Yup, at least here in NYS the IEEE stopped offering health insurance years ago. Thankfully my 3 person company has the vast clout needed to obtain health insurance, at probably only twice the rate of a 200 person company. If anybody gets seriously ill, we're all screwed.

Gotta love a system that promotes entrepreneurship and free enterprise. Next we'll take some lessons on efficient market reforms from Comrade Brezhnev.

Kevin,

You should read Three Worlds of Welfare Capitalism by Gøsta Esping-Andersen (1990). He's a Danish political scientist who is largely considered the leading expert in Welfare regime types. At least read the introductory chapters - it's pretty illuminating. I'm sure you'd find it interesting, particularly the economic logical behind social-democratic welfare regimes (as opposed to U.K., Canadian, and U.S.'Liberal' welfare programs, or corporatist, 'conservative' programs characteristic of France, Germany, and Italy).

It's not that insurance companies are evil, it's just that they're in business to make money and you don't make any money insuring sick people.

Oh, you make money insuring sick people -- you just don't make money if you then pay for the care of those sick people. As long as you collect the premiums, you're fine. It's once you begin paying out that there's a problem.

I'm extremely healthy, and have enough money reserved to pay for my own healthcare if I need it. The last thing I need is for the government to confiscate more of my money for a product I won't use.

yeah, you'll never get in any kind of serious accident that will permanently disable you, and you've got the hundreds of thousands you'll need to take care of yourself for the rest of your life.

oh, and even if you lead a healthy lifestyle, you'll never get a disease like cancer, just ask Tony Snow. God has placed a magical sphere of protection around you, dumbass.

or ask Lance Armstrong, he led a healthy lifestyle and he never got a serious illness either.

sleep tight.

Kevin, you're close, but you're still thinking of it in terms of an economic argument (generally speaking). In addition to the domains you name--access, efficiency, choice, and social justice--let me suggest that quality and patient safety must be part of the conversation. If they're not, national healthcare will be a non-starter. However, they can and should be emphasized in any national healthcare debate--especially because the system we have now performs so poorly in these areas. (Actually, there's a good deal of overlap: quality is commonly defined as possessing the following attributes: safety, timeliness, effectiveness, equity, efficiency, and patient-centeredness.

...have enough money reserved to pay for my own healthcare if I need it
-American Hawk

Wow. Just wow.
Hawk, honey, either you are incredibly ignorant of what good health care for chronic and/or devastating illness (or accident) costs, or your last name is Gates.

Which is it?

yeah Chicken Hawk, t'hell with cancer patients. If they can't take care of themselves, fuck'em.
Spoken like a good wingnut doggie.

My personal experience with dodging a bullet in today's Orlando Sentinel.

Nickel version: I just this past weekend survived a scrape with appendicitis. Had I not had good insurance, I would have waited too long and been in big trouble.

Cilo,

He's not a Gates; Bill Gates is a huge propponent of a National Health Care expansion.

and Bill Gates has been devoting a large amount of his money to fighting and preventing disease in Third World countries--as opposed to the Chicken Hawk "it's not my problem" philosophy.

Lord knows that these diseases have no effect on the greater population, productivity and business. Each person's disease exists in a vacuum and we shouldn't concern ourselves with them.

Glad to see Kevin acknowledge that national healthcare wouldn't save a great deal of money. The record of medicare shows that it will cost a great deal more money. The reason is that utilization will dramatically increase.

The increase in utilization means that many Americans would get more medical care, which is good. But, the cost estimates of its proponents are unrealistically low.

P.S. Maybe the government will be able to run health insurance more efficiently than private industry, but I wouldn't bet on it. Governmental programs generally run less efficiently than private industry.

I was individually insured when I had a serious accident. When I first spoke to my insurance company they said I was "not insured for accidents". That's the direct quote. When I tried to find out who was in charge of my claim, the person said it was them. When I called back on another day, another person said they were in charge of my claim. In other words, for individual policies, whomever answered the phone was your representative. They wouldn't give their last names either. Eventually I had to hire a lawyer just to get them to admit that I was insured and that they would pay for my care. The company got a huge tax incentive to keep their HQ in my city and promptly dropped all individual policies.

One area you forgot to mention is mobility. Cobra's and the like are ridiculous. Only if you work for a large corporation, it seems, are you able to get affordable healthcare with the incentive for the company to not treat you like crap.

Hi Hawk,

I'm healthy, and got enough jack for myself, but I've got nowhere near what it takes for healthcare for my parapalegic brother, mentally challenged sister, or my heart diseased father. I guess I'll let them get what they can out of SSI and hope they snuff it before it cuts into my cash.

A few days ago, during an email exchange with a friend, I mentioned that I don't usually tout cost savings as a big argument in favor of universal healthcare. It's true that a national healthcare plan would almost certainly save money compared to our current Rube Goldberg system, but I suspect the savings would be modest.

The cost argument is important not because it is the most compelling argument (as you note, it is not), but because it marshals the available facts to strongly rebut the only substantial practical counterargument offered by opponents (that whatever benefits it might arguably produce if it were practical, the costs make it impractical, and will therefore lead to a situation in which massive costs are incurred in an attempt to implement the program, but the benefits are not realized as the system collapses under the costs.)

Maybe the government will be able to run health insurance more efficiently than private industry, but I wouldn't bet on it. Governmental programs generally run less efficiently than private industry.

However true that might be "generally", its certainly not in evidence in healthcare even in our current mix of public and private systems where the private systems are able to choose their own populations to cover, nor is it supported by evidence from healthcare throughout the industrialized world more generally.

American Hawk,
My accident, two broken elbows, costs $23k the first day. Two surgeries and nine months of rehab later I was finally deemed 96% capacitated.
Good luck with that "I'm healthy" approach though.

