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Tilting at Windmills

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December 19, 2006
By: Kevin Drum

BEST IN THE WORLD, BABY, BEST IN THE WORLD....From John Derbyshire over at The Corner:

CHRISTMAS PRESENT [John Derbyshire]
My health insurer has just notified me, in a brief form letter, that my monthly premiums are to rise from $472.33 to $857.00 on January 1st. That's an increase of 81 percent. ***E*I*G*H*T*Y*-*O*N*E* *P*E*R*C*E*N*T*** Can they do that? I called them. They sound pretty confident they can. Ye gods!

A conservative reader emailed this item to me with the following comment: "I've heard people say a conservative is just a liberal who's been mugged. Then maybe a liberal is just a conservative who suddenly got this in the mail."

Kevin Drum 1:25 PM Permalink | Trackbacks | Comments (114)

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Posted by: d. b. cooper on December 19, 2006 at 1:35 PM | PERMALINK

Mr. Derbyshire can quit this insurance plan, and get another. Alternatively, he can set aside some money and self-insure. Or he can recruit a group of associates and negotiate a group rate with this or any other company. He has near infinite options for healthcare, as do all Americans.

Now, how would a Canadian go about changing his health plan if he doesn't feel like waiting six months for a hip replacement? Oh, right: Head to America.

Posted by: American Hawk on December 19, 2006 at 1:35 PM | PERMALINK

That reminds me. I've been planning to mug Harry and Louise and leave them bleeding by the side of the road with claim denial form letters shoved down their throats. Anyone have an up-to-date address for those two?

Posted by: ajl on December 19, 2006 at 1:37 PM | PERMALINK

Hawk: You win! It only took two comments for someone to trot out the "Canadian hip replacement" idiocy. And your comment is only the second by a technicality. Congratulations!

Posted by: Kevin Drum on December 19, 2006 at 1:38 PM | PERMALINK

"That reminds me. I've been planning to mug Harry and Louise and leave them bleeding by the side of the road with claim denial form letters shoved down their throats. Anyone have an up-to-date address for those two?"

Harry & Louise
666 Big Pharma Road
Republicanville, TX

Posted by: Petey on December 19, 2006 at 1:39 PM | PERMALINK

Mr. Derbyshire can quit this insurance plan, and get another. Alternatively, he can set aside some money and self-insure.

Or he can get rid of insurance all together and use Bush's private health accounts which are a much better deal anyway.

Posted by: Al on December 19, 2006 at 1:40 PM | PERMALINK

Mr. Derbyshire can quit this insurance plan, and get another.

And what, exactly, makes you think his premiums will be any less than with his current plan?

Alternatively, he can set aside some money and self-insure. Or he can recruit a group of associates and negotiate a group rate with this or any other company.

Of course, if he should have a major medical emergency while he's in the middle of this process, he's up shit creek.

He has near infinite options for healthcare, as do all Americans.

Apparently "near infinite" does not include "affordable"

Posted by: "Fair and Balanced" Dave on December 19, 2006 at 1:40 PM | PERMALINK

Mr. Derbyshire can quit this insurance plan, and get another.

Assuming he has no "preexisting conditions." If he does, good lusk getting on with a new insurance company.

Alternatively, he can set aside some money and self-insure.

Of course, everybody has hundreds of thousands laying around to cover major unexpected surgery.

Or he can recruit a group of associates and negotiate a group rate with this or any other company.

Sure, I'd love to have my rates tied to a small group of other people and whatever happens to their health circumstances. BTW, who gets to handle administering the group plan? It's not a small amount of work. And everybody has to agree on their deductibles etc. Plus a random group of people may not qualify for coverage from most health plans. And of course doing this does nothing to protect you from them jacking it up 81% next year.

Posted by: jimBOB on December 19, 2006 at 1:44 PM | PERMALINK

Sounds like typical libertarian nonsense, AH. Once one insurance company does something like this with no repercussions, they all will. Just like when American companies moved overseas, the stragglers complained that they had to outsource, otherwise they couldn't compete. Americans get screwed by people like you, and there's no reason for us to take it anymore.

Posted by: Mike B. on December 19, 2006 at 1:44 PM | PERMALINK

Instead of whining Derbyshire should enlist and go to Iraq.

I hear tell those lucky duckies get free medical care.

Posted by: ROTFLMLiberalAO on December 19, 2006 at 1:45 PM | PERMALINK

Now, how would a Canadian go about changing his health plan if he doesn't feel like waiting six months for a hip replacement?

Canadians can buy private insurance, too, ya moron.

Posted by: cleek on December 19, 2006 at 1:46 PM | PERMALINK

Mr. Derbyshire can quit this insurance plan, and get another. Alternatively, he can set aside some money and self-insure. Or he can recruit a group of associates and negotiate a group rate with this or any other company. He has near infinite options for healthcare, as do all Americans.

Now, how would a Canadian go about changing his health plan if he doesn't feel like waiting six months for a hip replacement? Oh, right: Head to America.

Why don't you email those suggestions to Derbyshire. I'm sure he'll take them under consideration and then he'll realize that they're really studid ideas. Self-insure? That's an oxymoron. Of course he could just find a bunch of friends and negotiate with the insurance company. I'm sure he'll end up with a fantastic rate, probably only twice as much as the $857 he pays January 1.

You are right, he does have infinite options. They are all just worse than the Canadian National plan.

I like to tell the story about how when I lived 50 miles from the Canadian border and my wife worked as a nurse who worked with Cardiac surgeons. Canadians poured in from Canada to have stints put in and do other artery work. THe Canadian doctors wouldn't do it nor would Canadian insurance cover it. The American doctors were glad to recommend surgery and take the Canadian dollars. So why wouldn't the Canadians do it? Because they believed it was a waste. The Canadians were right. A huge study was just released saying that invasive surgery to unblock arteries does not decrease and may increase your chance of a heart attack. But that's the kind of stuff that Derbyshire's extra insurance money is going toward in this country.

Posted by: SimulatedOutrage on December 19, 2006 at 1:47 PM | PERMALINK

Now, now, now, Derb; we all know that things work out for the best when we let the marketplace set the prices, unfettered by government interferance.

Posted by: Dennis on December 19, 2006 at 1:48 PM | PERMALINK

How about something like:

A conservative is just a liberal who's been mugged by a man on the street.

A liberal is just a conservative who's been mugged by the system.

