Editore"s Note
Tilting at Windmills

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March 2, 2006
By: Kevin Drum

UNIVERSAL HEALTHCARE....I'm just curious: is there a liberal blogger in the United States any liberal blogger who doesn't support universal healthcare? I can't think of one. Sure, we have arguments about both details and political strategy, but underneath it all it seems like pretty much everyone supports a genuinely comprehensive France/Germany/Sweden/Japan (pick your favorite model) version of national healthcare.

I don't read every blog in the world, though, so maybe I'm missing someone. Are there any dissenters? Or is this literally a policy that's supported unanimously by the left blogosphere?

Kevin Drum 5:36 PM Permalink | Trackbacks | Comments (77)

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Comments

I don't.

Just kidding!

Posted by: Alexander Wolfe on March 2, 2006 at 5:38 PM | PERMALINK

I don't read every blog in the world, though,

Why not? What are we paying you for, anyway?

Posted by: craigie on March 2, 2006 at 5:38 PM | PERMALINK

I don't care. SOCIALIZED MEDICINE!! WAITING FOR SURGERY IN CANADA!!!

Posted by: Alek Hidell on March 2, 2006 at 5:39 PM | PERMALINK

If they were consitent, the Big Government
Republicans now in power would be for it.

I am for it (easy to say before I see the
devil's details)

Posted by: Semanticleo on March 2, 2006 at 5:39 PM | PERMALINK

Someone who only reads Malcolm Gladwell occasionally?

Posted by: Allen K. on March 2, 2006 at 5:42 PM | PERMALINK

I think there's huge support for it, and not just on the left, now. I know a couple of Republican doctors who are wholeheartedly for it, who are fed up with the way the current system doesn't work, costs them hugely in administrative costs.

The devil, however, is in the details. We should move to discuss what we mean by universal coverage, how to implement it. There has been a series of detailed discussions going on at TPM Cafe -- don't know whether they're continuing at this point...

Posted by: PW on March 2, 2006 at 5:42 PM | PERMALINK

Are there any dissenters?

I'm against it because Universal Healthcare causes moral hazard problems.

First Universal Healthcare causes people to go to the doctor more for frivilous or non-existent medical problems because they don't have to pay for their own health care. This causes health care costs to rise.

Second Universal Healthcare causes people to stop paying attention to their health. Right now people try not to get sick because they know if they do they have to pay for it on their own. But with Universal Healthcare the government will pay it for them so they don't care any more. So Universal Healthcare actually causes people to be more sick and less medically well. These reasons are why Universal Healthcare is very bad.

Posted by: Al on March 2, 2006 at 5:43 PM | PERMALINK

Canada! England! National Health! Long lines! Rationing!

Posted by: Cranky Observer on March 2, 2006 at 5:44 PM | PERMALINK

Al is right. I know several people who really really wanna get sick, but can't afford to.

Posted by: elfranko on March 2, 2006 at 5:47 PM | PERMALINK

Al said, "Right now people try not to get sick because they know if they do they have to pay for it."

Are you kidding me? This country is so unfit and overweight that it's ridiculous. How is Universal Healthcare that stresses prevention going to make people lazier?

Posted by: nutty little nut nut on March 2, 2006 at 5:47 PM | PERMALINK

Al gets better by the day.

Posted by: lib on March 2, 2006 at 5:48 PM | PERMALINK

If the Al-bot doesn't have a core dump soon, it's going to be severely damaged.

Posted by: craigie on March 2, 2006 at 5:51 PM | PERMALINK

"Universal healthcare" is a phrase very similar to "Winning the War on Terror" in that almost as soon as you start defining terms, you are going to start hearing disagreements.

Posted by: paul on March 2, 2006 at 5:53 PM | PERMALINK

For example -- let's just look at the word "universal." Does that include all citizens? What about legal aliens? What about illegal aliens? What about incarcerated people? Does defining a universe of people who can get healthcare though a universal program preclude people from getting healthcare outside of that program? Can you opt completely out of a universal program? and if you can, is it universal anymore?

Posted by: paul on March 2, 2006 at 6:00 PM | PERMALINK

First Universal Healthcare causes people to go to the doctor more for frivilous or non-existent medical problems because they don't have to pay for their own health care. ...