Hey....

The only thing worse than Tony Snow having cancer is Tony Snow having cancer and NO HEALTH INSURANCE.

Thank god the American people are paying to cover him. He might lose his house otherwise.

Yes, I know, Everblue. Gates is quite human for a gaza-billionaire. Probably because he can recall not being one. Wish he would use some of his foundation money and innovational expertise to work on the poverty healthcare gap, which is not just due to lack of insurance.

Glad you did well, Greg. As you no doubt recall easily treated diseases kill every day in this country.

Are you aware that 5000 people die yearly from asthma? That's 14/day - almost 2 every 2 hours. ASTHMA for god's sake. Asthma is eminently treatable. most of the deaths occure in young healthy adults, too.
Every one preventable.
Every one.

I love AH's comment about letting people be part of the system if they WANT. Yup, I CHOSE to have health problems. And I should be punished for it. Insurance companies have a right to screw me, and if I don't have health insurance, I shouldn't be allowed to have healthcare unless I can afford it. I work full-time despite multiple chronic illnesses, so as to not be a "burden," and get the puny health insurance coverage that my job offers, but I don't make millions and healthcare is outrageously expensive. Thus, I don't get the treatments I need, which lowers my productivity, not to mention leaves me pretty miserable most of the time. I'm very happy for you that you're healthy and wealthy, AH. If only you were also wise.

ex-liberal: The record of medicare shows that it will cost a great deal more money.

More than what? (note that in a comparative sentence you need something to compare to).

the cost estimates of its proponents are unrealistically low

The cost estimates are based on the experience of every other country in the world that has UHC (i.e. every developed country outside the US). I find this type of evidence far more convincing than arguments that you pull out of your ass.

Governmental programs generally run less efficiently than private industry.

Uh huh. "Generally" don't mean shit, since we're talking about health care in specific. Again, I find overwhelming evidence more convincing than hand waving.

UHC is hardly a radical new and untried idea. Now, 50+ years ago it was somewhat different. Back then the hard headed business people who ran the Big 3 wouldn't listen to the business advice of self-avowed socialist and UAW president Walter Reuther, who predicted they'd be better off supporting UHC instead of assuming health care liabilities for their employees. Just think of how much better off they are having taken the road they did.

AH,

You obviously have no clue how fast even a minor injury can suck up all your savings. With all its warts, Americans ♥ Medical Insurance.

"The last thing I need is for the government to confiscate more of my money for a product I won't use."

In the interest of beating shit-stupid to a shit-stupid pulp...

Did any of you happen to see this brilliant animation of the L-curve?

correction:
That's almost 1 every 2 hours.

My math is suffering from my indignation. Sorry.
Point still holds.

"Glad to see Kevin acknowledge that national healthcare wouldn't save a great deal of money. The record of medicare shows that it will cost a great deal more money. The reason is that utilization will dramatically increase."

Horseshit, horseshit, horseshit, horseshit. There is no evidence at all, whatsoever, period, that people like to go to the doctor for frivolous reasons just because they're covered (it's the opposite- people delay needed care when not covered, get more seriously ill and end up costing much MORE when they finally go to the emergency room.) This is nothing but a standard right-wing lie. The relevant statistic is that Medicare's ADMINISTRATIVE costs are far LOWER than the general health care "system"'s. The fact is, we spend a lot higher % of GDP than the next most expensive system, France's, which provides high-quality care for EVERYBODY. There's just no way around that fact. Our wonderful "system", which works so well for the billionaire insurance-company suits, costs more and delivers less to the rest of us.

American Hawk makes me ill. If only my insurance covered that...

AH: If I get cancer, it's my problem, not yours.

Exactly.

And you needn't trouble yourselves with bleeding heart "get wells" either....

m: It is a shame that in your promos for government-provided health care you fail to give proper credit to one of those who provided it to his people years ago- Fidel Castro.

Even worse, in Cuba they have government run water supplies. Water! The perfect way for an evil government to disrupt people's purity of essence. Sometimes they put fluoride in it!

I strongly recommend that you drink only pure rain water and grain alcohol, and. in the physical act of love, deny women your essense. Now, POE, OPE, what was that recall code again?

Yawn. Same old same old. Unless we're willing to do something about rationing end-of-life care, health care "reform" is as meaningless as rearranging the deck chairs on the Titanic. Spending countless thousands of dollars on keeping a dying person alive for a few weeks more, when the patient's quality of life and chances of long-term recovery are both zero, is a complete obscenity. "Death with dignity" is a completely obsolete notion today, almost as quaint and meaningless as "preventitive medicine."

The following is a list of prominent conservatives who turned down employer or goverment based medical insurance our of principal:

AH what happens if you get a Terry Schivo thing going on.We can,t pull the plug, sombody has got to take care of your dumbass.

http://www.healthaffairs.org/press/mayjune0301.htm

NEW STUDY: UNITED STATES SPENDS SUBSTANTIALLY MORE
ON HEALTH CARE THAN ANY OTHER COUNTRY;
YET DOES NOT PROVIDE MORE SERVICES

The percentage of the US economy devoted to healthcare will drop, in such a system, from 16% of GDP, to between 8% and 12%. Like ALL OTHER developed countries in Europe and Canada.

...I'll take my chances. I'm extremely healthy, and have enough money reserved to pay for my own healthcare if I need it....

Posted by: American Hawk on March 27, 2007 at 2:12 PM | PERMALINK

Got to keep beating this horse. Put's all his other comments in their true perspective. If any further proof of this person's stupid self-centeredness was needed.

I've said it before, so, to be boring, I'll say it again. Healthcare is not a market. You can organize health coverage to work with encouragement and incentives toward efficiency but that is always in tension with the demand for services. So you can build in disincentives for overuse by patients; co-pays, etc.