Posted by: duality72 on December 19, 2006 at 1:48 PM | PERMALINK

Now, how would a Canadian go about changing his health plan if he doesn't feel like waiting six months for a hip replacement?

Canadians can buy private insurance. Look it up.

Posted by: cleek on December 19, 2006 at 1:50 PM | PERMALINK

How terrible it would be if a bureaucracy had the power to raise taxes to pay for health insurance! How glad we are that we have a rational market right now!

Posted by: Cryptic Ned on December 19, 2006 at 1:50 PM | PERMALINK

Our small 11 person company, after years of 15 to 20% increases in health care premiums, actually had a very small >>decrease

Posted by: Robert on December 19, 2006 at 1:50 PM | PERMALINK

Derb needs a Health Savings Account. That's what. Uh huh.

Posted by: Extradite Rumsfeld on December 19, 2006 at 1:53 PM | PERMALINK

... this year. But I doubt that will get repeated next year.

Posted by: Robert on December 19, 2006 at 1:53 PM | PERMALINK

"Set aside some money and self-insure"? Can anyone tell me what this means?

Posted by: keptsimple on December 19, 2006 at 1:54 PM | PERMALINK

That's got a nice ring to it, duality72.

Of course, I'd really just skip the first part nowadays, since there's no point in reinforcing the liberal "soft on crime" smear.

Posted by: ajl on December 19, 2006 at 1:55 PM | PERMALINK

A conservative is someone that hasn`t yet been screwed by the system. Someone that`s still, mentally, in junior high school.

Since I offer our resident trolls as prime evidence nothing more need be said.

"...economics runs around trying to figure out how people rationalized what they just did." - Stirling Newberry

Posted by: daCascadian on December 19, 2006 at 1:56 PM | PERMALINK

That's got a nice ring to it, duality72.

Of course, I'd preface the first part with "People used to say..." since there's no point in reinforcing the outdated "soft on crime" smear.

Posted by: ajl on December 19, 2006 at 1:56 PM | PERMALINK

I have a conservative friend. He brought his claim forms from Blue Cross in one day and started complaining bitterly about how hard it was to get them to pay a percentage of his baby son's care. This guy is a doctor's son and grew up being told that socialized medicine is evil.

I was ready with the punch: "You're right, it's a scandal: you can't tell me government-run single-payer would be any worse than this." For once this guy, who'd been lecturing me on the glories of Bush's tough foreign policy, actually had to think about his dogma.
"He can recruit a group of associates and negotiate a group rate"

I belong to an informal professional group (really just an e-mail list for freelancers). We looked into forming a group to get health insurance and were informed by an agent that it was illegal to form a group solely to purchase health insurance.

American Hawk, you're stubborn and closed-minded, your arguments are puerile and illogical (what other health plan is going to be cheaper?), but mostly, you're a fool and you're polluting this blog. Please go away.

Posted by: Happy Dog on December 19, 2006 at 1:58 PM | PERMALINK

Now, how would a Canadian go about changing his health plan if he doesn't feel like waiting six months for a hip replacement? Oh, right: Head to America.

And how would an American like Derbyshire get a heart valve replacement without paying $10,284 a year in insurance premiums alone (not including deductibles, copays, out-of-network specialists, and not-covered costs), whether he's sick or healthy?

Oh right. Head to India.

Posted by: Extradite Rumsfeld on December 19, 2006 at 1:59 PM | PERMALINK

No one's asked why his rates went up so much. Could it be because his insurer found out he was conservative, and thus less susceptible to the application of reason to his own health care?

Posted by: dcbob on December 19, 2006 at 2:00 PM | PERMALINK

. . . head to India, bitches.

Posted by: Extradite Rumsfeld on December 19, 2006 at 2:01 PM | PERMALINK

"Can they do that?"

Talk to the hand, Derb. The Invisible Hand, that is.

Posted by: Matt on December 19, 2006 at 2:03 PM | PERMALINK

Short-version defense of liberalism: If they're screwing over (___________), sooner or later they're gonna screw you over, too.

Posted by: Roddy McCorley on December 19, 2006 at 2:05 PM | PERMALINK

The insurance commissioners who are supposed to protect consumers are all former insurance executives. Talk about foxes guarding chicken coops!

Posted by: Global Citizen on December 19, 2006 at 2:05 PM | PERMALINK

The free market works!

Posted by: Al's Mommy on December 19, 2006 at 2:06 PM | PERMALINK

Even so, he says, he and companion Maggi Grace, 51, were startled in September 2004 by streets overflowing with people and bicycles and by neighborhoods where new offices butt up against tarpaulin-covered slums. They wondered whether the price of his operation -- $6,700 with Trehan at New Delhi-based Escorts Heart Institute and Research Centre compared with $200,000 at Durham Regional Hospital in the U.S. -- was worth the risk.

Posted by: Extradite Rumsfeld on December 19, 2006 at 2:09 PM | PERMALINK

Derb is not complaining. He is just saying that if he can accept eighty percent increase in the cost of his health insurance, so can anybody else. And as the prescient AH said above, he has the option of changing his carrier so may have the privilege of paying 160% more instead of 80%.

Posted by: gregor on December 19, 2006 at 2:16 PM | PERMALINK

Somewhere Harry and Louise are trying to dog paddle through their Donut Holes.

Posted by: thethirdPaul on December 19, 2006 at 2:20 PM | PERMALINK

AH posted: "Mr. Derbyshire ..... can recruit a group of associates and negotiate a group rate with this or any other company."

Actually, AH, that's exactly what Kevin and lots of us have in mind when we propose that all Americans get together and negotiate a nationwide group rate with a single payer. We'd like Congress to be our "agent" in arranging such a plan. But you have steadfastly opposed this. Why?

Posted by: thug on December 19, 2006 at 2:24 PM | PERMALINK

When the 'invisible hand' has a cold, firm grasp on one's testicles then one finally tends to pay attention.

Posted by: Tripp on December 19, 2006 at 2:27 PM | PERMALINK

initial caveat: I think the time for some sort of single-payer system (or some variant on that) has come. our current system is broken.

with that said, let there be no illusions that there aren't issues with the Canadian system (or any other single-payer system) -- some form of rationing is inevitable.

