 38) on
:
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?
Posted by ken (# 2460) on
:
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.
Posted by ken (# 2460) on
:
quote:
Originally posted by Honest Ron Bacardi:
Where exactly did this bizarre "death panels" stuff come from? How come nobody else has them?
Its weird. Its not just that, there is all the rest of the nonsense. The Stephen Hawking stuff was only the most egregious. It looks as if someone on the far right, for some reason, is really running scared. So scared they've be dropped any pretence at actual political debate and have resorted to screaming obscenities into the wind.
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.
Posted by New Yorker (# 9898) on
:
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.
Posted by ToujoursDan (# 10578) on
:
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.
So your fear of these so-called death panels (that haven't actually been proposed by anyone) comes from a song?
I never thought I'd see a whole country lose its grip on reality. But here it is.
Posted by Timothy the Obscure (# 292) on
:
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?
It was apparently made up by a talk-show host--NPR did a story on the origins of it, and played the tape in which she (I don't recall the name--it wasn't one of the really famous ones) claimed that on page 425 (or whatever number it was) of the bill there was a requirement that people over 65 be reviewed every five years to determine whether their lives are worth the cost of continued medical care. Pure fiction, of course, but that's the American right for you.
Posted by ken (# 2460) on
:
quote:
Originally posted by ToujoursDan:
I never thought I'd see a whole country lose its grip on reality.
A whole country? What whole country? Most Americans aren't falling for these tricks.
Posted by tclune (# 7959) on
:
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.
Wait! all those other countries don't speak English as their first language. That must be the key to lower costs!
The truth is that our costs are high because we had employer-supplied insurance, where nobody was paying attention to the costs until they became burdensome and our physicians had developed the expectation that they could become rich by working part time in a specialty like dermatology. Now, everybody gets their boils lanced by board-certified specialists instead of by grandma and the "customary and reasonable" reimbursement for that "surgery" is more than a typical person makes in a month.
Changing the mix of public and private insurers won't address our root problem. We need a single payer system to transform this bloated and self-serving medical establishment back into a service for patients instead of the mafia for physicians that it has become in this country.
--Tom Clune
Posted by Josephine (# 3899) on
:
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.
Posted by mjg (# 206) on
:
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%.
Just looking at numbers is misleading. What's the percentage in terms of dollars? They're going to reciss (if that's the right word) the really expensive stuff. Stuff that bankrupts people.
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.
Somebody has to look out for the consumer. God knows the insurance companies sure as hell don't.
Posted by mjg (# 206) on
:
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?
Hour long? She'll get her own weekly show.
Posted by Timothy the Obscure (# 292) on
:
She does sum up the conservative case against health care reform--"all I want is to get them [she says those who have been in office too long, but she clearly means Democrats] out of office." The Republican position is quite clearly "We don't care what might actually work to improve the health care situation (or even reduce costs to taxpayers, supposedly their big issue) we just want to hand Obama a defeat." It's a waste of time trying to compromise with conservatives because they don't believe in compromise.
Posted by CorgiGreta (# 443) on
:
Why doesn't her husband have coverage? Doesn't her plan offer spousal coverage? Is it not provided at any of her husband's two and a half jobs?
If her husband, God bless him, gets sick, will he stroll into an emergency room for free treatment at the expense those of us who pay for our coverage?
Greta
Posted by New Yorker (# 9898) on
:
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?
Not really.
quote:
I never thought I'd see a whole country lose its grip on reality. But here it is.
I think that happened on Election Day!
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.
And here is a link to the actual House bill.
Posted by mousethief (# 953) on
:
So you admit you know there are no death panels, and still you use that rhetoric to make some kind of rhetorical point.
Posted by tclune (# 7959) 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.
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.
My favorite "let them eat cake" moment from Lane's article was:
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.
Why doesn't everyone just call up their attorney and deal with this themselves? While it may be true in the abstract that Lane isn't "the only one who would rather do it that way", the fact that the typical American doesn't have an attorney on retainer might be a bit of a stumbling block.
Posted by New Yorker (# 9898) on
:
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.
I admit that the phrase "death panel" is not in the bill but the concept to which the phrase refers is in the bill. Kind of like the word Trinity is not in the Bible....
Now, of course, the Senate has assured us that the DPs will be removed from the bill. Or, as US News reports Score One for Sarah Palin. How does one remove something from a bill if it is not in there?
Posted by cliffdweller (# 13338) on
:
What is being removed from the bill is what's been spun into "death panels"-- reimbursement for doctors for time spent counseling w/ patients about end of life issues-- i.e. letting them know what their options are.
Oh, yeah, that's progress. We may still have people bleeding to death in ERs or dying because their HMO keeps punting their request to fund a transplant, by by God we'll be protected from the inhumane nightmare of having an uncomfortable conversation about death.
Posted by ken (# 2460) on
:
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!
That's those liberals all over.
Posted by davelarge (# 186) on
:
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%.
That was Blue Cross of California (just the one state, not all of Blue Cross) and two other insurers in this state (source here). There's no way they cover 50,000,000 people -- there are only about 36,000,000 people in California. According to the California Healthcare Foundation, 6.6 million of us have no health insurance. And we don't have just three major healthcare insurers in California -- while there are places that have just a few, we have lots.* So 4,000 rescissions per year for three companies in California is a lot.
One industry estimate is that this happens to 1% of individual policy holders (source here) (it supposedly doesn't happen to people in group policies, which is yet another reason some people stay in jobs they can't stand, but of course sometimes in a small business one sick employee can blow it for everyone). One insurance company says rescission happens to .1% of its policyholders. But think about who they're likely to be looking at -- the really sick -- and think about the likelihood that those people, who need health insurance more than anyone, are going to get their policies cancelled. Read this and do some math:
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.
*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.
Posted by tclune (# 7959) on
:
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.
Ruth, this is the sticking point for me: Blue Cross of California is not increasing its profits by 11 to 14% per year. It just does not appear to be the insurance companies that are, for the most part, the real source of the problem. I agree that there are problems that they represent -- denial of coverage, etc. But the growth in costs are not coming from the insurance companies.
I know that people are anxious to have something done about medical care. But I just can't get to a place where I can rationally believe that a public option addresses the real cost problems at all.
Single payer really does seem to offer the possiblity for reform where the problem lies. I would hope that it would include an honest enforcement provsion that would revoke those rare incompetent doctors' licences to practice, and then do away with the absurd malpractice morass that we have instead of real policing of the medical profession. But none of this is likely to happen until some half-way reform measure is tried and fails.
A public option just adds nothing positive to the mix. I can readily see it as poisoning the well further for a single payer option in the future, however -- "We tried a public option and it didn't help at all. Why should we turn the whole system over to something that has already been shown to not help?"
We need to acknowledge where the real problems are. They are in the way that medicine is practiced, not in how we pay for it. We need a lot less dependence on specialists and a lot more utilization of paraphysicians for primary screening, for example. We need to put more emphasis on wellness and less emphasis on treatment. We need to better determine whether drugs are as good for the patients as they are for the drug manufacturers and agressively pursue generics when possible.
No reforms of any sort in how medicine is practiced will be possible with a "public option." It is only possible with a single payer system, and physicians will fight it tooth and nail.
If we aren't going to do what is necessary to reform medicine, then we should just opt for tweaking the existing system with "insurance reform" that does not drag a "public option" into the equation at all. It will offer some genuine relief in the short haul and ignore the systemic problems. When they become impossible to ignore, we can revisit the issue without having tainted public involvement in the interim.
--Tom Clune
[ 19. August 2009, 20:39: Message edited by: tclune ]
Posted by davelarge (# 186) on
:
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?
Posted by aggg (# 13727) on
:
Seems to me that the veteran British politician Tony Benn made some good points on Democracy Now! yesterday - see and/or read here
People don't have a problem with state controlled universal schooling so why not healthcare?
Posted by Martin L (# 11804) on
:
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.
Prices are out of control. I certainly do not want the medical industry to be a for-profit industry.
Posted by tclune (# 7959) on
:
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?
But that is only true if the reason insurance is so expensive is because the insurance companies are price gouging. That, at the very least, assumes facts that are not in evidence.
--Tom Clune
Posted by Clint Boggis (# 633) on
:
You're right Tom. But how can we find out where the money's going?
Presumably big insurance companies have to file profit figures for tax purposes and their stock will be an indication of whether they're raking it in.
What about hospitals? Whether they're commercial or non-profit they must produce some financial reports which say whether their costs are rising as fast as their charges do.
What about drug companies? This may be harder because some are huge multinational corporations and will move cash around the world to reduce tax liability and fund research in the most favourable locations but their stocks will surely tell the story.
What about doctors and other individual health workers? They must file tax returns which show if their income is rising unreasonably fast compared with general costs.
Is the picture very hard to judge? Surely some journalists are looking into this kind of thing to find out where the vast sums end up and who benefits most.
.
Posted by mousethief (# 953) on
:
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.
Posted by Photo Geek (# 9757) on
:
Clint said
quote:
You're right Tom. But how can we find out where the money's going?
Evidently you're not the only one wondering about the money.
Article in the Wall Street Journal Online You may Need to register in order to read it.
Posted by CorgiGreta (# 443) on
:
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
[ 20. August 2009, 00:50: Message edited by: CorgiGreta ]
Posted by RadicalWhig (# 13190) on
:
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.
The irony is that a public single payer plan is very similar to a voucher plan, which the right supports for schooling. Both combine universal public funding with a choice of provision.
Posted by OliviaG (# 9881) on
:
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. ...
AIUI, insurance rates depend greatly on the state of the markets, because that is where insurance companies park their income. When the markets go down, rates go up. OliviaG
Posted by Alan Cresswell (# 31) on
:
Medical costs of $35,000 doesn't seem to be very much to me. I'd have expected practically anything that gets you more than a couple of days in hospital and course of generic painkillers or anti-biotics to be taken at home to exceed that. 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?
Posted by tclune (# 7959) on
:
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?
This varies by state. It doesn't happen in Massachusetts. There is something like three or four other states that regulate the industry in a way that precludes this to some extent. But MA is the champ currently in consumer protection wrt health insurance.
Many states have individual plans that run for something like six months. If you make a claim during that time, the company will not renew you because of your "preexisting condition" (the fact that you availed yourself of the insurance in the last six months).
It is not irrational to go without insurance in those states, but there's a catch. If you get medical services and pay for them yourself, you will pay retail. The insurance companies negotiate massively reduced prices for everything. My last bill for routine lab work showed that the bill was $400, but because I had insurance, the cost was $100, which my insurance company mostly paid.
One meaningful reform would be to just standardize the rates for services instead of selling medical services like we sell used cars. It is a shameful system all the way around. Reform is needed. Much of it can be improved for the individual in the way that Massachusetts did. But the really important reforms will require a structural change in how medical services are delivered, not just access to decent insurance even if your employer doesn't provide it.
--Tom Clune
Posted by Jason I. Am (# 9037) on
:
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.
My understanding of the difference is that the public option involves doctors employed by the state, whereas single-payer involves doctors employed by private companies, but bills for their services paid by the state.
In a single-payer system, what keeps the private companies from gouging like oil companies? And if there is price-cap regulation, is it still significantly different from the public option?
Posted by New Yorker (# 9898) on
:
The government screws up a used car program, but we want it to run our health care?
But don't worry, Obama's friends are doing very well while the rest of the country tanks.
Meanwhile, Thomas Sowell makes sense as usual. Three of the better quotations:
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.
Posted by Crœsos (# 238) on
:
quote:
Originally posted by New Yorker:
The government screws up a used car program, but we want it to run our health care?
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.
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.
Posted by tclune (# 7959) on
:
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."
Yes, VA medical care went through a major reform fifteen or twenty years ago, and is now generally very good. I meant to call Macx on his suggestion that VA was lousy medical care but never got around to it.
The follow-up care for Iraq War veterans was a genuine problem that resounded to the VA's discredit, but is anomalous in its current form. In the old days, the VA was awful. Now, they may be caught unprepared when there is a huge increase in a kind of care that just wasn't the norm in previous wars.
But we shouldn't over-interpret that slowness of response to an evolving medical situation. It was right to call attention to it, and my understanding is that it has still not been completely dealt with across the country, but the VA is moving in the right direction and will get to a point of addressing the needs in a timeframe that is pretty much the norm for a huge organization.
--Tom Clune
Posted by davelarge (# 186) on
:
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.
Posted by prettybutterfly (# 15024) on
:
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.
[ 20. August 2009, 14:41: Message edited by: tclune ]
Posted by tclune (# 7959) on
:
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.
I agree entirely. I am not proposing any particular form of single-payer system, just arguing that anything less is completely incapable of addressing the issues that plague our current system.
--Tom Clune
Posted by Erin (# 2) on
:
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.
NO MEDICARE as the universal plan. The only reason why Medicare recipients are happy is because of the price controls which ultimately result in cost shifts to those of us with insurance or paying out of pocket. A lot of the time the Medicare payment does not even cover the actual cost of the service, much less provide any sort of cushion to pay staff or for the upkeep of the facility at all.
Medicare needs to be off the table as an option as it sucks the hind tit right off a sow.
Posted by davelarge (# 186) on
:
OK, so when you say 'public option' you mean a government-run insurance scheme, not government-managed services?
[Edited to add - cross-posted with Erin. My question is aimed at tclune.]
[ 20. August 2009, 14:47: Message edited by: davelarge ]
Posted by ken (# 2460) on
:
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.
That's how it is in UK. Although most hospitals are publically owned (though by no means all), most doctors are not employed by the NHS. GPs run their own business affairs. Consultants (i.e. senior hospital doctors & specialists) are in effect private contractors. They do both private and NHS work.
I suppose in the US jargon (we don't really use those words here) the NHS is "single payer" but "mixed provider".
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.
Posted by lady in red (# 10688) on
:
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.
I'm struck that taken in isolation, this sounds a lot like the French system to me. National insurance + other insurance to pay what it doesn't cover. Up to the individual to decide whether they want to see a doctor charging more than the average (and therefore paying more, either in insurance or in upfront fees).
Healthcare in France is more expensive than in the UK, but the care is also better. You pays your money (literally), you takes your choice about which one you prefer.
[code]
[ 20. August 2009, 15:05: Message edited by: lady in red ]
Posted by tclune (# 7959) on
:
quote:
Originally posted by davelarge:
OK, so when you say 'public option' you mean a government-run insurance scheme, not government-managed services?
That's the "public" part of it. The "option" part requires that the government not be the only insurance offered to people.
There has been the suggestion that the "real" agenda of people proposing a "public option" is that they want to create a skewed playing field where the private insurance companies are driven out of business, so it is an end-run to get a single-payer system without having to endure the political flak in the process.
That strikes me as plausible. The arguments offered in favor of a public option make no logical sense as stated, which requires one to either believe the proponents are stupid or dishonest. I suppose it may be seen as more gracious to see them as dishonest.
In addition, it has been widely publicized that Medicare initially was intended to be a public option. It just ended up being subsidized to a point that nothing else could compete, and within a year it became the only game left standing. That was an unintended consequence of Medicare -- we just didn't realize what we were doing at the time. 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.
--Tom Clune
[ 20. August 2009, 15:19: Message edited by: tclune ]
Posted by Moth (# 2589) on
:
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.
Posted by davelarge (# 186) on
:
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.
The article most frequently cited is this one from Health Affairs, but it is unfortunately behind a subscription wall.
Posted by Dafyd (# 5549) on
:
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?)
Posted by Clint Boggis (# 633) on
:
Hawking said he wouldn't be here (presumably alive) today if it weren't for the NHS. That implies that he relies on it. Honestly -how could someone with his medical history get commercial insurance health cover at ANY price?
I was so pleased to see the ignorance and stupidity of those who think the NHS has death panels and lets us poor Brits die in the streets, revealed for what it is. Sadly those people don't listen to facts. Witness people here STILL citing Obama's "death panels" however slowly and simply they're told: "it's all fairy tales."
Stupidity may not be the sole reason some people are resisting change but (aside from personal financial gain) sure as Hell is the main one!
.
[ 20. August 2009, 16:47: Message edited by: Clint Boggis ]
Posted by Carys (# 78) on
:
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?)
I think you'll find that Crœsos was being sarcastic. It was an American editorial last week that suggested that Stephen Hawking would not be alive if it had been left up to the NHS (with the implication he was American). He has since come out to say how much he owes the NHS.
Carys
Posted by Lioba (# 42) on
:
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.
Neither Lutheran priest nor doctors are civil servants. The churches pay their clergy's salaries themselves and doctors run independent surgeries.
[ 20. August 2009, 17:22: Message edited by: tclune ]
Posted by Crœsos (# 238) on
:
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.
Most likely. But for the record, a brilliant scientist with an otherwise incapacitating condition on the run (metaphorically, of course) from his own evil government with nothing but his vast intelligence (and a rag tag team of friends) to keep him alive? That's a movie I'd pay good money to see. If anyone in Hollywood is reading this, I expect 10% of the box office. You're welcome!
quote:
Originally posted by Dafyd:
(Does Stephen Hawking really get all his medical treatment privately?)
“I wouldn’t be here today if it were not for the NHS. I have received a large amount of high-quality treatment without which I would not have survived.”
- Stephen Hawking
Posted by IconiumBound (# 754) on
:
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.
Posted by Crœsos (# 238) on
:
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.
It's been mentioned at least once already in a link to this blog post which makes many of the same points you do. Still, the question of why this isn't more widespread is probably similar in shape to angry seniors who want to makes sure the government keeps its hands off their Medicare.
Posted by RuthW (# 13) on
:
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
I'm well aware of all of this! I said there are a large number of health insurers in California not to say that people here have lots of choice in their health insurance; as you surmise, I have no choice (and dear God I wish it was Kaiser, but no, it's HealthNet). I was posting in response to mjg's assumption that the 4,000 rescissions per year figure was a national figure and took place out of a guesstimated 50 million people insured. Those 4,000 rescissions per year are just in California and just for a few of the many companies that operate here.
So the reality is that we have death panels run by insurance companies. That people like Chuck Grassley and Sarah Palin are getting away with their lies is despicable. If the language in the House bill that they are twisting and mis-reading into talk of death panels is eliminated, what it will really mean is that Medicare will not cover counseling about end of life care, hospice, living wills, etc.
Posted by Crœsos (# 238) on
:
Here's a polically relevent variation on end of life preparations:
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."
The law in question was passed in 2004 to prevent the possibility of then-Governor Mitt Romney appointing a successor to John Kerry should Kerry's presidential bid have been successful.
Posted by New Yorker (# 9898) on
:
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.
Posted by Josephine (# 3899) on
:
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?
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.
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.
So was I. I was commenting on the apparent ability of the US right-wingers to seize on any detail they can twist to support their lies.
Posted by davelarge (# 186) on
:
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.
What happens in Manitoba is that if you need an ambulance, you dial 911 and you get it.
Once your medical emergency has been taken care of, you are expected to pay $250 (I think). This is partly to help cover the costs, and partly to act as a deterrent from using the ambulance as a taxi service to the hospital. You have quite a long time to pay, and if you will find it difficult to pay, the cost can be reduced or waived.
I (fortunately) have never had to call and ambulance here, so I may have some of the details wrong. It may also be different in other provinces.
I was surprised by the arrangement when I first learned of it, but I can see what they're trying to do and I sympathize with the problem of false and spurious callouts. I don't think the charge is ideal, but at least there is wiggle room for those who cannot pay.
Posted by Moth (# 2589) 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.
.
You are indirectly charged if you get compensation for the injury that required the ambulance service. The most common example is road accidents. The person who caused the accident will have to compensate the victims, but of course, this is usually dealt with by his or her motor vehicle insurance policy. Part of that compensation will be to pay the medical costs of their care to the NHS, on a fixed scale of charges. You can read about it on the DWP web site . The person paying the compensation also has to pay back certain benefit payments, such as statutory sick pay etc. Of course, this reduces the compensation payable to the victim, but the rules are well-known, and taken into account when negotiating compensation.
