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Tilting at Windmills

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April 26, 2006
By: Kevin Drum

HEALTHCARE UPDATE....Here's the latest on America's (very) rapidly declining healthcare infrastructure. A new survey from the Commonwealth Fund reports that middle and high income workers aren't doing too badly though they're doing worse than they were five years ago but that workers with incomes less than $35,000 are in free fall. Five years ago 17% of moderate income workers were uninsured; today that figure has skyrocketed to 28%. And a whopping 41% were without health coverage at some point during the year.

Providing healthcare for the poor and working class isn't the only reason to support a sensible national healthcare plan. Cost, efficiency, peace of mind, and increased choice are equally important drivers. But when nearly half of even those who are solidly in the working class don't have medical coverage during some or all of each year, we're in trouble.

Needless to say, George Bush's beloved "ownership society" isn't the solution. It's the problem. There's no way to fix our dysfunctional healthcare system until we stop forcing corporations to be healthcare providers in addition to whatever their actual line of business is. As these figures show, they don't want to be in the healthcare business, and more and more of them are bailing out. It's time to face reality on this.

Kevin Drum 12:42 PM Permalink | Trackbacks | Comments (146)

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Comments

But Bush has nearly bankrupted the country, so how are we going to pay for UH?

Posted by: the fake Fake Al on April 26, 2006 at 12:47 PM | PERMALINK

the fake Fake Al:I wonder how much money we could get by confiscating all the assets of ALL the war profiteers and their top management?

Posted by: Karmakin on April 26, 2006 at 12:53 PM | PERMALINK

Each year the ens of millions of new immigrants, most of them invited by Kevin, require training, education, settlement before they begin paying the cost of their medical care. We can never catch up.

Posted by: Matt on April 26, 2006 at 12:58 PM | PERMALINK

We discussed the Ownership Society in the last century. We rejected the Ownership Society decicively, in the Civil War, otherwise known as the War against Southern Traitors.

The Ownership Society today is one in which large corporations and other fake entities own the actual citizens. I am getting DAMN good and tired of this Ownership Society crap. What we need is a Mutual Assistance Society, in which we work together for the common good.

Posted by: POed Lib on April 26, 2006 at 1:00 PM | PERMALINK


KEVIN DRUM: ...middle and high income workers aren't doing too badly though they're doing worse than they were five years ago but that workers with incomes less than $35,000 are in free fall.

Since 50% of all workers make less than $25k, I don't think it's exactly accurate to say in one breath that the middle is doing well, but that those making less than $35k aren't. Sure, it depends on how you define "middle," but it sells the value of people rather short to skew facts with mean statistics.


Posted by: jayarbee on April 26, 2006 at 1:05 PM | PERMALINK

Bush has already proposed the perfect solution in the form of Health Savings Accounts.

Save your own money tax free for your health care. Do whatever you want with it. Freedom. Liberty. Control over your own destiny.

Posted by: nut on April 26, 2006 at 1:05 PM | PERMALINK

POed Lib: War against Southern Traitors

I like it. Probably not a good campaigning term south of the Masox-Dixon line, but as a dyed-in-the-wool Yankee, I like it.

What we need is a Mutual Assistance Society, in which we work together for the common good.

Good point. May I suggest though the centuries old term "commonwealth" (as used by Massachusetts, Virginia, Puerto Rico, etc.).

Let's make America a commonwealth again (nah, they'll probably brand you a commie).

Posted by: alex on April 26, 2006 at 1:06 PM | PERMALINK

Since the free market solves all problems, what we really need to do is to recognize the intrinsic valuelessness of these uninsured people, and bring back slavery. Then Mr. Market will fix everything.

Posted by: craigie on April 26, 2006 at 1:08 PM | PERMALINK

If everyone has access to health care, then the terrorists will have won.

Posted by: craigie on April 26, 2006 at 1:09 PM | PERMALINK

Too bad they didn't include a category for "uninsured now, insured in the past year." This would have yielded a more complete picture. Since they didn't you can't really distinguish between the two groups they do list and should treat them as one big mass of sometimes-insured people, which actually strengthens your argument, Kevin.

Posted by: Rashad on April 26, 2006 at 1:10 PM | PERMALINK


CRAIGIE: Then Mr. Market will fix everything.

I prefer to call him Mr. Invisible Hand. It sounds more god-like, don't you think?


Posted by: jayarbee on April 26, 2006 at 1:12 PM | PERMALINK

What you're seeing here is people making choices. Some people may decide that they'd rather insure themselves, by saving money and paying for medical expenses as neccesary. Others choose to bet against themselves by purchasing insurance. A variance in making that decision is exactly what we would expect in a free society.

What Kevin Drum wants to do is force the most productive members of society to purchase insurance for themselves, then also buy insurance for the least productive members of society. It's yet another way the democrat party wants to punish the succesful.

Posted by: Al on April 26, 2006 at 1:13 PM | PERMALINK

Are the Democrats on the right side on this issue? Is there a Democrat in the Senate trying to get everybody insured?

Posted by: reino on April 26, 2006 at 1:13 PM | PERMALINK

There has been much gnashing of teeth in the liberal blogosphere as to what message the Democrats should run on. I believe it's very clear. We run on two main issues:

1) medicare for everyone;
2) energy independence in ten years.

Medicare for everyone is past due. It's time and I think it's a winning issue. Insurance lobbyists are so tainted by corruption and politics that I believe we can make it happen.

Energy independence in ten years is, also, a theme that runs on hope, not fear. This is where leadership comes in. People say they don't know what Democrats stand for - this is it. Energy independence is a pocket book value, an environmental value, and most importantly, it's a foreign policy value that will make the country safer. When Kennedy said, "we'll go to the moon in 10 years" he didn't know it could be done, but it happened. He addressed the greatest fear of that time - being beaten by Communism - with something concrete to focus on. I believe that it's time for Democrats to do the same with energy independence. We need to seize this issue, and run with it, not just because it will win elections, but for the future of our country.

Posted by: ExBrit on April 26, 2006 at 1:16 PM | PERMALINK

jayarbee: I prefer to call him Mr. Invisible Hand. It sounds more god-like, don't you think?

No, no, nothing godlike about it. Simple rationalism. Those free marketers are never motivated by emotion, only by facts.

Posted by: shortstop on April 26, 2006 at 1:16 PM | PERMALINK

craigie: what we really need to do is to recognize the intrinsic valuelessness of these uninsured people, and bring back slavery

What makes you think that slavery makes economic sense anymore? Economically it's analogous to serfdom. Very popular when Europe's population was small, but it involved reciprocal obligations. As the population grew serfdom was largely abandoned, as the extra people could simply be left to die on their own.

Posted by: alex on April 26, 2006 at 1:17 PM | PERMALINK

It would be interesting to see how many of those who did not have coverage for part of the time had been changing jobs, or how many of the currently uninsured are changing jobs right now.

Speaking from experience, COBRA was typically an enormously expensive option, and I didn't buy it for most of my job changes.

Posted by: tbrosz on April 26, 2006 at 1:21 PM | PERMALINK

I blame Harry Truman.

Posted by: Will Allen on April 26, 2006 at 1:21 PM | PERMALINK

God, is Al an idiot.

Posted by: Ace Franze on April 26, 2006 at 1:21 PM | PERMALINK


AL: It's yet another way the democrat party wants to punish the succesful.

Unfortunately, to their discredit, the Democratic Party doesn't have that goal -- but I do. Those who oppress should be punished. The greater their oppression, the greater should be their punishment. You probably have quite a whipping coming to you, don't you, Al?


Posted by: jayarbee on April 26, 2006 at 1:23 PM | PERMALINK

What makes you think that slavery makes economic sense anymore?

Are we going to take this seriously? Ok, then how's this: if a certain group of people are so valueless (let's presume that we also abolish the minimum wage, because, you know, fuck them) then why don't I just buy a few? And then, once I own them, it is in my own self-interest to make sure they don't get sick. So I would want to have insurance for them.

Unless, I guess, they were cheap enough that, if they got sick, I would just toss them out and buy new ones.

Are these the sorts of things that run through Cheney's head when he isn't busy destroying other countries in order to prove his masculinity? I dunno...

Posted by: craigie on April 26, 2006 at 1:25 PM | PERMALINK

The problem is smaller than you allege. Many of the high income people without insurance are healthy and are making a calculated decision to pay for their own medical costs, catastrophic or otherwise.

Posted by: tbrosz on April 26, 2006 at 1:25 PM | PERMALINK

It's yet another way the democrat party wants to punish the succesful.

Yes, there's nothing quite like being successful at avoiding cancer. That's the benefit of staying in school and becoming a captain of industry - you never need health care.

Posted by: craigie on April 26, 2006 at 1:27 PM | PERMALINK

tbrosz, COBRA gave you some insight as to the enormous costs of health benefits borne by employers, which of course, ultimately gets reflected to some degree in employees take-home pay.

Look, everything under the sun is either rationed by price, or by arbitrary restriction of supply by government. If we want to go down the path of the former, we need to foster more competition, and less price-fixing in providing health care. If we want to do the latter, we should be frank about the trade-offs, which nobody has the honesty to do.

Posted by: Will Allen on April 26, 2006 at 1:27 PM | PERMALINK

War against Southern Traitors.

Nice one. You must have had a run in with Feddie at Southern Appeal (or one of his clones).

Posted by: tomeck on April 26, 2006 at 1:28 PM | PERMALINK


TBROSZ: Many of the high income people without insurance are healthy and are making a calculated decision to pay for their own medical costs, catastrophic or otherwise.

You got any evidence to back up that claim? I suspect that the "many" high income, uninsured people you're talking about would be a tiny percentage of the work force.


Posted by: jayarbee on April 26, 2006 at 1:29 PM | PERMALINK

The problem is smaller than you allege.

tbroz: I don't think Kevin was saying that the problem was at the high end of the income scale. What do you think of the situation for the people on the bottom?

Posted by: tomeck on April 26, 2006 at 1:29 PM | PERMALINK

It is a Capitalist plot. The masses will be too sick to revolt.

Posted by: Hostile on April 26, 2006 at 1:38 PM | PERMALINK

jayarbee and tomeck:

There's a laugh riot here who has a lot of fun posting under my name. At least (now) he puts down a different e-mail address. Check that first.

