Editore"s Note
Tilting at Windmills

Email Newsletter icon, E-mail Newsletter icon, Email List icon, E-mail List icon Sign up for Free News & Updates

April 6, 2006
By: Kevin Drum

UNIVERSAL HEALTHCARE IN THE BAY STATE....Several emailers want to know what I think of the new Massachusetts universal healthcare legislation. Answer: I'm not sure.

As near as I can tell, the main point in its favor is that it's something. It's progress just to have a state pass any universal healthcare legislation at all, and it's a good example of a state acting as a laboratory for a new idea.

At the same time, the plan itself is a fairly unattractive kludge that, in essence, extends Medicaid to more people and levies a small fine (in the form of higher income taxes) on anyone who doesn't have health insurance but could afford to buy it. This doesn't do anything to address cost containment and doesn't do anything to make the system more efficient.

What's more, as several people have pointed out, Massachusetts is in a very unusual position: they have such a small uninsured population that they were able to pass their plan with almost nothing in the way of new taxes to fund it. There are very few states that are in this position, which makes the plan's usefulness as a model limited. On the other hand, I think Jon Cohn has an incisive take on the political ramifications:

Nationally the most important impact of this new law may be on politics, not policy. Once [governor Mitt] Romney starts boasting about how he achieved universal health coverage in Massachusetts, it will become that much harder for conservatives to demonize the very concept as "big government." Oh, they'll try and they'll have at least some success. But now Democrats will have this retort: If a Republican governor and leading presidential contender with strong conservative credentials thinks universal health care is a good idea, how radical an idea can it be?

That's right. If Romney runs, he's going to make universal healthcare a major plank in a Republican campaign. Even if he loses, that's a huge step.

Kevin Drum 12:18 PM Permalink | Trackbacks | Comments (95)

Bookmark and Share
 
Comments

How long have I been tellin' y'all that the Republican plan was to make it just like car insurance?

Posted by: dr sardonicus on April 6, 2006 at 12:32 PM | PERMALINK

Yeah, it might get the national conversation going in a more serious direction. Unfortunately, Romney's plan will likely end up being implemented nation-wide as just another HUGE windfall to the insurance industry. That, after all, is pretty much what the MA plan amounts to.

Posted by: Derelict on April 6, 2006 at 12:33 PM | PERMALINK

"If Romney runs, he's going to make universal healthcare a major plank in a Republican campaign. Even if he loses, that's a huge step."

He doesn't have a cat's chance in dog heaven.

But I agree... it would be one small paw forward for the GOP.

Posted by: koreyel on April 6, 2006 at 12:33 PM | PERMALINK

Romney, the Dennis Kucinich of the 2008 Republican race.

Posted by: tbrosz on April 6, 2006 at 12:35 PM | PERMALINK

On the other hand, the plan itself is a fairly unattractive kludge that, in essence, extends Medicaid to more people and levies a small fine (in the form of higher income taxes) on anyone who doesn't have health insurance but could afford to buy it. This doesn't do anything to address cost containment and doesn't do anything to make the system more efficient.

I don't agree with the socialist health care plan in Taxachucetts, but this part is the best idea in the plan and should be expanded. A good health care plan would be to make it illegal for anyone to live in Massachucetts not to buy a health care plan. This is no different than laws which make it illegal for anyone to drive a car without car insurance. This is the best kind of health care plan because it leaves health care to be decided by private companies and the free market instead of government controlled health care. And we could get rid of Medicare and Medicaid with such a plan because they would no longer be needed.

Posted by: Al on April 6, 2006 at 12:36 PM | PERMALINK

(OT)

Libby sez Bush authorized the Plame leak!

Posted by: Tripp on April 6, 2006 at 12:44 PM | PERMALINK

OK, all you poor people from around he world, to the Bay State! Lifetime health care, no expense excluded!

Oh, no, you have to do it nation wide to work.

Oh no, you have to do it over North America to work.

Oh, no, it has to be global health care, but let's at least put the clinic in Asia somewhere, please!

Posted by: Matt on April 6, 2006 at 12:46 PM | PERMALINK

I agree with Kevin, this plan does nothing about cost containment, and it does not make health care more efficient. Also, it keeps the insurance industry hand in the "till" which is one of the major cost drivers in health care spending.

Who decides what is affordable? Is $450 a month considered affordable for a family with a yearly income of $60,000. Unlike car insurance, if you can't afford it you don't drive, or you buy a hoopty and insure it for liability only. With this law, you don't have a choice -- buy the insurance or be fined.

Posted by: DCNative on April 6, 2006 at 12:49 PM | PERMALINK

Before we go rushing to embrace this on the national scene, why don't we let MA stand as a labratory of democracy? If this is implemented now, wait, say, 5 years (not the two and change it will be before the 2008 primaries and Presidential election) to see how well it works?

Posted by: Nemo Ignotus on April 6, 2006 at 12:52 PM | PERMALINK

Libby sez Bush authorized the Plame leak!

Actually, Libby sez Bush authorized the leak of sensitive intelligence about Iraq. Which, yeah, means Plame.

Now we're gettin' somewhere. Pass the popcorn.

Posted by: shortstop on April 6, 2006 at 12:54 PM | PERMALINK

I am a confirmed advocate for some level of universal health care (especially for preventable diseases and routine health care). I applaud the Massachusetts legislature for bravely taking on this difficult issue. I hope it works wonderfully.

Having said that, the plan (as I understand it) seems cumbersome and convoluted in its execution. And I can't comprehend the thought of Mitt Romney as the poster boy of low-cost, widely available health care.

Posted by: Topeka Satchel on April 6, 2006 at 12:57 PM | PERMALINK

What's up with all this I am not sure namby pamaby on almost everyone of Kevin's post these days?

Are you running for something? Or from something?

Posted by: lib on April 6, 2006 at 12:58 PM | PERMALINK

In the news accounts that I've read, Romney is making a point of saying that this is not a universal healthcare plan, and that the plan is not a government-run program.

He is already trying to set the rhetoric up so that he can claim credit for the plan and still be against UHC.

Will it work? Don't know.

And, Al ... Taxachusetts? Come on, man. Move the snark forward. Don't rely on old snark.

Posted by: Lame Man on April 6, 2006 at 1:00 PM | PERMALINK

tbrosz: I think Romney's chances are better than Kunicich's chances ever were...

shortstop:
"Actually, Libby sez Bush authorized the leak of sensitive intelligence about Iraq. Which, yeah, means Plame."

well, it doesn't. but even if it did..that makes the leak legal no matter what her status...

Posted by: Nathan on April 6, 2006 at 1:01 PM | PERMALINK

Two points:

1.) Out here in California where automobile insurance is mandated, approximately 30% or so of the drivers do NOT have the insurance. That's the last figure I've heard anyway. Kevin, you might know what the actual number is, if it is different than that. So I doubt you would get 100% coverage in any event.