Second Universal Healthcare causes people to stop paying attention to their health. Right now people try not to get sick because they know if they do they have to pay for it on their own. But with Universal Healthcare the government will pay it for them so they don't care any more. So Universal Healthcare actually causes people to be more sick and less medically well.

posted by Al

1: A small co-pay (5 or 10 dollars) removes most of this problem.

2: If people are not moving from plan to plan as they switch jobs, health care organizations have an incentive to keep people well by practicing preventive medicine. Now there is no such incentive. It's not a matter of not trying to get sick; it's largely a matter of what happens to you.

Posted by: anandine on March 2, 2006 at 6:01 PM | PERMALINK

Isn't that what makes you a liberal? It's kinda like asking whether Moslems support suicide bombings and beheading of infidels... The question is silly.

Posted by: Freedom Fighter on March 2, 2006 at 6:02 PM | PERMALINK

If the Al-bot could read and learn, it would be good for it to read this New Yorker article on moral hazard.

Bottom line: people want to play golf, not go to the doctor.

Posted by: craigie on March 2, 2006 at 6:12 PM | PERMALINK

It's kinda like asking whether Moslems support suicide bombings and beheading of infidels... The question is silly.

All the more reason we should allow them to take control of our ports!

Posted by: Freedom Fondler on March 2, 2006 at 6:13 PM | PERMALINK

Here's a question. What's greater.

The moral hazard of people not being able to pick their own health care, or the moral hazard of corporations profiting from denying health care to people.

Interesting question.

Posted by: Karmakin on March 2, 2006 at 6:14 PM | PERMALINK

Moslems! The Democrat Party! It's like belling a cat the way they train you people to speak.

Posted by: shortstop on March 2, 2006 at 6:15 PM | PERMALINK

Freedom Fighter is right: Liberals are always for universal health care; terrorists are for suicide bombings; neo-cons are for torture; kids are for candy; and dogs love to sniff crotches.

The problem is that I still don't get his point. Is he arguing that providing health care is a terrorist act? (I don't doubt it.)

By the way, universal health care IS a socialist act. So are highways and bridges, city run police departments, the military, all subsidies to businesses, street lights, public schools, and libraries. So let's get over the whole socialism bullshit and get to the issue: do we want universal health care or not?

Posted by: Dicksknee on March 2, 2006 at 6:17 PM | PERMALINK

We wouldn't need universal health care if we abolished the FDA, made all drugs over-counter, outlawed the AMA and produced enough health care professionals so that their rate of unemployment matched the rest of the country.
Free markets would extinguish the need for universal health care by lowering the costs to reasonable levels.

Posted by: slanted tom on March 2, 2006 at 6:18 PM | PERMALINK

Kevin - we're all for it. Do we have a party that supports it?

Posted by: Friend of labor on March 2, 2006 at 6:21 PM | PERMALINK

Oh, dear me, Kevin. You wrote, "I don't read every blog in the world, though, so maybe I'm missing someone. Are there any dissenters? Or is this literally a policy that's supported unanimously by the left blogosphere?"

And what of Molly Ivins? Barbara Ehrenreich? Jonathan Kozol? Paul Loeb? Bob Herbert? Cynthia Tucker? Joan Ryan? Michael Lerner? As far as I know, none of these, and none of hundreds of other liberal thinkers, commentators and pundits, have blogs.

Please, Kevin, look beyond the 'blogosphere'! There's a huge universe of opinion out there.

Respectfully,

Posted by: Joel Rubinstein on March 2, 2006 at 6:23 PM | PERMALINK

I'm on board. I tried to reschedule a dental appointment today in our free market system and was told that the next available was in mid-September. If I'm going to have good insurance and terrible options, everyone should.

Okay, that's snarky, but really. Either way health care is rationed. Might as well ration it to as many people as possible.

Posted by: shamanic on March 2, 2006 at 6:24 PM | PERMALINK

Phrased another way, are there any bloggers (except rightwing bloggers) who don't support universal healthcare?

Kevin fell into the frame trap again. Most people (bloggers or not) support universal health care. It is the right-wing bloggers who are unique in opposing it.

Posted by: morris on March 2, 2006 at 6:25 PM | PERMALINK

I'm pretty sure I read someone a while ago saying he preferred the British system...possibly on TAPPED, but I can't really remember.