Of course a lot of rich people pay cash for their health care, or fall into those categories (young people, no family, etc.) that don't bother with insurance. That's not really relevant to the argument here, so the fake post doesn't even make sense as a comment.

Posted by: tbrosz on April 26, 2006 at 1:44 PM | PERMALINK

But jayarbee!

The high income people are the political "core basis" for Bush. So its absolutely understandable that tbrosz is looking at them.

Posted by: Detlef on April 26, 2006 at 1:45 PM | PERMALINK

1. When offered health insurance through employers, ninety nine percent of employees sign up (sorry, no link). The proportion of people who are uninsured by choice is miniscule.

2. Re those who, according to Al, would be "punished" by being taxed to provide universal coverage: just because people don't have insurance does not mean they don't use the system. At the present time, the burden of caring for the uninsured falls on the health care system, hospital and providers who must write off the costs incurred by the uninsured. Prices for those with insurance are increased, accordingly. Thus, as a society, we are already paying "twice" for those who lack insurance.

3. Health savings accounts are great vehicles for people who don't actually need health care. If you are creating one in the expectation that you may use it if you are diagnosed with, say, cancer or any other significant illness, you are deluding yourself. "Control over one's destiny" is in fact a lesser goal than sheer survival and avoidance of bankruptcy.

Posted by: djinn on April 26, 2006 at 1:48 PM | PERMALINK

I trust Cheney had Mary Matalin send a dozen roses to his Administrative Assistant, George W, today.

When universal health care finally comes to our land, TBrosz will continue to post his sites to nowhere, saying, but, but, but if you would only consider this. Tom, you are truly comic relief.

Posted by: stupid git on April 26, 2006 at 1:51 PM | PERMALINK


TBROSZ: Of course a lot of rich people pay cash for their health care, or fall into those categories (young people, no family, etc.) that don't bother with insurance. That's not really relevant to the argument here, so the fake post doesn't even make sense as a comment.

Well, of course it would make sense as a comment if its (and yours also) basic premise were true. If there really are either "many" (fake tbrosz) or "a lot" (ostensibly real tbrosz) of wealthy uninsured people, that would significantly decrease the number of people who face actual hardship or risks to their health by not having insurance. So, while you disclaim authorship of the comment, you do take ownership of its point -- now prove it.


Posted by: jayarbee on April 26, 2006 at 1:55 PM | PERMALINK

Al wrote: What Kevin Drum wants to do is force the most productive members of society to purchase insurance for themselves, then also buy insurance for the least productive members of society.

So what's your definition of productive? Because there are a lot of people making under $25K a year who produce a lot goods that the execs making the megabucks would never deign to dirty their hands putting together. they're doing the physical labor and taxing their bodies, but can't afford the health care to take care of those bodies. Gee, that seems fair.

Posted by: EM on April 26, 2006 at 2:13 PM | PERMALINK

I am just trying to clarify the position of the liberals here. Do you really just want to provide health insurance for the poor and middle class or do you want to take over the entire health care system and remove any choice?

Why not push for a simple national insurance plan that provides bare bones catastrophic care only? This is something which might have broad base support. Why do you have to push for a one size fits all health care plan?

Furthermore, I don't understand your overall concern? Are you more concerned that the poor and middle class don't have health care, or that different people have different levels of access to health care? I have never understood the desire to make everyone receive the same thing. I am not uncomfortable with the fact that some heiress to some ridiculous amount of money is going to have access to every range of health care under the sun. Its her money she can choose how to spend it. I am uncomfortable with the obssession of some on the left that some people have more than others. Its not that I don't like fairness - its just that forced fairness where it is practiced( e.g.communism ) has shown itself to be a disastrous way to run a society.

Posted by: John Hansen on April 26, 2006 at 2:17 PM | PERMALINK

TBROSZ: Many of the high income people without insurance are healthy and are making a calculated decision to pay for their own medical costs, catastrophic or otherwise.

I know very many "high income people" and I can't think of a single one, not one, who goes without health insurance. Even those of my wealthy friends and business colleagues who don't have to work and thus don't hold a regular job have arranged health insurance for themselves through some sort of means.

Posted by: Stefan on April 26, 2006 at 2:19 PM | PERMALINK

What a crappy chart. Take it away until they do it right.

Posted by: mcdruid on April 26, 2006 at 2:19 PM | PERMALINK

I am not uncomfortable with the fact that some heiress to some ridiculous amount of money is going to have access to every range of health care under the sun.

Ah, but are you equally uncomfortable with the fact that some single mother of three house cleaner with no money is not going to have access to any sort of decent health care? And if so, what are you willing to do about it?

Posted by: Stefan on April 26, 2006 at 2:24 PM | PERMALINK

john hansen: Are you more concerned that the poor and middle class don't have health care, or that different people have different levels of access to health care?

We are concerned that the poor and middle class don't have health care. We don't care that different people have different levels of access to health care. That will always be true, everywhere. It is true in France, which appears to be the best model for health insurance in the world today.

I am uncomfortable with the obssession of some on the left that some people have more than others.

You know some weird leftists, or you have misunderstood them. The left wants a basic national insurance plan which guarantees decent, not gold-plated, health care to anybody. Almost everyone agrees that supplemental insurance should be available for those who want and can afford it. That, again, is the French (and Dutch and German) system.

It would have to cover more than just "catastrophic" care, though. Kids should get vaccinations and checkups, and people shouldn't have to let their ulcers or diabetes go untreated because treatment might cost too much. In the long run, those people will wind up in the emergency room at public expense, and it'll cost society more.

Posted by: brooksfoe on April 26, 2006 at 2:32 PM | PERMALINK

Stefan:

Please do not poison the debate with hyperbole. A working person has some money and has access in America to some health care.

I wish we could have enough resources for everyone to get whatever they want. This is not reality though. We have to make a serious decision on what can be provided without ruining the entire system.

I think providing a bare bones catastrophic insurance plan is probably doable and may in the long run prove beneficial to all. Providing everyone with all the health care they think they need and setting up the necessary bureaucracy to make decisions on who gets what is not doable. Where is the rational setting forth of a policy which avoids Hillary care, but also protects people from being totally uninsured?

Posted by: John Hansen on April 26, 2006 at 2:36 PM | PERMALINK

I am just trying to clarify the position of the liberals here.

Fair enough.

Do you really just want to provide health insurance for the poor and middle class or do you want to take over the entire health care system and remove any choice?

Not take over the entire health care system, as that would mean taking over the provision of health care -- we want a single-payer system which takes over how medical care is paid for.

Why not push for a simple national insurance plan that provides bare bones catastrophic care only? This is something which might have broad base support. Why do you have to push for a one size fits all health care plan?

Because a universal plan, as has been demonstrated in every other developed nation, is cheaper, more efficient, and more effective. It manages to provide more care for more people at a lower price than our patchwork hodge-podge system does.

Furthermore, I don't understand your overall concern? Are you more concerned that the poor and middle class don't have health care, or that different people have different levels of access to health care?

I'm more concerned that the poor and middle class don't have health care, and that everyone, regardless of economic and social status, does not have a guaranteed minimum baseline of health care. I don't really care whether different people have different levels of access, as long as everyone has some basic level.

I have never understood the desire to make everyone receive the same thing.

Don't you? After all, we try and make sure (though we often fail) everyone receives the "same thing" when it comes to fire or police protection, or when it comes to the vote, or to one's standing before the law.

I am not uncomfortable with the fact that some heiress to some ridiculous amount of money is going to have access to every range of health care under the sun. Its her money she can choose how to spend it.

See my point above. Also, in a universal payer plan the rich will still be able to provide extra care for themselves if they so desire -- no one will stop that.

I am uncomfortable with the obssession of some on the left that some people have more than others.

I'm uncomfortable with the obsession of some on the right that there actually exist a fair number of people on the left who care about this. That, or you seem to know an awful lot of Communists.

Its not that I don't like fairness - its just that forced fairness where it is practiced( e.g.communism ) has shown itself to be a disastrous way to run a society.

What we would like is not some sort of right-wing fantasy communist system where everyone has to share exactly the same health care, what we want is a system where every American citizen, whether rich or poor, young or old, is guaranteed a basic minimum level of decent quality healthcare, a society where we take care of and look out for each other.

Posted by: Stefan on April 26, 2006 at 2:36 PM | PERMALINK

Nice strawman, John Hansen. Do you see a single comment here that advocates removing choice for anyone who presently enjoys that position?

In fact, it is the poor and increasingly the middle class who either have no choice in regard to health insurance, or exercise the choice to buy food, shelter and utilities rather than health care. Some choice.

Since you are a bottom line kind of guy, let me point you to the American College of Physicians' report on health outcomes for uninsured Americans--www.acponline.org/uninsured/lack-contents.htm. Bottom line: those without insurance get sicker and have worse outcomes than those who are insured. And why should this concern you? Because the cost of caring for these sick, uninsured people gets passed onto you in the form of higher premiums, copays, etc. In other words, there is no free ride (a sentiment that I'm sure you're familiar with).

Posted by: djinn on April 26, 2006 at 2:38 PM | PERMALINK

Please do not poison the debate with hyperbole. A working person has some money and has access in America to some health care.

Exactly how much money does a minimum wage working person with a family and no insurance have?

Posted by: Stefan on April 26, 2006 at 2:39 PM | PERMALINK

The problem is smaller than you allege. Many of the high income people without insurance are healthy and are making a calculated decision to pay for their own medical costs, catastrophic or otherwise.

Well, I don't think Kevin was particularly concerned about the high-income people, so this is a bit OT. Nevertheless...

Speaking as someone who could take this route, I've investigated it and decided against it. Why? Because the insurance companies also negotiate rates for you. If any health care provider ever gets hold of someone who a) has money and b) doesn't have insurance, the charges seem to triple.

Just take a look at a claim processing document. For a lab test, the facility asks $75, but will take $25 as the negotiated rate. It goes on and on.

I've concluded that it's really much cheaper to have a high-deductible health insurance policy than to go it alone.

Posted by: Doctor Jay on April 26, 2006 at 2:40 PM | PERMALINK

Apologies to tbrosz for falling for the fake. Usually I'm smarter than that.

Posted by: Doctor Jay on April 26, 2006 at 2:41 PM | PERMALINK

Stefan

I think the point John Hansen is trying to make (and one which i agree with is) are you advocating forcing everyone into 1 heath care option and if so why? I dont think anyone would argue that a single mother should have access to health care at a affordable level. But if say i had the money to afford a private room in a hospital with a Tv what is wrong if i choose to spend my money that way?