2.) Since companies who don't provide insurance will be "assessed" $295/employee, what is to stop companies from dropping insurance which in many cases would be more expensive and just pay the lesser amount. Once one company in a particular industry does, it would be difficult for others not to follow suite lest they fall behind competively.

Posted by: leftcoastindie on April 6, 2006 at 1:01 PM | PERMALINK

This is no different than laws which make it illegal for anyone to drive a car without car insurance.

There is one difference, once can choose not to drive or own a car.

Posted by: David P on April 6, 2006 at 1:02 PM | PERMALINK

Kevin,

My initial take on the plan without knowing the details is similar to yours. Of the many ways to get to Universal Healthcare this version is one that doesnt even to begin to address the ineffcieincies in the system, and may make them a little worse.

The plan was certainly bi-partisan;

Tuesday's votes approving the bill -- 154 to 2 in the House and 37 to 0 in the Senate.

I hope Cohn is right.

What would be sad is this became the model and if instead of the reform we desperately need, Universal Healthcare is not established in the country by reforming the current system, but rather by merely mandating that everyone join the current bad system.

If not having health insurance is outlawed, then only outlaws will be without health insurance?

Posted by: Catch22 on April 6, 2006 at 1:02 PM | PERMALINK

well, it doesn't. but even if it did..that makes the leak legal no matter what her status...

Even supposing that it DOES make the leak legal, I'd be more than happy to see Bush directly in the chain of command on the leak.

Given the level of lying and deception he would be clearly implicated in (his assertions in rough paraphrase: "I don't know who was involved in this. But I'll hold whoever may have been involved accountable"), his Presidency and administration will be totally destroyed.

And that, in any case, is the real punishment for the Plame affair that most people should care about.

Posted by: frankly0 on April 6, 2006 at 1:19 PM | PERMALINK

Kevin Drum wrote:

the plan itself is a fairly unattractive kludge

That's an understatement, Kev...I'd like to see more details about the Massachusetts plan before making a firm judgement, however...

My un-firm take on this program is that it's another Rube Goldberg-esque policy designed to treat a symptom of a larger issue: US healthcare is barely- or un-affordable for a large portion of the US population.

From the linked article:

..it leaves the task of determining exactly how much some low-income residents will pay for their new, more affordable policies to a new agency that would serve as a liaison between the government, policyholders and private insurance companies.

Why require people to increase the income of the inefficient, over-expensive health insurance industry? Or even create a new government org to oversee/administer it?

Will these government-mandated insurance policies have the usual bullshit 'pre-existing condition'-type clauses and haggle with doctors and hospitals over whether or not that additional x-ray is necessary?

While I admire the requiring people paying for health care based on their income level, isn't this just another tax?...With the difference being that it goes directly to insurance companies...

As for the Romney's 'car insurance' analogy, I understand it, but I've never really agreed with how car insurance works as well, for many of the same reasons.

Posted by: grape_crush on April 6, 2006 at 1:24 PM | PERMALINK

Catch22 mentioned it, but I think the lede has been buried: "Tuesday's votes approving the bill -- 154 to 2 in the House and 37 to 0 in the Senate."

I don't think you can get the legislature to recognize the state high school basketball champs with that lopsided a vote!

There's a hunger out there....

Posted by: Mark on April 6, 2006 at 1:27 PM | PERMALINK

'Derelict' posted:

"Unfortunately, Romney's plan will likely end up being implemented nation-wide as just another HUGE windfall to the insurance industry. That, after all, is pretty much what the MA plan amounts to."

Yep.

It turns the health insurance industry into a utility. They just keep raking the money in and consumers are forced to pay. Too bad that less than half of every dollar in healthcare insurance premiums you pay actually goes to medical care. This a HUGE gift to the insurance industry. Consumers are left with NO bargaining power as individuals up against massive corporations.

The state model to be copied, is Hawaii, which basically implemented the Clinton plan years ago, and spend less on healthcare than the other 49 states. They have mandated employer-based healthcare, with the state covering everyone who is unemployed. They cover 99.9% of their residents.

The best part is they utilize health insurance purchasing alliances, which allow large groups of employers and consumers to band together and purchase health insurance with actual bargaining power.
.

Posted by: VJ on April 6, 2006 at 1:28 PM | PERMALINK

I would like to see a state purchase a local health insurance provider, and grow that provider to become a monopoly in that state. This would drive down cost.

Insurance companies affected by the loss of business could sell the policies they hold for locals under an eminent domain doctrine.

The State's monopoly would be made into a not-for-profit corporation or formed into a state-wide co-op, regulated by a regulatory board with members populating that board from all interest groups in the state: Doctors, Hospitals, Universities, Drug Manufactures, Employers, Employees, Unions, Representatives for the Elderly, etc...

In otherwords, it would function like any other well regulated utility company.

People would pay for their taxes in a seperate line item on their income tax withholdings.

Because the service would be universal, it would be more efficient than any other insurance company - it would have lower cost because it had lower premiums. People who work across state boarders would have an option to buy in.

Because it is an independent company, it can be sued.

This is the best of all worlds.

Posted by: Bubbles on April 6, 2006 at 1:28 PM | PERMALINK

I was wondering when you would get around to this. :)

Posted by: Lurker42 on April 6, 2006 at 1:29 PM | PERMALINK

frankly0, shortstop:

If what I'm reading is correct, this is all much ado about nothing.

apparently Bush authorized the leaking of portions of the NIE (Plame was never mentioned in the NIE...I don't think Wilson's trip mentioned either)...in which case he didn't authorize leaking her name

presidents, of course, authorize the leaking of intel all the time.

Posted by: Nathan on April 6, 2006 at 1:35 PM | PERMALINK

Kevin, you should have purchased some Apple stock the other day.

Posted by: B on April 6, 2006 at 1:38 PM | PERMALINK


FRANKLY0: Given the level of lying and deception he would be clearly implicated in (his assertions in rough paraphrase: "I don't know who was involved in this. But I'll hold whoever may have been involved accountable"), his Presidency and administration will be totally destroyed.
You mean the way he was clearly implicated and his presidency totally destroyed due to the level of lying and deception when he said (exact quote), "Any time you hear the United States government talking about wiretap, it requires -- a wiretap requires a court order. Nothing has changed, by the way. When we're talking about chasing down terrorists, we're talking about getting a court order before we do so." Destroyed like that, you mean?


Posted by: jayarbee on April 6, 2006 at 1:44 PM | PERMALINK

The number that I want to know about is the $295 charge to businesses who don't provide insurance. Is that per month or per year or one time?

Posted by: Ron Byers on April 6, 2006 at 1:47 PM | PERMALINK

I think Jon Cohn has an incisive take on the political ramifications

So many links to TNR. On the sidebars too. No thanks. Schmucks all. Are they co-owned with this site?

Posted by: luci on April 6, 2006 at 1:48 PM | PERMALINK

Didn't Maine or New Hampshire try something that didn't work out too well.