Posted by: Chris O. on March 2, 2006 at 6:26 PM | PERMALINK

Universal Healthcare!
Marx!
Engels!
Lenin!
Stalin!
Trosky!
Mao!
Pol Pot!

Posted by: alex on March 2, 2006 at 6:26 PM | PERMALINK

EVERYONE should be covered no matter where they are

The ROI ("return on investment" for non-MBA types) would be so positive that there probably would be several investigations to try and figure out where the "cheating" was going on

Take a look at the Veterans Administration & what they have done in the last decade (and ignore the babble/noise about any coming budget cuts - they are NOT going to happen)

Health Care for all !!!

"The only barrier to a successfully sustainable planet is ignorance." - R. Buckminster Fuller

Posted by: daCascadian on March 2, 2006 at 6:29 PM | PERMALINK

When the US gets universal healthcare, it will be because Big Business is tired of paying high premiums for its workers. While the non-insured suffer, the ones who pay the most money to HMOs are employers. Its surprising that corporations arent pushing universal health care already.

Posted by: jimmy on March 2, 2006 at 6:34 PM | PERMALINK

I'm for universal healthcare, but I'm not for spending as much as we do on people at the end of their lives. Universal Healthcare should be geared towards prevention and health, with a focus on children.

If universal healthcare mirrors our current system of neglecting prevention and the young to appease the voting elderly, I'm not enthused.

Healthcare is a finite resource, and it should be spent where it can do the most good.

Posted by: exhuming mccarthy on March 2, 2006 at 6:46 PM | PERMALINK

Did you check Joey Lieberman's blog?

Posted by: koreyel on March 2, 2006 at 6:51 PM | PERMALINK

The only type of blog that I can think of that would be basically liberal but against universal healthcare would be one written by an MD who thinks he/she is good at making money off the current situation.

I haven't searched through a bunch of MD blogs, but here is a link to a bunch of them.

Posted by: MonkeyBoy on March 2, 2006 at 6:53 PM | PERMALINK

I don't. But it is the case that I don't have a blog going... yet. I don't know that I've seen everyone backing universal healthcare, but I have seen a lot of bloggers - liberal and otherwise - who don't know what the hell they're talking about.

Posted by: weboy on March 2, 2006 at 6:53 PM | PERMALINK

I don't see how Universal Healthcare is socialist?

How would that be the same as "the means of production are owned by everyone"?

The doctors and hospitals are the means of production. They're privately owned. Universal Healthcare==Socialism is a non sequitur.

Posted by: Osama_Been_Forgotten on March 2, 2006 at 6:53 PM | PERMALINK

Joel: Believe it or not, I do read stuff outside the blogosphere. Amazing but true.

But I wasn't asking whether every liberal in the country supports universal healthcare. I was asking whether every liberal blogger does. It's a different question, and I have a reason for asking it.

Posted by: Kevin Drum on March 2, 2006 at 6:53 PM | PERMALINK

Most of the industrialized countries got through this debate decades ago and decided that, whatever the variations in the plan, universal health care was the only sensible way of handling things. Some countries have devised better plans than others. Canada's plan seems to have some fairly serious problems, not because they have universal health care but because, unlike most European countries, they have not permitted a private medical system to exist alongside the public one. (I think you will see that issue corrected in the next few years.) Beyond that point, would Canadians trade universal health care for our system? I doubt it. Sooner or later, the US is going to catch up with the modern world. Sooner would be better for everybody, except for the corporate interests making a bundle off the present mess.

Posted by: Chris K on March 2, 2006 at 6:56 PM | PERMALINK

I want Universal Healthcare as long as it isn't given to the undeserving.

Posted by: cq on March 2, 2006 at 6:56 PM | PERMALINK

Wise guys retort to Kevin,

Anyone who's ever looked at the issue seriously and hasn't drunk the GOP / Economist free market Koolaid agrees that a National Health Care system makes more sense.

But as someone said above - the devil's in the details.

But here the biggest opportunity and biggest possible source of cash and conflict. About 1.5 of the US GDP is just health care paperwork. Go to one system, streamline that and that money goes to covering the uninsured. Downside - wipe out the health insurance industry.

Lastly on this question above:
And what of Molly Ivins? Barbara Ehrenreich? Jonathan Kozol? Paul Loeb? Bob Herbert? Cynthia Tucker? Joan Ryan? Michael Lerner?