But, as others have said, there is no evidence that a single-payer system would be any more expensive than the present. When you consider that 46 million are uninsured (does this include illegals?), and an undefined number have partial coverage, catastrophic only coverage, or coverage that does not include their pre-existing condition, it is hard to imagine a less efficient system more full of injustices.

It seems extraordinary that the most "capitalist" of the advanced nations refuses to recognize the gains in efficiency throughout society from universal coverage, the evidence for which is plainly available if you wish to look.

There was no debate in the 90s, only right-wing canards. Hopefully this country has evolved to having a reasonable debate although it's obvious from the posts there are those who refuse to learn anything, only repeat their bogus talking points.

I just returned from a meeting where our guest speaker was the operator of a free clinic. The speaker's clinic is aimed squarely at people who are poor, and do not have employer provided health insurance, but make too much or are too old or too young to qualify for any government health care program. Her specific practice is aimed directly at people who have chronic diseases and need follow on care.

One of the problems she pointed out with our current system is the lack of consistent care. Once someone qualifies for one of the government poverty programs and can no longer qualify for her program, they are bumped from physician to physician. They simply become cogs in the medical wheel. The same happens to insured patients whose companies change insurance policies every year or two. She argued that outcomes for the chronically ill are not as good if they are jumped from doctor to doctor.

In many ways she thinks the 400 long term patients she sees in her free clinic receive better care than most of us, because she knows her patients. She also told us that her clinic serves less than 5% of the people who qualify for her service in Eastern Jackson County Missouri. Most just do without.

The last thing I need is for the government to confiscate more of my money for a product I won't use.

Direct benefit is not the point. I pay taxes in Ontario that benefit others' healthcare. Great! For in return, I get a better society around me.

If you don't give a damn about someone else, they sure as hell won't give a damn about you, especially if they have to pay a huge bill and you just snicker.

The record of medicare shows that it will cost a great deal more money.

Doubtful. I like good old American know-how. I think you will learn from us and we will learn from you. American national healthcare can be more efficient than the present mess and hence cheaper. Plus a more humane society will bring surprising efficiencies in education, crime, etc.

Go for it!

Another opportunity for cost savings is to realize that a goodly percentage of what primary-care physicians do could be done more cheaply and often better (given the mediocre communication skills and overfilled schedules of many MDs) by PA's and nurse practitioners. (And yes, I have had a PA as my primary care provider in the past and yes, he was very good.)

The record of medicare shows that it will cost a great deal more money.

I would like to see the proof for that proposition.

'If the U.S. could contain its health care costs, as every other country has managed to do, then there is no serious problem. If health care costs grow as projected, then the economy will be wrecked, even if we eliminate the government health care programs.' - Dean Baker

"But a single payer -- either through Medicare or the federal employee's health insurance program -- would avoid the current insanity by which private insurers spend hundreds of millions of dollars a year advertising and marketing to younger and healthier beneficiaries, and seeking to discourage older and riskier ones or people with pre-existing medical conditions. America now has the only health-insurance system in the world designed to avoid sick people." - Robert B. Reich
http://www.prospect.org/web/page.ww?section=root&name=ViewWeb&articleId=12404

McKinsey Global Institute: Most components of the U.S. healthcare system are economically distorted; no single factor is the silver bullet for reform."

AH:
I was just talking to a 27 year old patient this morning. She was just offered a new and better job, but before she could accept the job she suddenly went blind in one eye. The blindness has responded to high doses of steroids, but she has the brand new diagnosis of "multiple sclerosis". Now what should she do? Take the new job and run the risk of not having her pre-existing condition covered? Stay in her old, lower paying job? Stop working and go on disability? Perhaps you have some insight? She had previously been quite healthy.

Wow. Just wow. AH's remarks are truly reprehensible. Morally bankrupt. Dare I say . . . unchristian. I truly didn't grasp the full extent of his "me first, and only me -- it's all about me" mentality, but the last scales have finally fallen off.

Nationalized healthcare might cut out the profit presently generated in private insurance, but that profit is already a very tiny fraction of total healthcare spending of today, and I question how much savings are generated from eliminating the "overhead" in health insurance administration since many are assuming that insurance companies spend money on this for no rational reason at all; if there were no justification for it, why would the insurance companies not, at the very least, just keep this as pure profit? It is clear to me, at least, that this overhead is performed to control total costs of healthcare, and to try to insure that monies are spent in more efficient ways. One can debate whether insurance companies perform this activity well, but the government will have to do a similar thing, or simply control costs by fiat and explicit rationing.

On balance, it is wise not to promise that national healthcare in the United States will cost less while giving coverage to everyone that presently doesn't have it. Arguments that access to healthcare is a positive right are stronger, far stronger, than arguments based on the costs involved.

I guess I'll let them get what they can out of SSI and hope they snuff it before it cuts into my cash.

Posted by: Crow on March 27, 2007 at 2:31 PM |

And what's to stop SSI or whatever government agency that is created to handle health care from deciding that your paraplegic brother, mentally challenged sister, or your heart diseased father are not worth the expense of keeping alive? What with their poor quality of life and all.

As Mark Steyn famously said, "If the government is big enough to provide your health care needs, it's big enough to take them away from you as well."

Anyone who says insurance companies aren't evil doesn't know enough about insurance companies.

Chicounsel, if you think that never happens now in the "private" system when the money runs out, you're truly an idiot.

Yancey, as already pointed out, a simple comparison of the US to every other industrialized country is all that's needed to refute your claims. Just for starters, it's completely off-base to equate the adminstrative costs of the insurance scam with industry profits I sure hope you're not running a business if you don't know the difference...