My father has polycythemia vera. When he was first diagnosed (in 1991)...the prognosis was that he would be dead in as soon as five years. the only treatment known was simple blood-letting. in the mid-1990's they began experimentally treating polycy with interferons. as of 2006 my father is still in relatively decent health (and still injected with interferons).

my parents were living in Canada at the time. the Canadian medical system would not pay for the use of interferons for polycy until 2002 (it is several thousand a month). my parents couldn't afford that but they did have a secondary U.S. address through which a U.S. pharmaceutical company provided them the treatment free of charge on a "hardship" basis.

I say this not because I think the U.S. system is qualitatively superior (this is, after all, one case) but only to point out that there will be necessary tradeoffs (just as there are with our current system). just be sure that whatever system you choose, the tradeoffs will be less onerous than the current ones.

Posted by: Nathan on December 19, 2006 at 2:30 PM | PERMALINK

Alternatively, he can set aside some money and self-insure.

Of course, everybody has hundreds of thousands laying around to cover major unexpected surgery.

I had an emergency appendectomy this year. The total cost, virtually all of which was paid by my insurance, was about $20,000. Yeah, everyone, let's self insure. Great idea.

Posted by: Michael C. on December 19, 2006 at 2:33 PM | PERMALINK

We don't need a national debate about single payor health insurance. We need to talk about gay marriage and flag burning, just like the GOP says. We also need to spend every nickel of our tax dollars on bullets and bombs, because that is the most productive use of our money - even if we have to borrow ourselves into bankruptcy. Got it?

Posted by: The Conservative Deflator on December 19, 2006 at 2:38 PM | PERMALINK

Maybe it will be reassuring to Derb to know 20% of that premium will go to shuffleing paper around so the CEO of his HMO/PPO can recieve a 1.5 billion compensation package.

Posted by: Charles Stanton on December 19, 2006 at 2:41 PM | PERMALINK

Oddly enough, I just got a letter from Blue Cross stating that my health care insurance premiums would not be increased throughout all of 2007.

Posted by: charlie don't surf on December 19, 2006 at 2:41 PM | PERMALINK

Free Market? You're drowning in it!

Posted by: Mysticdog on December 19, 2006 at 2:44 PM | PERMALINK

I work for a manufacturing and high tech company about 150,000 strong with about 75,000 of those union workers. I am non-unionized and pay $0 each month for our gold-plated best plan.

Thank god for unions.

In the meantime the company has many overseas competitors that don't have to worry about paying for health care costs for their workers.

Support universal health care and support US business.

Posted by: jerry on December 19, 2006 at 2:45 PM | PERMALINK

Usually, you can increase your deductible to decrease your premium (with most plans). Whenever you all get on this topic, I can tell there is a lot of confusion between single payer and nationalized health care. I won't get into the differences, but I will add my 2 cents about which is better (sorry!):

With single payer, hospitals compete for patients and all bill a single source, ie government. The problem with this is that the govt will reimburse significantly less than cash payers or private plans. Hospitals would dump or refuse to care for those patients. You'd essentially have to outlaw private insurance for it to work. Or, conversely, you'd have to require every hospital/clinic/doctor to see a certain percentage of govt-insured patients, sort of like our current EMTALA regs. Either way, you have enormous amounts of regulation and red tape. This is basically an expanded Medicare system and would fix none of the problems that Medicare has.

The county I work for (I'm a doctor) gives free medical care to everyone who makes less than 300% of poverty level wages. I make significantly less than someone who works in the private sector. But the advantage is that I work in a county hospital, we have guidelines for medical care, and our liability coverage is provided by the government, which helps limit malpractice costs. It works pretty well, but don't expect that MRI anytime soon. So, in essence, I work in a Canadian-style system.

I think a two-tiered system would work fairly well. The catch is that for the public tier, you'd have to go to a public institution that has guidelines for care, like the Canadian system. (For example, CT brain not approved to evaluate dementia, MRI not approved for back pain unless severe signs of weakness develop, miss rate of 3% acceptable for heart attacks if EKG normal and risk factors low, etc).

There is just no way a private doc/hospital etc can care for patients with govt reimburse rates with the current liability problem. However, if the liability is limited by established protocols and guidelines, and if it can be established that suits are unlikely to be won if guidelines are followed (regardless of outcome), then govt reimburse rates are sufficient to cover costs (as in my county's system). In private systems, higher reimbursement would be required to cover liability costs. These hospitals should not be required by law to see patients with govt-reimbursement. This is what is currently causing hospitals to close all over the country.

I agree with one above poster that many doctors are reluctant to consider nationalized health care. But at the county where I work, it is an explicit goal and many are very politically active. As I said, we make less but have much less liability concern and are generally satisfied with the work. I would like to see our system on a national level, not just because it works, but because it would also lead to fewer regulations of private hospitals, which should be allowed to run their business as they see fit.

Posted by: Bad Shift on December 19, 2006 at 2:51 PM | PERMALINK

Dang - Great idea AH - Start your own insurance company - That is exactly what the late, not always great, Charlie O Finley did - While a patient in a hospital bed, he came up with the idea to provide life insurance for Doctors - expanded it to include others - Made so much money, he bought the Philadelphia A's and moved them to KC.

Now, you need a rather large group - Insure Flag Burners? - Why we have soooooooo many of them each year - But, no - Insure gay married couples? Nah, not enough cities and states are granting them that privilege - How about insuring Chicken Hawks? There seems to be a slew of them around.

Posted by: thethirdPaul on December 19, 2006 at 2:53 PM | PERMALINK

There is just no way a private doc/hospital etc can care for patients with govt reimburse rates with the current liability problem.

Bad Shift

Yes there is. Doctors can police themselves. They can demand that their peers adhear to high standards. If they don't, they don't get a wink and a nod, and a slap on the hand. Instead they find themselves managing a fast food joint.

In every hospital there are a few bad docs who are responsible for most of the screwups. Get rid of them and the liability problems dry up.

Physicians should heal themselves. A novel concept, I know, but one that just might work.

Posted by: Ron Byers on December 19, 2006 at 2:59 PM | PERMALINK

Nathan: Fair enough. There are several flaws in the Canadian system. But not insuperable ones, and in any case most advocates of single payer point more towards, say, France.

Posted by: Sandals on December 19, 2006 at 3:04 PM | PERMALINK

Ron Byers:

You're wrong.

I'm going to approach this as a lawyer. I worked on a hospital bankruptcy. I saw the numbers. Something around 80% of a hospital's malpractice liability costs relate to obstetrics.

Now I suppose you could assert that 80% of bad doctors are in obstetrics...but I find that highly unlikely.