Posted by: amy on April 26, 2006 at 2:43 PM | PERMALINK

Providing everyone with all the health care they think they need and setting up the necessary bureaucracy to make decisions on who gets what is not doable.

Why not? Every other developed country on Earth finds it doable, and at far less cost and with far greater efficiency than we do. Is your argument that Americans are so uniquely incompetent and venal that they will manage to screw up what the Europeans, Japanese and others have already managed to do?

Which, come to think of the last few years, might actually be a fair argument....

Posted by: Stefan on April 26, 2006 at 2:43 PM | PERMALINK

But if say i had the money to afford a private room in a hospital with a Tv what is wrong if i choose to spend my money that way?

Nothing. You're welcome to do so. Mazel tov and god bless.

See brooksfoe above: Almost everyone agrees that supplemental insurance should be available for those who want and can afford it. That, again, is the French (and Dutch and German) system.

Posted by: Stefan on April 26, 2006 at 2:45 PM | PERMALINK

Or as the guy in this week's New Yorker cartoon did, we could all become Christian Scientists.

Posted by: Ace Franze on April 26, 2006 at 2:47 PM | PERMALINK


JOHN HANSEN: I have never understood the desire to make everyone receive the same thing. I am not uncomfortable with the fact that some heiress to some ridiculous amount of money is going to have access to every range of health care under the sun. Its her money she can choose how to spend it.
So, you've never understood the desire to make everyone receive the same thing, eh? Please point me to a universal or single-payer health care plan proposed by the left or already in use in some other nation which does not allow those with means to obtain care beyond what is covered for all. Why do you sit here and argue with an imaginary enemy?
I am uncomfortable with the obssession of some on the left that some people have more than others.
Here you go again! Cite one example, provide one link, tell us a single instance when someone on the left has said that no person should have more than any other person. Not wanting hard working, innocent people--men, women and children--to continually struggle, suffer, and even die while others are surrounded by luxury and unending comfort is a far cry from demanding that all people should have equally allocated material goods.


Posted by: jayarbee on April 26, 2006 at 2:47 PM | PERMALINK

Doctor Jay:

I have a brother-in-law who is a medical coctor who believes this is the real problem with healthcare. There is really not a price for healthcare. Nobody really knows how much someone pays. Prices are set by backroom negotiations. We have removed all market forces from the system.

I think however there is a need to get back to some sort of real market system in healthcare, rather than have the government take it all over.

Posted by: John Hansen on April 26, 2006 at 2:50 PM | PERMALINK

I too would like to see a baseline of health care provided. However, I would like to have some market controls on how much that costs. I think one of the problems with health care is that people seem to not want to acknowledge that it should cost something.

The whole society has to adjust its thinking. Checkups, vaccinations, dental exams, eye exams ... these are the expenses of living. I need to budget a reasonable amount of money for them. I should not expect them to be provided for free.

Posted by: Stefan on April 26, 2006 at 2:55 PM | PERMALINK

"I dont think anyone would argue that a single mother should have access to health care at a affordable level. But if say i had the money to afford a private room in a hospital with a Tv what is wrong if i choose to spend my money that way?"

Posted by: A Hermit on April 26, 2006 at 2:55 PM | PERMALINK

*&%$# haloscan...

""I dont think anyone would argue that a single mother should have access to health care at a affordable level. But if say i had the money to afford a private room in a hospital with a Tv what is wrong if i choose to spend my money that way?"

Tha's how it works in Canada. The government looks after insuring basic services, you want extras you pay for it, and you can even buy extra insurance to cover it.

Posted by: A Hermit on April 26, 2006 at 2:57 PM | PERMALINK

I too would like to see a baseline of health care provided...

Sorry, that last comment should have been a reply to Stefan it was posted of course by me.

Posted by: John Hansen on April 26, 2006 at 2:58 PM | PERMALINK

Someone is stealing my name, I see. The 2:55 PM was not me.

Posted by: Stefan on April 26, 2006 at 3:00 PM | PERMALINK

To the best of my knowledge, corporations are not "forced" to supply health insurance.

Posted by: Yancey Ward on April 26, 2006 at 3:00 PM | PERMALINK

Oh, sorry, John. I assumed it was someone else.

Posted by: Stefan on April 26, 2006 at 3:01 PM | PERMALINK

Why not? Every other developed country on Earth finds it doable, and at far less cost and with far greater efficiency than we do. Is your argument that Americans are so uniquely incompetent and venal that they will manage to screw up what the Europeans, Japanese and others have already managed to do?

Yes, but is it sustainable. I don't think so. You have a different opinion obviously. I think these countries health care systems will eventually collapse and in the end provide much worse health care. I could be wrong. I would be interested in seeing proof that these programs do not eventually bankrupt the society.

Posted by: John Hansen on April 26, 2006 at 3:02 PM | PERMALINK

Checkups, vaccinations, dental exams, eye exams ... these are the expenses of living. I need to budget a reasonable amount of money for them. I should not expect them to be provided for free.

Stefan, I don't want to live in any society where poor kids' teeth fall out because poor people end up choosing between owning a TV or getting dental checkups for the kids. Or where they don't get vaccinations. Etc.

There are a number of ways to make sure poor kids' teeth don't fall out. One is to have some kind of sliding-scale reimbursement, where low-income people get full reimbursement for the dental exam, while wealthier people have sliding copays. (Btw, are you seriously afraid that people are going to go to the dentist TOO OFTEN? Come on, man!) But this is really complicated.

Another way to do it is to have a fixed copay, but make sure nobody in the country is so poor that they can't afford that copay. We gave up on that when we eliminated welfare in the '90s.

I don't really know what the answer is. But I know this: some basic healthcare goods are simply not that expensive, and I just don't want to live in the kind of country where poor people end up being a kind of inferior class of human because they have rotten teeth and their kids don't learn to read because they don't learn they need glasses until they're 15. That's just not the America I want to live in. And as for you, John Hansen, if you have to pay some taxes so that poor kids in this country don't die of the mumps, then you should fork over your damn taxes and shut up.

Posted by: brooksfoe on April 26, 2006 at 3:07 PM | PERMALINK

I think these countries health care systems will eventually collapse and in the end provide much worse health care.

John, you have to listen, here. I'm sorry, but you're tuning out. Their health care systems are CHEAPER than ours. Get that straight. They are CHEAPER. Not more expensive. Cheaper. It's a fact. France spends 60% of what we do, per person -- yes, per person -- and provides much better health care, for everyone.

If anyone's health care system collapses, it will be OURS. Ours is the one that costs twice as much, not theirs.

Posted by: brooksfoe on April 26, 2006 at 3:10 PM | PERMALINK

I think one of the problems with health care is that people seem to not want to acknowledge that it should cost something.

I think it would be more accurate to say that people don't want to have to choose between paying for insurance and making their mortgage payment.

The whole society has to adjust its thinking. Checkups, vaccinations, dental exams, eye exams ... these are the expenses of living. I need to budget a reasonable amount of money for them. I should not expect them to be provided for free.

Who's talking about providing them "for free"? Under a single-payer system, just as now for those who are insured through their employer, the money would be deducted from your salary.

And if you want to save up to pay for your own eye exams and dental work, John, go right ahead. Just hope you don't get cancer or need major surgery for anything.

Posted by: Alek Hidell on April 26, 2006 at 3:10 PM | PERMALINK

Oh, sorry Stefan. I should've known that wasn't you - it seemed weird.

Posted by: brooksfoe on April 26, 2006 at 3:12 PM | PERMALINK

"TBROSZ: Many of the high income people without insurance are healthy and are making a calculated decision to pay for their own medical costs, catastrophic or otherwise."

They're pretty stupid high-income people, and I'd have to wonder just how they came to be so "high-income" with such poor money-management skills. Why pay out-of-pocket when you can get an insurance company to pick up part of the tab?

Posted by: Geo. on April 26, 2006 at 3:16 PM | PERMALINK

I too would like to see a baseline of health care provided. However, I would like to have some market controls on how much that costs. I think one of the problems with health care is that people seem to not want to acknowledge that it should cost something.

I don't think that's the problem. We all understand that health care costs something -- that's why we keep pointing out that our current Rube Goldberg systems cost more, significantly do, than a single-payer system would. We want to reduce costs, not increase them.

The whole society has to adjust its thinking. Checkups, vaccinations, dental exams, eye exams ... these are the expenses of living. I need to budget a reasonable amount of money for them. I should not expect them to be provided for free.

How much do you budget for your police protection? For the fire department? For the roads you drive on? For the streetlights that illuminate your way home at night? For the water that comes out of the tap in your house, or for the sewer system, or for the military? I could easily write "police, fire department, roads, water, an army these are the expenses of living, and I need to budget a reasonable amount for them" -- but we as a society have decided that it's unfair and inefficient to make everyone pay for them individually, so we allocate the costs among everyone in the form of taxes.

We'd simply like to do the same with health insurance, recognize that we live in a society, that we have mutual obligations to each other, and that's its cheaper and more rational to allocate the costs among all.

No one wants them to be provided for free, of course -- they'll be provided in the form of taxes. But it will be cheaper for us all in the long run to pay taxes to a non-profit national healthcare system than it will be for us all to pay ever-higher insurance premiums and co-pays to for-profit private insurance companies.

Posted by: Stefan on April 26, 2006 at 3:19 PM | PERMALINK

Al and Tbroz are still getting free healthcare provided for them,and good for them.I ,like millions of others used to get healthcare provided for nothing.Them days are over and Tbroz and Al will find there selves on this side of the fence, it is just a matter of time.But they are Very wealthy and can afford the best med care in the world.

Posted by: Booo on April 26, 2006 at 3:19 PM | PERMALINK

"I would be interested in seeing proof that these programs do not eventually bankrupt the society."

You're the one making the claim. Why don't you tell us just how they bankrupt the society?

Posted by: Geo. on April 26, 2006 at 3:21 PM | PERMALINK

I think these countries health care systems will eventually collapse and in the end provide much worse health care.

John, assume that their system costs, for argument's sake, $100 a year. Ours costs $200. So why are you worried that they are the ones who aren't sustainable and will collapse when it's us who's spending more money faster? I'm sorry, that's just bizarre.