Anyone who says insurance companies aren't evil doesn't know enough about insurance companies.
Posted by: JHM

I agree completely. That caught my eye in Keven's post as well.

Every other country which lays claim to be an advanced society provides health care to all it citizens. Whether Japan or the Danes.

It's not that insurance companies are evil,

Actually, I dispute this. By definition, they are in business to not provide the service they collect money for. That's evil.

Did anybody actually read the LA Times story cited by Kevin. The story points out that 63% of the people who are uninsured are either self employed or work for small businesses that don't provide insurance. That means that most of the uninsured work for a living. Many simply can't afford insurance. Others are uninsurable for one reason or another.

AH, I assume you work for a large company. Millions have lost large company jobs in the last few years. Ford and GM are just two examples. Let me assure you that if your employer has a chance it will outsource your job. There is a very good chance you will have to go to work for a small company or start your own "Trolls R Us" consulting business. When you do you will be confronted with the high cost of health insurance. Hell, given your black heart you might not qualify at any price. Then tell us all about how efficient you find the "market." It will know doubt "efficient" you right into the ground.

My point of this post is simple. Universal health care is not the creation of a "welfare program" for the poor. It is needed to solve a serious impediment to wealth creation by members of the middle class.

Yancey Ward: Nationalized healthcare might cut out the profit presently generated in private insurance, but that profit is already a very tiny fraction of total healthcare spending of today, and I question how much savings are generated from eliminating the "overhead" in health insurance administration since many are assuming that insurance companies spend money on this for no rational reason at all; if there were no justification for it, why would the insurance companies not, at the very least, just keep this as pure profit?

The simple mnemonic is to swap the digits. 96% of Medicare costs go to health care providers, versus 69% for private insurers.

Aside from the overwhelming empirical arguments, you're making some unstated assumptions in your argument. Nobody is suggesting "that insurance companies spend money on this for no rational reason at all". From the insurer's POV, the way to cut costs is to dump coverage for those that they actually have to pay claims for. Therefore the costs are rational for the insurance company, but not from an overall policy and health care POV.

This is true of all insurance. Every insurer's goal is to collect premiums and not pay out on claims. A combination of regulation and competition keeps insurance working well enough in most markets, but health care is too complicated to satisfy the first requirement of a working market: that people know what they're buying.

By contrast a UHC system is legally required to cover everyone, so it's irrational for them to waste money to weed out high risk "customers".

Chicounsel, if you think that never happens now in the "private" system when the money runs out, you're truly an idiot.

Posted by: Steve LaBonne on March 27, 2007

I don't think it is necessary to call Chicounsel an idiot. I would prefer the word "ignorant" or "uninformed." Chicounsel points out a problem that exists in any managed care system public or private. Of course, I think we all have more clout with government officials who can be influenced by elections etc, than with private insurance companies run by officers under operating on behalf of boards of directors who are elected by shareholders. Note that the insureds are not part of the health insurance chain of command.

Yancey Ward: it is wise not to promise that national healthcare in the United States will cost less while giving coverage to everyone that presently doesn't have it. Arguments that access to healthcare is a positive right are stronger, far stronger, than arguments based on the costs involved.

But whenever you make an argument based on positive rights, people, correctly and rationally, ask what it's going to cost. All empirical evidence (the type that blows away all other arguments) says that it will cost less. This demolishes the main, and only serious, objection.

AH probably has government health care.

Certainly George Bush, Cheney, Rove and all the members of Congress, their families, and all their staff do. And damn fine government healthcare/insurance, too. Even with Cheney's known 'pre-existing' conditions.

He feels a twinge in the old leg - off he dashes. We pick up the bill.

If it's good enough for Congress I think it ought to be good enough for the public they are supposed to represent.

SSI has done a few revisions of the cases of both my paraplegic brother and mentally challenged sister and changed their benefits drastically -- It decided they overpaid my brother 15K$, adjusted his account downwards $15K and then set up a payment plan to pay themselves back with their own money. My sister's case was similar for $10K, They both were re-revised in the next year. Sis later got herself $12K in debt with a cell phone/credit card deal and dutifully paid it off in the working part time $4/hr+SSI budgeting framework rather than go bankrupt. The systems so fucking broken and bad that it you have to be financially divorced from anyone in it. My brother and sister will never be incentivized enough to pay for themselves, and will always be at the mercy of fate. Medicare has been paying the $20K or so in surgeries each of them has had every 4-5 years of their adult lives.

Maybe you should consider what would happen to Hawk or you under your preferred system if some of the underclass should spit some cooties on your healthy bodies. Heck, maybe the judgement-proof underlings ought to use their crutches to go around whacking healthy people in the neck to give them their very own chance at disabled healthcare.

Oh. That was to you, Chicouncil.

My point of this post is simple. Universal health care is not the creation of a "welfare program" for the poor. It is needed to solve a serious impediment to wealth creation by members of the middle class.
It's impossible to stress this point too strongly. In this and other ways, it's the current "system" that's a serious drag on economic performance.

On balance, it is wise not to promise that national healthcare in the United States will cost less while giving coverage to everyone that presently doesn't have it. Arguments that access to healthcare is a positive right are stronger, far stronger, than arguments based on the costs involved.

I'm not sure why arguments based on a priori ideology that is demonstrably not shared by the people that need to be convinced would be objectively stronger than arguments based on empirical evidence that are directed at concerns that are evidently quite common among the people that need to be convinced.

Please, explain.

Steve LaBonne: it's the current "system" that's a serious drag on economic performance

Yup, see my 2:12 (first post!) and J Bean's 3:15. UHC is no more antithetical to capitalism than the lighthouses that the government built to aid navigation during the Washington administration.

"UHC is pro-business" oughta be the new slogan (with thanks to Walter Reuther).