The reality is that medical malpractice claims follow certain types of bad outcomes. In certain areas, certain types of bad outcomes are inevitable -- thus creating malpractice claims without regard to actual fault. Obstetrics is obvious. There are relatively few claims with pediatrics because people don't die or have brain damage in those areas. Not because all the doctors in pediatrics are good and all the ones in Obstetrics are "bad apples".

That's the reality of the matter.

Posted by: Nathan on December 19, 2006 at 3:06 PM | PERMALINK

I'd throw in that I'm told by medical malpractice lawyers that in cases of brain damaged newborns and the like, juries often award large awards not because they actually believe the doctor is at fault, but rather to give the parents some compensation and assistance with their lives.

obviously, if we had another way of handling that assistance we might get rid of some of those suits and awards.

Posted by: Nathan on December 19, 2006 at 3:09 PM | PERMALINK

one other comment on medical malpractice litigation:

I've seen studies showing that juries apparently get it wrong much of the time -- but both ways.

they find no malpractice where it occurred and malpractice where it didn't. in other words, they're not equipped to determine actual malpractice.

Posted by: Nathan on December 19, 2006 at 3:10 PM | PERMALINK

Nathan: there is de facto rationing going on right now. Can't afford health insurance? Sorry, son, you're gonna go to ER or probably die. Can't afford the deductible? Sorry, child, you may end up in the newly reformed bankruptcy court and never be able to afford anything again. On Medicare or Medicaid? Sorry, you may be reviewed right out of coverage.

This is inhumane money-driven rationing, instead of rationing based on need and usefulness of the procedure.

Posted by: Carol on December 19, 2006 at 3:12 PM | PERMALINK

Sorry American Hawk, canada's heath care is not perfect, but it is a damn sight better than yours.
I have had some problems of late and am currently being treated by several specialists. They have the problem well in control and I am being given the BEST of care. The waits are not long as you are spouting about and I am totally satisfied with it. After 2 Cat scans and another 2 MRI's the problem has been fully diagnosed the treatment is proceeding very well (I am stacking them up, Diabetes and MS). Cost to me $0.00, Oh I forgot i have to pay $45.00 every 3 months for my Metformin.
Every health plan has a few problems (even France's) but YOURS... it has a truckload of em.
ttul

Posted by: balzar on December 19, 2006 at 3:12 PM | PERMALINK

American Hawk wrote:
> "Or he can recruit a group of associates and
> negotiate a group rate with this or any other
> company."

It is illegal for a group of private citizens to do this in America -- one must be a member of a business or professional organization to qualify for group rates.


Posted by: Carl G on December 19, 2006 at 3:16 PM | PERMALINK

Canadians are healthier, live longer have lower infant mortality and they pay 60% of what the US pays for health care.

Expalin how such a system would be a negative for the US.

Posted by: klyde on December 19, 2006 at 3:21 PM | PERMALINK

Thank you for the information, Nathan. What states?

I understand that every parent expects a perfect baby and some percentage are not going to be perfect.


Posted by: Ron Byers on December 19, 2006 at 3:25 PM | PERMALINK

This is the world's smallest violin playing just for the Derb

Posted by: Fledermaus on December 19, 2006 at 3:25 PM | PERMALINK

American Hawk will never know Derbyshire's pain, he lives in basement of an immediate relative and is still covered under their family plan.

American Hawk does not care that life does not address all humans equally and that other opinions in and about the world are drawn from other experiences in and about the world outside of his immediate attention span. Bless his grinchy little heart.

Posted by: Zit on December 19, 2006 at 3:26 PM | PERMALINK

I don't feel in the least sorry for Republicans who voted for George W. Bush only to have their health care premiums doubled, their credit card fees increased, their gasoline, their electricity and their natural gas bills soar into the stratosphere, college tuition for their kids going through the roof, college loans for their kids harder to get and more costly, the value of their homes dropping to the point where they owe more money on them than they are worth and their only option thus is foreclosure, their salaries frozen, and Wall Street millionaires and their banking and corporate clients stiffing them on their 40l(k) plans, etc., etc., etc. When you put the fox in charge of the hen house, what else can you expect?

Posted by: richard on December 19, 2006 at 3:27 PM | PERMALINK

I expect they will blame the liberals for all the above, as they have been for the past 6 years, according to Limbaugh and Coulter and...

Posted by: Drive By Blogger on December 19, 2006 at 3:29 PM | PERMALINK

As a Liberal who has been mugged, I've always disliked that saying.

Posted by: MDtoMN on December 19, 2006 at 3:30 PM | PERMALINK

Carol:

you don't think that some rationing in Canada isn't money-driven? all rationing is money-driven, ultimately.

Posted by: Nathan on December 19, 2006 at 3:33 PM | PERMALINK

Nathan,

No, all rationing isn't money driven. Especially rationing where there isn't a money economy, e.g., a barter based economy.

And even in money based economies you can put the lives and health of people before profits. That is, if your a regular human being and not a sociopath.

Posted by: Dr. Morpheus on December 19, 2006 at 3:40 PM | PERMALINK

I agree with Kevin...enough with the "six month hip replacement" B.S. Unless it's an emergency need resulting from an accident, hip replacements come at the end of a typically very long period of deterioration. Everyone I have known who has gotten a hip replacement has taken years to "get around" to getting it done, mostly due to aversion to surgery, not from lack of good medical plan.

I make most medical appointments for my mother and accompany her, and I can tell you that unless it's urgent (per your primary physician), visits to a new specialist, relatively easy outpatient surgery, or even certain routine exams take typically one-to-two months; just this week I made a mammogram appointment that involves a seven week wait. That's with Medicare, a good secondary retirement plan, and in the SF Bay Area, with plenty of doctors, hospitals and medical groups. The area certainly doesn't suffer from a "shortage" as if you were out in a rural area, but the demand for services pushes up against the supply enough that fairly long waits (at least longer than I would have expected) are the norm rather than the exception.

Posted by: Tom on December 19, 2006 at 3:41 PM | PERMALINK

American Hawk wrote: "Now, how would a Canadian go about changing his health plan if he doesn't feel like waiting six months for a hip replacement? Oh, right: Head to America."

My brother had to wait longer than six months for a hip replacement in the US. He had no money and no insurance, the Federal government rejected his application (they reviewed the x-rays showing complete degeneration of his hip joint and said that he only had "mild arthritis"), but he was finally able to get on a waiting list at a charity hospital and after several postponements, got the surgery.