Posted by: Stefan on April 26, 2006 at 3:23 PM | PERMALINK

I would be interested in seeing proof that these programs do not eventually bankrupt the society.

Um ... what sort of proof? Proof of a negative? How many years of a feasible system would you require before you believe, John?

Posted by: Alek Hidell on April 26, 2006 at 3:25 PM | PERMALINK

brooksfoe: Thanks for clarifying that you understood that the 2:55 was from me. I meant to type Stefan at the top of my comment and accidentally typed his name in the Name: field.

John, you have to listen, here. I'm sorry, but you're tuning out.

I am not tuning out. I think our current system of hidden costs is not sustainable either. We say we have a market system of health care but we do not.

I work for a large corporation. Most of my healthcare costs are covered. I go to the dentist twice a year, I go for eye exams once a year. I do not have a choice of what to pay, the entire thing is negotiated for me. I have no idea how much I actually pay for dental care or eye exams. I'll bet, however, with the money having to go through two bureaucracies ( my HR department, and our health plan ) there is a lot of waste in the system.

Why should I pay someone to pay for expenses I know I am going to have. Every time money goes through someone else's hands some gets taken away.

The left's answer to this is let's just let the government take it all over. I do not think this is a better solution.

How about if instead we re-educate people on the fact that health care actually costs something and then let them make choices. Health care savings accounts provide this.

I do not care if there is some sliding scale which lets low income people pay less - but let's not have the irrational postion that my health care is free. If I know that something is actually costing me something, I will make better choices, not worse.

Posted by: John Hansen on April 26, 2006 at 3:29 PM | PERMALINK

but let's not have the irrational postion that my health care is free.

??

John, who is arguing that health care is "free"?


If I know that something is actually costing me something, I will make better choices, not worse.

Um, John, I think people know that health care is costing them something. It's costing them a hell of a lot, and that's why many can't afford it.

Posted by: Alek Hidell on April 26, 2006 at 3:34 PM | PERMALINK

I don't believe in divine intervention, and I don't believe in the American healthcare system as it functions currently. If I had a medical crisis in this country, that would probably lead to bankruptcy and ruin for my family if I didn't die outright. Where does that leave me?

Posted by: whynotnow on April 26, 2006 at 3:35 PM | PERMALINK

We'd simply like to do the same with health insurance, recognize that we live in a society, that we have mutual obligations to each other, and that's its cheaper and more rational to allocate the costs among all.

Police - roads (except toll roads of course ), tap water- etc. All things that it does not make sense to have a direct exchange between the consumer and the provider.

Please give me a good argument how it will be cheaper and more rational to have everyone's dental exams paid for by the government, then for them to simply pay the dentist directly.

Posted by: John Hansen on April 26, 2006 at 3:35 PM | PERMALINK

Leaving aside the fact (the fact) that there are people for whom going to the dentist twice a year is an unimaginable luxury, this isn't really about that.

This is about serious health care for serious health issues. Right now, if you don't have insurance, you could easily be bankrupted by an illness. And if you do have insurance, that doesn't actually mean you are better off, because the insurance company will try like fuck to make sure you die before you can claim any more money.

So this system is expensive and unsuccessful. What's to defend?

Posted by: craigie on April 26, 2006 at 3:36 PM | PERMALINK

Um, John, I think people know that health care is costing them something. It's costing them a hell of a lot, and that's why many can't afford it.

Alek - I assume you had a dental exam this year, Can you tell me off the top of your head what was the total cost for that dental exam including all costs for the bureacracies who handled your claim and made payment.

Posted by: John Hansen on April 26, 2006 at 3:39 PM | PERMALINK

Please give me a good argument how it will be cheaper and more rational to have everyone's dental exams paid for by the government, then for them to simply pay the dentist directly.

Suppose the dentist determines that you need oral surgery, John. Gonna pay him directly for that, too?

Look: of course it would be cheaper. That's the entire idea behind insurance: spreading the risk across a populace. Suppose you wreck your car driving home tonight - are you ready to pay your mechanic "directly," or is it more rational (and cheaper) to have your insurance company, to whom you've been paying premiums for this very reason, handle a big chunk of it?

Posted by: Alek Hidell on April 26, 2006 at 3:43 PM | PERMALINK

My congratulations to Al, jayarbee, craigie, shortstop, tbrosz, John Hansen, stefan, brooksfoe, Doctor Jay and Alek Hidell. Rather more light and less heat in this thread. Let's hear it for honest debate and less name calling.

Posted by: tim on April 26, 2006 at 3:47 PM | PERMALINK

Congratulate everyone else on that list, tim. I'm just watching with admiration myself. Excellent thread.

Posted by: shortstop on April 26, 2006 at 3:50 PM | PERMALINK

"Suppose the dentist determines that you need oral surgery, John. Gonna pay him directly for that, too?"

As someone that has had to do exactly that when I had no insurance and was in so much pain that I needed my wisdom teeth pulled NOW, the last thing on my mind was spending time negotiating fees and searching for the cheapest oral surgeon.

Posted by: Geo. on April 26, 2006 at 3:52 PM | PERMALINK

John. Every other industrialized country in the world has a basic-level universal health insurance option provided by the government, and in every one of those countries, costs are about 50-60% of what they are in the US; in most, care is better. The only country in the entire industrialized world that has a system like the US's is Switzerland - and guess what? Switzerland has the world's second-highest health expenditures, around 80% of US levels. A simple rational evidence-based analysis indicates that the US should adopt a system more like those of the rest of the industrialized world.

If you throw out the evidence, and just try to think this system through on your own, in crude terms, you end up with mistakes like this:

How about if instead we re-educate people on the fact that health care actually costs something and then let them make choices. Health care savings accounts provide this.

How much do you pay for corn flakes? How much does Wal-Mart pay for corn flakes? Wal-Mart pays a tiny fraction of what you pay. Why? Because you are an individual. Wal-Mart is a giant corporation. When you go to a doctor and say, I need a bypass; how much will you charge me? - the doctor can charge whatever he likes. You can hardly say no. This is the most inefficient and costly possible way to provide health care. Furthermore, the time and effort you will expend in seeking out the best and least costly provider will dwarf the time and effort which a large insurance company would spend.

Health care savings accounts are an awful idea, especially in a country with an incredibly unequal income structure. Say you make $200,000 a year, and I make $30,000. How much can I possibly put in my health care savings account? How much will providers charge? Why should they bother to make procedures affordable to me? What if I develop a chronic back problem that costs $50,000 in medical bills? This is the whole reason we have insurance. We don't have auto accident savings accounts; we have insurance. Why should we have medical savings accounts?

The problem with health care in America is not that people are getting too much health care. They're not. The problem is that too much money is going into administration. Don't just think about this yourself based on some abstract principles; talk to a doctor. They know. The US already has a universal health care program. It's called Medicare. Its administration costs are a tiny fraction of the costs of private plans; it's vastly more efficient, not less efficient, than the private sector. We need to act like rational, sane managers, and pick the system that's been shown to work, not some theoretical kludge that we invent in our not-very-well-informed heads.

Posted by: brooksfoe on April 26, 2006 at 3:52 PM | PERMALINK

Please give me a good argument how it will be cheaper and more rational to have everyone's dental exams paid for by the government, then for them to simply pay the dentist directly.

That's the whole premise of an insurance system, that it's cheaper and more rational to have everyone's costs borne by the whole rather than for an individual to bear them on his own. That's how insurance, which I assume you carry for your home or car, works.

Suppose you had a fire which burned down your home, and when you tried to claim on your policy I answered "please give me a good argument how it will be cheaper and more rational to have your home rebuilding paid for by the insurance company, then for you to simply pay the construction company directly" -- can you see the value of a spreading the costs in that situation? If so, then why not with medical care? It's the same principle at work, that in the long run we're all better off by allocating costs.

Posted by: Stefan on April 26, 2006 at 3:59 PM | PERMALINK

Stefan: I see we're on the same wavelength. Naturally, that indicates you're a brilliant man. :)

Posted by: Alek Hidell on April 26, 2006 at 4:03 PM | PERMALINK

And John, to put this another way: I can see just from what you're posting here that you've done very little research into the question of what the world's most successful health insurance and health care systems are, what the reasons are for the high expense and low coverage percentage of the US system, and so forth. That's not surprising; who has time to research these kinds of things? But don't you think that this suggests that it will also be kind of hard for you, as an individual, to make rational, informed choices about your own health care, on your own, outside of any coherent system? How much time do you really have to put into researching health care options versus expenses? Is this really what you want to spend your time on? Why?

Posted by: brooksfoe on April 26, 2006 at 4:07 PM | PERMALINK

To the best of my knowledge, corporations are not "forced" to supply health insurance.

they cannot attract skilled workers if they don't provide it. the absense of a gun and bullet doesn't mean they aren't forced by circumstances that we can change to offer health insurance. this aside also doesn't do shit-all to address the real topic of kevin's post: the alarming increase in the number of uninsured.

Posted by: spacebaby on April 26, 2006 at 4:13 PM | PERMALINK

Look -

I certainly understand the concept of insurance. Insurance is provided so that risk is mitigated over a large pool of people. Its not difficult to understand.

The problem is that health insurance has evolved into health care plan. The consumer just does not buy insurance to mitigate risk, he buys a negotiated contract with many doctors that covers routine and catastrophic care. And the consumer does not even buy it, its true costs are conveniently tucked away in employee benfits under our system, or government funding in foreign systems.

Of course the government can administrate a bad system for less - our current system has no market forces for containing costs - a government system at least has bureaucrats trying to mainain it. But this hardly means it is a good idea to take a bad system and put it under government control.

I am not suggesting that catastrophic cases not be handled by insurance. I just don't see how we benefit from sharing everybody's health expense. Way up the thread I suggested that if Democrats want some health care to be nationalized they should try proposing a basic catastrophic plan. To me this makes some sense.

However, I think the real problem with the current health care system - state sponsored or private - is the complete disconnect of the contractual obligation between provider and consumer. How can there be any price controls on a system where the consumer has no idea what he is paying.

Posted by: John Hansen on April 26, 2006 at 4:25 PM | PERMALINK

We do have to think about how to swing this in a way that doesn't ruin the existing insurers, or they won't allow it (and however much you may hate them, they and their shareholders shouldn't just have to hold an empty bag to get something like UHC going.) We should try to make UHC (by say charging according to income as we do for Medicare, FICA, etc.) but let insurers get most of the money from it, with new regulations to prevent the sort of abuses we've been hearing about.