I'll bet you they're for it, too.

Posted by: Samuel Knight on March 2, 2006 at 6:57 PM | PERMALINK

One of the side benefits of Universal Health Care is that it produces beautiful women, as in Sweden.

Perhaps that's why conservatives are against it, as they like to fuck dogs.

Posted by: nut on March 2, 2006 at 7:00 PM | PERMALINK

Here's a big shocker- private health insurance has moral hazard problems too. You pay a $10-$20 copay for brand name pharmaceuticals you might not pay for if you were paying retail (and which cost tons more because they funnel their price hikes through the private system with no cost controls). You go to the doctor for the price of a copay because an underripe banana makes your mouth feel funny, but it costs your insurance plan much more.

Here's an insight- letting people choose when to go to the doctor is not a moral hazard. It's a moral value.

Posted by: clb72 on March 2, 2006 at 7:02 PM | PERMALINK

The basics are really pretty simple. You set up the Federal government as a single payer for a menu of health care and pharmaceuticals. Except in disfigurement situations, you do not get covered for cosmetic surgery, liposuction or viagra. Certain experimental stuff is optional with the government. Everyone seeks the health care of their choice with some co-pay to preserve a level of moral hazard. You pay for it in three ways--First you should save around 10% just by cutting out the insurance companies, the collection agencies, the lawyers etcetera. Second you tax all employers for full and part time employees based on the wages paid-no more free riders like Walmart and there is no limit. If the CEO thinks he is worth $4 million a year than his company can pay $400,000 a year to make sure he gets health care if he gets sick. Idea is not to further discourage employment of the poorest people because of the cost to employ them. Third, we make it unconstitutional for the States to tax tobacco, booze, fat and sugar and the Feds collect a tax on these items soley to fund health care. This adds an additional incentive for people to live a healthier lifestyle and answers all those holier than thou types who insist that they should not have to pay for those who do not take care of themselves. The states will go along because it gets them out of trying to pay for all the health care that no one else pays. While those types of taxes are regressive, they can be avoided. The system would more than pay for itself with the only people paying more in taxes being those companies who have been freeriders, those companies who pay a favored few exorbinant salaries and those people who smoke, drink and eat a lot of food that is bad for them. You could also do things like let people ride motorcycles without a helmet for a fee with the fee going to the health care fund, putting a tax on amunition for handguns to help fund healthcare etc. The whole concept of rationing is a function of how much countries like Canada and England pay for health care--hint a whole lot less than we do, despite generally better results. Doctors would generally toe the line if they always got paid and did not have to deal with the paperwork--most do it now with health plans. Hospitals could be a problem to the extent that they are for profit, but they are regulated a lot like utilities already. The pharmaceutical industry will probably be the toughest nut, but as long as the government lets them make a decent profit, they will have to come around too. The potential downside is that there might be less research and development dollars available, but maybe the drug companies will also act more ethically if the dollar stakes are not so huge. It really is not socialism. You can look at it two ways--like military defense or a mandatory insurance program with premiums adjusted based on the value of the worker as indicated in wages and the lifestyle of the insured as represented by the taxable items consumed.

Posted by: terry on March 2, 2006 at 7:07 PM | PERMALINK

Samuel Knight on March 2, 2006 at 6:57 PM:

Downside - wipe out the health insurance industry.

Uh, what was that downside again?

Seriously; A two-tier system like Australia or New Zealand's is workable, covers everybody, and still allows you to buy private health insurance if you don't want to wait six months for your quarterly rectal exam.

'Your' not meaning you, Sam, unless you actually are into that sorta thing, which I really don't want to know about if you are.

Posted by: grape_crush on March 2, 2006 at 7:12 PM | PERMALINK

"The potential downside is that there might be less research and development dollars available, but maybe the drug companies will also act more ethically if the dollar stakes are not so huge."

The drug companies are already exaggerating the research factor enormously. Marketing, and rebranding a drug so it doesn't go generic, are where the money is for them, not in true research.

Posted by: Chris K on March 2, 2006 at 7:12 PM | PERMALINK

Per latest Harper's Index: estimated amount of money
United States would save each year on paperwork
if adopted single-payer system: $161,000,000,000.