I suspect he would have had an easier time of it in Canada.

Posted by: SecularAnimist on December 19, 2006 at 3:48 PM | PERMALINK

Nathan sez:

obviously, if we had another way of handling that assistance we might get rid of some of those suits and awards.
Are you suggesting that public assistance would allow the private market to work more efficiently? What are ya, a commie?

Posted by: Disputo on December 19, 2006 at 3:52 PM | PERMALINK

Um, Nathan?
You don't seem to realize that you're arguing against that "another way of handling that assistance ...".
Do you?

It's not just a change in the economics of healthcare that is at issue - it's a change of paradigm to one that insists that the value of human life and health is greater than its itemized costs.

Posted by: kenga on December 19, 2006 at 3:54 PM | PERMALINK

Very interesting thread. First Derbyshire shows some off-the-reservation complaints about the "free market" in healthcare, then several of the more enlightened posters here admit that bizarro legal practices might contribute to the problem. Maybe bipartisanship is breaking out this Christmas season.
One small suggestion for Nancy Pelosi's suggestion box of inititives: the first step to reforming healthcare is advising the millions of smug "I've-got-mine-Jack" middle class types how much they are being subsidized. Why not require a box on next year's W-2 form to show how much the company has paid for your health insurance, another box for your contributions. Then the year after that you could start taxing those perks as income until we get some reform for the whole population.

Posted by: minion of rove on December 19, 2006 at 3:58 PM | PERMALINK

The reality is that medical malpractice claims follow certain types of bad outcomes. In certain areas, certain types of bad outcomes are inevitable -- thus creating malpractice claims without regard to actual fault. Obstetrics is obvious. There are relatively few claims with pediatrics because people don't die or have brain damage in those areas.

Or maybe it is because obstetrics is a high risk field (compared to eg pediatrics) where a premium is placed on a doctor's skill. In other words, the distribution of bad docs may be homogeneous, but the bad docs in obstetrics are more likely to cause severe damage/death.

Posted by: Disputo on December 19, 2006 at 3:58 PM | PERMALINK

We don't need a national debate about single payor health insurance. We need to talk about gay marriage and flag burning, just like the GOP says. We also need to spend every nickel of our tax dollars on bullets and bombs, because that is the most productive use of our money - even if we have to borrow ourselves into bankruptcy. Got it?

Posted by: The Conservative Deflator on December 19, 2006 at 4:00 PM | PERMALINK

Nathan:

1)My experience, from over a hundred jury trials, is that jurors work very hard to follow the instructions as given them by the judge.

2) The cost of liability insurance for hospitals is only slightly higher than it is for businesses generally in the U.S. (approximately 4% of gross vs. 2%);

3) Sounds like your OB/GYN department had some serious quality control issues;

4) Your hospital's business failure was probably due to a) mismanagement; b)Health insurors unwillingness to pay their bills.

Posted by: Jose Padilla on December 19, 2006 at 4:01 PM | PERMALINK

Jose Padilla:

the hospital was just a client. those obstetric stats are true for other hospitals as well.

4% is the difference between mildly profitable and bankruptcy over a period of time.

the hospital's bankruptcy ultimately had everything to do with the county it was in -- lots of poor people, very plaintiff-friendly juries. I can't say more than that.

juries following instructions isn't the issue. its that large-scale academic studies show that they continually get medical malpractice outcomes wrong -- both ways -- for plaintiff and defense.

Posted by: Nathan on December 19, 2006 at 4:06 PM | PERMALINK

Disputo:

that's true but that also begs the question.

medical malpractice jury awards appear to follow the severity of the outcome, not the actual presence of malpractice.

in other words, in a case where a broken arm wasn't set right the jury may well find for defendant even though an independent review of the file would find malpractice.

meanwhile, if a newborn dies, the jury will compensate the grieving parents even though the doctor was not at fault.

Posted by: Nathan on December 19, 2006 at 4:09 PM | PERMALINK

yes Disputo, I am suggesting that public assistance might be more efficient than the de facto public insurance through the malpractice system.

kenga:

that's a nice sentiment...and horribly unworkable. in the real world, all human lives have value, they have to. there is no upper limit to the amount that could be spent on medical care if you really wanted to eek out every last ounce of benefit, every last second of life. in the real world, we could spend trillions reducing environmental hazards to parts per trillion instead of per billion. but no one could afford that.

a few years ago the rough estimate of how much we would spend in regulation-decreed spending was about 10 million a life.

Posted by: Nathan on December 19, 2006 at 4:14 PM | PERMALINK

Dr. Morpheus: huh? how, pray tell, does rationing happen then?

Posted by: Nathan on December 19, 2006 at 4:16 PM | PERMALINK

Now, how would a Canadian go about changing his health plan if he doesn't feel like waiting six months for a hip replacement?

I'm not sure. But the average Frenchman would likely not wait longer than the average American. And that same Frenchman lives in a country where everybody is insured. Even if the conservative meme about the inferiority of the Canadian healthcare system were valid, it means nothing, since most well-informed Americans are aware that there are any number of non-Canadian-style alternatives to America's broken healthcare system -- all of which are demonstrably superior to the US model in myriad ways. The French system is my personal favorite, but Japan, Germany and Australia also all have intriguing systems better than America's. Conservative lackeys of the the healthcare industrial complex have too long enjoyed an edge in the PR debate, and they've gotten away with demonizing Canada's quite good universal healthcare system. I think it's time for American advocates of a saner healthcare system to really begin focusing on the plans of countries that are widely associated (including by conservatives) with centrist, non-"loony-left" politics. You know, something to the effect of "Aussie-style healthcare NOW!"

Posted by: Jasper on December 19, 2006 at 4:27 PM | PERMALINK

True enough, a conservative is a liberal who's been mugged, but a liberal is a conservative who's been arrested. cf. Tom Wolfe: Bonfire of the Vanities.

Posted by: Danzo on December 19, 2006 at 4:30 PM | PERMALINK
...all rationing is money-driven, ultimately... Nathan at 3:33 PM
Nonsense. A hospital won't give an elderly patient a new heart and the rationing is based on expected results even though they would be paid the same. You make a lot of claims, how about some citations? Posted by: Mike on December 19, 2006 at 4:52 PM | PERMALINK

OR:
A liberal is a citizen who's been screwed/mugged by a business

Posted by: Stewart Dean on December 19, 2006 at 4:55 PM | PERMALINK

I once had a libertarian friend say, "My insurance policy contract has a clause that says that they can't jack up my rates unless they also jack up rates on everyone in my age category. So if I get sick, they can't force me off the plan by raising my premiums." So I pondered for a moment what loophole I could find in this clause. Didn't take long.