The ambulance service is always free at point of use, and it is only if compensation is received that any charge is payable, and then it is usually paid by the insurance company directly, so the patient does not see a bill.
Posted by New Yorker (# 9898) on
:
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)?
Well, not all, surely things are not that bad!
quote:
Doesn't the possibility exist in your mind that seemingly sane, intelligent, freedom-loving people would choose and support universal health care?
Sure. There are lots of intelligent people who are wrong on specific issues.
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?
Every system has advantages and disadvantages. And, why would they want the American system? 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.
quote:
Are all us citizens of Canada, Australia, New Zealand, the UK, Europe, and Scandinavia really just that deluded?
Again, surely not all.
[N.B: I'll be away for a few days without assurance of internet. So your pardon if I am unable to post.]
Posted by davelarge (# 186) on
:
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.
.
I suspect that people are charged for frivolous misuse of the system such as dialling 999 because they have got a minor cough or a splinter in their finger - if you have a genuine emergency that requires attendance of a paramedic and/or urgent hospitalisation, the ambulance comes and you don't pay.
Possibly also some health authorities make a charge for the non-emergency ambulances to transport patients to outpatient clinics or return them home from a hospital stay. I'm just speculating here - however in my experience that has not happened. When I was in hospital for my knee replacement I requested transport home afterwards, and to my physiotherapy sessions, as I couldn't drive and didn't have anyone at home who could drive me, and this was provided at no charge.
Posted by New Yorker (# 9898) on
:
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.
We disagree stronly on this board, but I do wish each of you a great weekend.
Posted by Alan Cresswell (# 31) on
:
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!
Which is, almost certainly complete bollocks!
Posted by Ricardus (# 8757) on
:
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.
Posted by Sioni Sais (# 5713) on
:
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.
New Yorker must be writing about a proposed American socialized health care system. Under such a system these statements may well be correct, if only because many of those involved in it will be determined to see it fail.
Posted by RadicalWhig (# 13190) on
:
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?
Posted by Marvin the Martian (# 4360) on
:
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.
And how many people can afford to do that? It sounds like a great thing in principle, but in practice it's hideous. It amounts to no more than the poorer members of society being denied care. How any supposedly civilised group of people can sanction such a system is beyond me.
But that's the GOP all over. Their attitude is no more than "I'm all right Jack, and sod the rest of you". How very Christian...
Posted by tclune (# 7959) on
:
quote:
Originally posted by Ricardus:
quote:
Originally posted by New Yorker:
<snip>
Lies.
quote:
<snip>
Lies.
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
[ 21. August 2009, 12:47: Message edited by: tclune ]
Posted by lily pad (# 11456) on
:
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.
Posted by Moth (# 2589) on
:
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!
If you can point to one documented case of this, I'll be very surprised.
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.
You know, if you believe this, you are really crackers. If I don't get the treatment I want, I am perfectly free to pay for it myself. In terms of medical care, I am fortunate enough to be perfectly well, and haven't ever been denied treatment. The closest I've come is that my GP has said he can't prescribe something (nothing life-saving, maybe just a particular brand of skin-cream or antacid) and he writes the name down so that I can buy it myself from the pharmacy if I wish.
I buy my own dental care, as my preferred dentist is non-NHS. I buy my own optical care, as only children and those on benefits get free optical care on the NHS. My younger son is entitled to free spectacles, but I upgrade to buy him designer ones myself.
If I want medical care that I can't get on the NHS, I'll just ask the specialist concerned how much it is to go private, and then I'll check myself in to the nearby private hospital and have the treatment. The fact that I've never needed to do this speaks for itself; I don't even bother with private health insurance because I really don't need it. If I was concerned about costs, I'd check out the eastern European countries and maybe go there - Poland offers some very cheap dental implants at present, for example, and I'm told that the care is excellent.
I would guess I have spent about £500 - £1000 on health care this year on top of taxes, mainly on dental and optical care (I have expensive varifocal specs, and have needed complex dental care this year). In addition, the government pays about $2929 per capita per annum (2006 figures) for the rest of my medical care.
Would you like to give me your medical costs per annum? I can tell you that your government pays $3074 per capita per annum (2006 figures), so I guess I've already won on tax paid for medical care. I get a full emergency and non-emergency medical service for my tax dollars, other than optical and dental. What do you get? In addition, I get completely free care for my son (including dental and optical and all drugs), and can cap any drugs costs at £104 a year for myself. I have a card that entitles me to care in any EU country on the same terms as nationals of that state, which makes travel insurance cheaper except if I go to the USA.
quote:
We disagree stronly on this board, but I do wish each of you a great weekend.
You have a great weekend, too!
Posted by Josephine (# 3899) on
:
quote:
Originally posted by New Yorker:
One other thought before I depart.
Before you go, New Yorker, I have a question I hope you can help me out with. I have struggled for many years to follow the advice of Martin Luther from the Small Catechism, to interpret the behavior of others in the kindest possible way. And I'm having some real problems finding a kind way to interpret your behavior, and that of those who agree with you, in a way that seems kind.
Here's the deal. When you say something like this:
[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[/qb]
I wonder whether you actually know anything at all about how our system works or not.
I have a friend with good insurance and a child who is severely mentally ill. The doctors wanted to hospitalize her child. The insurance would not pay for a psychiatric hospitalization. For the hospital to admit her son, she would have to pay for the hospitalization up front.
Maybe you can blithely say, "You are still free to obtain the treatment and pay for it yourself," but I challenge you to look a mother in the eye, when her son is delusional and a real danger to himself and other people (including his siblings), and tell her that. It's like saying to a man who is unemployed, homeless, and hungry, "You are free to buy all the food you want and pay for it yourself."
That may be true. But the Scriptures have something to say about people who look at the poor and say, "Go on your way. Be warmed and fed."
You're a Christian man. You know that. So what am I to think of you?
Do you believe that it's okay for tens of thousands of people in this country to die every year because they couldn't afford medical care?
Or do you not believe that sort of thing really happens?
Do you believe that our system of delivering medical care is affordable and sustainable for the long run?
Do you understand that the various government-supported systems in other countries provides better results than ours does, at much less cost?
Because I'm having trouble figuring out whether, on this issue, you are ignorant (but how could you be? accurate information is not hard to get), or whether you are dishonest, or whether you are so invested in your political party and its platform that you are self-deluded, or whether you lack the mental abilities necessary to understand the issues and evaluate the facts.
As none of those explanations seems particularly kind, I'm hoping there's another option that I've missed. If you could help me find it, I'd be grateful.
Posted by davelarge (# 186) on
:
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.
And just to confuse things further, in Winnipeg, the (combined) paramedic and fire services are run by the city.
Posted by ToujoursDan (# 10578) on
:
Exactly. [EDIT: To Lilypad]
The Federal Government provides the finances to the provinces, but the actual healthcare services are administered by the provinces and vary greatly.
In fact, if you live in one province and seek NON-emergency care in another province, you will have to pay out of pocket. It's cheaper than in the states but it isn't free. (This also happens in some cases when you move to another province. There can be a 30 day window before coverage kicks in.)
And while New Yorker may not be intentionally lying, (s)he is passing on complete falsehoods about how the Canadian system works.
One thing that I have been amused about in this debate are all the untruths about the Canadian and British system I keep hearing about, like those repeated above.
It's even more bizarre when some Americans have told me these false claims with great sincerity and authority, when I (as a Canadian who has indeed experienced the Alberta and Quebec medicare system first-hand) have then replied that these claims simply aren't true and would have led to a national scandal and reform of the system if they were true (because, you know, Canada is a democracy and fairly responsive to the needs of the population), and have been told by these same Americans that I have it wrong, or I have been brainwashed.
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.
[ 21. August 2009, 13:19: Message edited by: ToujoursDan ]
Posted by ken (# 2460) on
:
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.
Here, if you call an ambulance, it just comes.
I have called an amublance recently (a neighbour of mine was collapsed in the street - drunk as it turned out). The ambulance came. The paramedics did their business, said goodnight, and went away.
Whay do you have a problem with that?
Posted by tclune (# 7959) on
:
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.
Anyone who believes this obvious was raised inadequately. Everyone should have learned that you need to clap really hard to make your heart's desires come true...
--Tom Clune
Posted by Clint Boggis (# 633) on
:
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.
It's amazing how often the truly ignorant are so completely sure of their 'facts'!
quote:
Originally posted by ken:
Here, if you call an ambulance, it just comes.
Why do you have a problem with that?
'cos of damned gummint interference!
[...]
What business is it of theirs to save people's lives indiscriminately, even if they're poor!
.
[ 21. August 2009, 14:06: Message edited by: Clint Boggis ]
Posted by Crœsos (# 238) on
:
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.
This is essentially arguing that there are no ambulances in Canada. Sure, you can call for them but they'll never show up, so it's the same as not having any. If that doesn't set off your bullshit detector, I don't know what will.
Here's an account by a Canadian of his encounter with the Canadian medical system. An excerpt:
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.
Now New Yorker and Dr. Day (who, according to his Wikipedia entry, is sometimes called "Dr. Profit") would have you believe that this could not possibly have happened, that since the Canadian system doesn't cover ambulance service no ambulance could possibly have taken this man to the hospital, i.e. there are no ambulances in Canada. Now I personally never needed an ambulance on the one occasion I was in Canada, but to imply they don't exist strains credulity.
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
I have some policy-related questions about this which are better addressed over in the Styx.
Posted by Leaf (# 14169) on
:
New Yorker: I did not see the interview with the former head of the CMA, so cannot say what was said or how it has been interpreted. But if you think that in Canada, "if you have a heart attack and ring for the paramedics, they won't come" that is simply, completely, totally false. I can say this with assurance because I have been present on occasions when 911 was called - the ambulance comes, even if it's to where the taxis won't go. The paramedics do not ask for proof of payment or insurance before treatment or transportation. They treat the person and take them to the hospital if needed.
Posted by OliviaG (# 9881) on
:
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! ...
Well, if that's what he meant, he's wronger than a wrong thing with wrong sauce on National Wrong Things Day. I've called an ambulance for a student with a tummyache and it came. They came, although we waited for almost 20 minutes. The response was much, much faster when I called an ambulance for a service worker who fell down the stairs and had a head injury and a broken arm. The calls are prioritized. And yes, there's a bill, and it's reasonable considering you're getting much more than a taxi ride, and a lot of people have extended health benefits which cover all or part of the cost to the rider/patient. Perhaps the good doctor was confused -- it's not beyond the realm of possibility that he's never actually had to call an ambulance. OliviaG
Posted by ToujoursDan (# 10578) on
:
My mother, who at that time was unemployed, divorced and in dire financial straits, had a heart attack in her home in 1989, called the ambulance and they were there in 10 minutes. They brought her to a small nearby regional hospital, but they were not equipped to do the kind of open heart surgery she needed and chartered a helicopter to fly her to a larger hospital to do the surgery. I made to hospital and saw her for a few minutes and then the doctor told me that the helicopter was here and that I needed to drive to the other hospital and wait. So I left. It was going to be about an hour's drive.
I stopped by my house to get a book and some supplies for the long night ahead of me when I got a message. Sadly, she died of an aneurysm soon after I left.
We weren't billed for any of it.
If people think doctors (or anyone else in Canada) don't have agendae, then they are incredibly naive. If something doesn't sound right, it is OUR responsibility to do a fact check before repeating it as if it were truth.
If ambulances weren't showing up like this there would be stories about it all over the internet. Wouldn't there? Wouldn't there be news stories asking why Americans get ambulances and we don't on TV and on the internet? Wouldn't something like this outrage people? Wouldn't they say and write something about it? If Canadians are anything we're obsessed about how we are different than Americans, both good and bad, so wouldn't something like this get a lot of play in the Canadian press?
Shouldn't the fact that there isn't raise a red flag? Isn't this the point where people actually wonder if things aren't what they're being told? Isn't this the point where we take responsibility for what we are saying and NOT say something unless we are sure it's factual?
It's this moral and intellectual laziness that really gets to me.
Posted by Ricardus (# 8757) on
:
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.
As I said in the Styx - I didn't mean to accuse New Yorker personally of lying, only to suggest that the allegations which he is repeating are lies. However, I appreciate that's not how it came across, so I apologise.
Posted by Hawk (# 14289) on
:
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.
Posted by Crœsos (# 238) 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.
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?
'Cause you're you and I know you'll appreciate it, here goes:
The responsibilities of the Federal Government and Provinces are outlined
here in Sections 91 and 92 of the Constitution Act, 1867.
The Provinces have responsibility for most "local services", including hospitals. Due to historic development, the Federal Government has always transferred funds to the Provinces and controls most of the income tax base and half the sales tax base. Every province gets at least a third of its revenue from federal transfers, often more.
The Feds pay for about half of national medicare costs under terms of the Canadian Health Act, which says that doctors and hospital services are the primary covered benefits. The act also bans extra billing by fining the extra amount from the provincial transfer.
Essentially we have national funding and local implementation. Most hospitals are owned by their local community, a charitable foundation, or a religious order. St. Joseph's Hospital is an extremely common name around here.
Posted by RadicalWhig (# 13190) on
:
Thanks, SPK. I always appreciate your explication of things Canadian.
Posted by New Yorker (# 9898) on
:
This thread has dropped to page 2. I don't know that it should be revived but I did want to answer Josephine.
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."
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.
Posted by RuthW (# 13) on
:
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.
Posted by New Yorker (# 9898) on
:
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.
Posted by tclune (# 7959) on
:
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.
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.
Instead, we'll get a steady drip-drip-drip of poorly-targeted cuts, like the freeze in Social Security benefits for everyone for at least the next two years.
But you should not feel guilt-free about this -- hysterical cries that "The death panels are coming" help insure that serious issues are not discussed honestly. We really do need to come to a consensus of what most of us are willing to pay for and what we are willing to forego to revamp our broken medical and retirement systems.
As long as people think that there is a political advantage in demagoguery, there will be no realistic possibility of coming to such a consensus through public discussion and debate.
--Tom Clune
Posted by cliffdweller (# 13338) on
:
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.
Reminds me of a speech by Harold Ockengae (first president of Fuller Seminary) in which he described an atheist and a fundamentalist walking in a garden. The atheist points to a flower and says "that's a rose". The fundamentalist hears "that's a not-made-by-the-triune-God rose".
Makes dialogue really, really challenging.
Posted by Crœsos (# 238) on
:
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
Well, the other problem is that when a group that has always maintained that certain programs shouldn't exist anyway (like Republicans with Social Security or Medicare) advocates cuts to that program, it will inevitably be seen as an attempt to weaken or undermine that program with an eye towards its eventual elimation. Especially if the group in question has publically advocated a tactic descriptively named "starve the beast".
Posted by Honest Ron Bacardi (# 38) on
:
I'm not sure how relevant this is to the discussion in hand, but since this thread is the closest...
There was an interesting programme here on BBC R4 this morning. Robert Peston (BBC economics specialist) was interviewing a leading American hedge fund manager. The discussion centred around shorting (i.e. short selling) and its part in the recent collapse of stock markets worldwide.
The interviewee (sorry - I've forgotten his name) pointed out that the whole financial market apparatus is based upon constant verification and confirmation. The successful hedge fund manager tunes all that out and looks for serious anomalies. It was hedge funds that spotted that Enron's highly-lauded business model was predicated on complex financial structures that turned hypothetical future profits into real profits today - and in any event lots of this profitability was gained by trading on favourable terms with wholly-owned subsidiaries. Once that was spotted, it became clear that the whole business was a ramp, so they went short on it. Yes, it crashed, but it would have crashed anyway, and it was not actually hedge funds that brought about its demise. Indeed, it could be said that it was better it crashed when it did, rather than it being allowed to suck even more cash from the gullible.
Likewise it was hedge funds that ceased to believe the rhetoric of the housing bubble, and the dependence of the ever-more-leveraged banks upon it. To blame the hedge funds for causing banks to crash by shorting them ignores the fact that the banks' business model was increasingly unsustainable, and that is what the true source of the problem was.
All very interesting, and no doubt arguable. But the really interesting bit came at the end, when Robert Peston asked what his tips were on the next big thing likely to get the shorting treatment. The interviewee pointed out certain things to look for - unsustainable finance being an obvious one, but others included increasing drifts from reality, unsustainable future projections, rhetoric unlinked from the real world... He then suggested a prime candidate would be American healthcare insurers.
I pass this on in case you might have any investments in this sector, but it is also interesting in relation to the discussions here.
Posted by Honest Ron Bacardi (# 38) on
:
(missed the edit window)
Just having looked it up, the interviewee was Jim Chanos.
Posted by RuthW (# 13) on
:
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.
That's a summary -- there is as yet no bill, so I stand by what I said.
Furthermore, I can see two major problems just from skimming through the summary.
1. What's going to make insurance companies participate in the exchanges? It's going to be the people who are racking up the medical bills who will be looking for insurance through those exchanges, and insurance companies will just opt not to participate.
2. The notion the $2300 per person rebate is going to be enough to cover a health insurance premium for someone buying individual health insurance (as opposed to getting it through an employer) is ludicrous. They think somehow that $2300 will be filled out with higher wages due to tax cuts, which is also laughable, especially considering that this is coming from the side of the Congressional aisle that's moaning about the size of the deficit.
Posted by New Yorker (# 9898) on
:
Ruth, here is a link to the bill itself. I am told that Pelosi is anxious to move it forward! (Right.)
Posted by RuthW (# 13) on
:
Busted link. Who told you Pelosi is anxious to move this forward?
Posted by New Yorker (# 9898) on
:
This link should work.
Sorry. I was joking about Pelosi.
Posted by 3M Matt (# 1675) on
:
As far as I can see, Healthcare is something which just very naturally lends itself to a single state run system, free at the point of need.
It stands to reason that a private system will be concerned with making profit. By and large, any company which makes a profit does so by A) convincing you to buy a product and B) persuading you to pay more for it than it actually costs
In my view, all private healthcare systems do this. They persaude people to spend money on things they don't need. (e.g. On British TV at the moment there is frequently an advert for a company who will do a whole-body MRI scan "check up" on you just to make sure nothing is wrong..an extremely unneccessary check which is likely to generate all sorts of false diagnosis)
Second you will pay over the odds. Witness the advertising of drugs on american TV which aim to convince you that a newer (i.e. More expensive) drug is better than the cheaper one you are already taking.
For healthcare to work well, profit has to be taken out of the equation, and that essentially means a state run service in my view.
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.
As a doctor, I can confidently state that nearly every patient I ever see gets the appropriate treatment for them. Not neccessarily as quickly as I would like, not necessarily in as pleasant surroundings as I would like, but, none the less, they get it.
If the NHS doesn't offer you a treatment, it's overwhelmingly likely it's because that treatment is not actually proven to do you any good...rather than just because we are being tight with the cash.
Of course, any private system is subject to market forces like product promotion and advertising, so there are vast numbers of americans out there who believe that they know what will do them good, and want to be able to choose it. (Regardless of the fact they have probably just been sold a lemon by the drugs company)
The main problem we have with the NHS financially, in my view, is "overspill" of our services into social services. Far too often the NHS plays "babysitter" for what are really social problems. (i.e. Old lady languishing in a £500 a night hospital bed for weeks because she needs a meals-on-wheels service made available for her at home)
The other problem is having a target driven healthcare system. Targets are wonderful for politicians, because it gives you quotable soundbites. "We've reduced X disease by Y percent in the last 5 years".
The problem is that anything which doesn't lend itself to statistical analysis and target setting is roundly ignored.
However, I cannot begin to imagine how you could have a private system which in any way functioned as well, and as fairly as a state run system.
Another point is the question of doctors in training. A state run system has a vested interest in training junior doctors. A private based system only has an interest in employing fully qualified exeperienced doctors.
That is why British medical schools are still considered amongst the best in the world.
Posted by Jane R (# 331) on
:
3M Matt said: quote:
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.
I don't want "choice", which is in any case a nonsense unless you live in a big city like London or Manchester and have several hospitals within easy travelling distance. I want to be able to rely on my local GP and local hospital to give me the appropriate treatment for any ailments and/or injuries I have, referring me on to specialist centres where necessary.