There are several areas where there is substantial room for savings from a single payer:

1.) Right now we have a "separating equilibrium" - the low cost patients are in the private sector and the more costly (poor and aged) are left to the government (think cream skimming). The returns to diversification are not captured by the general population - they accrue to the insurance companies.

2.) Currently, most participants are in plans for less than 5 years, so insurers are unlikely to recoup returns from investing in wellness programs. A number of studies suggest wellness programs can provide huge savings - but they receive scant investment.

3.) By not tying work and insurance, the friction associated with job changes would be reduced. This could be a boone to small businesses and start-ups.

Why not set up something similar to the GSE's (Freddie Mac, Sallie Mae etc)that creates demographically symmetric/homogeneous pools of individuals. These pools could then be auctioned off. Insurance companies would be required to pay for all non-elective proceedures that clients receive (with maybe a co-pay determined by tax return info). Insurers would be able to enhance returns by encouraging clients to engage in certain bevhavior (rebates for joining certain physician pools, participating in fitness programs etc). There are a lot of smart people out there, we can do better!

My point of this post is simple. Universal health care is not the creation of a "welfare program" for the poor. It is needed to solve a serious impediment to wealth creation by members of the middle class.

While I would agree that the benefits of UHC are not particular to the poor, I don't think this is particularly true as stated. First, I don't think that the impediment to wealth creation applies specifically to "the middle class", but rather throughout the economy, including the poor, the middle class, and, in fact, also being a drag on wealth creation by the rich (though, as they do quite well even without the drag, its easy to overlook that aspect.) Second, even with that note, I don't think that that distinguishes it from other well-considered welfare programs, even where the principal recipients are the poor. The absence of a social safety net in general promotes risk-averse behavior in the middle class, and thereby functions as a drag on activities that, on-balance, create wealth and crushing poverty creates a wide variety of social ills that interfere with the development of human potential and with wealth development, and so well-designed welfare programs designed to provide a social safety net and alleviate crushing poverty and reduce the disadvantages in opportunity faced by those in poverty do, no less than UHC, serve to promote wealth creation throughout the economy.

. . . The healthy do not exist to subsidize the sick, nor do the young exist to subsidize the old.
Posted by: American Hawk on March 27, 2007 at 2:12 PM | PERMALINK

Yeah, well, my face does not exist to subsidize my nose, so I cut it off.

C. Hawk should try a modest experiment, consisting of a long motorcycle ride without a helmet. I forgot to mention that as true believer in "Screw you, hooray for me!" he must ride as fast as he can, and should have the following tattooed on his chest: "In case of accident, only take me to a private hospital, and do not treat me until I fully pre-pay the estimated cost."

Of course, I think we all have more clout with government officials who can be influenced by elections etc, than with private insurance companies run by officers under operating on behalf of boards of directors who are elected by shareholders. Note that the insureds are not part of the health insurance chain of command.

Posted by: Ron Byers on March 27, 2007 at 3:48 PM

Who's being ignorant or uninformed now Ron?

Do you really think that unionized federal health care workers and/or the government officals that will run such a program are going to give a shit about your or your family's health care needs? What are you doing to do if you are dissatisfied with the care that they are providing? Go to another health care provider like you can go to another branch of the DMV?

Without paying customers a private sector health care provider will go out of business. Something a public sector monopoly will never have to worry about. So I ask you which is more likely to be responsive to their customers' needs?

haha-- Tell ya what: If I get cancer, it's my problem, not yours. Don't make your cancer my problem.
Posted by: American Hawk on March 27, 2007 at 2:19 PM | PERMALINK

Tell ya what: You ARE cancer, and it's everyone's problem.

Glad to see Kevin acknowledge that national healthcare wouldn't save a great deal of money.

Glad to see that "ex-liberal" is as dishonest as ever.

Some once told me that 60% of every Medical bill is for someones prophit.60% is just crazy it is no wonder Frist is fithy rich.Can you name the three Industries that have had the most succsess in the last 6 years.Big oil,Big Pharma,The heathcare biz.All three have had major players in the goverment.Cheney,Rummy,and Frist. HMMMMMMmmm.

Yeah, well, my face does not exist to subsidize my nose, so I cut it off.

LMAO.

alex: What I meant was that universal government-paid health care will cost a great deal more than current spending levels just as Medicare turned out to cost much more than spending levels for seniors before Medicare was enacted..

It's not realistic to assume that governnent-paid health care will cost the same in the US as it does in other countries. US health care costs much more regardless of who pays. E.g. US Medicare is much more expensive than government-supplied health care to seniors in other countries. Also US private healthcare is much more expensive than private healthcare abroad.

Yancey, as already pointed out, a simple comparison of the US to every other industrialized country is all that's needed to refute your claims.

Yeah, but mere facts aren't enough to refute Yancey's loony libertarian faith.

"ex-liberal," since you're a notorious liar, how about some sources for your assertions? Thanks in advance.

etoin: When they treat him anyway, they won't care what's on his shirt.

A more modest experiment would be to wear that shirt, grinning wide while skipping through the waiting rooms of the low-rent clinics where that kid died of complications of toothache. We'll see how long he keeps those pearly-whites of his healthy.

If we say "devil take the hindmost" to our hindmost 45 million (and counting,) we can't expect them to give a damn what happens to us, and some of them are going to try to take us down with them.

if there were no justification for it, why would the insurance companies not, at the very least, just keep this as pure profit? It is clear to me, at least, that this overhead is performed to control total costs of healthcare,

Yes.

and to try to insure that monies are spent in more efficient ways.

No.

The purpose of the administrative overhead is to chase good prospects and to deny coverage through outwaiting sick people, especially dying ones. These are time-tested and proven ways to make money in the insurance industry.