Here's what I came up with: periodically, phase out entire health plans by jacking up the premium to $5000/month. Simultaneously, introduce a new health plan which is essentially the same as the old one, with normal, sensible premiums. All the healthy customers migrate from the old plan to the new one. The sick customers, however, cannot get approved for the new plan. They're stuck on the old plan, but they can no longer pay the premiums. Once they default on their premiums, they're no longer covered.

Ain't the free market grand?

Posted by: Josh Yelon on December 19, 2006 at 4:55 PM | PERMALINK

Nathan:

You are innumerate. All other businesses, on average, pay two percent of gross. Hospitals, on average, pay 4 per cent. That's an additional two cents on the dollar. Also, maybe the reason the hospital failed was because the hospital executives engaged in wasteful spending. Check out: medscapenursing.blogs.com/medscape_nursing/2006/11/hospital_wastef.html

Finally, please remember that businesses that aren't good at what they do go out of business.

Posted by: Jose Padilla on December 19, 2006 at 4:59 PM | PERMALINK

Actually, Nathan does have a point that juries are more likely to find liability in cases of catastrophic damages. The reason is two-fold. First, in cases of relatively minor injuries (an infection that is cured with no residual problems, for example) the jury is likely to consider this a mere "complication" and not negligence. On the other hand, with a case of catastrophic injuries (death, brain injury) the jury is more likely to think that the providers screwed up when the outcome was this bad, especially if the patient had no underlying pathologies.

Posted by: Jose Padilla on December 19, 2006 at 5:20 PM | PERMALINK

I don't have the exact numbers and source at hand, but can find if needed...

The U.S. government is covering about 2/3 of the nation's health care right now. That's if you add Medicare, Medicade, VA, and all governmental employees' standard coverage. Everyone says we're paying twice what we should per capita for health care compared to other industrial countries. Doesn't seem like much a stretch to be able to afford universal coverage just with the current expenditure. Though I don't know what we'll do to replace those multi-million dollar bonuses to insurance company executives.

Posted by: dave on December 19, 2006 at 5:39 PM | PERMALINK

I guess National Review does not provide health care to its employees? That's the only way I can understand the premium Derbyshire is paying. It makes sense, of course, that NR wouldn't provide coverage. Fortunately for Mr Derbyshire, he's immensely wealthier than most workers and can no doubt afford the increase.

Posted by: Z on December 19, 2006 at 5:48 PM | PERMALINK

Tough shit, Derb. As ye sow, so shall ye reap.

Posted by: CN on December 19, 2006 at 6:06 PM | PERMALINK

There are many ways to get mugged. Health insurance is one of the most common.

Posted by: Scorpio on December 19, 2006 at 6:33 PM | PERMALINK

We live in a free country. Steinway & Sons are free to sell their pianos at a 200% markup. You are free to buy a Yamaha instead. Derbyshire's insurance company is free to increase or decrease their price however they like. He is free to drop his insurance or to insure with any of the dozens of competing companies.

However, one problem with health care financing is that so much of it is controlled. E.g., Medicare reimburses hospitals at a special rate. That means that other patients (or their insurance companies) have to pay extra to make up the difference.

Another example: By law, Emergency patients cannot be turned away. That law guarantees that poor people will get some degree of medical care. But, again, the deficit from unfunded emergency room care is made up by other patients.

BTW many of the largest insurance companies are mutuals, which means that they're owned by their policyholders. Any profits are returned to the policyholders.

Posted by: ex-liberal on December 19, 2006 at 7:22 PM | PERMALINK

Just pray to Jesus,I haven't been to the Doc in 35 years and am in perfect health all thanks to the allmighty above.Amen.

Posted by: Thomas2.0 on December 19, 2006 at 7:33 PM | PERMALINK

I always thought a liberal was a conservative who's been indicted.

Posted by: wufnik on December 19, 2006 at 7:36 PM | PERMALINK

My wife and I are over 55. She is a breast cancer survivor. We have individual insurance since I am essentially self employed.

Our premiums went up 30% this year. I doubt we will be able to afford commercial health insurance by the time we are 60. And what do you think our chances of finding a better deal with a cancer survivor in the family?

For those of you on the conservative side of the spectrum: in the future it will be very difficult for people to start their own businesses because they will not be able to afford health insurance. If Detroit is squealing over the cost of health care, what about the young man or woman with the great idea?

One last point: most states have a catastrophic coverage system for those whose health insurance premiums have increased beyond a defined point. In Texas it is twice the average premium. However, you cannot take this coverage unless you are already covered by another insurer. If you do not already have insurance you cannot join the high risk pool.

Posted by: Nat on December 19, 2006 at 8:48 PM | PERMALINK

I shared Derbyshire's post with a bunch of small business types this afternoon and discovered there is a lot of support out there for health care reform. The folks I talked too were sick to death of outrageous premium hikes. One lady said that after seeing Derbyshire's 81% increase she thought she might send her insurer a thank you for only raising her rate 34%. She said it with tongue firmly in cheek. They had enough with reducing benefits. They just can't understand why health care should be a cost of their doing business.

Posted by: Ron Byers on December 19, 2006 at 10:00 PM | PERMALINK

Ron Byers: I shared Derbyshire's post with a bunch of small business types this afternoon and discovered there is a lot of support out there for health care reform.

No suprise. As a small business type, I can tell you that we get creamed by health insurance premiums - worse than larger businesses. I'm told there's a magic price break at around 200 employees, which leaves us only 196 short.

I've long said that UHC would be, and should be promoted as, pro-business.

Posted by: alex on December 19, 2006 at 10:17 PM | PERMALINK

Al and Hawk, you simply don't know what you're talking about. I bet you have nice employer-subsidized health insurance, don't you? If you didn't, you would know that it is very difficult to switch insurance if you or any of your family have any pre-existing condition. Even mild asthma can disqualify you. (And yes, I know. I'm self-employed. I don't have employee-subsidized group insurance, and I have literally no options but to accept the draconian increases my insurance company sticks on there, not to mention "we won't cover this, we won't cover that"... constantly. They won't cover out-patient services or medication, for example, so you can just forget about cancer treatment, which is out-patient.)