Politicians are trying to introduce "choice" into the NHS because they think it will keep voters happy without significantly raising costs. I think they're wrong on both counts. Firstly, because most people who have just been told they have a life-threatening condition do not want the hassle of working out which of the many hospitals in the UK they would like to be treated at, and secondly, because all this extra "choice" introduces more bureaucracy. Which costs money.
Jane R
Posted by Timothy the Obscure (# 292) on
:
On Fresh Air yesterday, Terry Gross interviewed T.R. Reid , a foreign correspondent who has lived in several countries with different health care systems and is able to discuss them both as a professional observer and as a patient. Well worth listening to.
Posted by prettybutterfly (# 15024) on
:
I've just been referred to a specialist by my GP (NHS) and have been sent a letter informing me I can choose from five different centres in the county! I have no idea what to pick. I'm not especially fussed about choice, I'm just glad I get treatment free at the point of use, a speedy referral and a short waiting time.
Posted by Josephine (# 3899) on
:
quote:
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.
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."
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.
Thanks for answering, New Yorker.
You'll forgive me for pointing out that, in the rhetoric from the Republicans and their supporters on this issue (and I'm afraid that includes you), I hear very, very little concern for the poor. I don't even hear much that sounds like concern for fiscal sustainability. What I hear is:
quote:
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.
That may not be what the Republicans are saying, but it's what I'm hearing (and I'm deliberately leaving out the crazies are saying).
If you believe that taking care of the poor is a significant goal of health care reform, it would perhaps be a good idea to make that one of your significant talking points -- both why the current system has failed, and how the proposals by the Republicans would be better.
Posted by tclune (# 7959) on
:
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
Posted by cliffdweller (# 13338) on
:
quote:
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
I think it will make it more difficult-- he had excellent legislative instincts and, despite a reputation as a more extreme liberal, was a true bridgebuilder who was able to build coalitions across the aisle. I don't think it will be the "final nail" in health care reform-- pray that it won't be cause I don't think the economy will recover w/o it-- but it will definitely be a harder task.
It is sad that he passed away before being able to see health care reform pass-- something he'd worked for since the 60s.
Posted by Luigi (# 4031) on
:
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. I just pray that in Britain we never adopt anything like the American system. From what I can gather, I could pay for health care - but not everybody I care about could.
Posted by tclune (# 7959) on
:
quote:
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.
I think the concerns that aren't just political posturing are often centered around the will of people to continue on the given course. We are facing huge problems with Social Security (our retirement money that the government provides) and MediCare (the medical insurance that the government provides for all retirees). There have to be huge changes in these systems. People basically know that, and are worried about what those changes will look like.
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? We are going to run somewhere between 7 and 9 trillion dollars in the red as a government over the next decade. That's even a lot of money for the US government.
Compounding the problem is a generational divide. Young adults are looking at the huge cost of their parents' retirement benefits and not getting warm fuzzies about it. The post-WWII "baby boom" generation is huge, and we didn't have the usual 8.7 kids, so the number of young folks who would be paying for the retirement benefits of the baby boomers is not a lot more than the number of retirees. Oddly enough, our kids are just good enough at math to worry about that...
We have had a tendency to provide benefits without means-testing to make them more palatable to the recipients. Social Security is provided to the people who got those $100 million dollar bonuses on Wall Street as well as to the guy who worked in a blue-collar job that didn't pay enough for him to save for retirement. Medicare is provided to every wealthy blue-haired widow in Florida.
One effect of this is that the older generation is, as a group, better off than any other in the US. So our kids, again, look at the idea of "splitting the cost of health care" with granny and decide that that isn't really a great deal for them. Furthermore, the kids firmly believe that none of these programs will be there for their retirement, so they feel the need to save for their own old age.
All this put together makes for political dynamite.
--Tom Clune
[ 26. August 2009, 17:54: Message edited by: tclune ]
Posted by Crœsos (# 238) on
:
Social Security is not facing "huge problems", it's facing minor long-range difficulties that could be corrected fairly easily (at least compared to other programs). It tends to get lumped in with Medicare and Medicaid under the general term "entitlement programs", but there's no program called SocialSecurityMedicareandMedicaid. Medicare and Medicaid are having what could accurately be called "huge problems" mostly having to do with the large inflation in U.S. medical costs, but Social Security is doing all right. 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?
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.
Posted by RuthW (# 13) on
:
quote:
Originally posted by New Yorker:
This link should work.
I still think it's a recipe for disaster, and am no more convinced than before about the Republicans being at all concerned about people's wellbeing. 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.
quote:
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.
Is Medicaid unpopular because it's a bad program or because it serves the poor?
Posted by tclune (# 7959) on
:
quote:
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?
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. 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.
(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
Posted by cliffdweller (# 13338) on
:
quote:
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?
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. Add to that those who are insured but struggling to pay their premiums, and the companies going bankrupt under the weight of rapidly escalating benefits costs.
The reality is, we can't fix those other problems you mention w/o fixing health care. It's all inter-related. We can't fix the economy, deal with medicare or social security, if we continue to spend 2x what every other country is spending on health care. Yes, it's going to be a VERY rough AND costly transition, and yes, it's going to add to the massive debt inherited from the last administration. But there simply is no other way to get there.
In terms of the government taking on the cost of the uninsured, that happens already. We are already paying for the cost of the uninsured on all three levels of government (federal, state, and local) through government assistance programs and through our ERs. And we (the insured) are paying through it through higher insurance premiums to cover the cost of that ER care. The problem is that we are providing that care (for the uninsured) in the most expensive and least effective way possible-- through the ER.
So the question isn't really will we provide health care for the uninsured. We already do that, and of course will continue. The question is will we do so in a way that is both extraordinarily costly while at the same quite ineffective (leading to worse outcomes, including premature death), or will we do so in a way that is cost-effective and results in saved lives and improved quality of life? To me the choice is obvious.
Posted by RuthW (# 13) on
:
And another thing: Sen. Enzi (R-Montana) has admitted that he's not negotiating in good faith. Quoth Enzi:
quote:
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.
Posted by tclune (# 7959) on
:
quote:
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.
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
Posted by Crœsos (# 238) on
:
quote:
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.
Actually, many economists do accuse them of doing just that, for largely technocratic reasons. In order to 'err on the side of caution' the Social Security Administration routinely assumes substandard economic growth in its projections. On the other hand, if we assume growth levels more in line with the past thirty years the revenues are quite sufficient to maintain Social Security.
quote:
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.
The Trustees Report on which those FAQs were based was issued in May of 2009 and most certainly did include the recent economic collapse. That was what moved the exhastion of the Social Security surplus from 2041 to 2037.
As for the question of COLAs, no one ever promised that "benefits will continue to go up each year". It's been promised that benefits will remain constant in terms of purchasing power, which is what the COLAs are supposed to accomplish. The COLA for 2009 (which was set in mid-2008, before the economy went under) was 5.8%, a significantly larger "raise" than most workers got for 2009. Given that the change in the U.S. cost of living was actually negative from the beginning of 2008 to the beginning 2009, setting next year's Social Security COLA at 0% doesn't seem tremendously unreasonable, given that negative COLAs are forbidden by law. In short, the "COLA freeze" is not a cost-saving measure but rather an acknowlegement of the reality that the change in U.S. cost of living is relatively flat right now.
quote:
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
Maybe you and I have different definitions of "massive problem", but a government program that may, if economic growth is bad for the next few decades, be forced to cut back benefit levels to 74% of their current levels in twenty-eight years does not seem like a pressing crisis. It seems more like a back-burner issue that shouldn't distract from a health care system that seems to be imploding right now.
Posted by cliffdweller (# 13338) on
:
quote:
Originally posted by tclune:
quote:
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.
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
Ah! much better.
Posted by tclune (# 7959) on
:
quote:
Originally posted by Crœsos:
As for the question of COLAs, no one ever promised that "benefits will continue to go up each year".
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.
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.
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
Posted by Crœsos (# 238) on
:
quote:
Originally posted by tclune:
quote:
Originally posted by Crœsos:
As for the question of COLAs, no one ever promised that "benefits will continue to go up each year".
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.
I guess it depends on what you consider an "increase". For example, say you get a voucher for $20 worth of gasoline per month when gasoline is $2/gallon. Now suppose the following year your voucher increases to $25/month but gasoline is $3/gallon. In purely numerical terms your benefit has "increased" from $20 to $25, but in real world terms you've gone from something that's equivalent to 10 gallons of gasoline to something equivalent to 8.3 gallons. The modifier "with inflation" above seems to me to indicate an increase in numerical value while holding steady with regard to the rate of inflation.
quote:
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.
It may be true that a "senior adjusted" CPI would be different (and potentially higher) than a general CPI, but since the general CPI for the last year has been about -4% and since 0% is still higher than than that, it still holds true that the Social Security COLA is outstripping general inflation.
quote:
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
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.
Posted by Luigi (# 4031) on
:
Thanks Tom for that response. Will try to respond further in the morning.
Posted by tclune (# 7959) on
:
quote:
Originally posted by Crœsos:
quote:
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.
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.
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.
Whatever the real motivation, there is a great disturbance in the force, and voters are worried about how the federal government is running these programs that average people depend upon. You may not believe that. But it really is true, and as I indicated to Luigi, that is why Americans are more on edge about this set of reforms than seems warrented to an outside observer.
--Tom Clune
Posted by romanlion (# 10325) on
:
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.
Any participant who had taken the same percentage as SS from every check they ever earned and invested it in the markets would have retired wealthy years before SS eligibility. 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.
Anyone who honestly thinks that this kind of management and return on investment is what our healthcare system needs is, IMNSHO, daft. As someone totally opposed to the idea all I can say at this point is thank goodnes for Barack Obama!! We all knew he was a rank amateur, but his lack of political skill surprises even me. Under the same circumstances that dropped election in Obama's lap, Bill Clinton would have had his plan through well in time for summer recess.
*Up to the soon to be removed "limit" of course which has always been a lot more than I earn.
Posted by tclune (# 7959) on
:
quote:
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.
Have you been paying attention to the private pension funds at all??? They are all broke, and most have defaulted so that the government (thanks to Republican sleeze under the arch-fiend Reagan if memory serves) bails them out to the tune of 50 cents on the dollar. On a personal investment level, my own 401(k) tanked with the economy. Given all that, I'll gladly stick with the government. They may not be doing well, but they're outperforming the alternatives nicely.
quote:
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
[ 27. August 2009, 01:17: Message edited by: tclune ]
Posted by Crœsos (# 238) on
:
quote:
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.
If you say so. If that's the case, what is the proper, non-zero value for 2010's COLA, and how did you arrive at that number?
quote:
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.
That's pretty much by design. 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.
Either Social Security is separate from the General Fund or it isn't. If it's separate then the T-bill market is an irrelevancy as far as Social Security is concerned, a reflection of the desire of the U.S. to sell more debt than the market has confidence in, and thus really a problem of the U.S. Government as a whole. If they're not separate then there is no funding crisis particular to Social Security since funds can just be transferred over from the General Fund. In this second scenario there can be a General Fund crisis, but not a Social Security crisis.
Posted by Crœsos (# 238) on
:
quote:
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!
Posted by tclune (# 7959) on
:
quote:
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
Posted by Crœsos (# 238) on
:
quote:
Originally posted by tclune:
quote:
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
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!
Posted by tclune (# 7959) on
:
quote:
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!
The "normal retirement age" has not been 65 for some time. For the last of the boomers, it is currently pegged at 67. While the notion of when the baby boom ended is plastic, few sources push it as early as 1962. In fairness, few also push it as late as 1970, either...
--Tom Clune
Posted by ken (# 2460) on
:
quote:
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.
Sounds like a cheap-money scam to me. Like mortgage tax relief. Puts up prices. Supply and demand and all that.
US healthcare costs twice as much per pill as some other countries. Public provision pays the same prices as private. So tax breaks for insurance premiums increase the cost of healthcare paid for out of tax. A lose-lose situation.
Forgetting the morality of it, if you want to cut prices and save money you need to subsidise the supply side, not the demand side. Which is one reason its a good thing that many hospitals are charities.
Posted by Luigi (# 4031) on
:
Tom said quote:
quote:
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
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
[ 27. August 2009, 18:35: Message edited by: Luigi ]
Posted by tclune (# 7959) on
:
quote:
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
I was actually making the more generic point that good governance doesn't seem to be getting done, and not really getting into reasons why. But let me say emphatically that I do not believe Republican governance to be effective. The only things that GW seemed to do effectively was run up the debt, erode our liberties, and start pointless wars.
The problems the Dems are facing are many-faceted. First, the country itself is highly polarized. One person's good idea is another person's tyranny. Since these feelings tend to fall along geographical lines, they get fully reflected in our governing bodies. That was the intent of our founders, but things like the Civil War should have made us consider whether that original intent was a good one.
Second, we have created a money cess pool in Washington DC. There has always been a leaning in that direction, but under GW the lobbyists grew something like tenfold. We have not recovered from this infestation, and may never do so. It is exacerbated by our right-wing Supreme Court that insists that political money is free speech protected by the Constitution, even if the "person" speaking is a legal fiction instead of actually being human.
Third, without the usual political divide, we still have serious interest divides when it comes to health and retirement benefits reform. The most pronounced, of course, is between the young and the old.
But most distressingly, President Obama seriously mishandled the health care debate. He learned from President Clinton's mishandling that crafting a bill behind closed doors in the White House wouldn't work. So he let the Congress craft a bill behind closed doors on the hill. Surprise, surprise! That doesn't work, either.
I honestly believe that the kind of process that he had said he would use when he was running for office was the right one -- have open hearings on C-Span where the issues would be discussed in the open, the problems clearly identified for eveyone to see, and then the proposed answers hammered out in open and public meetings involving as many of the main stakeholders as you could fit into the meeting space.
You don't need every Tom, Dick, and Harry to have a chance at the mike. But you do need for every Tom, Dick, and Harry to see that their concerns have been given an honest hearing and have helped to shape the final legislation.
In point of fact, something very much like this process was used by Governor Romney when the Massachusetts plan was put together. People across the spectrum said pretty much the same thing about it when the final deal was hammered out -- it wasn't what they would have preferred, but it was as good an agrement as they could get, and was better than the status quo.
I get the distinct impression that all sides are unwilling to honestly discuss the issues. They are afraid that, if they admit that illegal immigrants are going to get access to health care anyway, they will be villified as soft on immigration. If they dare to say that we can't afford as much health care as anyone could ever want, even if it is not likely to be medically useful and will be exhorbatantly expensive, they are afraid that they will be accused of favoring death panels. If they say that physicians have to stop driving the system to more expensive but no more effective care, they'll alienate the doctors. And so it goes.
The answer seems to have been to opt for "mushroom" legislation, and the response of many voters has been that they feel like they've been kept in the dark and fed sh*t. Go figure.
--Tom Clune
Posted by romanlion (# 10325) on
:
quote:
Originally posted by Crœsos:
quote:
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!
Certainly can't argue with solid logic like that!. As long as I die married, or with minor children, or a dependent parent they can be secure in the knowledge that my 6% investment of every dollar I ever earned will provide them a crappy little check each month until they drop dead or turn 18. Fantastic! Wonder why the SSA doesn't advertise and accept private funds for investment in such an unbelievable opportunity? A tiny commission on the trillions of dollars that would roll in would save SS and retire the debt in a matter of months, I'm sure!
And who said anything about a conspiracy? Anyone who thinks SS is a great deal is fortunate that they continue to draw breath and blink on occasion. They certainly couldn't hatch any conspiracy!
Posted by Josephine (# 3899) on
:
An interesting article about using house calls to reduce hospitalizations, improve care, and lower costs.
Posted by Moth (# 2589) on
:
Josephine, we have such a system in the NHS - District Nurses. My elder son's girlfriend's mother is a District Nurse for our area. (She works the night shift from 10 p.m., allowing her to be around for her younger children after school until their Dad gets home). It's a good system.
Posted by Luigi (# 4031) on
:
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.
When I look at the USA and see the power and the vitriol of the right wing media, for example, I will be surprised if Obama can deliver half of what he wanted to do. Bearing in mind that probably the most important action he needs to take (for the rest of the world) needs to be in the area of climate change, and considering the difficulties he is having / will have with that, none of this makes me optimistic.
It seems that it is easier for humans to spoil than construct and we are at a point in history where we really need to guard against our natural myopic tendencies.
PS this post is not intended to send this thread off on a climate change tangent
[ 28. August 2009, 08:46: Message edited by: Luigi ]
Posted by tclune (# 7959) on
:
quote:
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.
It may have. But my honest best guess is that it would have led to a Massachusetts style insurance reform. This addresses a number of important issues -- universal coverage, people can't be refused insurance for pre-existing conditions or dropped when they get sick, individuals can buy group insurance instead of being in a risk pool of one, etc.
However, the 800 pound gorilla in the room is getting costs under control. This requires a single-payer government-run plan, and I don't think people would be willing to agree to that.
I suspect that all the secrecy and back-room maneuvering was an attempt to sneak that in, creating a "public option" as a stalking horse if necessary. But the electorate is just too damned stupid to realize what is at stake. I don't think there was any way to get this done openly, and we have seen that it doesn't fly as a stealth plan.
I guess we'll just have to wait (and not very long, either) for the crisis, and then do stupid things to try to recover from the disaster. We have overwhelming evidence that private enterprise does not tend to work for the public good (can you say world-wide economic collapse?), but there is a huge and baseless ideological commitment to privaate enterprise, even for services that scream to be public services.
For example, my garbage is collected by a private company, for which I am billed about three times what I used to pay when it was part of my town taxes. It is bizarre but completely predictable that the average American will see a successful government program as "wasteful" and an overpriced and unresponsive private company as "successful." I don't understand it, but I know that I can count on that form of stupiditiy from my countrymen.
--Tom Clune
Posted by New Yorker (# 9898) on
:
quote:
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.
Posted by Crœsos (# 238) on
:
quote:
Originally posted by New Yorker:
quote:
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.
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.
Posted by tclune (# 7959) on
:
quote:
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.
I think I agree with this, but would express it differently. When I was growing up, the major media periodically presented hour long "white papers" on important topics. They explored the issue and presented the understanding of the reporters on what was going on.
Nowadays, "reporters" get two media flaks from the two major parties together to yell at each other and interrupt each other's rants, and call that "fair and balanced reporting." It is lazy and uninformative crap. The only virtues of this approach is that the two major parties can't really complain about the "news coverage" because they were actively involved in insuring that no education took place, and the network didn't have to spend much money to clog the airwaves with the drivel that it produced. If this is what a "free press" looks like, I say bring on the chains...
--Tom Clune
Posted by Erin (# 2) on
:
quote:
Originally posted by ken:
US healthcare costs twice as much per pill as some other countries. Public provision pays the same prices as private.
NO THEY DON'T. How the hell many times do I need to say this?
Posted by Josephine (# 3899) on
:
quote:
Originally posted by New Yorker:
quote:
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.
I suggest you read What Liberal Media? by Eric Alterman.
Posted by Timothy the Obscure (# 292) on
:
quote:
Originally posted by New Yorker:
quote:
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.
Yeah. The Nation versus Fox News.
Posted by New Yorker (# 9898) on
:
quote:
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.
Posted by Erin (# 2) on
:
The Washington Times?! Are you serious?
Posted by mjg (# 206) on
:
Obama Faces the New Political Realities of Health Care
quote:
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.
Posted by Honest Ron Bacardi (# 38) on
:
quote:
Your claims here seem to be more a matter of ideology than history.
Which claims, mjg? (Just trying to follow your argument)
Posted by Hiro's Leap (# 12470) on
:
quote:
Originally posted by Honest Ron Bacardi:
Which claims, mjg? (Just trying to follow your argument)
I think that's just his sig, isn't it?