Al; don't see the socialism in this system. It's mandated that individuals indicate on their tax form whether they have coverage, people have to cover themselves unless they can't afford it (don't know how they figure that out), and companies who don't have plans for their employees have to pay $295 per head unless some of their employees claim too much, then some sort of fine comes into effect. It's insurance companies supplying the coverage. All strikes me more like a police state, tinges of fascism.

It's a start towards universal coverage. It always suprises me that there are a dozen (2 dozen?) different models out there, ongoing long term experiments but we in the US know too much to even look at them. We can't even debate it without immediately saying "socialist", "rationing" or some other hokie to prevent inquiry and debate.

For 25 years the answer here has been the markets will work. For 25 years health care inflation has totally outpaced overall inflation and incomes by a huge margin. We have rising millions not covered, more than we count. We spend twice as much per capita as most (any) other country. We have the biggest administrative overhead. We have some of the best practiced medicine in the world but we do NOT have the best health care system. Health care is already rationed here. Benefit is heavily tilted to the richer end of society. Money is not spent in the most efficient way for the best result.

I've said enough. But here's the kicker. Health care is NOT a rational market. You don't choose your health, sickness or accident. You're not qualified (without lots of time on your hands) to make an informed choice of treatment, etc., and often (for big ticket items) you will not be able or have time to shop around. I know it will freak the absolute capitalists out, but this is the prime example of your pure picture not holding (disregarding it doesn't work anyway).

Let's see if anyone can talk this through rationally.

Posted by: notthere on April 6, 2006 at 1:52 PM | PERMALINK

"That's right. If Romney runs, he's going to make universal healthcare a major plank in a Republican campaign. Even if he loses, that's a huge step."

A loss by Romney is a 'huge step' so a win by Romney would be a ... gigantic leap? I don't follow Kevin here. Is he saying that it would be good if Romney won [the Presidency] because he supports this type of 'UHC'? Is Kevin willing to hand over the Presidency to another Repub (Romney) because he supports UHC?

And isn't this merely the case, yet again, of the conservatives destroying a liberal wedge issue?

Posted by: sunbeltjerry on April 6, 2006 at 1:52 PM | PERMALINK

Oops. Previous posting should read:

While I admire the idea of requiring people paying for health care based on their income level, isn't this just another tax?...

Figured that I should change it before craigie got all pedantic on my ass...

Posted by: grape_crush on April 6, 2006 at 1:53 PM | PERMALINK

Much more likely, I think, that the Republicans will coopt "universal health care," deliberately in quotes, because that's the last thing they'll deliver. What they'll deliver is something which keeps the health insurance companies in their corner after the Medicare problems and which of course is nothing like universal healthcare.

In the meantime, the Dems, if they're not keeping eyes wide open, will lose the issue.

I want to hear more of what Uwe Reinhardt says about the Mass plan.

Posted by: PW on April 6, 2006 at 1:55 PM | PERMALINK

notthere, that's ParodyAl posting...It's helpful in a sense; (s)he's actually pointing out the problems with the Massachusetts plan in his/her own way...Which you expanded on nicely.

Posted by: grape_crush on April 6, 2006 at 1:59 PM | PERMALINK

Personally, I don't mind who does it or how it gets done, as long as the uninsured gets covered.

It might not be a good thing for the insurance companies to have an even bigger grip on our health system than they already do - which would be the inevitable result of all Republican-backed plans and more than a few Democratic plans also - but that's better than 40 million people going without coverage.

Posted by: mmy on April 6, 2006 at 2:00 PM | PERMALINK

Defendant testified that the circumstances of his conversation with reporter Miller getting approval from the president through the vice president to discuss material that would be classified but for that approval were unique in his recollection," the papers added.

Posted by: lib on April 6, 2006 at 2:04 PM | PERMALINK

Nathan,

My reading too of what's been divulged so far is that Bush has NOT yet been implicated in the Plame revelation per se. I was simply working out the entailments of the assumption that he was so implicated.

jayarbee,

The level of lying and deception involved in the Plame case, IF Bush did indeed authorize it, would be of much greater scope and visibility than the somewhat isolated assertion you quote -- not to mention the obvious fact that he would be in a position of having to defend the indefensible, namely, outing a clandestine agent for political purposes. THAT is why it would destroy his Presidency in a way not so far achieved. It's just a much bigger deal, politically.

Posted by: frankly0 on April 6, 2006 at 2:06 PM | PERMALINK

If everyone has insurance, the cost of medical care and insurance goes DOWN. Significantly. No matter how many times you explain this to people, they can't understand that simple fact. The reason medical care costs is spiraling out of control is because doctors and hospitals are recouping the cost of underfunded govt. programs and trying to recoup the cost of providing care to the uninsured.

Having uninsured people in the system is expensive for everyone who is paying for insurance. Does the general public think this care is just donated, paid for by some magical fairy somewhere, or what?

Posted by: undersiege on April 6, 2006 at 2:07 PM | PERMALINK

Thanks grape_crush. I'd better start checking source otherwise I'll get sucker-punched by that sort of line every time.

Posted by: notthere on April 6, 2006 at 2:07 PM | PERMALINK

Kevin, many thanks for addressing the issue -- but the one glaring omission I've seen in all the other coverage persists in yours as well.
Uninsurables.
What happens to the uninsurables under this plan? Does anybody know? Are insurers required to carry everyone, regardless of cancer, heart disease, Parkinson's, AIDS, and the heartbreak of psoriasis?

Posted by: Caladan on April 6, 2006 at 2:07 PM | PERMALINK

"This is the best of all worlds."
Posted by: Bubbles

Interesting idea Bubs.

Posted by: Lurker42 on April 6, 2006 at 2:08 PM | PERMALINK

PW on April 6, 2006 at 1:55 PM:

I want to hear more of what Uwe Reinhardt says about the Mass plan.

Me too. Without more detail, I'm not big on the Massachusettes plan. It does align with the 'minimalist increment approach to cover the uninsured' that Reinhardt has mentioned previously.

Posted by: grape_crush on April 6, 2006 at 2:14 PM | PERMALINK

Caladan: that's the nice thing about the present system isn't it. Insurance companies can refuse you coverage, so it's not really insurance as in spread risk is it; not for the companies, they try to define and limit risk. You loose your coverage if you loose your job (for those capitalists, that's got to be a friction on job mobility and efficient labor markets), and, like undersiege says, we all pay for it in the end, just the most expensive way both at the hospital and in lost productivity. Capitalism's remarkably short term outlook knows this but just can't bring itself to get behind a cheaper way of doing things.

Sort of contradicts the intelligence that actually functions in capitalism, eh?

Posted by: notthere on April 6, 2006 at 2:23 PM | PERMALINK
Several emailers want to know what I think of the new Massachusetts universal healthcare legislation. Answer: I'm not sure.

Why I am a surprised: On Amy's article on the effectiveness of Democrats: "I have my doubts.... But,..."