And Al, I had a medical savings account. This is what I learned. You still pay for your ridiculously inflated health costs. You just do so, if you're lucky enough to have thousands and thousands to sock away in the account, with pre-tax dollars. That's it. If you think that's a replacement for health insurance, I have a bridge to sell you.

And, btw, I am considering emigrating to Canada. Why? Because my medication-- which I need, and the insurance company I've paid $400 a month to for 5 years, won't cover, not because it's experimental but because it's "out-patient"-- is too expensive. And if I move to Canada, I will be able to take that medicine that is keeping me from being disabled. You can blather all you like about hip replacements. I'm talking about necessary medicine that I can't take here in the US because it's $18K a year... yes, and that's on top of my insurance costs.

I sure hope neither of you ever loses your job or your insurance, because it will be a painful lesson I wouldn't wish even on trolls. :)

Posted by: blast on December 20, 2006 at 12:09 AM | PERMALINK

Those dying for national health care had better be careful what they wish for. American spends far more on medical care than it does on military spending, yet the latter is already a nightmare of collusion between giant military corporations and government funds.

Everybody imagines this glorious altruistic national medical care system that will make all the right decisions on care for all the right reasons, and that lobbying, politics, and outright corruption will never be an issue.

You think all these gigantic medical companies aren't going to have anything to say in how things are done?

You think the military-industrial complex is something, wait until you see the medical-industrial complex.

Posted by: faircourt on December 20, 2006 at 12:21 AM | PERMALINK

Nathan, most state legislatures have made it very hard to sue for malpractice (like first you must go before a committee of physicians and get approved to sue). The insurance companies do settle claims, of course, but mostly they seem to just stick it to the physicians without paying out much $$. In my state, the top award-- even for lifelong total disability or death-- is a million. My mother was disabled by malpractice (repeatedly given a drug she was allergic to -- in a hospital, while she was in unconscious-- long after it had been established that she was allergic), and couldn't get a lawyer to sue the biggest hospital and biggest cardiology practice in the state. She finally gave up. But I always wonder who's getting these supposedly big malpractice awards, when it's next to impossible to get a lawsuit in front of a jury these days, thanks to those "free-market" legislatures.

Physicians save lives. We need to make them happy. I'm even fine with making them rich. But insurance company and HMO CEOs? They make millions, millions, and never save a life, do they? They're the ones who benefit from this system. Doctors are earning less than ever, and paying huge amounts to staff to coordinate billing to literally dozens of insurance companies-- often multiple billings of companies that routinely refuse the first bill. There is a better way.

Posted by: filler on December 20, 2006 at 12:28 AM | PERMALINK

If you want to know about other health care sytems go to the OECD website, particularly
http://www.oecd.org/dataoecd/20/51/37622205.xls

I have lived in Australia, the UK and France and so have been exposed to three variants of public health care. One of my children was born in Australia and the other in England, and my wife and I have had significant operations in France (and she has in England).

I agree that the French system is probably the best in terms of the level of resources devoted to patients, but it is also the most expensive - of these three, spending being around 10.5% of GDP compared to 9.6% in Australia and only 8.1% in the UK (Canada spends 9.9% of GDP and the US 15.3% in 2005, and I've seen this has gone up to over 16% this year).

The US actually spends close to the OECD average on public health spending, but because it spends a lot more in total than any other OECD country, this is only about 45% of the total level of spending.

My experience of these 3 countries is that of course there is rationing, but as pointed out already this is on the basis of assessed need. Sometimes doctors get the assessment wrong of course, but if anyone is assessed as having a serious problem they get attention as fast as possible.

Some Americans seem to have some sort of problem with the Canadian system, which I don't know, but I understand that when universal health insurance was introduced in Australia the Canadian system was a partial model.

It could be worth looking at the Australian system, because while it has universal public coverage, it also extensive private sector involvement. But the private sector is extensively regulated.

Australia has had a system of compulsory community rating for private health insurance (PHI) for the last 50 years.

According to http://www.oecd.org/dataoecd/5/54/22364106.pdf

"The principles of community rating and open enrolment were maintained in the PHI market after universal public health insurance was established. Community rating, requiring premiums not to vary by risk, is applied to the pool of individuals buying a given hospital or ancillary product in any given fund. This is linked to open enrolment, which guarantees access to PHI coverage by all applicants with no right of refusal for funds and include the continuous renewal of coverage over time.

Other regulatory provisions also seek to protect consumers and enhance opportunities for individuals to exercise choice of products and health fund. The PHI Ombudsman, a statutory corporation established in 1995 under the 1953 National Health Act, resolves complaints relating to PHI and acts as an umpire in dispute resolution (Ombudsman, 2002).

Funds are subject to premium and product approval requirements. While they are allowed freedom and flexibility to design new products, they are required to notify the Department of Health and Ageing of any new product, or change in product. This allows the government to prevent changes that would breach the requirements of private health insurance legislation. Funds can change the rules applicable to various PHI products unilaterally although they are obliged to communicate to insurees any change in policies or premiums adversely affecting their cover. The purpose of this regulation is to allow insurers to differentiate their products (which is desirable for individual choice) while preserving the principle of community rating by hindering insurers ability to make PHI products selectively available to lower-risk individuals at lower prices.

A financial equalisation system operates across all funds for hospital cover. The Australian system of reinsurance pools 79% of the cost of over-65 members and insurees who were hospitalised for more than 35 days, and equalises such cost across funds with different risk structures. The rationale for reinsurance is to remove funds incentives to select good risks that insurers may face in a voluntary PHI market with community-rated premiums, thus creating the conditions for fair competition across insurers with different risk structures."

Posted by: Far Away on December 20, 2006 at 3:51 AM | PERMALINK

Funny thing - if Derb had stayed in his native country, his health care would be free at the point of use, and (overall) just over half the cost of US health care, as noted above.

But then he'd be treated as a mad old man by everyone who knew him, rather than as an eminent expatriate British intellectual.

Posted by: ajay on December 20, 2006 at 5:15 AM | PERMALINK

With the $500 billion we have pissed down our legs in Iraq, we could have set up a single payor health insurance system that would be the envy of the world. Instead, we slaughtered half a million innocent people that had nothing to do with 9-11 becuase the immature brat that we have as president lied us into believing there was a connection.