Posted by tclune (# 7959) on
:
Slate has a pretty good brief article explaining the cost issue of medical practice. It (and NPR) somewhat misrepresents the situation in MA, though. There is no problem getting a primary care provider in MA -- it is just not necessarily a physician. Many people have PAs or nurse practicioners for their primary care provider. AFAIK, there is no evidence that this lowers the quality of care that people receive.
--Tom Clune
Posted by Sober Preacher's Kid (# 12699) on
:
Honestly, I think the situation is a little overblown. It's early September, and Congress isn't back in session. It's still the Silly Season. Wait for a month for real action to begin.
Canada had two doctor's strikes on the way to our current system, so a little rough-and-tumble is to be expected.
Posted by Josephine (# 3899) on
:
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.
Posted by alienfromzog (# 5327) on
:
quote:
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.
This is why it's such a mind-boggling debate from this side of the pond.
The NHS is not a system without problems. I work in it and could tell you a few stories. However, whichever way you look at it, our single-payer 'socialised medicine' is better than the US 'system.' The shear dishonesty or ideologically-blinded zeal with which the NHS has been attacked recently is astounding (I can't tell which it is).
It has been put to me before that this is America's problem and that we Brits should butt-out. Well there are two things I'd say to that. Firstly, I am a humanitarian, I want good healthcare for ALL of God's people - even Americans. Those that wine about it aren't generally the ones that suffer and it's a gross injustice. And secondly, the NHS is the subject of political attack constantly, and anything that undermines it like the attacks we get from over the pond folds into an on-going agenda from some on the right-wing that want to do away with it and leave us with an American - based private system. As a doctor, I'd probably be financially better off in such a system but I would seriously consider emigrating if that were to happen.
Some simple facts.
1. The NHS's total cost is ~£1700 per capita for total coverage
2. The UK's life expectancy and healthcare outcomes are better than those in the US
3. The tales of years-long waiting lists simply aren't true. The longest you can wait for a non-urgent operation is 17 weeks. The longest you can wait for a cancer appointment is 2 weeks.
4. The UK system has a built-in bias to preventative care, particularly over the last 10 years, this has significant long-term benefits which insurance schemes don't have.
5. The NHS is the most effecient system in the world.
6. The US is the only developed country without univeral coverage.
There are some better healthcare outcomes in other European countries with insurance-based schemes but they spend a lot more money than we do. We should be spending the same in my view. The major disadvantage of the NHS is that it's subject to political whim and interference from the top. (Both political with a small and large 'p'). There have been several suggestions as to how to improve this and I live in hope of some of them coming to be. In the meantime, the downside of the NHS is, in my view, a price that is well worth paying for the massive massive benefits.
Maybe that's the problem; it's a complex debate. The argument (from my distant perspective) seems to be; We don't want a single-payer system because of a, b, c, d, e, f and g...
Where a, b, c and d aren't true;
d and e are true but are no worse than the current situation
and f and g are completely true but much better than the downside of the current system.
In a sound-bite culture those that shout loudest - ie. those with the most money tend to be most heard.
That's enough from me, for now, except to say, the NHS is great.
AFZ
Posted by Clint Boggis (# 633) on
:
Thanks for the summary of facts AFZ from inside the NHS.
I'm another satisfied NHS 'customer'. Like so many others on this thread, I'm aware of its faults, but I appreciate its efficiency and ability to produce very good results from meagre resources. Well done NHS!
I'd love to be able to point out to the US 'right' who despise the idea of a system which covers everyone and believe the usual lies about the NHS that we're due an election within a year in Britain and any party which threatens or hints that they want to cut back or reduce the NHS in any way is committing political suicide.
That should be an indicator as to the true picture here and how we value it. We're not daft!
.
[ 07. September 2009, 17:14: Message edited by: Clint Boggis ]
Posted by Sober Preacher's Kid (# 12699) on
:
Wow. Either all our American shipmates are in shock or Obama gave one snoozer of a speech. Or Comcast has overloaded, or something.
Obama proposed what I thought he would: a Massachusetts plan. Honestly the Commonwealth should charge the president royalties for stealing his ideas. Better yet, that system was signed into law by none other than Mitt Romney.
I never thought Obama would go for single-payer: IMO it's a no-flyer in the US.
What he is proposing could work. Before anyone jumps on the dreaded "Public Option", let me explain exactly what he proposed: a classic not-for-profit Blue Cross/Blue Shield plan with no plan limits. That's all it is. It will involve Community Rating, a system that was abandoned in the 1970's as other insurers cherry-picked the best customers. The only reason such a system is not available everywhere in the US right now is twofold:
1) Some Blue Cross plans have become for-profit and some have been acquired by third-party for-profit insurers.
2) Blue Cross plans have steadily abandoned the Community Rating system which takes all comers.
The simple solution is to re-convert the for-profit Blues back into not-for-profits. Everything else can be done within the existing framework.
Obama even compared his plan to Auto Insurance legislation. Hehe, I made that comparison before his speech.
Before anyone jumps up an says that Obama's plan won't work in the US, remember, it is currently found in Massachusetts.
Where's tclune when you need him?
Posted by cliffdweller (# 13338) on
:
quote:
Originally posted by Sober Preacher's Kid:
Obama even compared his plan to Auto Insurance legislation. Hehe, I made that comparison before his speech.
LOTS of us did.
Posted by New Yorker (# 9898) on
:
Barry's most important line of the night was when he said (something to the effect of) "we still have to work out the details."
Posted by tclune (# 7959) on
:
quote:
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.
It's important to keep in mind what the MA plan does. It provides essentially universal coverage that cannot be cancelled and eliminates the exclusion for preexisting conditions. It also provides a guaranteed minimum amount of coverage for all people who are insured. If the federal plan adds that there is no maximum coverage beyond which one is no longer covered, I'm not actually sure that MA provides that. For typical people, it hasn't been an issue, but I just don't know the details well enough to know whether this would represent an extension of MA coverage or not.
The BIG thing that the MA does not do, and that the Fed plan does not do AFAICT, is address run-away costs. The big lie in all the Democratic rhetoric on health care reform is that the costs are due to insurance companies gouging the customers. There is just no evidence of that being a wide-spread problem as far as I know.
The costs are due to the way that we practice and pay for medicine. We send all real conditions to specialists and they opt for treatments based, at least in part, on what is most lucrative for them. I don't think that doctors generally choose to hurt patients, but they are running a business. If they can sell you a Cadillac instead of an Aveo, they will. As a society, we are simply not yet willing to acknowledge that basic and well-documented reality.
So I think that Obama is getting what the country has agreed they want -- universal coverage. And he's punting on cost reform. The problem with the way we're proceeding is that he has not come out and said as much. When we get the reform through (assuming we do), people are going to feel cheated because it doesn't save money. I think that's a dangerous way to govern, although I can appreciate that folks will take what they can get, in whatever way they can get it.
If anything has become clear during this debate on healthcare, it is that combining cost reduction and universal coverage into one bill will guarantee that the bill dies -- there are just too many oxen being gored at once by that approach. 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 would be nice if man were a rational animal, but it appears that he is not.
--Tom Clune
Posted by mjg (# 206) on
:
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:
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?
Posted by tclune (# 7959) on
:
quote:
Originally posted by mjg:
quote:
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?
Medical care is consuming vast amounts of our GDP. 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. It has become an insatiable moonster.
While the population is aging, the massive increases include that God-awful prescription drug benefit, AKA big-pharma enrichment plan. In addition, we continue to push medical care up the expense ladder without regard to whether or not we are gaining any medical benefit thereby.
The people driving the medical decisions are the doctors, and they are benefitting mightily by the current sytem. Nobody is telling them "No," and they have done a terrific job convincing people that "rationing" their over-priced and under-effective services is a socialist plot!
We cannot continue to give this small segment of our society even the current ~20%, let alone allow the wild growth rate to continue. When they have bankrupted Medicare and the insurance prices become too much for us to bear, even with Federal subsidies for the lower and middle classes, we will have reached a crisis. I can't imagine our being able to put the day of crisis off more than another decade. But I am constantly amazed by the ability of the American people to tolerate pain for no apparent reason.
--Tom Clune
Posted by Hiro's Leap (# 12470) on
:
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?
Posted by Hawk (# 14289) on
:
quote:
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.
Posted by tclune (# 7959) on
:
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?
It was something like that, yes. I guess the growth is slower than I remember, but pretty staggering anyway. Thanks.
--Tom Clune
Posted by Erin (# 2) on
:
quote:
Originally posted by Hawk:
quote:
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.
Doctors are not limited in any such way. There is an excellent article from June's New Yorker magazine that talks about doctors gone wild.
Posted by tclune (# 7959) on
:
quote:
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.
Doctors are free to prescribe whatever they want, without regard to whether there are generic equivalents or not. Doctors are heavily courted by the drug companies, and patients are bombarded by ads on television and in print media. Doctors routinely prescribe the brand name drug and patients are fine with getting a name they have seen on television, becasue they don't pay for it directly anyway.
As to exams, there are times when, e.g., MRIs are more appropriate than x-rays. For example, when one wants to image the soft tissue or liquid in a bony environment like the knee, there is really no substitute for an MRI. But MRIs are ordered in many contexts where an x-ray is equally effective. The reason is money -- the doctor makes about ten times as much money interpreting the MRI as he does interpreting the x-ray.
Many diagnostic procedures are ordered basically because they are "free money" to the doctor. In almost no case, for example, does it make sense to screen a woman for osteoporosis. But an annual BMD will be paid for after menopause, so the woman gets a BMD every year, even if she's an elephant.
This has nothing to do with "defensive medicine." It is all about running a business. There is nothing evil in that -- it just needs to be subject to controls from knowledgeable people who aren't getting paid to keep the game going.
We see the same effect in, e.g., executive compensation. It has shot up because the people who determine what the executive should be paid are people who have a vested interest in incrasing the executive's salary. There is no mystery about what happens in these circumstances -- we just want to believe that somehow doctors aren't economic animals. It's weird.
--Tom Clune
Posted by The Blessed Pangolin (# 13623) on
:
quote:
Originally posted by New Yorker:
quote:
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.
Oh, dear God. If you think CBS, et al., are left wing, you wouldn't know a socialist if he/she bit you on the ass.
Posted by RuthW (# 13) on
:
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.
No, he's a political realist.
And just because you haven't heard it doesn't mean Obama has not discussed this:
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)
However, getting rid of fee-for-service payment for doctors will not be all we have to do. 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.
Posted by Hiro's Leap (# 12470) on
:
Last year the Guardian had an intriguing article about the inevitability of spiraling health costs:
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%.
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.
Posted by tclune (# 7959) on
:
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.
While the wellness idea makes sense, the notion that doctors 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 still. But most specialties have done considerably better than that. 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.
--Tom Clune
[ 10. September 2009, 17:18: Message edited by: tclune ]
Posted by RuthW (# 13) on
:
quote:
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.
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:
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.
It's not the individuals -- it's the structure they're working in that conditions their behavior. Of course doctors are economic animals, just like everyone else. Change the structure, change the incentives to reward different behavior, and they'll act accordingly.
Also, they're not just economic animals (again, just like everyone else). If they only wanted to make money, they'd have gone into MBA programs or been entrepreneurs instead of going to med school. As a group, doctors do want to make money, but they also want to do something difficult and rewarding, and they want to help people, and they like prestige.
[ 10. September 2009, 17:23: Message edited by: RuthW ]
Posted by tclune (# 7959) on
:
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.
Not handy, no. This sort of thing is surprisingly hard to get reliable numbers on. When you do see an in-depth analysis of physician incomes, you find that one problem with many tables (especially those provided by the professional groups) is that many specialties have undergone little growth in income as a physician, to use the term that is often tacked on to these misleading tables. For example, if a physician buys all or part of an imaging center, and gets half of his income from that, it is not reported in these studies as his "income as a physician." But his hours working "as a physician" have also gone down, and his total income, all of it based on his practice of medicine, has gone up dramatically.
I'm not trying to paint physicians as the bad guys here. But it is within their power to change the system, and they don't do it because it is working very nicely for them, thank you very much.
Actually, the New Yorker article that Erin linked to is very good. It doesn't have the tables of income you asked for either. But it provides a pretty interesting study of the nature of the cost problem (It's by a physician, if that matters to you). If I manage to run across good data on physician income over time by specialty, I'll provide a link. But, as I mentioned, objective and reliable data for these things are rare as hen's teeth.
--Tom Clune
[ 10. September 2009, 18:34: Message edited by: tclune ]
Posted by ken (# 2460) on
:
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.
Of course. Healthcare expenditure will go up and up. There are vast amounts of new technology coming down the pipe that will make it possible to cure many more illnesses and extend healthy life much longer. No-one sane wants to grow old and die, so if we can pay to put that off we will.
One day medical expenses will probably take the majority of the income of the whole world, more than everything else put together. Why not? You can only use so many cans of beans or DVDs but you can always use an extra year of life so if you can get it by paying for it you will.
What if most people could live to a hundred and twenty if we all spent five times as much on healthcare as we do now? (From a scientific point of view that is very plausible, maybe even conservative - we might be able to in effect re-engineer ourselves for an indefinite lifespan). The British or Japanese might be able to pay five times what we pay now. Healthcare would go up to 40 or 50% of the total economy. That is believeable.
But if US unit costs for healthcare continue to be 150%-200% of those in other developed countries they will hit the wall sooner. YOu can't spend 100% of all your money on healthcare (or anything else). You probably can't even spend 80 or 90% of it.
At them moment Americans on average live a few months less than British or Japanese (who pay much less for healthcare), maybe a year or two less then Canadians, French or Scandinavians (who pay a little less). If things go on as they have been (which of course they almost never do) then in twenty or thirty years time Americans might be living for five or ten years less than the French. And I am sure they won't like that.
So unit cost reduction is going to happen. But it might be associated with a continuing increase in the total healthcare spend. Because people who can buy health for money will want to get as much as they can for their buck. And voters will vote for life rather than death.
Posted by Sober Preacher's Kid (# 12699) on
:
Ruth, I find your information on drug plans appalling. As a former insurance agent and a long-time diabetic, I can say that Manadatory Generic Substitution plans are the norm in Canada. It defies common sense if they aren't in the US. It's the easiest cost-containment plant o implement and generics are just that: equivalent to brand-name in terms of their active ingredient.
One of the minor scandals of Canadian healthcare is that the provincial drug formularies which hospitals use have far too many brand-names on them instead of generics. Drug companies have good lobbyists.
Actually nothing would benefit my financial life better than generic insulin at generic prices.
Posted by Crœsos (# 238) on
:
Unfortunately the U.S. Bureau of Labor Statistics only has online wage data going back to 2001. According to them, though, the average pay for a worker in "Health Care & Social Services" in the private sector was US$631/week in 2001 and US$811/week in 2008. (The 2008 value is preliminary and may be adjusted up or down later.) That represents an average annual pay increase of 3.7%
If we just look at private sector hospitals (which leaves out family physicians, nursing homes, etc.), health care workers there made an average of US$691/week in 2001 and US$924/week in 2008. That's about a 4.2% increase per year. Whatever's driving the increasing cost of U.S. healthcare, that money doesn't seem to be going into the pockets of health care workers.
Posted by Dave W. (# 8765) on
:
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.
[ 11. September 2009, 01:10: Message edited by: Dave W. ]
Posted by Crœsos (# 238) on
:
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.
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.
Posted by tclune (# 7959) on
:
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
Posted by Josephine (# 3899) on
:
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?
One thing to keep in mind, when looking at charts like this, is that in the 1930s, when medical expenses were 4% of GDP, there wasn't a lot that medicine could do, and doing nothing is cheap.
In 1932, my dad was a toddler. He was sick, feveris, having trouble breathing. The doctor came out to the house, diagnosed pneumonia, and told his parents that the crisis would come during the night, and if he survived 'til morning, he'd probably be okay. He put an extra bit of coal on the fire in the room, and advised them to keep the room very warm. I don't know what the visit cost, but it couldn't have been much. (My grandparents didn't have much.) My father, of course, survived, but he was a sickly child for many years after that.
Fast-forward 50 years or so. My oldest son was a baby. He sick, feverish, having trouble breathing. We took him to the hospital. They did a chest X-ray, diagnosed pneumonia, prescribed medication, and sent him home. No one worried that he might die. There were no long-term effects from his illness. In fact, within two or three days, you couldn't tell he'd been sick.
My daughter was blue and floppy at birth. (For those of you who are familiar with them, her Apgar scores were 2 and 3.) There were no risk factors we knew of -- she was full-term, and the pregnancy had been uncomplicated. As soon as she was born, she was whisked off to neonatal intensive care, where they determined that she had pneumothoraces. She recovered completely and was allowed to go home from the hospital when she was 3 days old. Three days in neonatal intensive care costs a small fortune. In 1930, it wouldn't have cost anything. She'd simply have died.
We will never go back to spending just 5% of our GDP on medical care, nor should we. We should, of course, spend prudently. We should insist that health care providers do basic things like wash their hands to prevent infections. We should refuse to give antibiotics for every sniffle and sneeze. We should insist on getting full value for all the money we spend on health care.
But we should recognize that doing something will always cost more than doing nothing, and when we spent 5% of our GDP on health care, nothing was pretty much all we could do.
Posted by Crœsos (# 238) on
:
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
I'll see what I can do to find it. Part of it seems like the logical consequence of significant number of not-for-profit insurers changing over to for-profit operations, including some of the larger Blue Cross/Blue Shield organizations, during that timeframe. Naturally if you have to produce a certain level of profit to satisfy shareholders you're going to have to take that out of somewhere, but even given that, a fourfold increase in the 'skim' seems excessive.
As a quick check, according to the annual reports issued by Wellpoint, the for-profit insurer that controls (among its other holdings) California Blue Cross/Blue Shield, their annual cut of the premium pool has been in the twenty-something percent range since at least 1998 (when they were known as Anthem). I have no idea how typical Wellpoint/Anthem is among health insurance giants, they were just the first one that came to mind.
Posted by Dave W. (# 8765) on
:
Slate now has a correction to the article I quoted, saying doctors' take-home pay is 10%, not 1%, of US health care spending. Here's a direct quote from Prof. Reinhardt in the NYT:
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.
Posted by Clint Boggis (# 633) on
:
If those on the political right are dead set against President Obama's proposals, are they committed to going back to the current patchy health cover, allowing insurance companies to not cover those who have claimed much, the huge economic drag caused by employers' health costs, depressed labour mobility, health-related bankruptcies and dramatically rising health costs as a proportion of GDP? Wouldn't that make them appear rather stuck in their ways, puppets of the health lobby and fighting against the general good?
Which parts of the proposals would they be most likely to change when they get the chance?
Assuming something like Obama wants actually gets implemented (in the face of strident opposition) what's going to happen in the next few years? 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. And better outcomes are not easily costed as overall benefits.
I can imagine his legacy as a one-term president who saved the country from its short-sightedness.
.
Posted by Josephine (# 3899) on
:
Erin, I've got a question for you. You've mentioned plenty of times that Medicare is bad because its reimbursement rates are so low. But is it really worse than the reimbursement rates from private insurers?
I'm asking because I just got an EOB from our plan. It's for a bunch of lab tests. First test, billed at $18, they paid $1.95. Next test, billed at $48.00, they paid $8.18. Next, $30, they paid $6.15. And so on and so forth, for a total amount billed of $873.60, and total amount paid $132.29.
The $132.29 represents the price negotiated by the insurance company. It's all the provider is going to get. We're not responsible for the difference.
Is Medicare really worse than that? Significantly worse? About the same?
What I found myself thinking, when going over the EOB, is that this idea that people with insurance are carrying the load for the uninsured is baloney. The truth is that people with insurance and enough cash, savings, and income to pay even part of their bill are carrying the load for both the insured AND the uninsured but totally broke.
That seems totally, absolutely nuts. But that looks like the way it works.
Posted by Alan Cresswell (# 31) on
:
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.
Certainly better access to preventative medical care should result in reduced costs. But, as you say those savings aren't going to kick in over the short term. As Obama reaches the end of his second term he might be able to provide a demonstrable saving to help his successor in the race to the White House. But, even then it's likely to be a small saving if all he has is the scheme I've read about in the papers over here. There seems to be very little in it that addresses some of the bigger excess costs people have noted on this thread.