Chicouncil,

How do you go to another health care provider? They won't cover an existing condition, so you can't pick and chose in the existing system. And since most insurance is provided by your employer, how do you get them to change their group policy?

You are in fantasy land if you think the existing system is any easier to deal with than a government agency. At least we can vote in a new board of directors with the government.

We don't need to worry about the morality of "American Hawk". There is no "American Hawk", just a Republican hack paid to clog the thread.

Nobody who could afford to keep a half million to pay for a possible illness would do so. They would purchase insurance.

"American Hawk" is just another symptom of the wheels falling off the right-wing noise machine.

When they treat him anyway, they won't care what's on his shirt.

The trauma bay is the most egalitarian place on the face of the earth. Everyone gets treated exactly the same - trust me - you do not want to be on that gurney. But if you are, your ability to cover the nut is not even on our radar. The patient is a human being, and as such deserving of certain fundamentals - like preservation of their life. Even if they are poor.

Blue Girl is right, and this extends to pretty much everyone in the ED. It's an unfunded mandate, but it's the right thing to do until national health care comes along.

On the other hand, I recently quit my job for the government (county hospital) and became a private contractor in the private sector. As such, I pay my own health insurance.

It's $150/month.

For my wife and myself, full medical and dental amounts to less than $300/month. And we both have a couple minor medical problems.

I've only recently ever had to provide my own coverage, but I've got to say, this seems really reasonable. Is this the kind of dollar amount that has everyone freaking out about affordable health care? Or do the premiums skyrocket once you reach a certain age, or what?

That's why I get so frustrated by the young people who say they can't afford health care insurance, yet smoke away way more than $150/month, or spend it on lattes and useless junk.

What they mean is that they don't feel like they should have to pay for healthcare.

"I'll take my chances. I'm extremely healthy, and have enough money reserved to pay for my own healthcare if I need it. The last thing I need is for the government to confiscate more of my money for a product I won't use."

You're talking like a young healthy guy who has not the first clue how much serious health care will cost when you finally do need it. My wife's breast cancer cost $80,000 for the first 8 months of treatment. (It settled down to a lot less per year during the three years after that. Since we have good insurance through my employer, it's only been a few thousand out of our pockets.)

Do you really have a spare $100,000 or more in liquid assets just sitting around waiting to be spent on health care in a single year or less when you're barely 50, and still saving for retirement?

You are obviously saying that *all* health insurance is a waste of money for a healthy guy like yourself, so you're better off going without and just saving for that rainy day on your own. I hope no one else is depending on your planning and judgment.

Since you're not planning on having any accidents, your car insurance is obviously a waste of money as well. Are you planning to drop that too?

Nothing bad is going to happen to your house, either. Why don't you just tell your bank that you want to keep your mortgage, but stop wasting money on the insurance?

Yes, American healthcare will continue to be more expensive if we don't rein in costs, even with universal coverage.

But the origin of those costs are the government regulations that create monopolies. For example, a $600/month Dromolol prescription could be replaced by marijuana the patient grows at home. And we certainly don't need to let the drug companies claim, on their tax forms, the $24,000 they spend on each doctor each year as a legitimate business expense.

The reason our healthcare is so expensive is the thicket of government rules created by monopoly industries and professional classes. The only way to cut this Gordian knot is to create universal coverage with enough voice to start hacking at the thickets of privilege.

Bad Shift;
I don't know what your $150 policy covers, but when I hear of friends who are contractors or self-employed trying to get health insurance, most family policies are more like in the neighborhood of $1500 per month. Seriously.

"I've only recently ever had to provide my own coverage, but I've got to say, this seems really reasonable. Is this the kind of dollar amount that has everyone freaking out about affordable health care? Or do the premiums skyrocket once you reach a certain age, or what?"

Try asking your insurer how much it would be if you and your wife were both in your late 50s, with 8 to 10 years to go before Medicare kicks in, and one or both of you had some pre-existing condition, such as cancer treatment.

You'd be a lot less blase about the figure, if your insurer is willing to sell you any policy at all.

See, nemo, if anyone agreed to marry Henery in the first place (a horrifying thought in and of itself) he would divorce her in her hospital bed should she be diagnosed with cancer. It's the Republican way.

And let me just say this about Kevin's belief that businesses are more efficient that the government- baloney, you're talking about two entirely different products.

A business puts up a shed they intend to use for 5-10 years, and promises to deliver widgets, if enough people can be found to pay their price. If this doesn't work, well, that's just one of the 50,000 business failures in the US each year, and the whole thing is quietly buried.

The government decides, usually through the legislative process, to deliver widgets that are free of fault, and puts up a shed that has to last 50-100 years. Some government spending, such as that on war, is allowed to be wasted freely and this, understandably, leads to more waste. Other spending, like that on buses, is subject to intense scrutiny, with voters constantly urging legislators to make the product betteror more available, and if something goes wrong here, the audits are all part of the public record.

All of this is quite different from the traditional freedom of the Ford company to build an Edsel, or the astounding ability of the Jeep company to fail repeatedly in spite of the fanatical devotion of Jeep buyers.

What the government does and what private businesses do are two entirely different products.

Bad Shift: What is covered? I am a Jewish woman, over 40, walking around with the BRCA 1 and BRCA 2 genetic mutations. I purchased a cancer policy a few years ago - not wanting to rely solely on TriCare (or financially wipe my family out) if or when the diagnosis is handed down. It covers no screenings, no testing - nothing - only kicking in when a diagnosis is made, and it costs twice as much as you are paying. But it's a bet I'm willing to hedge, because I have a hell of a lot to live for.

Blue Girl, that's a nasty thing to say, true, but nasty.