God must be shaking his head over our collective foolishness.

Posted by: The Conservative Deflator on December 20, 2006 at 6:40 AM | PERMALINK

Since this kind of gouging will be unacceptable when Hillary or another Dem gets the presidency, the HMO's are going for the rate increases now.

Posted by: bob h on December 20, 2006 at 7:03 AM | PERMALINK

Economist Dean Baker of the liberal Center for Economic Policy Research says the nation can afford Social Security but not the current health care system. "If we don't fix health care, it's hard to imagine what our country looks like in 20 years," he says.

But what issue does the Current Occupant want to 'work with Democrats' on? Um..that same old tired rip-off of SS to the benefit of those poor needy souls on Wall Street.

And in other news: Chairman of Goldman Sachs is warded (largely by himself to himself) %53 million bonue.

Posted by: MsNThrope on December 20, 2006 at 7:44 AM | PERMALINK

Ah, the unfettered free market capitalism of Derbyshire's dreams . . . SMELL IT!!!

Posted by: chuck on December 20, 2006 at 8:21 AM | PERMALINK

Typo world.

'awarded' '$53 million'

Need more coffee.

Sorry.

Posted by: MsNThrope on December 20, 2006 at 8:22 AM | PERMALINK

Goldman Sachs and the 53 Million.

Ah, to be an old man sitting with hat in hand on Wall Street, as he walks by. A ha'penny will do.

Thank ya, Guv

Posted by: stupid git on December 20, 2006 at 8:28 AM | PERMALINK

Actually $53.4 million...with his regular salary of $600k (and other platinum perks and benes probably worth about the same) that's $54M this year alone.

Posted by: MsNThrope on December 20, 2006 at 8:49 AM | PERMALINK

Our resident rightwing aliens are falling down on the fucking job here. I like The Phantom back on Majikthise, he seems to know what he's talking about. These guys... seriously, Al, AH, you're not convincing. Study up and come back.

Posted by: perianwyr on December 20, 2006 at 10:24 AM | PERMALINK

And as we all know, John is a very sick boy!

Posted by: madmatt on December 20, 2006 at 11:04 AM | PERMALINK

AL ,Hawk and I live rite,eat healthy and we pray to jesus every day,You fat bastard librul that want to eat at mcD's every day ballon up to 300 pounds and then when your health starts sinking you want Healthy people like us three to pay your way.NO you must pray to Jesus and eat rite every single day.Too hard for you Godless Libruls.

Posted by: Thomas2.0 on December 20, 2006 at 11:50 AM | PERMALINK

"Set aside some money and self-insure"? Can anyone tell me what this means?

It means you're screwed unless you're rich, which is what Republicans want.

Posted by: Mike on December 20, 2006 at 12:57 PM | PERMALINK

Thus spake ex-liberal:

We live in a free country. Steinway & Sons are free to sell their pianos at a 200% markup. You are free to buy a Yamaha instead. Derbyshire's insurance company is free to increase or decrease their price however they like.

I'm sure Derb will be relieved to know that if he gets sick, he can always get a good deal on a Yamaha piano.

Snarkiness aside, your understanding of basic economics leaves much to be desired.

One of the first things they teach in Economics 101 is the difference between "elastic" and "inelastic" demand.

The demand for a consumer good such as a piano is extremely "elastic". I.e., there is an inverse relationship between the cost of a Steinway piano and the quantity demanded. A Steinway concert grand piano costs around $80,000 and only a limited number are sold each year. If they sold for $800 a lot more people would be buying them.

By contrast, the demand for health care is extremely "inelastic". A person having a heart attack is not going to be skimming through the Yellow Pages trying to find the best cardiac care bargain. If that person needs emergency open-heart surgery, the demand for that surgery will not change whether the cost is $100 or $100,000 because the alternative is not a cheaper piano, it's death.

Another thing you apparently missed in Econ 101 is the basic rule that a for-profit business will produce output up to the point where marginal revenue equals marginal cost--i.e., the point where the cost of producing one additional unit of product equals the revenue gained by selling that product. Obviously the marginal cost of health insurance for healthy people is significantly lower than the marginal cost of health insurance for those who have health problems.

Additionally, there is an obvious conflict of interest between the healthcare insurers and healthcare providers. A doctor's decision about treatment for a patient, ideally, is based on obtaining the best possible output--i.e., doctors are professionally obligated to do whatever is necessary to cure their patients. The insurance company, by contrast, strives to limit costs as much as possible in order to maximize profits.

The standard spin we get from the wingnuts whenever the subject of universal healthcare is raised is that they don't want their healthcare decisions made by "some bureaucrat" when, in cold hard fact, that is exactly what is happening under the present system.

Posted by: "Fair and Balanced" Dave on December 20, 2006 at 1:41 PM | PERMALINK

Who really cares about John Derbyshire anyway.. he's the worst type of unprincipled conservative.

Posted by: Andy on December 20, 2006 at 2:17 PM | PERMALINK

Funny thing - if Derb had stayed in his native country, his health care would be free at the point of use, and (overall) just over half the cost of US health care, as noted above.

Well, Derbyshire still has catastrophic health insurance, at the cost of a plane ticket: he can fly back to Blighty.

Posted by: ahem on December 20, 2006 at 2:48 PM | PERMALINK

We also need to spend every nickel of our tax dollars on bullets and bombs, because that is the most productive use of our money - even if we have to borrow ourselves into bankruptcy. Got it?

And lets not forget tax cuts. Lots and lots of tax cuts.

Posted by: Gus on December 20, 2006 at 5:20 PM | PERMALINK

Posted by: American Hawk: "Now, how would a Canadian go about changing his health plan if he doesn't feel like waiting six months for a hip replacement? Oh, right: Head to America."

Heck, I waited 7 months; I'm in the USA.

Major elective surgery frequently has long waitlists. One's insurance company can cause longer waits, especially if they have a limited set of surgons for which they'll pay.

Posted by: Barry on December 20, 2006 at 5:53 PM | PERMALINK

Jane Galt explains the issue here.

Posted by: Floyd on December 21, 2006 at 11:20 AM | PERMALINK

"Set aside some money and self-insure"? Can anyone tell me what this means?

If you ever get ill and can't pay for healthcare, you deserve to die.

Posted by: Another Bruce on December 21, 2006 at 11:00 PM | PERMALINK




 

 

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