Posted by: Augustus on March 2, 2006 at 7:13 PM | PERMALINK

So Universal Healthcare actually causes people to be more sick and less medically well.

Hmmm. So many synapse misfires, so little time. Suffice it to say that line of reasoning is right up there with "Hitting yourself on the head with a hammer because it feels so good when you stop."

Posted by: Joshua Norton on March 2, 2006 at 7:14 PM | PERMALINK

Kevin

Congratulations for your fine article sometime ago prognosticating that the Bush second term will be mired in scandal. With today's publication of Murray Waas story, your prediction must now be graded as being 100% accurate.

What the congress does about these scandals is another matter. But I think that with Katrina tape and the Waas article, the presidency has been rendered not just lame duck but legless.

Posted by: lib on March 2, 2006 at 7:15 PM | PERMALINK

Yeah, Semanticleo, the devil IS in the details.

I was for the addition of a drug benefit to Medicare before the Republicans actually did it. I'm still for a drug benefit being added to Medicare, just not the current Republican ripoff.

Posted by: Rick B on March 2, 2006 at 7:17 PM | PERMALINK

Try:
www.HMOliberal.com
or
www.liberalswholovehighinfantmortalityrates.com
or
www.singlepayTHIS.com (not sure if she's a liberal though)
or
www.deathwishliberal.com
or
www.paperworkliberal.blogspot.com
or
www.inefficientliberal.com

I'm starting to think there are too many blogs.

Posted by: kj on March 2, 2006 at 7:20 PM | PERMALINK

AI says we will go to the doctor for frivolous reasons but not care about our health. Brilliant.

Posted by: Dan-O on March 2, 2006 at 7:29 PM | PERMALINK

Terry,

interesting approach. At the very least it provides a detailed enough plan to futher discussion. Hopefully, Mr. Drum is thinking about that type of discussion when he states "It's a different question, and I have a reason for asking it." But, I suspect, his reason has more to do with Blog navel gazing. Ah well, its his blog.

Posted by: Edo on March 2, 2006 at 7:31 PM | PERMALINK

Most people (bloggers or not) support universal health care.

Possibly, but where can I find data supporting that conclusion?

Posted by: pencarrow on March 2, 2006 at 7:41 PM | PERMALINK

I think it's a no-brainer that we owe ourselves, our fellow citizens, and particularly children, a basic and reasonable level of universal health insurance.

However I don't think it's possible or acceptible to force doctors to accept the payments that such a system offers; and so there will be some doctors -- probably the best doctors -- who won't. Which means I'll want the right to buy health coverage that these doctors take, if I can afford it.

Posted by: larry birnbaum on March 2, 2006 at 8:21 PM | PERMALINK

Universal? as in "not just affluent folks"? Eeeeeeew!

Posted by: BroD on March 2, 2006 at 8:42 PM | PERMALINK

Here's my experience:

http://bendtherail.blogspot.com/2006/03/hopefully-educational-rant.html

Posted by: Mike on March 2, 2006 at 8:47 PM | PERMALINK

I think every is for universal healthcare until they talk about picking up the tab and giving up their existing arrangements.

Its like 'End Global Poverty', you'd have to be a sociopath to not say something positive.

Posted by: McA on March 2, 2006 at 8:55 PM | PERMALINK

Folks, as more people wind up not having employer based healthcare or find that their condition is considered pre-existing they will be forced to hold off on preventative healthcare. This will lead to more and more people having a serious health issue before they even try to see a doctor, at which point they are going to the hospital, not the local office. This will cost a heck of a lot more than a standard doctor vist, which they already cannot pay. No money for the emergency room visit will mean that the patient will wind up filing bankruptcy and the hospital will have to eat the cost. Well the hospitals will only eat this cost for so long before they in turn either go out of business or raise prices on those that can pay until a larger number of people cannot pay the costs, creating a larger burden on the hospital. The last option is for the hospital to beg the government for cash or go under. How politically acceptable will it be for hospitals to close down if the next hospital is 50-100 miles away? Think this wont happen? Its happening right now!

So the only real question is are we going to plan for government provided healthcare so that it comes about in a reasonable and effecient way or just wait for it happen by default at a far far higher cost? If history is any guide, it will be the latter, because we are that damn stupid.

Posted by: clyde on March 2, 2006 at 9:02 PM | PERMALINK

Our current healthcare system is the real death tax in this country.