I was going to ask him where he got his coverage. I pay over $800 a month for one those MSA thingies. Essentially, I self insure the first $4,000 and have a policy to handle the overage. That is $800 for my wife, my daughter and me. None of us have serious preexisting conditions, unless you count my age.

I don't know what your $150 policy covers

It can only cover catastrophic. I'm paying roughly the same for a $2500/yr deductible policy.

He most likely has a 5,000 or 10,000 dollar deductable ouch that could hurt.But hey it's only 150 dollars a month.

When middle class retirees are willing to accept the same level of health care rationing that middle class retirees accept in the systems kevin favors, then there will be a chance of reform.

There is still no better place on earth to be a middle class, fat, 75 year old diabetic, with a heart condition and arthritic hips, than the U.S., especialy if one, or one's family, wishes to take all measures to extend life as long as possible. This is also the demographic most highly sought by congressional candidates.

The odds against dramatic reform are pretty steep.

I don't know that what you are saying is true, Will Allen. I have several patients who divide time between the U.S. and Europe. As far as I can see, the care is about the same. I had one diabetic patient who used to complain about paying a bundle for his fancy U.S. drugs and who was perfectly cheerful about his free, old-fashioned, U.K. drugs. Although, for all I know, he complained to his British doc, too. French care seems about parallel in my experience (albeit anecdotal) and I just saw a patient who was in India and had a ridiculous, over-the-top work up for low back pain ... at the age of 17.

"If the government is big enough to provide your health care needs, it's big enough to take them away from you as well."

That is not a knock against government or UHC. That statement is equally true of insurance companies and big employers.

No individual -- except the very, very wealthy -- can afford to provide for his health care needs on his own. Nearly everyone depends on *some* large organization that is big enough to provide health care benefits, and is big enough to take those benefits away as well.

"I don't know what your $150 policy covers

It can only cover catastrophic. I'm paying roughly the same for a $2500/yr deductible policy."

If you are 30 you can get a pretty comprehensive plan for that. Hmm, yea, $155 a month for a healthy non-smoking 30 year old $500 deductable plan with $20 copay office visits. For a forty year old it was just over $200, a fifty year old has to pay $307, and a sixty year old $428.

quotes from:
www.ehealthinsurance.com
from whom I once bought a catastrophic policy which cost exactly as advertised so I think their quotes are accurate, at least with no pre-existing conditions.

"If the government is big enough to provide your health care needs, it's big enough to take them away from you as well."

If the government is big enough to provide your Criminal Justice needs, it's big enough to take them away as well.

As Bush has proven.

If the government is big enough to provide your Flood Control and Disaster Rescue needs, it's big enough to take them away as well.

As Bush has proven.

(shall I go on, or have I made my point?)

It's not Big Government we need to worry about.

It's Big Republican Government.

J Bean, most people who advocate large reform (and I'm not necessarily opposed to a large reform of our monstorus hybrid) constantly refer to life expectancy stats to prove that other systems deliver better care. Strangely, they fail to note that life expectancy at age 80 is markedly superior in the U.S., compared to other industrialized nations (it was a New England Journal of Medicine study where I read this), and everything I've read indicates that an elderly person who desires a hip replacement, for instance, has a better chance of getting it in the U.S., or getting it more quickly.

Middle class elderly people are the most highly sought-after electoral group in the U.S., and any change which causes them to endure more rationing, even in terms of longer waits, is not likely to be embraced by them. It can also be expected that opponents of reform will be very energetically educating the middle class elderly of the implications of reform.

Wendy said: Wow. Just wow. AH's remarks are truly reprehensible. Morally bankrupt. Dare I say . . . unchristian.

Good point. Truly unchristian practice and thought process by the wingtipped, christian stompers.

I just got back here so I have some reading to do.

Will Allen, thanks to years of misinformation you make the propaganda disposed mistake of thinking it's all or nothing.

There are so many ways to skin this cat. In the UK, for instance they have both the single-payer government financed healthcare, the National Health System, that runs in parallel with privately purchased healthcare and private insurance as a supplement to the NHS, allowing people to jump queues (lines), get private rooms, and alternative medicines, etc., etc.

People really need to open up to this debate and not blinker themselves ideologically, selfishly, or by preconceived ideas. Think in broader terms and the benefits to society as a whole and, particularly, the poor or semi-served.

Next time you want to mention waiting times for non-critical operations in countries with universal healthcare, think about those in this country who receive no care until their case is critical, and treatment the most expensive and most difficult for a decent outcome.

"...Strangely, they fail to note that life expectancy at age 80 is markedly superior in the U.S., compared to other industrialized nations...."

Jesus, Will Allen. You really fall for it don't you. Of course those over 80 have a better life expectasncy in the US. We already killed off most of the less better served.

Here's the extreme example. What's the life expectancy of a black inner city male at birth compared to a suburban white female. Yes, there are more factors than medicine but that comes into it to: sex, income, education.

You just don't get how priviliged some are, and how tilted against the poor this society is in outcome.

and everything I've read indicates that an elderly person who desires a hip replacement, for instance, has a better chance of getting it in the U.S., or getting it more quickly.

No, an elderly person with good insurance who desires a hip replacement has a good chance of getting it in the US. An elderly person with no or inadequate insurance has a zero chance of getting it. If you don't have insurance your waiting time for a non-emergency procedure is, effectively, infinity.

By only citing those with health insurance, you're distorting the statistics. Waiting time statistics in other developed nations draw in 100% of the population since 100% are covered, while here we only count the most favored 70% with insurance, leaving the 30% without out of the calculations and thereby making the stats appear better than they are.

Stefan, thank you. More clearly put.

But it's more than 30%. The 46 million or more are the uninsured. Then the under-insured or catastrophic only. Then the not-pre-existing-condition insured. I haven't found figures for all that but I think I'm going to start looking. These are all significant numbers. Certainly all feature in my daily experience with people.