One saving that probably will kick in very quickly would be reduced costs for ER departments. I don't know quite how big those savings would be, but they should be happening in the first year or two of any scheme that provides a better option than going to the ER.
Posted by Erin (# 2) on
:
Josephine, that actually sounds like a BCBS EOB. Their reimbursement isn't really much better than Medicare or Medicaid until the payers collectively haul their asses in front of the state insurance commissioner and/or attorney general. If it's not BCBS, your plan has a very good contract negotiator, and you should probably take him with you the next time you buy a car. That is on the low side of traditional reimbursement from private payers. Most payers don't get that kind of cut, they pay a percentage of charges that is much, much higher than that.
Posted by Josephine (# 3899) on
:
Thanks, Erin. You're right, it's a BCBS plan. And of course, in my last post, I meant that it looks like the healthcare costs are all being carried by people who do NOT have insurance, but have enough resources to pay at least part of their bills. The rest of us skate by as they refinance their homes, clean out their savings, max out their credit cards, and ultimately are driven into bankruptcy.
Frank Schaeffer, son of Francis Schaeffer, was interviewed last week on Chicago Public Radio. It's a fascinating show. Basically, he says there are three groups opposing health care reform: First, liars, like Sarah Palin and a few others, who know what they're saying isn't true, and say it anyway. They need to be told to quit lying. Second, the fearful and ignorant, who repeat the lies the liars tell them, who need to be given the truth. Then there are corporate interests.
Because he talks at length about the role of the religious right in the current debate, and because he was one of the founding members of the religious right, all of us who have ever wondered why conservative Christians have the opinions they do on health care reform should listen.
Posted by Crœsos (# 238) on
:
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]
[ 15. September 2009, 17:58: Message edited by: Crœsos ]
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.
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]
Bollocks, bollocks, and thrice bollocks. Pretty much all healthcare funders decide what they will and won't pay for. Over here, they generally try to do so on the basis of spending the public funds as wisely as posible- a difficult and thankless but necessary and laudable job. Private insurance corporations basically do it on the basis of protecting their profitability. 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?
[ 18. September 2009, 20:27: Message edited by: Albertus ]
Posted by Josephine (# 3899) on
:
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.
Posted by alienfromzog (# 5327) on
:
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.
Have you considered moving to the UK? England really is beautiful and we even have hospitals...
AFZ
Posted by ken (# 2460) on
:
quote:
Originally posted by Josephine:
Albertus, I think your irony detection meter needs to be recalibrated.
Not so sure. There are plenty of right-wing Americans posting much more blatant nonsense than that all over the Internet. Its hard to tell the lies from the jokes sometimes.
Posted by Albertus (# 13356) on
:
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 ]
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 ]
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.
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?
Posted by Martin L (# 11804) on
:
quote:
Originally posted by Clint Boggis:
...or is the answer rather meaningless because it's predetermined by your political position?
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 ]
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?
Posted by cliffdweller (# 13338) on
:
quote:
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?
It's not entirely a done deal yet-- the house and senate bills need to be merged, which will take more negotiation, compromise, and sadly, no doubt more pork*. But still, it looks like a very promising New Year for those of us struggling to care for our families here...
*gotta chuckle at all the GOP Senators who are shocked! shocked I tell you! that pork and special deals were made. Maybe if they hadn't played Lucy-with-the-football last time they'd have gotten a little Christmas bacon themselves.
Posted by ken (# 2460) on
:
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
Posted by sharkshooter (# 1589) on
:
Whereas the Premier of a Canadian province went to the USA for surgery recently.
Posted by cliffdweller (# 13338) on
:
quote:
Originally posted by sharkshooter:
Whereas the Premier of a Canadian province went to the USA for surgery recently.
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.
Posted by tclune (# 7959) on
:
quote:
Originally posted by cliffdweller:
quote:
Originally posted by sharkshooter:
Whereas the Premier of a Canadian province went to the USA for surgery recently.
America does have some of the best health care in the world... for those who can afford it.
Yeah, it really does feel like the very few people who can afford to fly to the Mayo Clinic for their routine check-ups are terrified that they will have to share their health care with the hoi poloi, and are trotting out their usual bag of tricks to get the great unwashed to oppose what is in their interest so that the rich will not look as sleezy as they are. In this country, we call that "Republican family values."
--Tom Clune
Posted by Sober Preacher's Kid (# 12699) on
:
quote:
Originally posted by cliffdweller:
quote:
Originally posted by sharkshooter:
Whereas the Premier of a Canadian province went to the USA for surgery recently.
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.
Medicare does not pay for out-of-province services which are available in-province. Danny Williams had to foot the bill entirely on his own. As he is both the Premier and a successful businessman, he can afford to do so.
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.
Posted by sharkshooter (# 1589) on
:
quote:
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.
and Québec.
Posted by New Yorker (# 9898) on
:
quote:
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
More than a little misleading. What Governor Palin said is that when she was a child her family used to travel from Skagway to Whitehorse for health care. Her father latter elaborated that such was the only option. Read the story here.
What her family did when she was a child out of necessity is not the same thing as Governor Palin traveling to Canada as an adult seeking health care.
Posted by New Yorker (# 9898) on
:
“But we have to pass the [healthcare] bill so that you can find out what is in it, away from the fog of the controversy."
From a recent speech by Speaker Pelosi.
Shouldn't we know what is in it before it passes?
Posted by sharkshooter (# 1589) on
:
quote:
Originally posted by New Yorker:
...Shouldn't we know what is in it before it passes?
Where's the fun in that?
Posted by tclune (# 7959) on
:
quote:
Originally posted by sharkshooter:
quote:
Originally posted by New Yorker:
...Shouldn't we know what is in it before it passes?
Where's the fun in that?
For that matter, where's the precedent?
--Tom Clune
Posted by Jason™ (# 9037) on
:
quote:
Originally posted by Sober Preacher's Kid:
Danny Williams had to foot the bill entirely on his own. As he is both the Premier and a successful businessman, he can afford to do so.
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.
Well I certainly hope we continue to make it so the richest can also stay the healthiest. Makes sense when you think about it. Rich people have so much more to enjoy, of course we'd want to make sure they can live longest and healthiest. Poor people have crap lives, and probably want to die anyway.
Posted by Martin L (# 11804) on
:
quote:
Originally posted by Jason™:
Well I certainly hope we continue to make it so the richest can also stay the healthiest. Makes sense when you think about it. Rich people have so much more to enjoy, of course we'd want to make sure they can live longest and healthiest. Poor people have crap lives, and probably want to die anyway.
Lately my Right-Wing acquaintances have been complaining about the higher premiums we will have to pay when pre-existing condition exclusions are lifted. They believe, and with good reason, that some people won't purchase insurance until they are afflicted with a life-threatening ailment. [I wonder what channel they've been watching and which AM radio shock jock they've been following...] In the meantime, those of us who prefer not to handle things that way will be footing a higher bill to make up for all the premiums that the companies won't be receiving monthly for those people anymore.
My tongue-in-cheek solution to remove profit entirely from the medical industry was not received well. Honestly, I tend not to utilize my health insurance very often, and I'd rather my basically unused premiums be used to help others less fortunate than to line the pockets of profiteers.
It's a good thing the fire department, police, and schools were non-profited and government-absorbed a long time ago; otherwise we'd all be in trouble.
Just think what it would be like if the schools were run in the same way...
Teacher 1: The checks from the Ed-surance companies haven't come in lately, and I've submitted the paperwork to all of them five times in triplicate.
Teacher 2: I just don't accept students who are covered by Edu-Net and EdWorld Industries.
[ 09. March 2010, 22:03: Message edited by: Martin L ]
Posted by mousethief (# 953) on
:
quote:
Originally posted by sharkshooter:
Whereas the Premier of a Canadian province went to the USA for surgery recently.
God forbid the Beautiful People should have to wait in line with the underbelly masses.
Posted by Sober Preacher's Kid (# 12699) on
:
Danny Williams is Premier of Newfoundland & Labrador; Newfoundland Premiers are by definition crazy.
Posted by Leaf (# 14169) on
:
Seems like the vote passed in the US.
Let the congratulations/howling begin.
Posted by Lietuvos Sv. Kazimieras (# 11274) on
:
CONGRATULATIONS!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Congratulations to us!
Oh yes, and let the Republicans in Congress go fuck themselves.
[ 22. March 2010, 03:35: Message edited by: Lietuvos Sv. Kazimieras ]
Posted by mousethief (# 953) on
:
quote:
Originally posted by Lietuvos Sv. Kazimieras:
CONGRATULATIONS!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Congratulations to us!
Oh yes, and let the Republicans in Congress go fuck themselves.
Yeeeeehaaaawwww!
Posted by cliffdweller (# 13338) on
:
Rep. Bart Stupak is my new hero.
Posted by Erin (# 2) on
:
Have they figured out who called him "baby killer" yet?
Posted by Sober Preacher's Kid (# 12699) on
:
As a diabetic, I feel so happy for my American friends.
Does this Act have a good acronym like OHIP or NHS that can be incorporated into the general tongue?
Posted by Crœsos (# 238) on
:
quote:
Originally posted by cliffdweller:
Rep. Bart Stupak is my new hero.
He's certainly received the pop culture recognition he deserves with an urban dictionary entry.
Posted by MrSponge2U (# 3076) on
:
I believe that Glenn Beck's and Rush Limbaugh's heads just exploded. Fox News should now change its name to the Angry White People's Network.
I think that it's about time that the US passed some kind of health care reform. The opposing voices in the media have become so insane, listening to Norwegian heavy metal music is relaxing in comparison.
I am glad for people that are no longer going to be kicked off health insurance for preexisting conditions. This is not going to destroy America.
[ 22. March 2010, 04:27: Message edited by: MrSponge2U ]
Posted by mousethief (# 953) on
:
Rush Limbaugh said he'd move to Costa Rica if this happened. He's a man of his word, isn't he?
Posted by Josephine (# 3899) on
:
We watched several hours of the debate this evening. Fabulous civics lesson for Littlest One. For me, too. It was great.
There was a congresswoman from Florida who gave an amazing speech. I don't know if they even said her name (all representatives being introduces as "the gentleman from" or "the gentlewoman from"), but I would expect that we'll see more of her in the future.
Littlest One was impressed by the speech of one of the older black congressmen -- might have been Representative Lewis of Georgia, but I'm not sure. He spoke with the passion and cadence of a black preacher.
Watching the number of votes on the screen change was like watching a ball game. The number hadn't changed to 216 on the screen when the people in the chamber all started chanting "Nancy Did It! Nancy Did It!" Like at a high school basketball game. We knew they must have seen the numbers change just seconds before we saw it.
Exciting day. With this bill, as imperfect as it is, we've finally joined the rest of the First World.
Lord, have mercy. Thanks be to God.
Posted by Think² (# 1984) on
:
Congratulations !
Posted by Golden Key (# 1468) on
:
Wheeeeeeeeeeeeeeee!
I'm glad we've got our feet in the door. IMHO, it's probably still going to be a long haul. They still have to hammer out many things. And, of course, if there's a way to trip up or stop the process, opponents will.
Posted by bush baptist (# 12306) on
:
Good to hear on tonight's news that it looks like things are going well for you all in this.
Posted by MSHB (# 9228) on
:
quote:
Originally posted by mousethief:
Rush Limbaugh said he'd move to Costa Rica if this happened. He's a man of his word, isn't he?
You could send him a one-way ticket just in case. I am sure many people would be only too glad to donate.
RL is so notorious that we have even heard of him in Australia.
Posted by Josephine (# 3899) on
:
quote:
Originally posted by Golden Key:
I'm glad we've got our feet in the door. IMHO, it's probably still going to be a long haul. They still have to hammer out many things. And, of course, if there's a way to trip up or stop the process, opponents will.
Part of it -- the Senate bill -- is a done deal. The House passed the Senate bill, in spite of many of them having significant reservations about it (mostly because they thought it didn't do enough; some over the issue of abortion). The only thing that part needs now is Obama's signature.
The second part -- the reconciliation bill, which is the package of fixes the House got the Senate to agree to pass -- still has to be passed by the Senate. That part could be stopped. But I don't think it will be. As I understand it, the House said they wouldn't pass the Senate bill without strong assurances that the Senate would pass the reconciliation bill. I think it will happen, and happen soon.
We'll see, though.
Posted by New Yorker (# 9898) on
:
I heard this morning that today is the anniversary of the British parliament's passing the Stamp Act part of a series of Acts that lead, in part, to the American Revolution. Gladly we have elections now to effect a new revolution and will not have to resort to violence to get rid of these current petty street thugs running things.
And, I don't think Republicans need fuck themselves. That was done by the Democrats when they voted for this horrible bill!
Posted by Crœsos (# 238) on
:
quote:
Originally posted by New Yorker:
I heard this morning that today is the anniversary of the British parliament's passing the Stamp Act part of a series of Acts that lead, in part, to the American Revolution.
Today is also the anniversary of the Khatyn massacre, if what you're looking for is inflamatory incidents that coordinate with the Earth's revolution around the sun.
Posted by tclune (# 7959) on
:
quote:
Originally posted by Crœsos:
quote:
Originally posted by New Yorker:
I heard this morning that today is the anniversary of the British parliament's passing the Stamp Act part of a series of Acts that lead, in part, to the American Revolution.
Today is also the anniversary of the Khatyn massacre, if what you're looking for is inflamatory incidents that coordinate with the Earth's revolution around the sun.
No, I'm sure that New Yorker was actually celebrating the culmination of our freedom in finally enacting a basic human right though democratic means that was denied us by our tyrannical British overlords...
--Tom Clune
Posted by New Yorker (# 9898) on
:
quote:
Originally posted by tclune:
No, I'm sure that New Yorker was actually celebrating the culmination of our freedom in finally enacting a basic human right though democratic means that was denied us by our tyrannical British overlords...
--Tom Clune
You still think health care is a right?
Posted by tclune (# 7959) on
:
quote:
Originally posted by New Yorker:
quote:
Originally posted by tclune:
No, I'm sure that New Yorker was actually celebrating the culmination of our freedom in finally enacting a basic human right though democratic means that was denied us by our tyrannical British overlords...
--Tom Clune
You still think health care is a right?
Of course not. The notion that life, liberty, and the pursuit of happiness are inalienable rights is just 21st century liberal clap-trap.
--Tom Clune
Posted by mousethief (# 953) on
:
quote:
Originally posted by tclune:
Of course not. The notion that life, liberty, and the pursuit of happiness are inalienable rights is just 21st century liberal clap-trap.
But that was Thomas Jefferson, wasn't it? And he's being stripped from all the textbooks in Texas even as we speak. And with any luck we can get Montecello taken off the bus tours in D.C. next. Freak liberal among the otherwise solidly neo-conservative Christian founding fathers.
Posted by Martin L (# 11804) on
:
quote:
Originally posted by New Yorker:
quote:
Originally posted by tclune:
No, I'm sure that New Yorker was actually celebrating the culmination of our freedom in finally enacting a basic human right though democratic means that was denied us by our tyrannical British overlords...
--Tom Clune
You still think health care is a right?
Why is this any different from fire departments, police departments, and schools? If anything, schools are not a matter of life or death, but health care is.
Posted by Jason™ (# 9037) on
:
Not if Obama wants to do it, it isn't. New Yorker is nothing if not consistent. If Bush did it, it was great. If Obama does it, it's eeeeeeeeeevil.
I agree about those damn petty thugs, though, how they're always trying to insure me in spite of my pre-existing conditions.
Posted by Trudy Scrumptious (# 5647) on
:
quote:
Originally posted by New Yorker:
quote:
Originally posted by tclune:
No, I'm sure that New Yorker was actually celebrating the culmination of our freedom in finally enacting a basic human right though democratic means that was denied us by our tyrannical British overlords...
--Tom Clune
You still think health care is a right?
As opposed to being a privilege for those who can afford to buy it?????
I feel dragged into your health care fight since the premier of my province, Danny Williams, was mentioned on the last page and has been held up as an example by the anti-health care forces in the US, due to his having gone to the US for surgery which was in fact available in Canada.
In response to SPK, no, this did not happen because all Newfoundland premiers are crazy. It happened because all super-rich people have the privilege, as they have always had, of going anywhere in the world they want to, and can afford to go, in order to seek out the kind of health care they want. It has no bearing on the needs of ordinary people, particularly the working poor who are the people most in need of good health care. There's never been any question about whether the Danny Williamses of the world can buy the privilege of good health care. Whether good health care is available to the guy who checks out Danny's stuff at WalMart and pumps gas into his car -- that's when it becomes a question of rights. In Danny Williams' case, the "little people" who elected him to public office and who made his staggering wealth possible by their labour DO have the right to good health care, because we live in a country that has decided health care is a basic human right. We haven't developed a perfect, foolproof, flaw-free system -- I doubt any country on earth has -- but when we work to improve our system, we work to improve it for everybody, because we believe everybody has that right.
Working people in the USA should be so lucky.
[ 22. March 2010, 18:02: Message edited by: Trudy Scrumptious ]
Posted by New Yorker (# 9898) on
:
quote:
Originally posted by tclune:
[Of course not. The notion that life, liberty, and the pursuit of happiness are inalienable rights is just 21st century liberal clap-trap.
Well, the feds can't even get the first in your list right so I suppose they'll screw up the health care as well.
Posted by Og: Thread Killer (# 3200) on
:
quote:
Originally posted by New Yorker:
I heard this morning that today is the anniversary of the British parliament's passing the Stamp Act part of a series of Acts that lead, in part, to the American Revolution. ...
Is there any time within 3 days of the whole year where in an event from that outrageously violent and class filled civil war, fought often more over money and power then over rights, could not be invoked by people against one bit of politics or another?
At least we as a country have come to terms with the fact that we exist only because a bunch of Ontario and Quebec lawyers wanted to get money from railway land speculation.
To mythologise your beginnings as if the fact that an action exists from that time makes it applicable to all times is just sooo.......niave.
Posted by mdijon (# 8520) on
:
quote:
Originally posted by tclune:
[Of course not. The notion that life, liberty, and the pursuit of happiness are inalienable rights is just 21st century liberal clap-trap.
quote:
Originally posted by New Yorker:
Well, the feds can't even get the first in your list right so I suppose they'll screw up the health care as well.
Not really an answer, though.
I think either one believes in rights or one doesn't. If one does, one has to accept that the whole notion is silly, illogical, and riven with inconsistencies. How can it possibly be a right that someone else provides you with something you are lacking as a result of your own mistakes, your parents mistakes, or bad luck? The notion that companies must be prevented from providing poor working conditions by the state rather than simply workers voting with their feet? It's all illogical because one can't draw the lines clearly.
Why is secondary school education a right but university not quite a right in the same way? If healthcare becomes a right does it stop with cosmetic procedures? Or just cosmetic procedures we approve of like dealing with disfiguring burns?
And, as NY observes, the government tends to fuck up running things, and what are the mechanisms for putting that right in a timely way that doesn't rely on a vote in 4yrs time? All illogical nonsense.
If one doesn't believe in rights, then one is left with a predatorial, dark society where might is right and no-one cares if you go down.
Perfectly logical and yet not somewhere any of us would want to live.
So one has to draw an illogical arbitrary circle around things that a society wants to do to create a society worth something.
Personally, I put healthcare in that circle.
By the way, I heard a great conversation captured elsewhere on the net;
quote:
This is the first step towards a socialist state controlling our health, then through that controlling what we eat, what we drive and who we are. It makes me sick to the core of my stomach.
quote:
"At least you'll now be able to afford the healthcare that the core of your stomach is going to need without going broke."
[ 22. March 2010, 19:41: Message edited by: mdijon ]
Posted by Lietuvos Sv. Kazimieras (# 11274) on
:
quote:
Originally posted by mousethief:
quote:
Originally posted by tclune:
Of course not. The notion that life, liberty, and the pursuit of happiness are inalienable rights is just 21st century liberal clap-trap.