You will spend 90% of what you spend on healthcare in your life in the last 10 years of your life, in fact in the last 6 months of your life.

Lots of lifetime estates are depleted into nothing at the end of ones life, leaving the decedents heirs to figure out how to pay the debts.

Meanwhile, in Europe, a person who has accumulated a few bones doesn't lose it all pay for their health care.

As far as universal healthcare is concerned: it doesn't have to be government run - We have a universal phone service - provided by a private oligopoly that is well regulated by a combination of state and federal regulators. It works perfectly and over the years the regulators have surgically introduced market mechanisms and competition without degredations in reliability of service.

I think that's the way to go, personally, though no nation has taken this route yet, it is perfectly suitable to the United States: Universal Health care monopoly, private (preferablly not-for-profit) oligopoly providing the service.

The reason repbulicans are against universal health care is because it eats into their rice bowl. They're making billions on this and they don't give a fuck if tens of millions of Americans don't have health insurance. You know, the same American's that might some day get drafted to go fight in the middle east to protect rich republicans property rights.

The corruption of Republicans just staggers the imagination.

Posted by: E Publius on March 2, 2006 at 9:02 PM | PERMALINK

Next, you'll be talking about socialized education.

Speaking of which: what's this I hear about health-care vouchers?

Posted by: adam on March 2, 2006 at 9:05 PM | PERMALINK

So the only real question is are we going to plan for government provided healthcare so that it comes about in a reasonable and effecient way or just wait for it happen by default at a far far higher cost? If history is any guide, it will be the latter, because we are that damn stupid.

This reminds me of another great quote atributed to Winston Churchill.

"Americans always do the right thing,...after they've tried everything else."

It should be dawning on conservatives now, as it is on the general public, that American healthcare system is a good metaphore for their whole entire movement - dysfunctional and increasingly, nonfunctional, and thus increasingly discredited.

The enraged denial spews, shortly there after, but, as the English say, "the sea will not waite". When the tide rushes in, as surely it must, it will wash all their sand castles away.

Posted by: E Publius on March 2, 2006 at 9:13 PM | PERMALINK

I'm for universal ability to get coverage under a standard plan offered by a government agency -like Medicare, or a small set of plans offered through the federal government with fixed minimum features and available to all who want to join (no exclusions), like the Federal Employees Health Benefit Plan (FEHBP).

These standard federal plans should have mimimal co-pays for routine treatments and cover all drugs. All US citizens and green card residents would be covered. Non-US citizens/non-green card holders could participate if they are paying federal and state income tax, Medicare, and Social Security taxes as long as they continue to pay these taxes.

Funding the program would come from increased federal and state taxes that are regained from businesses not being able to deduct health care expenses for their employees plus the funds at state and federal levels now going toward Medicaid for the poor. I'd even accept some partial premiums from those covered who have incomes above some figure (maybe $75K/yr for singles, adjusted annually for inflation) if needed for fiscal balancing.

I would allow people to opt-out of coverage on a one-time basis (for their life) and only one opportunity to opt-in again, so the wingnuts, trolls, libertarians, and whatevers would not bitch for eternity. Once out, only one chance to get back in. (We will then see how many really believe in paying their own way without limit.)

I would eliminate HSA's, MSA's, Medicare Part D and any other current government health care plans and fold those people into the universal program. The risk pool is essentially the population, less the wingnuts and libertarians.

For those who are retired and receiving supplemental coverage to Medicare through their employers, I'd provide an optional Medicare equivalent program, funded by increased taxes from employers who currently write off these expenses, with perhaps some retiree contribution if needed to self-fund this supplement.

Services would continue to be offered by private providers, reimbursed similarly to that in Medicare today. Private patients could pay whatever they wanted for above-standard service, with no deductability of these payments.

Posted by: JimPortlandOR on March 2, 2006 at 9:19 PM | PERMALINK

Universal Health Care - so obvious - so inarguable.

Except In the USA, land of the rightwing-Christian-nitwit-creationist-men-once-rode=around-on-dinosaurs-while-women-raised-the-younguns.

Seriously, is there somehow a connection? An explanation? Christian super-ignorance abounds in the only industrialized nation too dumb to have universal healthcare.