Will, an elderly person in the U.S. has good insurance. It's called "Medicare". They would indeed get a hip, if necessary.

Stefan, throughout my posts I refer to middle class elderly, which usually means Medicare and Medicare supplements. They are the people whose votes are most sought, and they are the ones who will have to experience more rationing, even if it only in terms of waiting times for non-critical procedures, if large reform is made. This is politically problematic.

notthere, poor people don't vote in high percentages, compared to other groups. Their desires in regards to health care simply are not going to have as much political impact, compared to the middle class elderly. Also, it is interesting that so many people who advocate reform use life expectancy stats to argue that Americans get poorer care on average, and usually don't mention the factors not related to health care which cause life expectancy at birth to be lower, like homicide and auto fatality rates, how premature birth fatalities are recorded, or rates of obesity and sedentary lifestyles.

As soon as a life expectancy stat which casts Americans as being longer lived is cited, however, that stat is discounted as being not representative of the quality of health care delivered, despite it encompassing the demographic most likely to utilize intensive health care services. Why, it would almost cause one to suspect that many don't make their arguments in good faith.

Also, it is interesting that so many people who advocate reform use life expectancy stats to argue that Americans get poorer care on average, and usually don't mention the factors not related to health care which cause life expectancy at birth to be lower, like homicide and auto fatality rates, how premature birth fatalities are recorded, or rates of obesity and sedentary lifestyles.

Uh, factors such as rates of homicide and auto fatalities, obesity, sedentary lifestyles and premature birth fatalities are all related to health care.

Well, that's what I mean, J Bean. The segment of the population least exposed to health care rationing in the U.S. is Medicare recipients, and it is their votes which are most sought. That isn't a good recipe for reform.

Stefan, there are no trauma centers on earth where you are more likely to immediately survive a gsw or serious auto acident than a American trauma center in a large urban area, simply because the personnel have more experience with these cases, and insurance has very little impact on the immediate outcome. No health care system can, on average, overcome a person's decision to balloon up to 300-plus pounds, and not get any exercise.

Also, stefan, I wrote "how premature birth fatalities are recorded", not "premature death fatalities". Uh, the terms are not synonymous.

I might quibble with Kevin's assertion that insurance companies are in business to make money. It's true that some are, but much health insurance is sold by not-for-profit companies, who are in business to break even. They don't need to make a profit, but they do need to cover their costs. If their outgo exceed their income, they will go bankrupt and fail.

Similarly, the federal government can fail, if its outgo exceeds its income. A certain amount of debt is no problem, but too mudh debt could result in foreign banks selling their dollars, foollowed by high inflation, a drop in the value of the dollare abroad, and disastrous impact on our economy.

The largest governmental liability is not shown as a part of the national debt. It's the unfunded liabilities of Social Security and Medicare, which added up to $84 trillion dollars in 2006 and is growing rapidly. Adding health coverage for all Americans would cause this unfunded liability to grow even faster. This unfunded liability is a kind of "time-bomb" that could destroy our economy.

Ah, Kevin.

No thanks. I'll take my chances. I'm extremely healthy, and have enough money reserved to pay for my own healthcare if I need it. The last thing I need is for the government to confiscate more of my money for a product I won't use.

Posted by: American Hawk on March 27, 2007 at 2:12 PM

Shorter American Hawk-- I've got mine, FUCK YOU.
You are one great American. You POS>

ex-lib et al. -- the public inefficiency vs. private efficiency argument doesn't hold up when applied to healthcare. We're taught to believe that private capitalist enterprise is more "efficient" in many ways -- and the incentives of the free market do bring efficiency to the production and sale of widgets, but this ceases to work when we talk about delivering medical care. In the first place, everyone doesn't have to have a widget, or a Lexus, or a TV. Everyone will require health care at some time and when you have a heart attack, you don't spend the afternoon calmly going over your "choices" as a consumer of medicine. If you need chemotherapy for your cancer, you can't go to Wal-Mart and by the generic "Keemo-therapy" for $6.99 a dose. So that eliminates a critical dimension of choice. Secondly, private insurance companies are not interested in providing access to health care (as GM has an interest in providing you with a car), but rather have an incentive to restrict it, placing them in an adversarial relationship to their "customers" -- this results, as Kevin as often observed, in the phenomenon of "adverse selection" and, eventually, the death spiral of private health insurance.

This is one area of life and the economy, as every other developed country in the world has figured out, that must been provided for by the state. The things that make free markets "efficient" for producing other goods simply don't apply to health care and we're seeing why now.

True enough, jonas, the unwillingness to engage in large scale rationing by price limits what efficiencies can be achieved by private health care provision. One shouldn't neglect, however, when looking at reforms, what the American system does very well, in an effort to fully grasp what trade-offs (and everything in this world involves unpleasant trade-offs) various proposed reforms contain. The American system IS exceedingly good at providing very large financial incentive for technology innovation, and health care, at it's core, is a technology enterprise.

Now, other state-dependent industries, like military technology, innovate fairly well, but with an extreme amount of inefficiency, due to Congress being heavily involved in directing capital flows. In health care, where the average voter will have a very large demand to personally utilize the service, compared to the average voter's demand to, say, personally utilize a, M-1 tank, the cost pressures will be absolutely huge, and Congress will act as a very tight overseer of capital directed to technology development, and this oversight will very likely result in significant malinvestment. 535 politicians in D.C cannot have as much overall success as a robust private or venture capital market.

Now, I think our hybrid system is so dysfunctional that additional state action is worth looking at, but that doesn't mean that one should nonchalantly dismiss the many pitfalls that are likely to be encountered.

jonas, I agree with you that our med