But that was Thomas Jefferson, wasn't it? And he's being stripped from all the textbooks in Texas even as we speak. And with any luck we can get Montecello taken off the bus tours in D.C. next. Freak liberal among the otherwise solidly neo-conservative Christian founding fathers.
Those are damn long bus tours in D.C. if Monticello is included -- Charlottesville is rather a ways from D.C., I think you'll find. Perhaps you meant the Jefferson Memorial?
Posted by mousethief (# 953) on
:
Oops. I haven't been there in a while. Please edit as applicable.
[ 22. March 2010, 19:50: Message edited by: mousethief ]
Posted by New Yorker (# 9898) on
:
Of course, while I may not believe that health care is a right, as a Catholic I do think that there should be adequate access to health care. I just don't think the current bill does that. It's more about raising taxes and creating a larger bureaucracy than anything else.
Posted by Horseman Bree (# 5290) on
:
But, since you see EVERYTHING as a device to make you pay more taxes, you are, I guess, being consistent.
Posted by mousethief (# 953) on
:
Do you suppose the anti's will avail themselves of the effects of the bill, even though they were dead set against it? Or will they sign affidavits that if their kid gets a major illness, they'll quit their insurance plan? Or if they lose coverage and then get some terrible disease, they'll refuse until they die to get help from any health insurance? Surely they'd be willing to stand behind their position?
Posted by Janine (# 3337) on
:
Most things won't change, really -- we've had "guvmint" health care for years. The few things that are going to change mostly look good, for the individual benefiting.
What I'm not looking forward to is when the IRS is enforcing the rule that says everyone has to buy health insurance, eventually fining people hundreds a year if they don;t want to but it. It's against some people's religious convictions, I wonder how that will be handled?
And I'll be watching my own insurance premiums rise, I'm sure. We'll see if the "caps" on premiums help me any.
One thing I will watch with interest is this:
Already, with the existing Medicaid program, I have to call and solicit and arm-twist to get some patients to come in for routine care, preventative care like a yearly physical or vaccinations. There's no expense to them, it's being paid for them -- and they still won't come in.
OTOH, I can't convince some parents to stop coming in so much. A perfectly healthy child with a little sinus drip or a cold does not need to miss school and show up at the clinic twice a week for months at a time. I'm supposed to be triaging on the phone, guiding and suggesting and setting appointments properly -- but because it's Medicaid I (my employer) can't deny anyone, must see them within 24 hours if they won't be swayed. For every damned hangnail, sniffle and hickey.
So, these things I will be watching for, to see how things change. If they change.
Posted by cliffdweller (# 13338) on
:
quote:
Originally posted by Janine:
And I'll be watching my own insurance premiums rise, I'm sure. We'll see if the "caps" on premiums help me any.
You think they're going to raise more than the 30-70% Blue Shield raised rates earlier this year?
Posted by Augustine the Aleut (# 1472) on
:
Janine posts: quote:
but because it's Medicaid I (my employer) can't deny anyone, must see them within 24 hours if they won't be swayed. For every damned hangnail, sniffle and hickey.
But aren't hickeys a chronic condition in some circles?
Posted by Trudy Scrumptious (# 5647) on
:
quote:
Originally posted by Janine:
What I'm not looking forward to is when the IRS is enforcing the rule that says everyone has to buy health insurance, eventually fining people hundreds a year if they don;t want to but it. It's against some people's religious convictions, I wonder how that will be handled?
The article I read summarizing the changes said there would be exemptions for those who religious convictions precluded them from getting insurance. That stood out to me as I thought I was one of the world experts in odd and inconvenient religious convictions (being SDA will do that to you), but even I'd never heard of people objecting to insurance. But there ya go ... I guess as soon as somebody comes up with anything, someone else finds a religious basis for objecting to it.
Posted by Dumpling Jeff (# 12766) on
:
Does anyone actually know what's in the bill that just passed?
I'm currently uninsured. When will I need to get insurance? Being a diabetic, will I be able to afford it or will it be cheaper to cough up the fine? I heard they can't deny coverage anymore, so I'd like some major medical coverage (if that's true, which I have doubts about).
I like paying for my own medical care. You get what you pay for and all that. Will I be able to continue to do that? Can I tip the doctors so they do a good job?
What are the abortion rules? I won't pay for an abortion or otherwise aid in one, even if it means going to prison. Should I buy some striped clothes or did they take that out?
Posted by CorgiGreta (# 443) on
:
Some of my old, hyper-Calvinistic, Christian/Protestant/Netherlands Reformed relatives had religious objections to insurance. They felt that it was an affront to the sovereign will of God.
Strict Christian Scientists might also object. Perhaps some fringe Pentecostals also?
Greta
[ 23. March 2010, 01:39: Message edited by: CorgiGreta ]
Posted by cliffdweller (# 13338) on
:
quote:
Originally posted by CorgiGreta:
Some of my old, hyper-Calvinistic, Christian/Protestant/Netherlands Reformed relatives had religious objections to insurance. They felt that it was an affront to the sovereign will of God.
Strict Christian Scientists might also object. Perhaps some fringe Pentecostals also?
Technically one could say that the law is requiring you to purchase insurance, but it's certainly not going to require you to use it. No one is going to drag (adult anyway) Christian scientists into the GP's office against their will.
The real objection then would be to having to pay for something you don't intend to use. But we require childless people and home-schoolers to contribute their taxes to pay for public schools. We even require pacifists to contribute toward taxes that help support the military.
Posted by CorgiGreta (# 443) on
:
My strict Calvinist relatives happily collected their Social Security checks (which are arguably insurance benefits) even though they considered FDR and all his programs to be Communist.
Greta
[ 23. March 2010, 01:55: Message edited by: CorgiGreta ]
Posted by tclune (# 7959) on
:
quote:
Originally posted by Dumpling Jeff:
Does anyone actually know what's in the bill that just passed?
I'm currently uninsured. When will I need to get insurance? Being a diabetic, will I be able to afford it or will it be cheaper to cough up the fine? I heard they can't deny coverage anymore, so I'd like some major medical coverage (if that's true, which I have doubts about).
I like paying for my own medical care. You get what you pay for and all that. Will I be able to continue to do that? Can I tip the doctors so they do a good job?
What are the abortion rules? I won't pay for an abortion or otherwise aid in one, even if it means going to prison. Should I buy some striped clothes or did they take that out?
AIUI, the fines for not having insurance don't start until 2014. They apparently start out low and then ramp up in succeeding years until it makes no sense to pay the fine. The magic about 2014 is that that is the year that the new insurance pools are supposed to be in place, so you will be able to join a large risk pool as an individual. The basic idea is much like insurance through a job -- you won't pay a higher price based on your personal health issues.
I am less clear about the interim situation. My understanding is that there will be some sort of high-risk pool set up almost immediately to insure those who currently can't get insurance. I believe that the pool will be underwritten to some degree by the government, to keep the premiums within reason. You won't have to join that, but you will have the opportunity to.
Abortion, at least elective abortion, is not covered by the government pools at all. I believe that it will be theoretically possible for a woman to buy a rider through private insurance that would cover the cost of abortion. I don't know that any insurance currently offers such a thing, and it isn't clear whether the market prospects for it would be worth the business downside to set up. Nonetheless, my understanding is that it would be legal for such a thing to exist. The executive order apparently only assures that the government won't be involved in that business.
I have not read the bill itself -- I've only read the reporting on it, so none of this is guaranteed to be correct.
--Tom Clune
Posted by Og: Thread Killer (# 3200) on
:
quote:
Originally posted by Trudy Scrumptious:
..... That stood out to me as I thought I was one of the world experts in odd and inconvenient religious convictions (being SDA will do that to you), but even I'd never heard of people objecting to insurance....
Some Amish and Mennonite groups might.
Posted by cliffdweller (# 13338) on
:
Most private insurance in the US already covers abortion, cuz really, Blue Shield would much rather pay for your abortion than labor & delivery and another 18+ yrs of pediatrics. That wouldn't change under the new provisions, which, as orfeo noted, only apply to the government pools. Which points out the inherent flaw of the argument in the first place: most Americans already fund abortions through their insurance premiums. Somehow that's more moral than funding it through taxes?
Posted by Choirboy (# 9659) on
:
quote:
Originally posted by Dumpling Jeff:
Does anyone actually know what's in the bill that just passed?
I'm currently uninsured. When will I need to get insurance? [...]
You are likely to do quite well under the new bill. If you have been uninsured for at least 6 months, you will be able to purchase insurance in a government-organized pool of plans for 'high risk' individuals this year at a far lower cost than you can now. If your income is below a certain threshold, the cost of this plan will be subsidized for you. You cannot be excluded or dropped from this plan on account of getting sick or your pre-existing conditions. The price of a plan for an older person cannot be more than 4 times that of a younger person. Adjustment of the price based on your level of health is not permitted.
Currently, the bill ensures that no federal money will be used to pay for an abortion. Persons who want to purchase additional insurance to cover abortions may do so, but states may individually prevent this practice. This only covers insurance from the pool, not employer-provided insurance (or self-purchased) from private companies outside of the pool.
The exact provisions of the insurance plans that will be open to you are yet to be determined. There will be minimum standards that such plans have to adhere to in order for a plan to be in the pool. I expect there will be a number of creative ways companies will attempt to do that. Some plans will limit care to certain facilities, just as HMOs do now. Others may allow a wider selection of doctors but limit how much they pay toward any visit or procedure; you may be responsible for the rest, but it seems like it would still be a bargain compared to paying everything yourself, given that you have a chronic condition.
Things may change somewhat in the final version after the reconciliation measure is passed.
Posted by Jason™ (# 9037) on
:
quote:
Originally posted by cliffdweller:
Most Americans already fund abortions through their insurance premiums. Somehow that's more moral than funding it through taxes?
That's what I've been wondering, too...?
Posted by Dumpling Jeff (# 12766) on
:
Choirboy wrote, quote:
[I]t seems like it would still be a bargain compared to paying everything yourself, given that you have a chronic condition.
By paying cash and avoiding unnecessary tests and the like, I end up paying about twenty percent of what insurance covers. This is suspiciously about the same as a copayment.
But the real reason I stopped getting insurance was because I had my appendicitis denied as a pre-existing condition. Why pay premiums when I know the insurance company isn't going to cover anything anyway? Fool me once...
I know that's supposed to end. It will be interesting to see what loopholes the insurance companies managed to get put in place. I hope I'm not forced to buy a product that doesn't do any good.
Posted by Think² (# 1984) on
:
Buy it when you need it is fine until you suddenly require something very expensive; like a heart bypass. What I wonder, is how you know when tests are unnecessary ?
Posted by Belle Ringer (# 13379) on
:
quote:
Originally posted by Think²:
What I wonder, is how you know when tests are unnecessary ?
I turn down unnecessary tests all the time. I ask what the test will show and when the results will be known. For example, a problem solved by an antibiotic they are prescribing immediately, test results don't be known until after the antibiotics are done--I refuse the tests in the grounds that the antibiotics are sufficient test. It works, or it doesn't and that's when we do a test to figure out the next step.
Always surprises doctors when I say no.
I've said no to quite a number of surgeries over the years, too, and I'm still here.
I value the docs who discuss options with me instead of throwing prescriptions and tests at me.
(I don't always fill prescriptions. I discuss with the pharmacist what it's for and what the negative effects are, and I go looking on line for safer and cheaper herbal or alt med approaches, then I decide whether to use the drug or a different method. Pharmaceuticals can be lifesavers, but their side effects can be so damaging, as a friend with liver failure from pharmaceuticals proves.)
Posted by Think² (# 1984) on
:
quote:
Originally posted by Belle Ringer:
I discuss with the pharmacist what it's for and what the negative effects are, and I go looking on line for safer and cheaper herbal or alt med approaches, then I decide whether to use the drug or a different method.
Couple of questions; why can't you have the side effect discussion with the doctor before the prescription, why is the doctor not prescribing the cheapest effective version of the drug, do you go for empirically validated herbal and alt med approaches, if you don't have the test how do you know the anti-biotic caused you to get better rather than say remission of a chronic condition that flares up from time to time ?
I spent years being told I just had a cold and was prone to them, or being treated for a chest infection developed after said cold (effectively, the anti-biotics killed whatever caused the bronchitus that developed as a secondary effect) before I got a GP with enough nous to order the tests that determined I had unstable asthma. She said, you have had a cough longer than x time, I will send you for a chest x-ray and give you a device to measure your peak-flow. X-ray was clear, peak-flow diurnal variation diagnosed my asthma.
Posted by Phos Hilaron (# 6914) on
:
quote:
Originally posted by Augustine the Aleut:
Janine posts: quote:
but because it's Medicaid I (my employer) can't deny anyone, must see them within 24 hours if they won't be swayed. For every damned hangnail, sniffle and hickey.
But aren't hickeys a chronic condition in some circles?
You obviously move in the wrong (or maybe the right) circles
Posted by mdijon (# 8520) on
:
quote:
Originally posted by Belle Ringer:
I discuss with the pharmacist what it's for and what the negative effects are, and I go looking on line for safer and cheaper herbal or alt med approaches, then I decide whether to use the drug or a different method.
quote:
Originally posted by Think²:
Couple of questions; why can't you have the side effect discussion with the doctor before the prescription
I agree. In general, I think that's exactly the discussion doctors should be aiming for - allowing the patient to take an informed decision based on the information they have.
I'm completely in favour of being critical about taking treatment. We often have too high an opinion of the efficacy of treatment given, and not enough consideration of the potential side effects.
What I'm also not clear about is why one wouldn't be equally critical about the herbal/alternative route. Very little treatment in that category has any evidence to support it.
Posted by ken (# 2460) on
:
quote:
Originally posted by mdijon:
What I'm also not clear about is why one wouldn't be equally critical about the herbal/alternative route. Very little treatment in that category has any evidence to support it.
Yes but some does.
A lot of herbal medicine is really just using appropriate drugs, no different from using synthetic drugs, except these ones grow on trees and aren't patented.
At least some naturally occurring herbal remedies have been subjected to the same kinds of tests as synthetic drugs - for example St John's Wort and garlic. Morphine is a a herbal remedy!
Posted by Erroneous Monk (# 10858) on
:
quote:
Originally posted by ken:
At least some naturally occurring herbal remedies have been subjected to the same kinds of tests as synthetic drugs - for example St John's Wort and garlic. Morphine is a a herbal remedy!
However, different over the counter products can contain very different amounts of the active herb - it is very difficult to know what you're buying.
Herbs that are effective also have side-effects and contraindications. It is not a simple case of good (herbal) and bad (pharma) medicine. I'm in favour of informed choice, but I don't think you can rely on the high street health food shop to provide that information.
[ 23. March 2010, 14:01: Message edited by: Erroneous Monk ]
Posted by Jason™ (# 9037) on
:
Very interested in what people will say when the earth doesn't collapse into itself over the next year, like so many have been predicting. The complaints are going to turn into, "Well yeah but just wait another few years and THEN you'll see!" There's a good article in the Times about that from yesterday.
Personally I would have been behind this bill if they estimated it to cost $100 trillion, and I'm completely behind requiring everyone to get insurance, so I don't see much of a downside here.
Posted by Dumpling Jeff (# 12766) on
:
Think wrote, quote:
[W]hy can't you have the side effect discussion with the doctor before the prescription, why is the doctor not prescribing the cheapest effective version of the drug[?]
I do discuss my medications with my doctor. But a doctor is not a pharmacist. They often don't know about the drugs they prescribe.
Doctors learn about new drugs from drug company reps. They then prescribe what they think works. Since most patients don't care about cost because they're insured and they want "the best", most doctors don't take the time to find a cheaper alternative.
Taking time to discuss lower cost options or alternative options to drugs will help your doctor find a treatment that's right for you. Make sure to then discuss all your drugs (including the herbals) with your pharmacist. Pharmacists know things like which drugs use shared enzymes and shouldn't be taken at the same time.
Also, don't take unneeded drugs. This is very important with herbals as well. Remember hemlock is an all natural, herbal supplement. Herbs may contain "drugs" you don't need as well as the ones your looking for.
Not all conditions need to be treated. A doctor may prescribe a drug because you mentioned a minor complaint. Make sure to ask if you can skip it and live with symptoms.
Doctors take an oath not to share medical knowledge with their patients. Sometimes this leads them to being tight lipped. Make sure to talk about changes to your drugs before you make them. It's possible the drug you thought was for a hangnail is keeping you alive.
Posted by Think² (# 1984) on
:
quote:
Originally posted by Dumpling Jeff:
I do discuss my medications with my doctor. But a doctor is not a pharmacist. They often don't know about the drugs they prescribe.
They really ought to !
quote:
Doctors learn about new drugs from drug company reps. They then prescribe what they think works.
One would hope they read and critically appraised the professional literature - as they are trained to do. (Personally I am also in favour of the move to stop accepting CPD events from phamarmaceutical companies.)
quote:
Since most patients don't care about cost because they're insured and they want "the best", most doctors don't take the time to find a cheaper alternative.
Again, that is rather poor practice.
quote:
Pharmacists know things like which drugs use shared enzymes and shouldn't be taken at the same time.
True, but the doctors really ought to know this stuff too.
quote:
Doctors take an oath not to share medical knowledge with their patients. Sometimes this leads them to being tight lipped.
Never come across that idea before ? Are you sure about that, ours are supposed to copy every letter they write to the patient.
quote:
Make sure to talk about changes to your drugs before you make them. It's possible the drug you thought was for a hangnail is keeping you alive.
We agree on something *falls over knocked down by a passing feather*
As regards herbal medications, it is certainly true that effective herbal medications may also have side-effects St John's Wort being the one that spring's most obviously to mind.
Posted by RuthW (# 13) on
:
quote:
Originally posted by Dumpling Jeff:
Doctors take an oath not to share medical knowledge with their patients.
I'm probably going to be sorry I asked, but WTF?
Posted by Erin (# 2) on
:
quote:
Originally posted by Dumpling Jeff:
Doctors take an oath not to share medical knowledge with their patients.
Wow. That is weapons-grade stupidity right there.
Posted by Spiffy (# 5267) on
:
quote:
Originally posted by Dumpling Jeff:
Doctors take an oath not to share medical knowledge with their patients.
Funny. I've worked in hospitals for seven years now and I've never heard that oath. Do you have the words? I think I'll need to make sure my docs are up to date on their oaths.
(I'm wondering if Dumples is actually talking about HIPAA Title II [Healthcare Insurance Portability and Accountability Act], which is focused on ensuring patient information privacy in this age of electronic medical records. It has a heck of a lot of impact on the daily life of us medical professionals, but it impacts patients primarily through the need to sign waivers to share information between insurers and healthcare providers, which can sound like an oath to not discuss medical information. Even though it's not an oath, it's a fear of lawsuits...)
[ 23. March 2010, 17:31: Message edited by: Spiffy ]
Posted by romanlion (# 10325) on
:
quote:
Originally posted by Jason™:
Very interested in what people will say when the earth doesn't collapse into itself over the next year, like so many have been predicting. The complaints are going to turn into, "Well yeah but just wait another few years and THEN you'll see!" There's a good article in the Times about that from yesterday.
Personally I would have been behind this bill if they estimated it to cost $100 trillion, and I'm completely behind requiring everyone to get insurance, so I don't see much of a downside here.
As long as you have no particular understanding of or affection for our Constitution there is no downside, and whats a hundred trillion of someone else's dollars between parasites anyway? I say print it and get it in circulation, the faster the better!
Posted by Gildas (# 525) on
:
Originally posted by Dumplin Jeff:
quote:
Doctors take an oath not to share medical knowledge with their patients.
Last time I went to see a Doctor when I wasn't feeling well he diagnosed my illness and prescribed a course of drugs to make me feel better. I was under the impression that this was fairly common behaviour among the medical profession. I had no idea that he had violated his Blood Oath of Secrecy and could be struck off for malpractice for letting me in on the Hidden And Arcane Knowledge, Too Dark For Meer Mortals To Bear And Which Must Be Confined Only To A Handful Of Elect Initiates Lest Dread Ry'leh Rises From It's Watery Grave and Cthulhu Wreaks Chaos And Darkness Across The World that I was suffering from shingles.