(And yes, they have fossils to prove that humans and dinosaurs lived at the same time. Monkey brains. Not even)

Posted by: geo on March 2, 2006 at 10:44 PM | PERMALINK

Here are two problems that must be solved before universal health care is feasible.

1. The downside of Portability. If you can easily walk away from your health plan, they will have less incentive to spend dollars on you for prevention. One major reason the best plans spend money on massive programs to screen and prevent disease, is that they will save money in the long run when patients do not get sick and end up in the hospital. That's one reason the best HMOs and the VA do so well in quality surveys, and are thought to be superior to fee-for-service.

2. Who pays for population management of disease? Same thing. A good HMO costs less to enroll in than standard fee-for-service. Making efforts to ensure consistent treatment of high risk disease (eg. risk for coronary disease) across a population costs more in the short run but pays off in fewer hospitalizations. You cannot remove the incentive to manage populations.

I agree there are advantages to universal coverage, but there are pockets of outstanding quality here (superior to what's going on in France) that could be destroyed by universal care, if these problems are not addressed.

Posted by: Brian MD on March 2, 2006 at 10:49 PM | PERMALINK

Pockets of outstanding quality. I had those on a suit once. Good line, Dr. Brian.

Frankly, the last thing I'm concerned about is pockets of outstanding quality when there are people who have no access, limited access or can't afford access to the same health care I get.

I'm happy for the coverage my employer provides, but it's a damned outrage my employer provides it and it's a damned outrage you lose coverage with a job.

The whole system is a damned outrage.

By the way, Kevin?

Who cares if there's a liberal blogger who's against National Health Care, and who ever said you were a liberal?

Liberal bloggers are some kind of early warning system now, like canaries in coal mines?

Come on, Drum, snap out of it.

Posted by: lettuce on March 2, 2006 at 11:00 PM | PERMALINK

Whoever does run on socialized medicine is going to have to counter the moronic charge that, omigod, THEY ACTUALLY HAVE TO WAIT FOR HEALTH CARE IN CANADA!!!

As opposed to here in the US, where anyone who has even a hint of a possible problem is immediately whisked away -- if they so chose -- to a waiting operating room.

Right.

I had an identified coronary artery blockage a couple years back, and it still took two months to get space for an angiogram in the cardio lab. And I have the best possible insurance available to modern man: My wife is a professor at a state university, and I'm a GS-14 with full Federal benefits.

Posted by: phein on March 2, 2006 at 11:09 PM | PERMALINK

I love how on a topic of whether any liberals who don't support universal health care, you get an argument. The answer should be "No", "Yes" or "I don't know."

Posted by: Alexander Wolfe on March 2, 2006 at 11:23 PM | PERMALINK

Al: "Second Universal Healthcare causes people to stop paying attention to their health. Right now people try not to get sick because they know if they do they have to pay for it on their own..."

Freedom Fighter: "Isn't that what makes you a liberal? It's kinda like asking whether Moslems support suicide bombings and beheading of infidels... The question is silly."

You guys are unreal. I mean literally unreal; I cannot possibly understand how you can believe the BS that is coming out of you. You're serious about this? You really think this stuff? Boggles the mind.

Posted by: mmy on March 2, 2006 at 11:33 PM | PERMALINK

But of course, mmy, our Soviet Canuckastanis nanny state makes us crave unemployment and poor health! We love it! Heh. Al-bot sure has us pegged!

Anyway, some people here in Soviet Canuckastan have speculated that Soviet health care promotes labour market mobility (Oh no! Flexible markets!) because people aren't scared shitless of losing their health insurance when they switch jobs.

Posted by: Soviet Canuckastani on March 3, 2006 at 12:06 AM | PERMALINK

If you are looking for liberal bloggers that do not support Universal Healthcare, shouldn't you be asking (your grrl friend) Ann Althouse, Glenn Reynolds, Michael Totten, Marc Danziger, Roger El Simon, Jeff Goldstein, James Lileks, Hinderaker and his Powerblog and the other true liberals?

Posted by: jerry on March 3, 2006 at 12:50 AM | PERMALINK

Waiting for surgery in Canada is one hell of a lot better than not being able to afford it in the US.

Posted by: peter Brooks on March 3, 2006 at 2:29 AM | PERMALINK

Oh, Kevin. That's so "old Europe". Don't you know the Bush regime prefers the 'new Europe', like Albania, where its "every man for himself and the devil take the hindmost". Rugged individualism, as Rush Limbaugh puts it....