On George Sargent's piece on the motivation for Rove and Libby's lying: "I'm not sure if I buy it or not, but it does fit my own theory..."

So, really, what should be expect on this? Of course, we still haven't heard what you think of California's proposed single-payer universal healthcare legislation, but I'd guess that's also something rather indecisive.

Posted by: cmdicely on April 6, 2006 at 2:36 PM | PERMALINK

I always know when I make my arguments about insurance transfer of costs and why medical costs soar, it stops people COLD and they flee. I can never find anyone to argue with. They run away.

So in the meantime I just keep hoping perversely that they keep dramatically cutting Medicare and Medicaid so the cost of private ins. goes up and up and the system collapses faster. How many people have to die, I don't know, but I guess you have to burn the village to save the village.

In the meantime, can anyone find out just how many underwriters in Mass. will get paid their 50,000 annual salary to scrutinze health records and pick the most profitable insurance customers? How many claims adjusters are they going to pay to try to deny coverage or fight over it with another insurer. How many ins. executives will get paid how many millions. It all costs tons of money.

Posted by: undersiege on April 6, 2006 at 2:42 PM | PERMALINK

Are there lots of illegal aliens in Taxachusetts?

Our gov Blago got medical insurance for all children passed in Mexinois, and it couldn't be more obvious that he was pandering to the Hispanic vote.

Posted by: Myron on April 6, 2006 at 2:46 PM | PERMALINK

"If everyone has insurance, the cost of medical care and insurance goes DOWN. Significantly."

The test here is the statistical law of large N, you get enough folks in the insurance pool then no individual suffers from random variations. The N you need is on the order of 2 million; not 200 million. Do the math; look at the variations of major illness compared to population size. And, medical costs do not reduce, they simply get spread around.

Only two elements can reduce medical costs. One is rationing, which this author would like to have done by government. This author, being liberal, also wants government to ration energy and probably housing. It is simply goverment rationing of resources, nothing to do with medical business pe se.

The other cost reduction is to expand coverage so large and uniformly as to discourage massive populaton migration, something which liberals love. This is similiar to the Kyoto approach on carbon emissions.

The argument for universal health care still rests on one fundamental which has never been aswered, what industries should or should not be nationalized, and why the diferences? Liberals have never come up with a consistent theory to answer this.

Posted by: Matt on April 6, 2006 at 2:52 PM | PERMALINK

t is simply goverment rationing of resources, nothing to do with medical business pe se.

Here's a well paid insurance co. actuary subscribing to the Republican religion that all government is BAD.

But we're back to the magic fairy theory, the costs of uninsured people driving up health insurance rates is NEVER addressed. Can't face the issue on the ground, only in airy fairy statistical theory and delusional political arguments.

When you and your employer take out the checkbook and pay the insurance co. what exactly are you paying for? That's the issue on the ground, where the theory meets real life.

Posted by: undersiege on April 6, 2006 at 3:01 PM | PERMALINK

cmdicely on April 6, 2006 at 2:36 PM:

Of course, we still haven't heard what you think of California's proposed single-payer universal healthcare legislation..

No shit. VJ at 1:28 PM gave us a nibble of Hawaii's healthcare plan, of which I had no clue even existed...Anyone know of a site that has some form of side-by-side comparison of US state healthcare plans, possibly including international comparisons as well?

Posted by: grape_crush on April 6, 2006 at 3:09 PM | PERMALINK

Caladan, this is precisely what I'd like to know, since I'm uninsurable. Is MA going to force ALL companies to insure me? And if so, will ALL of my conditions be covered? Because making a company insure me, but not forcing them to actually cover anything, just forces me to put more money out of pocket and get nothing in return. Not a great bargain since the money I'll be paying to an insurance company could be going to actual treatment. And will HOW MUCH coverage you get be mandated? For instance, will everyone have to have just catastrophic insurance, or do they have to pay for insurance that includes things like maternity?

Posted by: EM on April 6, 2006 at 3:14 PM | PERMALINK

[..Anyone know of a site that has some form of side-by-side comparison of US state healthcare plans, possibly including international comparisons as well?]

Because it's unendingly complicated no journalist is interested in trying to sort this out. USA today had an article yesterday about state efforts but just briefly described what had been passed and then repealed. Mass. is big news because very little effort has been made in other states.

Posted by: undersiege on April 6, 2006 at 3:18 PM | PERMALINK

"the costs of uninsured people driving up health insurance "

underseige, think a moment. Lung cancer cures cost the same regardless who pays for it. Making people insured may reduce your subsidization of the poor, but it does not reduce the cost of lung cancer cures.

To reduce your medical premiums, somebody must be taxed, or somebody else must subsidize, or you are stuck. You have to explain how your plan reduces the cost of providing lung cancer cures to poor people without raiding your pocketbook.

If you are talking about preventitive medicine, then you are starting with anti-drug, ghetto housing, crime control, family counseling etc. These are the things that make people sick.

Posted by: Matt on April 6, 2006 at 3:18 PM | PERMALINK

[... think a moment....To reduce your medical premiums, somebody must be taxed, or somebody else must subsidize, or you are stuck.]

I've thought about this more than you. I have a degree in insurance. Worked in the industry for over 20 years.

Dramatic emotional lung cancer treatment costs aside, any care that a hospital provides to uninsured people or to a underfunded Medicaid patient is not simply absorbed. It is PASSED ON. Why don't you lower the emotionality of your argument and think about basic care. An aspirin in a hospital costs $10 or $50. Why do you think it cost that much?

Posted by: undersiege on April 6, 2006 at 3:32 PM | PERMALINK

More opinion, this time from Dr. Peter Rost, courtesy of HuffPost:

But what about the employers who don't provide insurance for their employees? They will also be penalized. They'll have to pay a whopping $295 per employee. Per year. Considering that health insurance may cost an employer from several thousand dollars to over ten thousand dollars per employee, the choice would appear to be a real tough one.
BusinessWeek in a recent cover article listed their annual ranking of the 50 fastest growing corporations. But they failed drawing any conclusions from the fact that after Apple Computer landed in the number one spot, the computer maker was followed by three companies that make all their money on administering drugs and healthcare to sick Americans; WellPoint, the nation's biggest health insurer, Caremark Rx, one of the largest pharmacy benefits managers (a company that manages prescriptions for patients and pharmacies), and UnitedHealth Group which provides health insurance and other services to 65 million Americans. Guess who is paying for their growth?

This is starting to sound like the privatization of Social Security...A shifting of the public dollars to benefit an industry...An industry, which since 1996, has given almost 70% of its campaign contributions to 'publicans...