Posted by mdijon (# 8520) on
:
quote:
Originally posted by ken:
Yes but some does.
A lot of herbal medicine is really just using appropriate drugs, no different from using synthetic drugs, except these ones grow on trees and aren't patented.
At least some naturally occurring herbal remedies have been subjected to the same kinds of tests as synthetic drugs - for example St John's Wort and garlic. Morphine is a a herbal remedy!
I don't think garlic really works, and St John's wort barely works. Morphine isn't really a herbal remedy - it's a highly processed extract of a herb (or plant?).
Many of the active ingredients that way today use with herbal sources (aspirin, digoxin, morphine, artemisinin) when used as herbal remedies are either in too low doses to be likely to be effective, used for the wrong thing (e.g. artmemisinin used for piles for centuries although now a potent anti-malarial) or if they were effective were often dangerous because of the uncertainty about dosing and impurities in the herbal mixtures (e.g. morphine).
Posted by mdijon (# 8520) on
:
quote:
Originally posted by Dumpling Jeff:
Doctors learn about new drugs from drug company reps. They then prescribe what they think works.
It pains me to admit this is often true. It summarizes what is deeply wrong with much of modern medicine.
What they should do (and what many do) is to learn about new drugs from reputable journals publishing hard evidence, look to guidaince from their professional bodies, apply this all with a healthy dose of cynicism regarding who sponsored the study/professional body, and then have an open chat with their patients about what they can prove and what they really have evidence for (rather than just what they think) and let the patient decide.
What they personally "think" works shouldn't come into it much. And what the drug rep said bloody well shouldn't come into it at all. They shouldn't talk to them.
Posted by Mr. Spouse (# 3353) on
:
quote:
Originally posted by Dumpling Jeff:
Not all conditions need to be treated. A doctor may prescribe a drug because you mentioned a minor complaint. Make sure to ask if you can skip it and live with symptoms.
This is about the only part of your post I can agree with. A little cross-pond perspective: Last year Dr Mrs Spouse & I were in California for several months. By the good fortune of HIPAA, the UK National Health Service qualified us for coverage under an HMO plan without pre-existing conditions (it counts as a 'Governmental plan').
I did notice that the doctors had a tendency to prescribe first and check symptoms later; much more so than doctors over here, who will frequently tell you that the problems may not need drugs to get better.
Having diabetes and not having health coverage is just scary. I hope you never get really sick.
Why is it wrong for doctors to get knowledge from the drug companies? Where do pharmacists learn? I'm grateful to the ones that contact me from time to time offering new equipment to monitor and control my condition, which I can then discuss with my doctor for him to prescribe. What if Lilly want to give me a $150 insulin pen for free on the basis they will get it back on prescriptions? So long as it's keeping me healthy and I'm not being actively denied better treatment I don't really care.
I can't say I understand the objections to the health bill. Having had a very limited opportunity to directly compare the 'social coverage' of the NHS and the free-for-all that is the US system, our imperfect money trap is so, so far preferable. I know if I am sick, I can see a doctor. If I break my arm, I can visit the hospital and not have to check my credit card limit first. It will take time to settle down - these things always do - but I hope that very soon people will wonder what the fuss was all about.
Posted by tclune (# 7959) on
:
quote:
Originally posted by Trudy Scrumptious:
The article I read summarizing the changes said there would be exemptions for those who religious convictions precluded them from getting insurance. That stood out to me as I thought I was one of the world experts in odd and inconvenient religious convictions (being SDA will do that to you), but even I'd never heard of people objecting to insurance. But there ya go ... I guess as soon as somebody comes up with anything, someone else finds a religious basis for objecting to it.
MA exempts Christian Scientists from having to get health insurance. It isn't that they object to health insurance -- they object to health care. So the insurance is meaningless for them, and the law in MA said that they did not have to get the insurance. I expect the federal law is similar.
--Tom Clune
Posted by Imaginary Friend (# 186) on
:
quote:
Originally posted by Mr. Spouse:
I can't say I understand the objections to the health bill.
The only objections I understand are the ones that say it doesn't go far enough.
In my opinion, America, the Democrats and Obama have missed the opportunity of a lifetime to do something truly memorable. Now that "Healthcare Reform" has been done, nobody is going to have the political capital or willpower to push reform further for a long time. Public insurance, a single-payer system, further extension of preventative medicine, and many other good things will not now happen. That is something to be mourned. If centerist Democrat Congresspeople had taken a long-term view (instead of worrying about re-election) they could have got the job done. As it is, they bottled it. It's a shame.
Posted by Jason™ (# 9037) on
:
quote:
Originally posted by romanlion:
As long as you have no particular understanding of or affection for our Constitution there is no downside, and whats a hundred trillion of someone else's dollars between parasites anyway? I say print it and get it in circulation, the faster the better!
That's true, I do hate the Constitution. And liberty. Fucking liberty.
I'm sorry but I have trouble taking anyone seriously who was ok with spending trillions of dollars to fight them ter'ists abroad so we don't have to fight them at home but are now whining about spending money to keep all those newly protected individuals healthy.
Hurrah for the Patriot Act, but healthcare is a loss of liberty. Ha!
Posted by 205 (# 206) on
:
quote:
Originally posted by Jason™:
Very interested in what people will say when the earth doesn't collapse into itself over the next year, like so many have been predicting.
This bit made me wonder about 'sustainability'. Depending on who you listen to, Medicare / Medicaid / Social Security / Massachusetts State Health Care are all doomed to implode in some not too distant future.
It would be nice to REALLY know who is right about that aspect.
Posted by Dumpling Jeff (# 12766) on
:
No one can know everything. Doctors know about drugs by reading reading reference books. They books contain information from the drug companies because they are the ones who do the studies.
But pharmacists specialize in knowing about drugs. They don't fix broken arms or check temperatures or learn diagnostics or any of the thousands of other things doctors learn. They learn drugs. They learn chemical interactions and how they work in the human body.
It would be nice if doctors could learn all that and everything else, but there's only so much time in a day. Instead, they consult pharmacists when they see a problem.
Really, try talking to your pharmacist. They are a lot more than pill counters.
Several people show surprise that doctors swear to keep silent on medical knowledge. Here's the relevant line from the Hippocratic Oath: quote:
All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.
This seems originally intended to keep knowledge of poisons and the like away from a lay public which might use it to perform undetectable murders (as well as the normal confidentiality issues).
Obviously this oath does not preclude sharing knowledge needed to keep patients alive. It doesn't cover treatment options or dozens of other medical subjects. But some doctors talk less than they should in order to avoid breaking the oath.
Posted by mdijon (# 8520) on
:
quote:
Originally posted by Mr. Spouse:
Why is it wrong for doctors to get knowledge from the drug companies?
Because drug companies lie. They sell drugs, the advertise them, they twist evidence, they exagerate claims, and their primary loyalty is to the share holder.
Granted, the vast majority of the life-saving drugs around today were developed by them. We clearly can't do without them. But taking their sales pitch as knowledge about how to use their drugs is like taking a car salesman's advice on the merits of second hand car purchasing.
Pharmacists train in universities (like doctors) and then get their information from journals and professional bodies (like doctors).
If a drug company has some important data about their drug they can have it published in full in a journal following peer review and it can be discussed openly. If they want to slip in a claim in promotional material with the claim "data on file" but not open to scrutiny we shouldn't pay any attention.
Posted by Jason™ (# 9037) on
:
quote:
Originally posted by Imaginary Friend:
The only objections I understand are the ones that say it doesn't go far enough.
...
Public insurance, a single-payer system, further extension of preventative medicine, and many other good things will not now happen.
I agree with you on the first, but not the second statement. I just don't think they could have ever pushed through a single-payer system. There has been so much resistance to even this much, I'm positive that a bill that would have wiped out the entire private insurance industry would have killed the entire thing and made healthcare reform impossible.
I think what President Obama has done is to pave the way for (hopefully) successful results with these first big steps, and maybe our next charismatic president some years down the road will be able to push it through the rest of the way, based on some new impetus as it arises.
Here's hoping, anyway.
Posted by mdijon (# 8520) on
:
quote:
Originally posted by Dumpling Jeff:
But some doctors talk less than they should in order to avoid breaking the oath.
Erin was less prosaic, but this is just wrong. There are all sorts of reasons why doctors don't talk about medicine (ranging from misjudgement about what the patient wants through to being busy to being bored assholes) but this isn't one.
The Hippocratic oath is rarely taken, and when it is I don't think anyone follows it literally. There's also a promise to teach one's teacher's children medicine, live with the teacher and share one's earthly goods, not do operations for renal stones, not give pessaries for abortion etc.
About learning from drug companies, read my earlier posts.
[ 23. March 2010, 19:00: Message edited by: mdijon ]
Posted by Jason™ (# 9037) on
:
quote:
Originally posted by Dumpling Jeff:
Several people show surprise that doctors swear to keep silent on medical knowledge. Here's the relevant line from the Hippocratic Oath: quote:
All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.
This seems originally intended to keep knowledge of poisons and the like away from a lay public which might use it to perform undetectable murders (as well as the normal confidentiality issues).
That sounds a lot more like, if you hear something that shouldn't be shared with the world, you should keep it secret. Doctor-patient confidentiality. It's "things I find out while doing my job that shouldn't be shared abroad", not "things I learn while studying to be a doctor".
Posted by Imaginary Friend (# 186) on
:
quote:
Originally posted by Jason™:
I just don't think they could have ever pushed through a single-payer system. There has been so much resistance to even this much, I'm positive that a bill that would have wiped out the entire private insurance industry would have killed the entire thing and made healthcare reform impossible.
Yeah, you're probably right. Having lived my whole life in countries that have either nationalized healthcare, or a single-payer system*, I completely fail to understand why so many Americans don't want it**. I guess that's just the goggles through which I view the world.
quote:
Originally posted by Jason™:
I think what President Obama has done is to pave the way for (hopefully) successful results with these first big steps, and maybe our next charismatic president some years down the road will be able to push it through the rest of the way, based on some new impetus as it arises.
I hope you're right too. I fear that impetus will be a long time coming though.
Edited to add footnotes:
* And in general finding that these systems work quite well.
** If anyone fancies having another go at explaining it to me, then fire away.
[ 23. March 2010, 19:16: Message edited by: Imaginary Friend ]
Posted by Erroneous Monk (# 10858) on
:
quote:
Originally posted by Dumpling Jeff:
Several people show surprise that doctors swear to keep silent on medical knowledge. Here's the relevant line from the Hippocratic Oath: quote:
All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.
This seems originally intended to keep knowledge of poisons and the like away from a lay public which might use it to perform undetectable murders (as well as the normal confidentiality issues).
Erm no. Surely it's about patient confidentiality?
Posted by FreeJack (# 10612) on
:
You might find that some strict Muslims would object to some forms of insurance. The problem is not insurance or health care, but either the financing, the risk-taking or the presuming on God.
I wouldn't imagine they were the group that Congress had in mind though.
Posted by Erin (# 2) on
:
quote:
Originally posted by Imaginary Friend:
Having lived my whole life in countries that have either nationalized healthcare, or a single-payer system*, I completely fail to understand why so many Americans don't want it**.
** If anyone fancies having another go at explaining it to me, then fire away.
This is actually fairly easy to understand, as I have some reservations about it myself. Right now the government controls three major payers -- Medicare, Tricare and Medicaid. Medicare and Tricare are administered via regional fiscal intermediaries and carriers; Medicaid through each state. Medicare and Medicaid have had significant, negative impact on the healthcare landscape, in several ways.
First: the government sets the prices that they will pay you for services, regardless not only of what a provider actually charges, but also of what the service actually costs. Many providers lose money on Medicare and Medicaid patients. Medicare providers have to prepare a yearly cost report stating how much it cost us to treat Medicare beneficiaries, which may entitle us to an end-of-the-year bonus to meet actual costs, but may not. You get another couple of bites of the pie if you are a teaching hospital, but not much.
Second: there are regional FIs and carriers who administer the Medicare program on behalf of the federal government. Not only are we constrained by what CMS says, but also by how the FI/carrier interprets the regulations. If your enterprise spans multiple regions (as mine does), you have to figure out how to comply with, say, three different FIs and three different carriers being billed out of the same system. There are more pages in the Medicare regulations than there is in the US tax code. Now imagine trying to adhere to that with four different people interpreting it four different ways without descending into fraud or abuse.
Third: Medicare pulls all kinds of last-minute decisions out of its collective ass that basically fucks everyone else up. For instance, up until a week ago we were preparing for a 22% reduction in the Medicare fee schedule, but at the last minute they decided to forego that until April. You, as a provider, have to bill with their fee schedule, it's not like you bill the charge and adjust the fee to match. Also, they decided late last year that they were no longer paying on the consult CPT codes, which means that we had to scramble (and are still scrambling) to figure out how to switch the CPT code on Medicare patients (and only Medicare patients) to either a new or established CPT code. And all because they just up and decided, hey, let's do this!
Fourth: Medicare decides whether or not they'll pay for a test based on diagnosis alone. If you have abdominal pain and your doctor decides to send you for a CT or a GI study, Medicare isn't going to pay for that even if your medical history supports that test. THEY are the ones telling your doctor what tests he can do just like any other insurance company.
If I thought that this system was going to be shoved down all of our throats, I'd be packed and ready to move. Basically it boils down to the fact that the federal government has thoroughly fucked up the pieces it has its hand in up until now. I don't have much confidence that it would get any better if they took over the whole dance.
Posted by Seeker963 (# 2066) on
:
quote:
Originally posted by Erin:
This is actually fairly easy to understand, as I have some reservations about it myself. Right now the government controls three major payers -- Medicare, Tricare and Medicaid. Medicare and Tricare are administered via regional fiscal intermediaries and carriers; Medicaid through each state. Medicare and Medicaid have had significant, negative impact on the healthcare landscape, in several ways.....
I'm so glad that I'm not subject to anyone else's decision about my healthcare.
It's simple, the insurance companies have priced me out of the market and I can't afford either health insurance or to get any serious chronic illness.
So I know for certain that I have the freedom to suffer horribly and then die; and I know that I have the possibility to throw myself at the mercy of a hospital and let them decide which treatments they would and would not give me. But so much better for the private sector to decide what I can and cannot have than for the government to decide what I can and cannot have.
Not sure where in the West that anyone would move to where the medical system is completely free of government control. One certainly can't move to Europe.
Posted by Erin (# 2) on
:
Don't get pissy with me, I actually support the current healthcare bill (now law). I'm just explaining the way that many Americans view the idea of a single government payer. I have fabulous insurance through my employer; I would cry if I had to switch to a Medicare-type plan. Medicare sucks.
Posted by Seeker963 (# 2066) on
:
quote:
Originally posted by Imaginary Friend:
Yeah, you're probably right. Having lived my whole life in countries that have either nationalized healthcare, or a single-payer system*, I completely fail to understand why so many Americans don't want it**. I guess that's just the goggles through which I view the world.
From someone who agrees with your view (and so obviously will not be unbiased), and who just returned to the US after 20 years living in the UK....
1) I think all people fear change. We know what we've got now and we don't know what a new system would look like. It could be worse than what we have now.
2) This country was founded on distrust of government. As cliched as that sounds and as far away as that seems, I actually think that significant communal events live for centuries in the values of the communities they gave birth to.
3) There is a deep individualistic streak that also goes back to the founding of this nation. Our ethics tend to focus first on individual rights rather than on the common good.
4) Many people link "common good" with "socialism" with "20th century communist dictators". Thus, to want healthcare decisions made for the common good is also to desire Stalinist or Maoist totalitarian dictatorship. I don't think people would put it in those terms, but I think that there is an unconscious emotional reaction in that direction.
Posted by Carex (# 9643) on
:
quote:
Originally posted by Imaginary Friend:
In my opinion, America, the Democrats and Obama have missed the opportunity of a lifetime to do something truly memorable. Now that "Healthcare Reform" has been done, nobody is going to have the political capital or willpower to push reform further for a long time...
Given the legislative process in the US Congress, particularly the Senate, getting anything through is a major accomplishment. I suspect this bill was carefully crafted to get enough votes to pass.
My guess is that, once "Healthcare Reform" is in place and working, it will be much easier to make changes to, since those changes will be more incremental. It is far easier to make small changes to an existing program than to introduce a new program full of uncertainties. But this will establish the notion that all people deserve healthcare that they can afford, and as that becomes accepted over time further changes can be made.
Remember all those who objected to the notion of having the "Gummint" run Health Care, while decrying any changes to their Medicare benefits? They probably would have been firmly opposed to the introduction of Medicare, using similar arguments, at the time it was introduced, but are now firm defenders of it. I suspect we'll see a similar pattern with the recent legislation.
Posted by Mr. Spouse (# 3353) on
:
quote:
Originally posted by Seeker963:
I'm so glad that I'm not subject to anyone else's decision about my healthcare.
It's simple, the insurance companies have priced me out of the market and I can't afford either health insurance or to get any serious chronic illness.
See, this is what I can't get my head round. Others have decided on your healthcare, by denying you coverage. I can appreciate the reservations about Government-mandated (or denied) treatments - that's no different in the UK - but I still don't see how that is so different from insurance companies controlling what or who can and cannot be treated. If I had stayed longer in the US I would have had to change my treatment regime as the HMO we had would not pay for some of the medications I get for free in the UK.
quote:
Not sure where in the West that anyone would move to where the medical system is completely free of government control. One certainly can't move to Europe.
I presume you are talking about cost, not safety. In the UK anyone is free to elect to pay for their own treatment outside the NHS system.
Posted by Mr. Spouse (# 3353) on
:
quote:
Originally posted by Dumpling Jeff:
pharmacists specialize in knowing about drugs. They don't fix broken arms or check temperatures or learn diagnostics or any of the thousands of other things doctors learn. They learn drugs. They learn chemical interactions and how they work in the human body.
It would be nice if doctors could learn all that and everything else, but there's only so much time in a day. Instead, they consult pharmacists when they see a problem.
Really, try talking to your pharmacist. They are a lot more than pill counters.
In the UK we are encouraged to for minor ailments. But I still don't understand. You trust a pharmacist to tell you which drug works, but not a doctor to diagnose you? Odd.
Posted by Imaginary Friend (# 186) on
:
Erin, thanks for taking the time to write that long explanation. There is a lot of jargon which I don't really understand, but is it fair to sum up your criticisms of Medicare and Medicaid as follow?- Badly managed
- Underfunded
- Too bureaucratic
It seems to me that those are pragmatic concerns, rather than ideological ones*. Have I understood you correctly?
Seeker693, let me address your four points individually.
- Fear of change. Fair enough!
- Distrust of government. That's okay so far as it goes, and I certainly agree that "significant communal events live for centuries in the values of the communities they gave birth to"**. But people trust the government for a whole host of other things, so why not this?
- Individualism. I see that this is a Pond difference which I'm not going to understand unless I live in the States (and I am due to move there in a few months).
- Socialism. This is the point which I really don't understand and find frankly laughable. But then, I'm left-of-centre by UK standards, so I would say that. I would link this to my response to the second point: The government provides many other services and functions, so why do they not elicit the same reaction (conscious or otherwise)?
Carex, I hope you're right.
* It's not that I think that pragmatic arguments are invalid, but I understand them better (the ongoing arguments about how best to manage the NHS show that these are really difficult issues). It's views such as those that equate socialized medicine to communism that I don't get.
** In fact, it's arguable that World War II (a rather significant communal event in the UK) lead to the formation of the NHS.
Posted by Erin (# 2) on
:
quote:
Originally posted by Imaginary Friend:
Erin, thanks for taking the time to write that long explanation. There is a lot of jargon which I don't really understand, but is it fair to sum up your criticisms of Medicare and Medicaid as follow?- Badly managed
- Underfunded
- Too bureaucratic
It seems to me that those are pragmatic concerns, rather than ideological ones*. Have I understood you correctly?