Posted by: Neil' on April 26, 2006 at 4:51 PM | PERMALINK

I still don't understand that damned chart. Is the time uninsured in the past year in hours? Why does it seem that there are more than 100% of adults?

Posted by: mcdruid on April 26, 2006 at 4:54 PM | PERMALINK

John -

What you say has some merit, as long as you restrict it to regular preventative care, but even there, you have to be careful.

The problem is that you want to believe that Mr Market solves all problems. But health care really isn't like any other consumer good. If I make bad choices - or choose to forgo it altogether because of cost - that affects everyone else who comes in contact with me.

That's different from the bad choices I make maintaining my car, or painting my house, or whatever, where those choices only affect me.

Posted by: craigie on April 26, 2006 at 4:56 PM | PERMALINK

"1) medicare for everyone;"

Yeah, THEN Health Savings Accounts to provide for the donut hole in the prescription drug coverage.

Posted by: Cal Gal on April 26, 2006 at 5:00 PM | PERMALINK

Of course the government can administrate a bad system for less - our current system has no market forces for containing costs - a government system at least has bureaucrats trying to mainain it. But this hardly means it is a good idea to take a bad system and put it under government control.

Um, if the government can cover more people more efficiently for less money, then why isn't it a good idea to take a bad system and put it under government control? Why on earth not?

Posted by: Stefan on April 26, 2006 at 5:04 PM | PERMALINK

Kevin says that "There's no way to fix our dysfunctional healthcare system until we stop forcing corporations to be healthcare providers in addition to whatever their actual line of business is." While his phrasing of this is very slightly off base, this is an incredibly important thought.

The fact is that we don't "force" corporations to provide healthcare. Our current tax system encourages them to, but they only got into this sideline business a half century or so ago when, to get around wage and price controls, they used employee benefits such as health care as a means of attracting workers. That was a perfectly sound strategy to compete for good employees then, given the context they were in.

But now we are at a stage where healthcare has become, not only an enormous part of every employee's compensation, it is one of the largest costs corporations face. Last week on 60 Minutes, the story on Starbuck's noted that Starbuck's spends more each year on health care than it does on coffee beans. That illustrates the problem.

The parties in the best position to do something about this are -- the corporations, themselves. Nothing in nature says that employers have to provide health care. It's just that they are a sensible grouping of risks that can help spread costs insurers will be responsible for.

If corporations decided they wanted out of this business, it would be entirely rational for them, but insurers have a perfectly understantable desire to make sure that risks continue to be spread somehow. If they can look at each individual and decide who to take and who not to -- as happens every day when unemployed individuals try to get insurance for themselves or their families -- insurers would clearly prefer to sign up only the healthiest people.

So the options are either (1) a single payer system of some kind; or (2) something like the present system, only using some grouping mechanism other than employers. That could be as random as the first letter of your last name, or zip codes or God knows what else. The primary criterion would be that the grouping *not* be based on the desire to purchase health insurance (to avoid the obvious problem of sicker people getting into a single group -- the arrangement has to spread the risk, not group according to risk).

The fairly rich irony is that the corporations who suffer most from the present dysfunctional system are the very ones who argue against changing it -- classic abused spouse behavior. Until they realize they are the ones who block change, and are the ones who can make change, we will continue to have the present chaos we persist in calling a healthcare "system."

Posted by: Prospero on April 26, 2006 at 5:14 PM | PERMALINK

Nut,

I take it you have never had a health savings account. I have. It isn't nearly as good as it is cracked up to be. All the problems of an HMO with a very high deductible. The theory is you will be able to shop for price. My daughter was taken to the emergency room last month. We have to pay the $3,500 bill out of our health savings account ($4000 deductible.) Nobody let me negotiate the price of a cat scan. Give me a break.

Posted by: Ron Byers on April 26, 2006 at 5:15 PM | PERMALINK

John,

I do know what I am paying. $300/month is my share of a plan provided by my employer that allows me to get most of the care I need, for coverage for me and my husband. I have copays ranging from $10 (PCP visit, level 1 prescription) to $50 (ER visit). Overall, we are spending about $5000/year on healthcare, and I know that if something terrible happens health-wise, we won't go broke.

I have several chronic conditions that no catastropic plan would touch. Without insurance covering those, my costs would be in the range of $600 per month for prescriptions, and about $600 every three months for specialist visits. That's just for me, and includes no screening tests (mammograms, colonoscopy, pelvic etc.) and no other preventive care; don't count my (luckily very healthy) husband.

I don't earn enough for a "medical savings account" to make up the difference in cost. I doubt very many people except for the healthiest and richest do, either...

Posted by: quietann on April 26, 2006 at 5:18 PM | PERMALINK

Cragie:

This is precisely why we have to re-educate people that health care costs something. Some people will not practice preventive health care even if it is free. What you really are admitting is that there is a significant amount of people you want to practice preventive care, that really do not value it as much as it costs to provide them with it.

You wish to have the collective of the population subsidize the person who does not value the preventaive health care at its true cost so that it comes down to a price where they will be willing to pay for it. But I think that this is a losing game. I think eventually that the people you are trying to motivate to practice cheaper preventative care will demand free preventative health care as a right. I don't think that Mr. Market solves everything, I just think he solves more problems than Mr. Bureaucrat.

Posted by: John Hansen on April 26, 2006 at 5:19 PM | PERMALINK

Um, if the government can cover more people more efficiently for less money, then why isn't it a good idea to take a bad system and put it under government control? Why on earth not?

Becuase rather than take the bad private system and convert it to a bad government system, its better to junk the bad system ( prices negotiated by huge conglomerates, costs completely hidden and no market forces ) and replace it with a good system ( some market forces in place the check rising costs ) and then keep it in private hands.

Posted by: John Hansen on April 26, 2006 at 5:23 PM | PERMALINK

"But if say i had the money to afford a private room in a hospital with a Tv what is wrong if i choose to spend my money that way?"

Please let us all know which single-payer plans do not allow this kind of extra to be paid for by the patient?

Posted by: Cal Gal on April 26, 2006 at 5:25 PM | PERMALINK

"corporations are not "forced" to supply health insurance."

Except in Massachusetts!

Posted by: Cal Gal on April 26, 2006 at 5:27 PM | PERMALINK

"Why does it seem that there are more than 100% of adults? "

I think your problem with the chart is that the percentages shown on each bar are not of total adults but of adults in that cohort that year.

Posted by: Cal Gal on April 26, 2006 at 5:35 PM | PERMALINK

"Is this really what you want to spend your time on?"

Yes.

"Why?"

For the same reason I want to be able to make my own choice about any other product or service I might buy, rather than have the choice made for me by the government.

Posted by: GOP on April 26, 2006 at 6:34 PM | PERMALINK

Stefan,

"Why not?"

Because demand for health care outstrips supply. Therefore, rationing is inevitable.

"Every other developed country on Earth finds it doable,"

No they don't. No country on Earth finds it doable. All countries ration health care. The differences are in the way it is rationed, not in whether it is rationed.

Posted by: GOP on April 26, 2006 at 6:36 PM | PERMALINK

brooksfoe,

"John, you have to listen, here. I'm sorry, but you're tuning out. Their health care systems are CHEAPER than ours. Get that straight. They are CHEAPER. Not more expensive. Cheaper. It's a fact. France spends 60% of what we do, per person -- yes, per person -- and provides much better health care, for everyone."

No it doesn't.

According to a commission established by the French government itself, the French health service is on the verge of collapse.


Posted by: GOP on April 26, 2006 at 6:42 PM | PERMALINK


GOP: the French health service is on the verge of collapse.

Couldn't find anything more recent than an article dated January 24, 2004, eh? You'll be happy to know they did a bit of tinkering that same year and all's well now. The French have to pay about a euro more for each consultation. Whew! That was close though, huh? It almost came toppling down on them!


Posted by: jayarbee on April 26, 2006 at 7:25 PM | PERMALINK

"Couldn't find anything more recent than an article dated January 24, 2004, eh?"

Well, the article Kevin Drum cited recently extolling the supposed virtues of the French system was from 2000, and I don't remember you or anyone else objecting to that.

"You'll be happy to know they did a bit of tinkering that same year and all's well now."

Wow, a system that the French government's own commission concluded to be on the verge of collapse was made well by "a bit of tinkering," was it? Care to substantiate this wildly implausible claim? No? I didn't think so.

Posted by: GOP on April 26, 2006 at 7:57 PM | PERMALINK

So low income in 2006 has 53% insured now, 37% uninsured now and 10% neither insured nor uninsured? And High Income had 90% neither insured nor uninsured? Or maybe it is 53% were uninsured at some point in time the last year (contrary to what the legend says), of which 37% are still uninsured?
My brain hurts.

Posted by: mcdruid on April 26, 2006 at 8:29 PM | PERMALINK

Stefan,

"How much do you budget for your police protection? For the fire department? For the roads you drive on? For the streetlights that illuminate your way home at night? For the water that comes out of the tap in your house, or for the sewer system, or for the military? I could easily write "police, fire department, roads, water, an army these are the expenses of living, and I need to budget a reasonable amount for them" -- but we as a society have decided that it's unfair and inefficient to make everyone pay for them individually, so we allocate the costs among everyone in the form of taxes. We'd simply like to do the same with health insurance, recognize that we live in a society, that we have mutual obligations to each other, and that's its cheaper and more rational to allocate the costs among all."

You appear to be under the strange impression that there's no such thing as a water or sewage bill. As for the other things you mention, there is considerable variation in the distribution of costs and benefits, even for services funded entirely by taxes, like the national defense. And many of these services are funded in part privately, or receive different levels of public funding in different communities. Some roads are toll roads, and some streets and streetlights are funded by private entities like corporations and homeowners' associations. And wealthier communities tend to have better roads, better police protection, and better fire service than poorer communities even where those things are funded entirely by taxes.

If you think it's better to fund important goods and services through taxes, and have those things provided by the government or some proxy for the government rather than by private enterprise, then you should advocate government funding/provision of food, shelter and clothing, which are amoung the most important goods and services of all. Do you? Just how big of a commie are you?

Posted by: GOP on April 26, 2006 at 9:53 PM | PERMALINK

High-income is US$60,000 or more....kind of a low definition.