Posted by: grape_crush on April 6, 2006 at 3:44 PM | PERMALINK

Mass. passed "universal" -- well not quite, it aims for 95% eventually-- "health care"-- not quite again, it is mandated individual coverage-- cost not determined yet, but estimate at more than $300 per month for an individual. As a Starving Artist and adjunct university instructor I carried an individual policy for years-- until went up to nearly $300 per moth and I had to drop it or literally starve. $1000 plus fines for those who fail to buy in? -- is it really a secret plan to force all the under-employed to leave the state because they --we, my artist colleagues and my kids, who foolishly thought IT would enable them to earn a middle class living and are now living from temp contract to temp contract -- won't be able to afford either the coverage OR the fine?
I am afraid that this bill will turn out to be a big step backwards. It adds extra layers of red tape to a failing system that already eats up a disproportionate % of our GNP. That's without factoring in the lost time and psychic damage that ordinary people-- like me!-- suffer from any time they are rejected, misinformed, erroneously billed or arbitrarily cut off from treatment-- or forced to shift from a doctor/patient relationship that works to an iffy new one that is "covered". "Coverage" or "Insurance" does not insure care-- it is a business, and it can only stay in business by taking in more money and paying out less than its competitors. Medicare D is what happens when government and business lobbyists "cooperate" -- a dysfunctional nightmare.
If state resources were pored into real community-based clinics with strict standards of Public Health based care, with no frills and no expensive end-of-life heroic measures, Massachusetts could prove that a Canadian-type system could work in the US. This one is bound to fail, and further "prove" the alienating proposition that governmental good intentions are the problem, not the solution.

Posted by: G.L.Horton on April 6, 2006 at 3:48 PM | PERMALINK

I thought for sure some repub/capitalism flakies would be drawn into this. What happened to them?

Matt, it's not just a question of N with the way the system runs now. The savings are bigger because people who are now excluded get treate4d through emergency, when their problem is advanced. Undersiege expressed this.

As stated, this is not a true market so, yes, some form of rationing is needed with price controls of some sort. e.g. utilities who negotiate pricing and profit for the benefit of being a monopoly within an area. More typically rationing would be by higher prices. It's obvious why that doesn't work for medical care but does in, say fuel costs. We started talking about energy policy in the 70s. European vehicles average what mpg I'm not sure, but its a hell of a lot higher than our 28 mpg, and you can't account for the difference just because we drive longer distances. They priced gas high.

Here's an idea off the top of my head. I think you don't need insurance companies but if someone can work them into the process in a competitive and money saving way and relieve government from market operations they don't need to be in, all the better:

Overlapping and competing HMOs. People who want better coverage are allowed to pay extra premiums for it, but a basic comprehensive level of health care including regular check-ups, child immunization and treatments is agreed and covers everyone. Coverage would be re-assessed to include new technologies and drugs, etc. as they are judged to become suitable, cost-efficient. All enrolled members pay deductibles, if able, to encourage self-control without discouraging proper health care.

HMOs negotiate pricing of drugs, materials, equipment with pharmas, etc., of treatments with government body (money out, money in). Allowance is made for research or teaching hospitals/establishments. HMOs are allowed a set profit line which rises or is rewarded with cost savings/results; could be worked as a rolling 3 or 5 year basis, whatever works. Govt body with reckoned budget can raise the money in a number of different ways, how it suits; it is tax.

There's an idea. Here's another thought:
At the moment the US vehicle industry is crying, just like they did in the 70s and 80s when they found they weren't making cars people wanted. One of their beefs is that health care costs them $1500-2500 per car (the number seems to vary) and their competition doesn't bear that same cost. Of course the truth is they do bear the cost and probably disproportionately more because vehicle manufacturing comes quite high up the taxable scale in a universal health care economy. It's just that health care costs half as much.
Now car companies are starting to get on board the idea of universal health care to defray costs of employees, families and (early) retirees. So they will be lobbying for that but the present insurance and HMO companies will be pitching what's best for them at the same time.

Waaay tooo Looonnnngggg!

Posted by: notthere on April 6, 2006 at 4:02 PM | PERMALINK

"..a underfunded Medicaid patient is not simply absorbed. It is PASSED ON. "

By passed on we mean passed on to the private, generally employer managed health insurance costs. Not a rational allocation, but insurance companies respond controlling their own hospitals and contacting out to specialized clinics. It is public, community hospitals that bear the brunt of underinsured.

inevitably, government health care is rationed, or taxpayers will agree to provide universal health care for anyone with an airline ticket. This debate is all about rationing government health care to the uninsured, it always is. You can argue that the poor are better off if we government provides housing, medical, clothing, food, travel, and on and on. Or you can argue that government has to ration the services it provides.

There is no large N that serves the poor, no miracle, no economies of scale; just dumb taxpayers who have to decide how much they want to subsidize the poor in all their activities.


Posted by: Matt on April 6, 2006 at 4:17 PM | PERMALINK

It is worth noting that universal health care in Canada was initiated as a provincial program in Saskatchewan and later expanded nationwide with provincial governments continuing to administer it.

Posted by: Jeff on April 6, 2006 at 4:25 PM | PERMALINK

undersiege: Ah! you probably have better knowledge than I do. Me, I've seen the US and UK systems in person, and a friend of mine (US) got food poisoning on his way from Ireland to France this fall. Went to a hospital in Paris. Got all the works and it cost him Euro60! Don't know if they thought he was Irish?! Plenty more stories like that.

Try the Kaiser Family Foundation. www.kff.org Haven't been there for a while but they have research papers on healthcare from all angles. You'll find it interesting.

Matt, don't bother working your way through my long stuff. Reread undersiege. It's plain enough where the savings are if we're paying for it anyway.
Where your right in the US is that poverty is a very good predictor of birth and infant mortality, longevity and poor healthcare habits. Even if you have health care, the last few years of increasing co-pays, etc. have discouraged poorer members from taking proper care of themselves or even filling prescriptions. Maybe you don't know it, but some people have no, I mean no spare $$.
Medicaid coverage? Seen where the Repubs have chosen to balance the budget. Suprising, isn't it, in the worlds richest nation?
Try Kaiser for malnutrition figures. Any food banks near you?

Posted by: notthere on April 6, 2006 at 4:28 PM | PERMALINK

I'm a Massachusetts resident, so can provide a bit of perspective. First, the Commonwealth was forced to deal with this issue under the threat of having federal Medicaid funding reduced. I don't understand all the details, but this change did not happen out of nowhere.

There were several competing proposals, including one that would have charged a levy of something like 4% of payroll to any company that did not provide health insurance. (I don't know how employees who chose not to be covered would have been dealt with.) Needless to say, the business community screamed bloody murder at that one.

Universal (government-provided) healthcare was not one of the proposals, but there is a ballot measure for it in the November elections.

The $295 levy for employers that do not provide insurance is PER YEAR. That does have some of us employees out here worried that our employers will just drop health insurance as a benefit. (Not me specifically -- I work for Harvard and we have a very strong union -- but people who work for smaller companies.)