Yes. That's why intelligent people have concerns about single-payer government-run healthcare. The rest are deluded teabaggers who listen to Rush, Glenn, Ann et al and think that the aforementioned assholes actually have their best interests at heart.
[ 23. March 2010, 21:40: Message edited by: Erin ]
Posted by Antisocial Alto (# 13810) on
:
quote:
Originally posted by Mr. Spouse:
quote:
Originally posted by Seeker963:
I'm so glad that I'm not subject to anyone else's decision about my healthcare.
It's simple, the insurance companies have priced me out of the market and I can't afford either health insurance or to get any serious chronic illness.
See, this is what I can't get my head round. Others have decided on your healthcare, by denying you coverage. I can appreciate the reservations about Government-mandated (or denied) treatments - that's no different in the UK - but I still don't see how that is so different from insurance companies controlling what or who can and cannot be treated.
To be fair, there is a slight difference. People in the US who are free-market aficionados point out that with a number of insurance companies available, you can (in theory) change providers if one of them screws you, whereas with a single-payer system, customer service is not as important to the big provider. Republicans have been suggesting de-coupling health benefits from employers, as well as allowing us to buy health insurance across state lines, to increase competition in the market and maybe make more attractive plans available to the consumer.
Of course the reality is that ALL of the many available providers are likely to screw you, because it's their job to make a profit. But many Americans view the Free Market as being on a par with life, liberty, happiness, motherhood, baseball and apple pie.
Posted by Seeker963 (# 2066) on
:
quote:
Originally posted by Mr. Spouse:
quote:
Originally posted by Seeker963:
I'm so glad that I'm not subject to anyone else's decision about my healthcare.
It's simple, the insurance companies have priced me out of the market and I can't afford either health insurance or to get any serious chronic illness.
See, this is what I can't get my head round. Others have decided on your healthcare, by denying you coverage.
I agree with you and this is precisely the point that I’m “being pissy” about . We seem very happy to have the private sector say “No, we are not going to pay for that procedure” or “No, we are not going to give you health insurance.” or “Pay us 90% of your monthly income to cover you for your good health and one case of mild asthma between the two of you; but you have committed the cardinal sins of being over 50 and not having employer-provided insurance”.
quote:
Originally posted by Mr. Spouse:
quote:
Not sure where in the West that anyone would move to where the medical system is completely free of government control. One certainly can't move to Europe.
I presume you are talking about cost, not safety. In the UK anyone is free to elect to pay for their own treatment outside the NHS system.
I'm saying that if a person is philosophically opposed to government-provided healthcare, why would they want to move to such a horrible place where people value that healthcare so much that they are willing to pay for it? I lived for 20 years in the UK and when I try to tell people here in the US that the NHS works, I get told that I only think the NHS works because of my political bias. And this is from people who have never lived in the UK!
Six weeks before we moved to the US, my husband went to A&E with what turned out to be a detached retina. It took him a total of three hours to leave work, get to the hospital, have laser surgery, and come home with his retina fixed. I honestly thank God this happened before we came here or I don't know what we would have done.
Posted by Erin (# 2) on
:
God help me, because I hate the insurance companies more than I hate the government, but I'd rather argue with them about noncovered services than with FCSO or Noridian. With Medicare, if they decide something isn't covered, it is not covered. Period, end of discussion. There is no medical review to see if they will grant an exception. At least with a private insurer you have an ever-so-minuscule chance of getting the medical director to override their coverage decisions.
Posted by Seeker963 (# 2066) on
:
quote:
Originally posted by Erin:
God help me, because I hate the insurance companies more than I hate the government, but I'd rather argue with them about noncovered services than with FCSO or Noridian. With Medicare, if they decide something isn't covered, it is not covered. Period, end of discussion. There is no medical review to see if they will grant an exception. At least with a private insurer you have an ever-so-minuscule chance of getting the medical director to override their coverage decisions.
And some people don't have an insurance company they can even argue with and the response is either "Suck it up" or "Trust in God and we'll bring you a casserole."
Posted by Erin (# 2) on
:
Are you aware we just passed a healthcare law that will provide access to insurance to those who don't currently have it for whatever reason?
Posted by Mr. Spouse (# 3353) on
:
quote:
Originally posted by Seeker963:
I'm saying that if a person is philosophically opposed to government-provided healthcare, why would they want to move to such a horrible place where people value that healthcare so much that they are willing to pay for it?
Ah, I understand what you mean now.
I had to go to A&E with someone not long after getting back from the USA. I spent most of the time thinking, 'how much would this have cost us?'
Posted by Spiffy (# 5267) on
:
quote:
Originally posted by Dumpling Jeff:
Several people show surprise that doctors swear to keep silent on medical knowledge. Here's the relevant line from the Hippocratic Oath: quote:
All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.
I would admit you were right, DumplingJeff... if it was the version that docs swear to these days. But it's not. From the very web site you cite:
quote:
The Hippocratic Oath (Modern Version)[10]
“ I swear to fulfill, to the best of my ability and judgment, this covenant:
I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.
I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.
I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.
I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.
I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.
I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.
I will prevent disease whenever I can, for prevention is preferable to cure.
I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.
If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.
Nothing in there about keeping medical knowledge secret, buddy.
Posted by Dumpling Jeff (# 12766) on
:
Mr. Spouse, when others decide by their actions, I can decide with my feet. If I don't like health insurance companies not paying on technicalities I can not buy insurance. Sure that sucks, but I don't have to help perpetuate a fraud.
But when government takes over, that's the end. If I don't like the service they provide me, I can always try the service they provide me in prison. There is no choice.
Government is always fair and good -- except when it's not. Then it's off to prison for us dissenters.
Please don't take me as an opponent of this bill. There's a lot to like about it. It's just that people will live or die by the details here and all I've heard has been hype from people with agendas. I have questions and the answers are buried in reams of paper.
Posted by Seeker963 (# 2066) on
:
quote:
Originally posted by Dumpling Jeff:
But when government takes over, that's the end. If I don't like the service they provide me, I can always try the service they provide me in prison. There is no choice.
Government is always fair and good -- except when it's not. Then it's off to prison for us dissenters.
Actually, I feel fairly confident that an individual will be able to get sick, refuse to use any and all healthcare resources and refuse to buy health insurance without the government bothering to imprison them. Of course, I also bet most people will find that they want to use healthcare resources when they do get sick. Although yours is a good argument for a government-run health system. If healthcare is free at the point of delivery, no one will send you to prison for refusing to go to the doctor or refusing to go to the hospital.
I feel the opposite about what is under the patients' control. I've seen the democratic process improve healthcare in the UK. My feeling is in the US system, one is at the random whim of faceless insurance and pharmaceutical companies whose primary and fundamental concern is their own profit and who don't give a damn about anyone's health. And there is nothing we as a society can do to change this until we come together and say that "profits before people" is a bad way to run a significant portion of the healthcare system. (I think that healthcare professionals who deal directly with patients mainly do care about people but that the entire system is still run as if the raison d'etre is to make money.)
Posted by Dumpling Jeff (# 12766) on
:
Seeker, it's my understanding that there will be fines for those who don't get insurance. It's also my understanding that private insurance will be taxed so as to force people to choose the government plan. So not paying the fines, etc. will get one thrown in prison for non-payment which is a felony.
Once most people are on the government plan, it's a short hop to the government mandating certain types of care (exercise plans, low junk food diets, etc.) to reduce public costs.
Live free or diet.
This health bill has a lot of potential to limit freedom. Further, some of the bills supporters seem to have this as a goal.
But that doesn't mean it will end up that way. Sufficient safeguards to freedom may exist in the bill. That's why I asked questions about how the final law is structured. I do find it disappointing that the answers are not available.
The old system was clearly broken. We needed something new. I hope this works.
Posted by mdijon (# 8520) on
:
quote:
Originally posted by Dumpling Jeff:
Once most people are on the government plan, it's a short hop to the government mandating certain types of care (exercise plans, low junk food diets, etc.) to reduce public costs.
Yes, that's the path it's taken in every other democracy that has government run health care.
Posted by Moth (# 2589) on
:
quote:
Originally posted by mdijon:
quote:
Originally posted by Dumpling Jeff:
Once most people are on the government plan, it's a short hop to the government mandating certain types of care (exercise plans, low junk food diets, etc.) to reduce public costs.
Yes, that's the path it's taken in every other democracy that has government run health care.
Exactly. Every time I go to the doctor, he makes me sign a pledge to say I haven't eaten in McDonald's for at least three months. I'm sure every American visiting the UK has noticed how slim we all are, how few junk food outlets are available, and how all of us are just exercising like crazy!
Posted by mdijon (# 8520) on
:
quote:
Originally posted by Dumpling Jeff:
Once most people are on the government plan, it's a short hop to the government mandating certain types of care (exercise plans, low junk food diets, etc.) to reduce public costs.
quote:
Originally posted by mdijon:
Yes, that's the path it's taken in every other democracy that has government run health care.
quote:
Originally posted by Moth:
Exactly. Every time I go to the doctor, he makes me sign a pledge to say I haven't eaten in McDonald's for at least three months. I'm sure every American visiting the UK has noticed how slim we all are, how few junk food outlets are available, and how all of us are just exercising like crazy!
You're giving a misleading impression though, that's only because all the fat ones are locked up until they slim down.
Posted by Antisocial Alto (# 13810) on
:
There is no government plan- that was taken out of the bill months ago. Unless you count the things that already exist, like Medicaid.
Posted by Clint Boggis (# 633) on
:
quote:
Originally posted by mdijon:
quote:
Originally posted by Dumpling Jeff:
Once most people are on the government plan, it's a short hop to the government mandating certain types of care (exercise plans, low junk food diets, etc.) to reduce public costs.
quote:
Originally posted by mdijon:
Yes, that's the path it's taken in every other democracy that has government run health care.
quote:
Originally posted by Moth:
Exactly. Every time I go to the doctor, he makes me sign a pledge to say I haven't eaten in McDonald's for at least three months. I'm sure every American visiting the UK has noticed how slim we all are, how few junk food outlets are available, and how all of us are just exercising like crazy!
You're giving a misleading impression though, that's only because all the fat ones are locked up until they slim down.
Don't TELL them! We WANT them to walk right into the trap and give up their lovely freedom and become government controlled drones like us. Bwahahaha!
[And the only thing they'll get in return is longer, healthier lives and reduced costs!]
.
Posted by Trudy Scrumptious (# 5647) on
:
Just this morning I was about to grab a Tim Horton's glazed donut for breakfast when the door burst open and two armed, uniformed officials from the Department of Health and Fitness burst in, tore the donut from my hands, ground it to dust beneath their heels, and forced this bowl of All-Bran, trail mix and skim milk upon me. I didn't even buy the stuff -- they brought the little packets with them and mixed it up on the spot. Unfortunately they don't do dishes, but it's a small price to pay for free health care.
I <3 socialized medicine!!!
Posted by FreeJack (# 10612) on
:
quote:
Originally posted by Seeker963:
I'm saying that if a person is philosophically opposed to government-provided healthcare, why would they want to move to such a horrible place where people value that healthcare so much that they are willing to pay for it? I lived for 20 years in the UK and when I try to tell people here in the US that the NHS works, I get told that I only think the NHS works because of my political bias. And this is from people who have never lived in the UK!
Six weeks before we moved to the US, my husband went to A&E with what turned out to be a detached retina. It took him a total of three hours to leave work, get to the hospital, have laser surgery, and come home with his retina fixed. I honestly thank God this happened before we came here or I don't know what we would have done.
And indeed we have the largest eye hospital in the world here in London. (Even if your husband wasn't treated at Moorfields, it is quite possible that he was treated under someone who had been trained there.)
So the base level of care is likely to be as high as you could have got with a million bucks.
Posted by Clint Boggis (# 633) on
:
quote:
I lived for 20 years in the UK and when I try to tell people here in the US that the NHS works, I get told that I only think the NHS works because of my political bias. And this is from people who have never lived in the UK!
A possible response: "I know the NHS works reasonably well from personal experience over 20 years of using it. Is your view based on long term personal experience or third hand stories? The British live longer and spend less on health than we do. So who's really the one spouting misinformation based on political bias?"
.
Posted by Rowen (# 1194) on
:
quote:
Originally posted by Moth:
quote:
Originally posted by mdijon:
quote:
Originally posted by Dumpling Jeff:
Once most people are on the government plan, it's a short hop to the government mandating certain types of care (exercise plans, low junk food diets, etc.) to reduce public costs.
Yes, that's the path it's taken in every other democracy that has government run health care.
Exactly. Every time I go to the doctor, he makes me sign a pledge to say I haven't eaten in McDonald's for at least three months. I'm sure every American visiting the UK has noticed how slim we all are, how few junk food outlets are available, and how all of us are just exercising like crazy!
And Moth, this is true of Australia too! We have government-financed health-care as well.
(No McDonalds here for us to swear not to eat- and I mean that literally, living in a tiny country town miles away from any fastfood joint!)
[ 24. March 2010, 13:24: Message edited by: Rowen ]
Posted by Moth (# 2589) on
:
quote:
Originally posted by Rowen:
quote:
Originally posted by Moth:
quote:
Originally posted by mdijon:
quote:
Originally posted by Dumpling Jeff:
Once most people are on the government plan, it's a short hop to the government mandating certain types of care (exercise plans, low junk food diets, etc.) to reduce public costs.
Yes, that's the path it's taken in every other democracy that has government run health care.
Exactly. Every time I go to the doctor, he makes me sign a pledge to say I haven't eaten in McDonald's for at least three months. I'm sure every American visiting the UK has noticed how slim we all are, how few junk food outlets are available, and how all of us are just exercising like crazy!
And Moth, this is true of Australia too! We have government-financed health-care as well.
(No McDonalds here for us to swear not to eat- and I mean that literally, living in a tiny country town miles away from any fastfood joint!)
Actually, I'm quite prepared to believe that, Rowen. Any country which produces so many good sports stars must have some secret government programme to ban junk food and force people to exercise. It's not as if you have any nice, sunny weather to tempt people run around outside, is it?
Posted by Mr. Spouse (# 3353) on
:
quote:
Originally posted by Dumpling Jeff:
Seeker, it's my understanding that there will be fines for those who don't get insurance. It's also my understanding that private insurance will be taxed so as to force people to choose the government plan. So not paying the fines, etc. will get one thrown in prison for non-payment which is a felony.
Once most people are on the government plan, it's a short hop to the government mandating certain types of care (exercise plans, low junk food diets, etc.) to reduce public costs.
Live free or diet.
Aren't the penalties to be imposed through the tax system? If they are less than the cost of coverage you wouldn't have to take it, and probably won't end up in jail (provided of course that you pay the tax).
In the UK, I've read that around 12% of the population have some form of private healthcare. Those of working age still have to pay for Government care through taxation on top of that.
Posted by mousethief (# 953) on
:
quote:
Originally posted by Dumpling Jeff:
This health bill has a lot of potential to limit freedom. Further, some of the bills supporters seem to have this as a goal.
Which ones? Please cite sources.
Posted by FreeJack (# 10612) on
:
quote:
Originally posted by Mr. Spouse:
In the UK, I've read that around 12% of the population have some form of private healthcare. Those of working age still have to pay for Government care through taxation on top of that.
Yes. What's wrong with that? I am one of them, though I have hardly used it, but I have used the tax-paid NHS.
Depending on the coverage, you might get counselling helplines, a better room and food as an in-patient in hospital recovering from an operation, shorter waits for the best specialist for non-emergency care. And you might get the whole cost paid, or you might be able to reclaim say 50% of the cost. You pay your premium accordingly.
About 7% of parents pay for private school education on top of taxes for education too.
Surely it shows that most of the population are happy with the state-funded service most of the time, but there is still choice for those that want it.
Posted by Imaginary Friend (# 186) on
:
quote:
Originally posted by FreeJack:
Surely it shows that most of the population are happy with the state-funded service most of the time, but there is still choice for those that want it.
No it does not. All it shows is that the choice is there for those who can afford it.
Posted by Mr. Spouse (# 3353) on
:
quote:
Originally posted by FreeJack:
quote:
Originally posted by Mr. Spouse:
In the UK, I've read that around 12% of the population have some form of private healthcare. Those of working age still have to pay for Government care through taxation on top of that.
Yes. What's wrong with that? I am one of them, though I have hardly used it, but I have used the tax-paid NHS.
I never said there was anything right or wrong. I was pointing out to Dumpling Jeff that even with social systems like the NHS there is still capacity for free choice.
But now you have put it that way, what IF said.
Posted by FreeJack (# 10612) on
:
But our choice is at the choice end of the health system.
How much choice you want in hospital food you want post life-saving operation is a discretionary lifestyle choice. The same ambulance still picks you up from the car crash in 15 minutes and takes you to hospital for the same life-saving operation in an hour first and asks insurance cash and lifestyle questions after.
And as I understand it the small premium I pay for the discretionary extras I choose are proportionately lower than they would be in the USA, and affordable to most of the country if they wanted it. (Unlike private education which is genuinely out of most people's reach.)
Posted by Mr. Spouse (# 3353) on
:
quote:
Originally posted by FreeJack:
But our choice is at the choice end of the health system.
How much choice you want in hospital food you want post life-saving operation is a discretionary lifestyle choice. The same ambulance still picks you up from the car crash in 15 minutes and takes you to hospital for the same life-saving operation in an hour first and asks insurance cash and lifestyle questions after.
As I understand the US system, emergency treatment in those circumstances would be provided in some form.
quote:
And as I understand it the small premium I pay for the discretionary extras I choose are proportionately lower than they would be in the USA, and affordable to most of the country if they wanted it. (Unlike private education which is genuinely out of most people's reach.)
Chances are you aren't getting anything like the same extent of cover through your insurance. Chronic conditions, for instance, are probably not included in your health plan (because the NHS provide that).
I'm not sure about your definition of affordable. I certainly couldn't afford private healthcare on my current annual income. But I'm not against it for those that can afford to pay. If it eases some of the pressure on the public system then that's not a bad thing.
Posted by Think² (# 1984) on
:
What annoys me about private health care in the UK, is the right wing think tanks and others bigging up its a efficiency etc. Without acknowledging that it immediately dumps people with chronic and complex conditions back to the NHS.
Yes, the NHS would be more efficient and have lower waiting times if it screened out all the difficult patients. The other fairly stupid thing about private healthcare in the UK is a large portion of the staff are NHS or ex-NHS fitting extra clinics / shifts.
I remember taking my gran to see a priavte opthamologist for laser surgery at a BUPA hospital, and then bumping into him in an NHS hospital a week later. On the other side of the fence, the people I know who choose to work privately tend to do so in order to work less hours for the same money, to have a set of simpler cases or to be able to screen cases so they treat only people who match their special interest.
I work in secondary care in the NHS and treat almost exclusively, people with chronic complex conditions whose conditions leave them without the ability to negotiate effectively and advocate effectively for care. They would be absolutely screwed in a private system.
Posted by Think² (# 1984) on
:
Is says something about the ass-backwards nature of medical insurance that they don't cover preventative health care.
You'd help to quit smoking would lower your long term costs - but then again the NHS does provide that so I guess they don't think there is the demand.
Posted by Martin L (# 11804) on
:
quote:
Originally posted by Mr. Spouse:
As I understand the US system, emergency treatment in those circumstances would be provided in some form.
True, but there's a problem with emergency rooms in the US. Since people know that they are going to be covered, some people use emergency rooms as their primary care. To make matters worse, some insurance companies cover emergency room visits at a better rate than they cover those quick-care clinics that have been popping up all over. My employer offers an HMO option for insurance, and one of my co-workers on the HMO plan asked the insurance whether she should go to a quick-care clinic or not. The insurance company representative was quite candid and told her to go to the emergency room--it would cost less. Something is clearly wrong with a system that does things like that.
© Ship of Fools 2016
UBB.classicTM
6.5.0