Posted by: Stephen Kriz on March 3, 2006 at 6:42 AM | PERMALINK

What's more, we have a working model for UHC: Medicare. Medicare is no hassles, covers everything, and evidently is more efficient than HMOs for this population.

Posted by: bob h on March 3, 2006 at 7:38 AM | PERMALINK

Only someone who has had good, consistent health insurance think the system is just peachy the way that it is now-- a very typical GOP attitude. They don't understand the issue, have no experience with the problem, but have a VERY STRONG OPINIONS about what it must be like to be uninsured, poor, gay, etc. But the truth is they don't have a freaking clue how other people live but they think they should dictate the rules to everyone else. These are the same people who don't even believe in universal health care for CHILDREN. And they have the nerve to call themselves Christians.

People who have never had a problem with health insurance, who have never gone a long time without it, and think we don't need universal health care should just STFU right now.

Not having insurance means a lot less stability in life, overall. It means never going to the doctor or dentist, it also means going to the ER for both minor ailments, which is why going to ER is usually a royal pain in the ass. 50% of the things ERs deal with are things that a regular doctor could handle, BUT the uninsured *must* go there, and by doing so they risk losing their jobs from missed work. This is how health care is subsidized for the uninsured, it's just not healthy for anyone.

Not having universal health care is a drag on the economy and hurts the economic stability of poorer/uninsured people and it hurts the economic mobility of people who have to stay at a particular job because of the health insurance benefits.

Posted by: zoe kentucky on March 3, 2006 at 10:03 AM | PERMALINK

Does Joe Klein have a blog? Check there.

Posted by: sohei on March 3, 2006 at 10:27 AM | PERMALINK
Here are two problems that must be solved before universal health care is feasible.

1. The downside of Portability. If you can easily walk away from your health plan, they will have less incentive to spend dollars on you for prevention.

With most models I've seen proposed for universal healthcare in the US, it would be impossible to walk away from a health plan, even if you can switch providers. The only model I've seen where that might not be the case is the mandatory-insurance-with-need-based-subsidy model proposed by some health insurance companies as a possible universal system, but I don't think anyone who supports universal coverage that isn't on a health insurance company payroll actually favors that model, and I suspect that when it got down to nitty-gritty details, that the insurance companies trying to sell that as the only viable universal solution would propose features that would discourage switching plans quite fiercely.

2. Who pays for population management of disease?

Seems to me that's a trivial question in a single-payer system.

I agree there are advantages to universal coverage, but there are pockets of outstanding quality here (superior to what's going on in France) that could be destroyed by universal care, if these problems are not addressed.

Both of those problems are problems that seem more pronounced in a system of private insurance where people have market options, not problems especially found in universal systems (and they seem to be especially inapplicable to single-payer universal systems.)

Maybe I'm misunderstanding your concerns...


Posted by: cmdicely on March 3, 2006 at 11:53 AM | PERMALINK

Okay, on the one hand you've got a doctor or a hospital ER. OTOH, you've got a guy who's just been in a car accident. His arm is hanging crooked by a thread of skin, he's moaning horribly, just about unconscious or unconscious and bleeding profusely. Then the doctors says, "Now we can negotiate prices."

If the government can step in and protect a patient under these horribly unbalanced situations, then there is no need for us to go on -- we'll have failed as a nation.

But, it's different for someone with chronic pain or some other treatable illness. They can negotiate in good faith and still get screwed because they know nothing of medical costs, only that they are in pain or dying and need treatment. They'll pay ANYTHING to get well soon.

The question is how government intrudes into the relationship between patient and doctor.

Guy comes into an ER and asks the doctor what it costs to get his illness treated. The doctor just laughs and says, "It'll be on the bill."

The government has to keep competition in the equation to keep costs down, but regulate price gouging and protect those in extreme situations: children with no incomes, elderly with bankrupting expenses, those needing experimental treatments, etc.

Can't this be done through mostly regulation, rather than complete 'socializing' or 'nationalizing' of the industry?

Posted by: MarkH on March 3, 2006 at 6:44 PM | PERMALINK

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Posted by: online on March 3, 2006 at 11:39 PM | PERMALINK




 

 

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