The "low cost" insurance that those without other insurance will be forced to buy will cost approximately $300/month for a single person, and twice that for a family. Anyone making below 100% of the federal poverty level will be subsidized 100%; those making up to three times this level will get a partial subsidy. (Please remember that Massachusetts is a very expensive state to live in. This is not -- contrary to right-wing opinion -- because of our taxes, which are actually a relatively LOW percentage of income compared to other states.)

The "low cost" insurance will have a fairly high deductible, and it does not cover prescription drugs at all. (This would be a huge issue for me because my medications and insulin pump supplies would cost me about $700/month if my insurance did not cover them.)

The "low cost" insurance will not exclude pre-existing conditions entirely, but those high deductibles will definitely be an issue.

With the current plan, I don't really see a lot of benefit to anyone except insurance company executives and those few people who experience a catastrophic health care expense. e.g. The high deductible means that poor people won't stop going to emergency rooms for primary care.

Posted by: quietann on April 6, 2006 at 4:37 PM | PERMALINK

[... Matt - By passed on we mean passed on to the private, generally employer managed health insurance costs. Not a rational allocation, but insurance companies respond controlling their own hospitals and contacting out to specialized clinics. It is public, community hospitals that bear the brunt of underinsured.]

Matt the actuary is arguing that private hospitals and doctors do not see underfunded Medicaid or Medicare patients.. No private hospitals or doctors see the uninsured and then try to collect from them or pass their costs on.

Absurd argument on its face.

Posted by: undersiege on April 6, 2006 at 4:37 PM | PERMALINK

"Having uninsured people in the system is expensive for everyone who is paying for insurance."

This is the essence of undersiege's argument. The answer is yes, providing health care to people who do not pay for it costs someone else some money. Fixing this with taxpayer money will cost someone else some money.

undersiege is not talking about helping the poor, he is talking about shifting expenses to the taxpayer for the uninsured. There is no savings, just a proposed rationalization of the insurance company system.

Good idea to make the market rational for insurance companies? I doubt it, but tell me how much my taxes will icrease.

Posted by: Matt on April 6, 2006 at 4:40 PM | PERMALINK

notthere on April 6, 2006 at 4:02 PM:

I thought for sure some repub/capitalism flakies would be drawn into this. What happened to them?

Perhaps their heads exploded when they realized the inherent ideological conflicts that the Massachusetts plan presents.

Posted by: grape_crush on April 6, 2006 at 4:42 PM | PERMALINK

Matt:
Maybe someone can tell me if senators and representatives healthcare has changed the last 5 years. For everyone I know, healthcare is already being rationed to people who are covered.
If you have had speacilized treatment for years, one day you turn around, your employer has a new plan and your specialist isn't on the list; or he/she is on a premium system that's way more expensive. Suddenly the HMO you've been using, that group has dropped from this coverage. Last time I booked in for a check-up it was a complete merry-go-round. Half the time the person your talking to doesn't know if your coverage works at this or that clinic. You'd think you coverage card would work somewhat like a creditcard, what with computers and all. But no. You end up filling in duplicate information. Deductibles go up. Co-pays go up. Benefits get more restrictive.

And you can't blame your employer outright. Insurance inflation is 8-15% and their declared profits 20%. The only time either got held down was in 1996-7 when they got scared by the publicity while Clinton pushed his plan. Bounced right back though. Admin costs are the highest of any western healthcare system. So much for private vs public efficiency.

For a so called intelligent consumer society we sure do get blinkered!

Posted by: notthere on April 6, 2006 at 4:58 PM | PERMALINK

'PW' posted:

"Much more likely, I think, that the Republicans will coopt 'universal health care,' deliberately in quotes, because that's the last thing they'll deliver."

The Republicans in Ohio (who control the Governor's office and both houses of the legislature - sound familiar ?), have proposed a TWO-TIERED healthcare system, in which they would offer 'low-cost' healthcare which does not have screenings for most common diseases and a lot of other short-comings. Of course, they consider this "Universal Healthcare".

Obviously, the RNC is attempting to pull another in a long string of appearing to solve a problem scams by use of an opportunistic title.
.

Posted by: VJ on April 6, 2006 at 5:14 PM | PERMALINK

As is pointed out by a few posts above, the Mass plan is not actually universal - something like 30,000 people still wouldn't be covered, I believe. Also, its not a real plan yet - I don't believe key concepts such as "affordable" have been pinned down - also, there's simply an assumption that insurance co's will rush to provide affordable coverage - this may not occur, or, if the options are high-deductible plans, these aren't really insurance in any practical sense of the term for many people. On the other, hand, one imagines this would be a real boon for insurance co's

Posted by: Aidan on April 6, 2006 at 5:14 PM | PERMALINK
On the other, hand, one imagines this would be a real boon for insurance co's

Which is probably why several insurance company executives have previously embraced "mandatory insurance" models like this as a way to wring even more profit out of the publics widespread desire for universal health coverage.

Posted by: cmdicely on April 6, 2006 at 5:18 PM | PERMALINK

Who's going to stick around for this argument, I wonder.

[Matt says...Good idea to make the market rational for insurance companies? I doubt it, but tell me how much my taxes will icrease.]

Just plain stubborn. You're worried about taxes? Suppose you're fully insured. 80% coverage. Your illness and stay in the hosp. cost $50,000. The ins. co. bargains it down to $20,000 and pays. The remaining 20% will be billed to you but NOT on the negoitated rate but the FULL rate. So you owe $10,000. Happy? Still worried about taxes?

Many "fully insured" people are going bankrupt from health care costs every day. Surprised? What if you had a chonrically ill child. Could you pay that $10,000 or more co-payment each and every year over and above your insurance costs? Still worried about taxes? Worried about bridges to nowhere or the $9 billion missing in Iraq. or the 9 trillion in govt debt. What I worry about is rationality and the survival of the middle class.

And the He is a She.

Posted by: undersiege on April 6, 2006 at 5:35 PM | PERMALINK

still looking for an argument... kinda wishing that I could get one... sorry that I am sounding hostile. Apologies to all who are bothering to read this.

Posted by: undersiege on April 6, 2006 at 5:51 PM | PERMALINK

undersiege on April 6, 2006 at 5:51 PM:

still looking for an argument... kinda wishing that I could get one

No need for apologies...And you are in no way sounding hostile. As for the lack of argument, I think that the usual argumentative crew got distracted by the latest Libby/Plame development.

Posted by: grape_crush on April 6, 2006 at 6:05 PM | PERMALINK

grape_crush thanks for your kind comments. I'm going to go drink some grape koolaid. It will have real sugar, clean water and no carbonation. That's 'bout the best I can do today.

Why is everyone surprised the Pres. lied... what's the big shock, I don't get it.

Posted by: undersiege on April 6, 2006 at 6:11 PM | PERMALINK

Randy at R's Rant, who is a progressive Democrat and union organizer in Sacramento, is blogging the California bill for universal healthcare (840) that's in the works. Look here

http://bayneofblog.blogspot.com/2006/04/gearing-up-for-health-care-wars.html#links

and here, where he compares and contrasts to the Massachusetts bill:

http://bayneofblog.blogspot.com/2006/04/sham-massachusetts-health-care-bill.html#links

I think these posts deserve to be in the mix - I haven't seen analysis of this bill elsewhere, and it has been in the works for some time. Kevin, are you listening?