Does anyone know what the treshold is for Medi-Cal or the equivalent. I would have thought the bottom two categories would qualify ... which would mitigate the impact of the problem you speak of.

Posted by: McA on April 26, 2006 at 10:19 PM | PERMALINK

The question for you, GOP and John Hansen, is whether you accept evidence, or whether you continue to believe in theology.

You can continue pronouncing that the French and German and Dutch and British and Canadian and Japanese and South Korean and Taiwanese and Singapore and Hong Kong and Swedish and Norwegian and Danish and Finnish and Austrian and Italian and Spanish and Irish and Belgian and Australian and Israeli health care systems are "on the verge of collapse" from now until forever. But they never collapse, do they? You know why? Because the material you're citing is crap, health-insurance-industry propaganda. And since our own system is also "on the verge of collapse", it doesn't seem to mean much anyway, does it?

Like global warming denialists, your time on this issue has run out. Look, there are five kinds of car out there. One has a piston engine, is made in Detroit, gets 25 mpg and costs $35,000. The other four have piston engines, are made in Paris, Munich, Tokyo, and Stockholm, get 35 mpg and cost $20,000. The rational person buys one of the foreign cars. You keep saying: no, we have to switch Detroit to making rotary engines! They're theoretically more energy-efficient! Even though every rotary engine that's ever been built has been less fuel-efficient (just as, around the world, the bigger the private individually paid portion of the health care system is, the more expensive the care is).

Health insurance and health care are complicated. If they were simple, everyone would know how to do them right. Pure individual market solutions don't work: they make your people sick and cost your country more. That's what the evidence shows. You have to start accepting facts, instead of doing grade-school economics thought problems in your head. This issue is way more complicated than grade-school economics.

Posted by: brooksfoe on April 26, 2006 at 10:23 PM | PERMALINK

The second group's treshold is US$ 35,999.
If these stats include people eligible for the state program as uninsured, they exaggerate.

----------

"And since our own system is also "on the verge of collapse", it doesn't seem to mean much anyway, does it?" Posted by: brooksfoe on April 26, 2006 at 10:23 PM | PERMALINK

So why change?

And you are right. The system is way more complex than grade school economics. Its so complex the kindergarden level "no free lunch" principle works fine.

Posted by: McA on April 26, 2006 at 10:29 PM | PERMALINK

Like global warming denialists, your time on this issue has run out.

Posted by: brooksfoe on April 26, 2006 at 10:23 PM | PERMALINK

So your defence of European healthcare is "it hasn't collapsed yet" but you believe in global warming?

My defense of ignoring global warming is "it hasn't collapsed yet" and climatologists have been predicting disaster of some kind, since I was 4.

Posted by: McA on April 26, 2006 at 10:31 PM | PERMALINK

brooksfoe: You have to start accepting facts, instead of doing grade-school economics thought problems in your head.

Love that phrase, "grade-school economics thought problems in your head".

Market fundamentalists always remind me of the old *nix saying: if the only tool you have is a hammer, then every problem looks like a nail.

Oh no, a screwdriver, a saw, a chisel. Apostate, he doesn't believe that the Holy Hammer is the One True Tool.

Posted by: alex on April 26, 2006 at 10:31 PM | PERMALINK

And GOP, as long as we're doing grade-school economics, here's the Jan. 2004 article you cited:

"The high council on the future of national health insurance said yesterday that if present trends continued, the service - forecast to finish this year 11bn (7.3bn) in the red - will be a staggering 70bn (47bn) over-budget by 2020."

France's population is about 55 million. So they would have to raise health care expenditures by about $1500 per person to make up a shortfall of 70 billion euros (about $80 billion).

If they were to do that TODAY, they would then be spending about 80% as much as the US does on health care, but they'd still be getting better health outcomes and universal coverage. But by 2020, with US healthcare expenditures growing much faster than French ones (about 7% per year), the gap will be much wider, so I'd bet they'd still be spending not much more than 60% as much as we do, and getting better outcomes and universal coverage.

What they consider "collapse", we would consider a staggering improvement. The threat to our system is far, far more grave than the threat to theirs. In fact, ours is already collapsing, just looking at those percentages for people without insurance.

Posted by: brooksfoe on April 26, 2006 at 10:34 PM | PERMALINK

McA: the kindergarden level "no free lunch" principle works fine

That's about the only principle in economics that does work consistently. Of course saying that some lunches are a better bargain than others doesn't violate this principle, so what's your point?

Posted by: alex on April 26, 2006 at 10:36 PM | PERMALINK

brooksfoe,

You can continue pronouncing that the French and German and Dutch and British and Canadian and Japanese and South Korean and Taiwanese and Singapore and Hong Kong and Swedish and Norwegian and Danish and Finnish and Austrian and Italian and Spanish and Irish and Belgian and Australian and Israeli health care systems are "on the verge of collapse" from now until forever.

Considering that I haven't pronounced that at all, I can hardly "continue" pronouncing it. I did cite a French government study that found that the French health system is on the verge of collapse. This seems rather relevant to the discussion in light of the frequent assertion from critics of the U.S. health care system that the French system is superior and that we should emulate it.

But they never collapse, do they? You know why? Because the material you're citing is crap, health-insurance-industry propaganda.

Er, the 53-member commission that found that the French health service is on the verge of collapse was established by the French government and consists of academics, economists, doctors and other professionals. It has nothing to do with the health insurance industry.

And since our own system is also "on the verge of collapse", ...

It is? Substantiate this claim. Or did you just make it up? You keep going on about rationality and evidence, but your own posts are notably devoid of them. You do like making grand claims without an iota of substantiation, though.

Health insurance and health care are complicated.

Right. Which is one reason why comparisons of the health care systems of different countries are also complicated, and why dogmatic claims to the effect that the health care system in France/Canada/Britain/Germany/Wherever is "better" than the U.S. system are dubious and silly. Even more stupid are claims to the effect that different countries' health care systems can be ranked on some meaningful scale of "better" and "worse" on the basis of a handful of crude health-related aggregate statistics such as life expectancy and infant mortality.

Posted by: GOP on April 26, 2006 at 10:51 PM | PERMALINK

brooksfoe,

France's population is about 55 million. So they would have to raise health care expenditures by about $1500 per person to make up a shortfall of 70 billion euros (about $80 billion).

The funding deficit is only one of the problems cited by the report. Adjusting for propulation size, it's like a U.S. deficit, just for public health costs, of about $70 billion per year in 2004, and about $435 billion per year by 2020. But that wouldn't be a serious problem, right? Because we're so good at balancing our federal budget already that putting it an additional $435 billion per year in the red wouldn't matter.

If they were to do that TODAY, they would then be spending about 80% as much as the US does on health care, but they'd still be getting better health outcomes and universal coverage.

You have provided no evidence that the French health care system produces "better outcomes" than the U.S. system, and the problems with the French system identified in the commission's report strongly undermine the claim. Even if the French system were producing "better outcomes" (and how are you measuring that, exactly?), it would be doing so via massive and obviously unsustainable deficit spending.

Posted by: GOP on April 26, 2006 at 11:09 PM | PERMALINK

brooksfoe,

In fact, ours is already collapsing, just looking at those percentages for people without insurance.

What about those percentages? How are they evidence that our system is "collapsing?" Do you have an actual argument to make?

Posted by: GOP on April 26, 2006 at 11:20 PM | PERMALINK

Don P, posting as GOP, is still mentally ill.

What does this say about the effectiveness of our free-market healthcare system?

Posted by: obscure on April 26, 2006 at 11:25 PM | PERMALINK

God, I need another martini. And hand me my prozac, would you?

Posted by: obscure on April 26, 2006 at 11:28 PM | PERMALINK

What about those percentages? How are they evidence that our system is "collapsing?" Do you have an actual argument to make? - GOP

No, you've made it for me. Thanks!

Posted by: brooksfoe on April 26, 2006 at 11:41 PM | PERMALINK

But that wouldn't be a serious problem, right? Because we're so good at balancing our federal budget already that putting it an additional $435 billion per year in the red wouldn't matter.

I take it back, GOP: you're incapable of solving grade-school economics thought problems. You're too confused. We're not talking about putting the US an additional $435 billion in the red; we're talking about France spending an additional $80 billion. France does not have our budget deficit and our health spending; they have their budget deficit and their health spending. Their health spending is about 40% lower than ours. So when we put the analogy together, if the US converted to France's health care system TODAY, then the US would SAVE about 40% of its national health care budget (which is about 20% of our GDP), or about 8% of GDP - which we could use to, oh, turn the federal budget deficit into a huge surplus, or invest in the stock market and send it through the roof, or whatever.

If however we factor in that France's system might need to pump in an extra $80 billion a year by 2020, and if we imagine that the ratio of French to US health care costs per capita will otherwise remain the same (which is an absurd assumption, since US health care costs are actually rising much faster than French ones, but let's be conservative and hold them steady), then that would mean France would need to pump in an extra $1300 or so per person, which would bring their health care costs up to...well, let's say health care costs only go up 50% over those 15 years (actually they will rise far more at current rates of health care inflation); then that extra $1300 would mean that French costs per capita would be about $5800 instead of $4500, while US costs would have risen to about $7500. So if we adopted the French system in 2020, we would only be saving about 22% on our health care costs, instead of 40% today. Assuming health care has by then grown to say 25% of GDP, that would mean we'd only save maybe 5% of GDP - which would still hopefully be enough to turn the massive projected federal budget deficit into a surplus.

In other words, the French system is in so much trouble that by 2020 it might be only way cheaper than our system, not staggeringly cheaper.

You have some weird notion in your head that converting to the French system involves spending more money. That's because you've translated the word problem into an inappropriate and confused equation, and you have your x's and y's mixed up. You flunk.

As for the evidence that French people are, on the whole, healthier and live longer than Americans, that evidence is so abundantly available on the net that it's superfluous to append it. Let's just say their life expectancy for men and women is significantly longer than ours; you can hunt for the rest if you want.

Posted by: brooksfoe on April 27, 2006 at 12:03 AM | PERMALINK

"Even more stupid are claims to the effect that different countries' health care systems can be ranked on some meaningful scale of "better" and "worse" on the basis of a handful of crude health-related aggregate statistics such as life expectancy and infant mortality."