Posted by: Leila on April 6, 2006 at 6:26 PM | PERMALINK

underseige -
Do you have any sense of how care costs are affected when uninsured patients use emergency care as primary care? Insofar as they both increase the volume of emergency care patients, and as they tend to be in further advanced illnesses or injuries when they seek care?
I don't have that info.

I could talk to honorable mother, but she's already left the hospital(in MA) for the day.

I will solicit her opinion and pick her brain.
Next time this comes up I hope to be somewhat better informed.

Posted by: kenga on April 6, 2006 at 7:37 PM | PERMALINK

"Do you have any sense of how care costs are affected when uninsured patients use emergency care as primary care? Insofar as they both increase the volume of emergency care patients, and as they tend to be in further advanced illnesses or injuries when they seek care?"

Look at emergency room costs from the stand point of my sister-in-law. She says one thing drives up the costs, mororcycles and methamphetamine use. Then comes bad drivers, then alcoholism and other drug use.

Posted by: Matt on April 6, 2006 at 7:58 PM | PERMALINK

kenga--
you don't have to have any information about costs of uninsured people using emergency rooms. All the info you need is

no little magical fairy is paying those costs.

Anyone with money, insured or not, that comes into contact with that hospital, will pay those costs.

Posted by: undersiege on April 6, 2006 at 8:24 PM | PERMALINK

Good points Matt, trauma is not cheap to treat.
Not relevant so much to MA. We don't have much of a meth problem relative to other states. Stats I've seen say we're into the weed instead.
Motorcycles are only on the road 6-8 months of the year, and only 4 for the casual, careless, or neophyte riders. (few of them ride when it's cold, cause it's COLD!)
If bad = crazy vis-a-vis auto drivers, I'll bet we get a lot of that. (Anecdote - reason MA drivers don't use turn signals? Why would I tell my enemy what I plan to do? Not that bad, but it seems adversarial at times.)
Booze and other drugs? Probably about par, maybe a little higher for the booze given how most of the state is suddenly Irish for the two weeks around Mar 17.

As I said, I'm going to speak to someone who knows the deal in a sizable chunk of MA, for a public hospital.

Posted by: kenga on April 6, 2006 at 8:30 PM | PERMALINK

underseige -
oh yah, costs are costs.
But if the number of uninsured drop dramatically, those costs are no longer being passed to others, except other policy holders, I would think.

And if emergency care costs are reduced as it is less used for primary care and more resources are available to deal with trauma and emergencies not-caused-by-waiting-until-you're-on-death's-door before-you-deal-with-it, does it not make sense that the cost situation will improve?

Hopefully greater levels of insurance would also lead to more preventive care as well, compounding the savings.

All hypothetical, as I don't have data and probably wouldn't know what to do with it if I did.

Thanks for sticking around to reply.

Posted by: kenga on April 6, 2006 at 8:37 PM | PERMALINK

underseige
shut down for dinner and a hail/thunderstorm that went right overhead. Let me catch up, but I can't promise and argument but maybe we can set a bait.

Posted by: notthere on April 6, 2006 at 8:41 PM | PERMALINK

'undersiege' posted:

"Many "fully insured" people are going bankrupt from health care costs every day."

More specifically, HALF of all bankruptcies are filed due to runaway medical bills, the majority of which by people who have health insurance, a job, and own a home. They don't discover until it's too late that their employer bought cheap-ass health insurance coverage with a low catastrophic threshold.

Welcome to American healthcare run by the Corporate RightWing.
.

Posted by: VJ on April 6, 2006 at 8:41 PM | PERMALINK

Kludge is right. The Rube Goldberg approach (IMHO) won't address systemic problems - the rising cost of care, fairness, access, blah, blah, blah. What does "affordable" mean? Given the high cost of living here in Mass, many people are already paying more than an "affordable" portion of their income just for housing. How much can you realistically expect people to pay for a health care plan? I think a more reasonable approach would be to implement single-payer coverage for routine and preventive care, and catastrophic care. Check-ups, vaccinations, common medications, and counseling can go a long way to helping people take care of themselves before conditions get bad. When the populace realizes what a good deal this is, there will be more support for truly universal health coverage. Catastrophic care is necessary for the got-hit-by-a-bus situations that no one can realistically plan for. (My scorn for Bush's health care savings accounts shows here.)

Posted by: Buffalo Gal on April 6, 2006 at 8:55 PM | PERMALINK

This is unbelievable! Everyone but the rich with secure jobs and money, real money in the bank worries about their health coverage. If they have a family and kids, more so. But no one wants to debate healthcare.

Encroyable!
Some idiot talks about warching the MA labratory (sic) experiment for more than 2 years as if there is no information out there and this crap breaks any new gound.

Matt waffles about the market place and insurance companies like they've produced even ONE semi-solution in 25 years. And if we go on another 10-15 years, healthcare will eat 25% of GNP or more and the majority of the country will not be taking care of themselves properly.

What's not sexy about the US facing up to a non-market solution for a non-market problem.

I spent a little time looking for a good summary of the MA Healthcare but found nothing that gave all the informnation on the major points. Only the bill itself; 148 or something articles, some with subsections a-m. Not even bedtime reading.

My take on emergency care is, as far as I know, it hits downtown emergency cares disproportionately with those patients unable to pay. So long-standing teaching and research hospitals or foundations so situated are getting hit hard. Some emergency rooms work shorter hours or close completely. Another way to ration health care and further raise its cost even when it's an emergency.

All 'cos it goes against the loonies mantra: "Money, money, money, money ...."

MADNESS!!!

Posted by: notthere on April 6, 2006 at 9:14 PM | PERMALINK

I'd like to modify:

What's not sexy about finding a near-market solution to a non-market problem?

Yeah! That's the idea I'm trying to get to. Anybody want to help? Would do you linear thinking repub clones some good to stretch out a bit.

Posted by: nothere on April 6, 2006 at 9:18 PM | PERMALINK

kenga you are exactly right, you don't need data, you just need common sense. But the anti-government libertarian delusion about the health care system in the U.S. deliberately leaves out the transfer of costs. The always talk over the cost of the uninsured, as if it's absorbed magically or donated by good hearted medical providers. It's complete nonsense.

Rush Limbaugh years ago (probably still does) proudly declared that anyone can get medical care in the U.S., he'd say that hospitals just provide it to anyone. I always wondered how many of the idiots who listen to him stopped paying their insurance or dropped it.

Posted by: undersiege on April 6, 2006 at 9:19 PM | PERMALINK

"All strikes me more like a police state, tinges of fascism."

Hear, hear. The merging of (insurance) corporations and government is the essence of fascism.