Well, lets see...
Ours:

1. Costs way more than anyone else's.
2. Large numbers of people not covered.
3. When you lose your job you lose your coverage.
4. People with pre-existing conditions are unable to change jobs or move out-of-state because of medical insurance.
5. People without insurance are charged 300-400% as much as those with insurance.
6. People trying to buy individual policies can be turned down for existing health problems, no matter how much they are willing to spend.
7. Large numbers of people deeply in debt or in bankruptcy because of medical bills.
8. Conditions that could have been treated early became major.
9. The paperwork is so complicated and time-consuming that it eats up a huge amount of money.
10. Doctors spend large amounts of their time dealing with insurance companies instead of treating patients.
11. Insurance company clerks make medical decisions.
12. Children with untreated medical and dental problems do poorly in school and become social problems in later years.
13. Hospitals and emergency rooms are being closed down all over the place as unprofitable, leaving many areas underserved in case of a flu epidemic or other public health emergency.
14. Drugs cost much more in this country because we don't negotiate the price.

Theirs:
1. None of the above.

Posted by: denise on April 27, 2006 at 12:04 AM | PERMALINK

The party to adopt these policies will run away with elections.

Posted by: aaron on April 27, 2006 at 1:27 AM | PERMALINK


GOP: The funding deficit is only one of the problems cited by the report.
You're still flogging that old report? Why don't you keep up with the times?
GOP: Care to substantiate this wildly implausible claim? No? I didn't think so.
You think too much. Or maybe not enough. Either way, you probably think this link will be from some "liberal" source. Wrong again. It's from the fine folks at IMF. Probably good friends of yours, no?


Posted by: jayarbee on April 27, 2006 at 2:25 AM | PERMALINK

Instead of trying to figure out who to distribute our healthcare to, maybe you might want to figure out how to increase the supply.

Posted by: aaron on April 27, 2006 at 2:41 AM | PERMALINK

Ron Byers,

Sorry in advance for being a dick. Somethings just cost, no way around it. The real questions is, did she need that CAT scan? Was is needed to deal with an emegency, or was it taken as "a precaution"? What vital information was this CAT scan supposed to provide?

Personally, I'd like to see nationalized insurance, but which is very strict about under what circumstances it pays-out. Insurance for emergencies, and HSA's for healthcare. None of this deductable and co-pay bullshit. If you want something that isn't covered, you pay out of pocket or get special low-interest government loan. Insure me for against a broken arm and heartattack, not high blood-blood pressure, high colesterol level, ADD, or depression. Give rebates to people who take preventative measures for the value of the risk redudction.

Posted by: aaron on April 27, 2006 at 3:20 AM | PERMALINK

Give rebates to people who take preventative measures for the value of the risk redudction.

So you mean, if someone goes in for a pap smear to detect cancer early so the potential cost of treatment is lowered, you'd give them a rebate for the value of the risk reduction.

This is also known as a "copay".

For someone who gets vaccinations for his kids, which would save the country the cost of treating his kids if they get those diseases, not to mention the cost of treating the other people his kids might infect, you would give them a "rebate" which would amount to the entire cost of the vaccination. (It's cheaper to vaccinate the entire country against mumps than to treat the cases of mumps that would result if we didn't vaccinate. Obvious.)

In other words, you favor making vaccinations free. Fine.

You think you know what you think, but actually, you have no idea what you think.

Posted by: brooksfoe on April 27, 2006 at 7:39 AM | PERMALINK

Going way way back to a comment by CalGal:

In Massachusetts, employers will NOT be required to provide health insurance to their employees. If they have more than 10 workers, and do not provide access to health insurance, they will pay a $295/YEAR fee/tax/whatever to the state government. One of the big worries with this plan is that employers will DROP coverage, because that fee is a lot less than the cost of providing insurance.

Employers who aren't providing the insurance will be billed for some part of their uninsured employees' use of the state "Free Care" pool -- although the details are complicated, and it's not the full cost by any means.

In the MA plan, the onus is on the individual to purchase insurance (though persons with lower incomes will have their premiums subsidized on a sliding-scale.) I am surprised that the business community is letting something like $295 annual fee stop them from seeing what a win this is for them.

Posted by: quietann on April 27, 2006 at 11:41 AM | PERMALINK

CORRECTION NEEDED -- UNDERSTATING PERCENTAGE

Kevin,

You say that 41% of those with incomes under $35,000 were without insurance at some point in the past 12 months. Actually, that 41% figure is for $20,000 to $40,000 in income (they've shifted moderate income up to an upper limit of $40,000 for the latest survey).

Since low income people (under $20,000) had at 53% chance of being uninsured in the preceding 12 months, the likelihood of being uninsured must be somewhere between 41 and 53 percent for people earning less than $40,000.

Posted by: Correction Needed on April 27, 2006 at 11:44 AM | PERMALINK

Aaron --

you assume that all chronic conditions can be prevented by lifestyle changes.

Tell that to the kid with cystic fibrosis, the person with Type 1 diabetes (that's me BTW), the many many people whose depression is deep, chronic, and clearly due to some biochemical issue, the parents of a premature infant who will need lifelong care for medical problems caused by prematurity, and so forth.

Not all chronic health problems can be prevented. Some of them are VERY expensive to treat, well beyond what a medical savings account will cover.

And you say nothing about people who don't have a dime in their budgets to put into a medical savings account. It only works (and even then, not very well) if one can afford to put money into it...

Posted by: quietann on April 27, 2006 at 11:47 AM | PERMALINK

How much would our health care cost if people residing in the US paid exactly the same price for prescription medication? Could any of the foreign national heath care plans if they where required to pay the same dollar amount that the US pays for medication? The impression is that other nations healthcare is subsidized by the high US drug prices. Drug companies make the vast majority of profit off of the US. How would things change if the US lowered drug prices so that it was the same rate as other first world nations? What would happen if the US lowered its drug prices and other first world nations increased their prices such that the current profits levels where a result of even cost distribution?

Posted by: james on April 27, 2006 at 11:50 AM | PERMALINK

jayarbee,

"You think too much. Or maybe not enough."

You don't think at all. Not only does the document you link to fail to substantiate your claim that "all's well" with France's health care system after some "tinkering," it explicitly contradicts your claim. The document says "recent estimates indicate that the target of balance [in the health budget] in 2007 may be difficult to reach." In addition the document says nothing whatsoever about any of the other critical problems in France's health care system identified by the government commission.

Try again.


Posted by: GOP on April 27, 2006 at 12:28 PM | PERMALINK

brooksfoe,

I take it back, GOP: you're incapable of solving grade-school economics thought problems.

You're incapable of adding two and two.

We're not talking about putting the US an additional $435 billion in the red; we're talking about France spending an additional $80 billion.

We're talking about the French health service. Adjusted for the difference in population size, the French health service is running an enormous deficit that in U.S. terms is projected to grow to $436 billion per year by 2020.

France does not have our budget deficit and our health spending; they have their budget deficit and their health spending.

And if we adopted France's health system, we'd have their enormous, unsustainable deficit health spending too. That's one of many reasons why it would be a bad idea to emulate the French health system.

In other words, the French system is in so much trouble that by 2020 it might be only way cheaper than our system, not staggeringly cheaper.

The issue isn't whether it's cheaper or more expensive. The issue is whether it works at all. It doesn't work. It's in crisis. It is, as the French government's own commission stated, on the verge of collapse.

You have some weird notion in your head that converting to the French system involves spending more money.

Converting to the French system would most definitely massively increase government spending on health, and would massively increase the federal budget deficit. That would be a very bad thing.

As for the evidence that French people are, on the whole, healthier and live longer than Americans, that evidence is so abundantly available on the net that it's superfluous to append it.

Then you should have no trouble producing this allegedly abundant evidence. Where is it? Put up or shut up.

Posted by: GOP on April 27, 2006 at 12:40 PM | PERMALINK

1. Costs way more than anyone else's.

Provides way more than anyone else's.

2. Large numbers of people not covered.

At any one time, a small minority of the population does not have health insurance. That doesn't mean they don't receive health care.

3. When you lose your job you lose your coverage.

False.

4. People with pre-existing conditions are unable to change jobs or move out-of-state because of medical insurance.

False.

5. People without insurance are charged 300-400% as much as those with insurance.

False.

6. People trying to buy individual policies can be turned down for existing health problems, no matter how much they are willing to spend.

False.

7. Large numbers of people deeply in debt or in bankruptcy because of medical bills.

Large numbers of people in other countries do not get important, and even life-saving, medical care when they need it.

8. Conditions that could have been treated early became major.

That happens in other countries too.

9. The paperwork is so complicated and time-consuming that it eats up a huge amount of money.

That happens in other countries too.

10. Doctors spend large amounts of their time dealing with insurance companies instead of treating patients.

Doctors spend large amounts of time on adminstrative tasks in other countries too.

11. Insurance company clerks make medical decisions.

In other countries, government bureaucrats make medical decisions.

12. Children with untreated medical and dental problems do poorly in school and become social problems in later years.

That happens in other countries too.

13. Hospitals and emergency rooms are being closed down all over the place as unprofitable, leaving many areas underserved in case of a flu epidemic or other public health emergency.

False.

14. Drugs cost much more in this country because we don't negotiate the price.

No, drugs cost more in this country because the market supports higher prices. Those higher prices fund R&D that allows new and better drugs to be developed.

Posted by: GOP on April 27, 2006 at 12:54 PM | PERMALINK

I googled "French + healthcare + collapse" and I posted the one thing I found. I googled "French + healthcare + collapse" and I posted the one thing I found. I googled "French + healthcare + collapse" and I posted the one thing I found. I googled "French + healthcare + collapse" and I posted the one thing I found. I googled "French + healthcare + collapse" and I posted the one thing I found. I googled "French + healthcare + collapse" and I posted the one thing I found. I googled "French + healthcare + collapse" and I posted the one thing I found. I googled "French + healthcare + collapse" and I posted the one thing I found. I googled "French + healthcare + collapse" and I posted the one thing I found. I googled "French + healthcare + collapse" and I posted the one thing I found.

Posted by: "Don P" on April 27, 2006 at 12:54 PM | PERMALINK

brooksfoe,

So you mean, if someone goes in for a pap smear to detect cancer early so the potential cost of treatment is lowered, you'd give them a rebate for the value of the risk reduction. This is also known as a "copay".

No, a copay is a payment made by a recipient of health care services for those services. It is not limited or targetted to preventive or diagnostic services. Do you oppose copays?