As opposed to socialism, which would just provide the danged health care.

Looks like another way to provide for those Insurance Co. CEO vacation homes.

As others have pointed out, the car insurance analogy is just foolish, but all those people (like Michael Brown, et al.) who assume everyone has a car will undoubtedly by into the comparison.

BTW, how are they going to require people to "prove" health insurance when they file their tax returns? You have to attach a copy of your coverage page?

And letting employers off for $295 PER YEAR when coverage PER MONTH is more than that ... just makes me scream. THAT's a Republican't idea if ever I saw one. They should call this the "Free Employers from Providing Insurance Act."

Posted by: Cal Gal on April 6, 2006 at 9:26 PM | PERMALINK

VJ had a good point about the bankruptcies and I should have used it much earlier.

undersiege: you were totally clear about the unhidden costs of uninsured and how they were covered. Matt just didn't seem to click on it; or did I miss a post.
And how do you listen to Rush L. I used to try but (I can't really remember now) about 10 minutes was the most I could ever go. Tooo frustrating. Like Crossfire but more so 'cos there's only one idiot.

And it is all commonsense. For some figures try //cthealth.server101.com/the_case_for_universal_health_care_in_the_united_states.htm (could be _healthcare_) as well as Kaiser www.kff.org

Anyway, I've got it on these weak minded Repubs. There is no party piece they've learned to repeat because the central praesidium never tried to get there mind around it. They stop at "socialist." And they haven't got the intellect to form an original coherent argument. So they've blogged off.

Comeback, you cowards!...

Posted by: notthere on April 6, 2006 at 9:47 PM | PERMALINK

universal healthcare a major plank in a Republican campaign. Even if he loses, that's a huge step.
Kevin Drum 12:18 PM Permalink | Trackbacks | Comments (82)

The above statement is definitive proof that moderation is a debilitating illness leading the afflicted to lose their pattern recognition skills.

Posted by: Michael7843853 G-O in 08! on April 6, 2006 at 9:50 PM | PERMALINK

"undersiege: you were totally clear about the unhidden costs of uninsured and how they were covered."

Nohere, I quoted him exactly, I restated his words, his point is taken. Even undersiege knows that.

"Matt waffles about the market place and insurance companies like they've produced even ONE semi-solution in 25 years."

I did not waffle. I pointed out that insurance companies do not like paying for medical services for someone else's coverage, exactly the point that undersiege made.

No one has explained how to reduce the energy and resources to pay for medical services, all you have done is explain how someone else should be fixing the insurance market, usually government. An aspirin is still an aspirin, whether it is taxed by the hospital or by government, it is still an aspirin.

I guess the point of all this is to force us to buy the proper insurance, one way or the other. We would all be better served by forcing us to live healthier and die younger.

Posted by: Matt on April 6, 2006 at 10:08 PM | PERMALINK

Cal girl: thanks for reading. I mean it but I was trying to involve Al. Turned out it was a fake Al. There's been no competition on this at all.

Drum's started a new line on some tweeb complaining about his healthcare for a bad knee. Nothing surprising, but no trolls there either.

This is obviously an idea the repubs would like to hijack for the companies involved, but even their pleebs have no stomach to debate it.

Posted by: notthere on April 6, 2006 at 10:10 PM | PERMALINK

Ah, Matt. You live.
I did qualify my statement by saying I might have missed something of yours as I skated through to catch up and I am not a speed reader.

I think the first point is this is a non-market situation.
Emergency rooms don't get to turn peolple away (or maybe you'd like to have that?) so people who can't pay, or who the HMO can't recover from, get to be treated and that costs. The government doesn't step in and fill the gap. There is a tension between health providers and the insurance companies. Either the providers loose money (see earlier for problems arising in the cities) or the insurance companies effectively pick up the difference in how they are charged for services provided.

There is no market or win-win solution for this. Either you exclude hurt, sick or dieing people, or there has to be a regulated solution. Yes, it gets paid for one way or the other, but there really are cheaper ways of doing this. Again see earlier posts and links.

I made what I considered a coherent stab at a premise and some form of solution with a 2 or 3 paragraph idea that tried to stay close to market forces. I haven't seen you tear it down or offer an alternative.

Am I still missing something you said. If so, I apologise.

Posted by: notthere on April 6, 2006 at 10:25 PM | PERMALINK

As is pointed out by a few posts above, the Mass plan is not actually universal - something like 30,000 people still wouldn't be covered, I believe.

Aidan:

I'd be wiling to give Massachusetts credit for enacting "universal" health insurance if they indeed got the number of uninsureds down to 30k, because that would imply better than 99.5% coverage for a state of 6.3 million. I've heard this plan will push up the Mass. rate to only 95% -- and that would leave over 300,000 people uncovered, which is truly underwhelming. Not sure which figures to belive at this point, though, being a Bay Stater, I hope yours is.

Posted by: P.B. Almeida on April 6, 2006 at 10:51 PM | PERMALINK

I could be mistaken - I am thinking of the analysis on the front page of the Wall St J a few days ago and unfortunately I don't have the paper now. Nevertheless, my view is that access to health care should be approached as an issue of human dignity/ rights. Its not OK for any citizen not to have access to basic medical care.

Posted by: Aidan on April 7, 2006 at 10:55 AM | PERMALINK

Aidan,
I agree that it's not OK for people to not have access to basic medical care but not just for citizens.
H5N1 is coming, and several multi-drug resistant strains of TB. Who knows what else. This isn't even bio-warfare, either. A person with TB can cough, once, in a subway station - 3 hours later, TB laden aerosolized droplets will still be in the air, being breathed in.

Preventing people from becoming ill, or isolating them and treating them quickly is a matter of security as well as health.
We will NOT be able to prevent or mitigate an epidemic or pandemic if 1 out of 6 people is without smoe form of healthcare coverage.

It is not only a matter of human interest, but self-interest too.

Posted by: kenga on April 7, 2006 at 1:36 PM | PERMALINK

Hey, if the basic medical care is below the deductible. This does nothing.

What do you expect for US$295.

Posted by: McA on April 7, 2006 at 3:11 PM | PERMALINK

Here's my Republican dream ticket: Romney-Rice.
The Mormon-Black-Woman combo makes Republican Fundie-Racist-Misogynist heads implode. Sweet!

Posted by: Alan Coltharp on April 8, 2006 at 12:14 AM | PERMALINK

You gotta admire the Republicans. We steal another issue from the liberals. And a single payer system it isn't. :)

Posted by: Tymbrimi on April 8, 2006 at 1:34 AM | PERMALINK

Mike Furir Mike 10

Posted by: Mike Furir 672 on April 8, 2006 at 1:57 PM | PERMALINK




 

 

Read Jonathan Rowe remembrance and articles
Email Newsletter icon, E-mail Newsletter icon, Email List icon, E-mail List icon Sign up for Free News & Updates

Advertise in WM



buy from Amazon and
support the Monthly