For someone who gets vaccinations for his kids, which would save the country the cost of treating his kids if they get those diseases,

No, it would save the kids' parent, or more likely their insurance company, from the cost of treating his kids if they get those diseases. So why should vaccinations be "free" (by which I assume you mean "funded by taxpayers") rather than funded by the kids' parent or health insurer?

You think you know what you think, but actually, you have no idea what you think.

That statement seems to apply to you in spades.

Posted by: GOP on April 27, 2006 at 1:06 PM | PERMALINK

Well this was a pretty smart thread: liberals and some conservatives airing out a big issue with decency and consideration.

And then GOOP and McAsshole show up....and spooge all over the place.

Way to go, peckerheads.

Posted by: Locutor on April 27, 2006 at 2:46 PM | PERMALINK

quietann,

"Not all chronic health problems can be prevented. Some of them are VERY expensive to treat, well beyond what a medical savings account will cover."

Medical savings accounts would be for healthcare. Insurance will take care of basic needs, people who don't have the means just won't have premium care available to them. Whether or not insurance will cover the cystic fibrosis child would depend on whether the result of the treatment are worth the expense. Even if it doesn't, we can create a low interest loan program. The family wouldn't be denied care, but they would need to atleast try to pay for it over time. If it's not worth it for them to borrow, that's up to them. That whole senario is moot however, a condintion that is will lead to death or is debilitating and that can be treated would fall under the nationalized insurance (the non-patented stuff atleast).

Posted by: aaron on April 27, 2006 at 3:11 PM | PERMALINK


GOP on April 26, 2006 at 6:42 PM: "verge of collapse"
GOP on April 26, 2006 at 7:57 PM: "verge of collapse"
GOP on April 26, 2006 at 10:51 PM: "verge of collapse"
GOP on April 27, 2006 at 12:40 PM: "verge of collapse"

You took really copious notes during Spin class when you attended Republican Shills Academy, didn't you? Verge of collapse, you say? And how do you know that? Extensive study? Intensive research? Exhausting Googling? Well, no. You read one article written by the British press nearly 2 1/2 years ago concerning the French healthcare system. What did that one article say that so convinced you of the imminent collapse of the French healthcare system? It touted its source ("The high council on the future of national health insurance"), which itself, according to the article, made no mention of the "verge of collapse" that the British had chosen for their headline. Upon reading that scary article, you promptly dubbed the high council "The French government's own commission." (You mean as opposed to a Zimbabwe commission?) And then you invoked the authority of the renamed council again and again . . . at 6:42 PM, at 7:57 PM, at 10:51 PM, at 11:09 PM; and the next day at 12:28 PM and at 12:40 PM.

Meanwhile, early on, it was explained to you that, while there had been problems with the French system as described in the old article you linked to, reforms had soon after been implemented which an authority no less than the capitalism friendly IMF had lauded. It was further explained that the primary impact on users of the French healthcare system would be a nominal increase in consultation fees. The sources for this revised assessment were far more recent than your own. Yet you persist in relying on your original source, which was never more than a cursory view of the matter, because it failed to emphasize that reforms were already being discussed and committed to.

Let's review:

1. In January of 2004, a French high council releases a report stating that unless steps are taken to avert shortfalls, their prized healthcare system will be deeply in debt by 2020.

2. In late April of 2006, you cite, not the report itself, but a British newspaper article which describes the French council's report, using its inflammatory headline "verge of collapse" as evidence.

3. Between the above two events, beginning immediately following the first (if not sooner), the French government proposes reforms to combat projected healthcare system shortfalls.

4. The reforms take effect in
early 2005 and are immediately praised by the IMF.

5. You ignore everything except the headline in your single source -- including the article's very first sentence, which begins: "A government commission has warned that without fundamental reforms...

They made the reforms!

Look, GOP, you Goofy Old Propagandist, if Bush had been successful in selling his ridiculous social security reforms to the public last year and congress had written them into law last summer mandating that they take effect this past January, would you now give any credence to someone claiming SS was on the verge of collapse and touting a January '05 report warning that there would be shortfalls by 2025? It'd have to be the very same trumped up report Bush was spinning to get the reforms in the first place! You'd laugh in his face and ask where's he's been. Which is what I'm doing to you.

GOP: Try again.
No. No more. You try keeping current.


Posted by: jayarbee on April 27, 2006 at 3:26 PM | PERMALINK

jayarbee,

Verge of collapse, you say?

No, verge of collapse the commission that issued the report says. That commission was established the French government for the purpose of evaluating the French health service.

You read one article written by the British press nearly 2 1/2 years ago concerning the French healthcare system.


It's not an article written by the British press, it's a report issued by a 53-member commission established by the French government to evaluate the French health service.

What did that one article say that so convinced you of the imminent collapse of the French healthcare system? It touted its source ("The high council on the future of national health insurance"), which itself, according to the article, made no mention of the "verge of collapse" that the British had chosen for their headline.


You really are completely incapable of reading aren't you? The very first line of the Guardian report:

"A government commission has warned that without fundamental reforms France's national health service, rated the best in the world by the World Health Organisation, will collapse within the next 15 years.

What part of this don't you understand?

Meanwhile, early on, it was explained to you that, while there had been problems with the French system as described in the old article you linked to, reforms had soon after been implemented which an authority no less than the capitalism friendly IMF had lauded.

Tee hee hee. You don't even read your own citations. The IMF article stated that the fiscal reforms of France's health care system are likely to fail, and made no mention at all of any reforms to correct any of the other critical problems in the French health service identified by the commission.

It was further explained that the primary impact on users of the French healthcare system would be a nominal increase in consultation fees.

This is nonsense. You don't know what you're talking about. You haven't produced one iota of evidence that "the primary impact on users of the French healthcare system would be a nominal increase in consultation fees."


Let's review: 1. In January of 2004, a French high council releases a report stating that unless steps are taken to avert shortfalls, their prized healthcare system will be deeply in debt by 2020.

False. The commission's report stated that unless fundamental reforms are made in the French health service, it will collapse within 15 years. No such reforms have been made.

I'm still waiting for you to provide one iota of evidence to substantiate your preposterous claim that the French "did a bit of tinkering that same year and all's well now" with the French health service.

Posted by: GOP on April 27, 2006 at 9:19 PM | PERMALINK

Nope, still doesn't make sense.

Posted by: mcdruid on April 27, 2006 at 9:24 PM | PERMALINK

GOP: You haven't produced one iota of evidence that "the primary impact on users of the French healthcare system would be a nominal increase in consultation fees."
See item #4: (early 2005)


Posted by: jayarbee on April 27, 2006 at 9:47 PM | PERMALINK

jayarbee,

See item #4: (early 2005)

Er, there is no item 4 in that link. Item 3 imposes substantial new restrictions on access by French patients to specialists, which contradicts your claim that the "primary impact on users of the French healthcare system would be a nominal increase in consultation fees." There is no indication that the reforms listed, or any others, have been successful. There is no indication that the reforms have addressed the critical problems identified in the French health service by the government commission, let alone resolved those problems. This isn't terribly surprising, since the problems have been apparent for a long time, and successive French governments have failed to address them.

The website does, however, confirm the likely failure of the 2004 French health sector fiscal reforms suggested by your earlier IMF citation:

"The 2003 health budget deficit was confirmed at 11.9 billion Euros and the aim of these reforms is to balance the budget by 2007. Quite frankly this seems unlikley. Principal revenue raising measures such as the higher rate of CSG and the 1 Euro per medical act charge will not be in force until 2005. The much needed reforms such as targeting abuse of sick leave and the new "cartes vitales", even if successful, will take some time to make a real impact on the balance sheet . So proposed reforms that were not pushed through this time could be introduced later as the ambitious target of a balanced budget in 2007 appears unattainable."

I'm still waiting for one iota of evidence to support your preposterous claim that the French "did a bit of tinkering that same year and all's well now" with the French health service.

Posted by: GOP on April 27, 2006 at 10:12 PM | PERMALINK

Peter Owen, the Health Care Topic host at the website jayarbee links to, summarizes the effect of the 2004 reforms as follows:

The reforms announced last year emphasised the shifting of the financial burden from the state to the individual and complementary insurers. Those of you in France, and who already have a complementary insurance, will have noticed quite steep premium increases on renewal.

In other words, the French government is trying to move to a more American-style health care system by shifting health care expenses away from the government and on to individual patients and private insurers.

Owen is also quite pessimistic about the prospects of proposed structural reforms being passed into law:

It is one thing to propose structural reform in any sphere of French life and quite another for it to be implemented. It inevitably leads to the citizens taking to the streets which in turn tends to weaken the resolve of the government. For instance the head of the CPAM in Lyon is openly sceptical of the feasibility of the reforms succeeding. It is wait and see. So if through political expedience much needed structural reform fails to materialise it will be back to good old tax rises in their various forms.

This is pretty much business as usual in France. Someone points out that public services are underfunded, wasteful, inefficient and in urgent need of major reform. The government proposes reforms to fix the problem. This incites mass public protests. The government backs off, and the mess continues...

Posted by: GOP on April 27, 2006 at 10:25 PM | PERMALINK

GOP, you still can't add.

If we adopted the French system, we would spend about the same amount per person on health care as they do. Right? Or is there some reason why Americans are genetically inferior, and thus their system would automatically cost more over here?

They spend less than $4000 per person per year on health care.

We spend nearly $6000 per person per year on health care.

So if we adopt their system, we will save money.

As I have posted over and over and over again, the amount by which their system is currently in deficit is tiny compared to the difference between the amount they spend per capita and the amount we spend per capita. So if we adopted their system and paid up its deficit, then we would still SAVE MONEY.

Posted by: brooksfoe on April 28, 2006 at 7:35 AM | PERMALINK

Adopting a nationalized system won't lower the cost person, it will raise it. Adding more people to the system means more demand and higher costs. Only inproving the supply or lowering demand (effective preventative care) will lower costs.

Posted by: aaron on April 28, 2006 at 9:00 AM | PERMALINK

This means that we have to get more people into medical professions, without increasing their compensation. Basically, we have to make becoming a doctor more attractive and lower the cost of educating doctors (eliminating uncessary courses and training requirements and ineffective practices, allow students to specialize and finish earlier).

Posted by: aaron on April 28, 2006 at 9:09 AM | PERMALINK




 

 

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