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 medical delivery system isn't efficient. As you say, private insurance companies are not interested in providing access to health care. Unfortunately, neither are government bureaucrats. The only people truly interested in your health care are you, your family and your doctor.

It's noteworthy that the parts of health care NOT covered by insurance nor government are the most efficient. E.g., the price of lasek surgery has dropped by a factor of 5 to 10 in the last few years.

The best system for health care would let people pay their own medical costs for smaller items, but have catastrophic care insurance, provided either by the government or private companies. Such a system would let individuals control their own health care to the degree that it was affordable.

Will Allen --

have you even looked at any other health systems, their outcomes, efficiencies and costs. It certainly doesn't seem so.

You're naiviety shows with comparison to defence contracts. You want to come again as to that?

You can't disconnect healthcare, poverty, education, wealth, social mobility, etc. They all compound each other.

I have a feeling you've never felt the bite of any deprivation.

Want to tell us.

The best system for health care would let people pay their own medical costs for smaller items, but have catastrophic care insurance, provided either by the government or private companies. Such a system would let individuals control their own health care to the degree that it was affordable.

Posted by: ex-liberal on March 27, 2007 at 10:13 PM | PERMALINK

And what is catastrophic? And what is not but has high on-going costs? And the insurance companies have the same incentive: not to pay. There's a conflict.

Individuals CAN'T neccessarily control their costs as to what is affordable. That's an idiotic assertion.

Your idea makes no sense in terms of affordability versus income. Want to propose another idea?

ex-liberal: It's noteworthy that the parts of health care NOT covered by insurance nor government are the most efficient. E.g., the price of lasek surgery has dropped by a factor of 5 to 10 in the last few years.

That's unsurprising.

1. LASEK is relatively new, and so, like many new technologies, the price drops early on. This has been true to some extent of other medical technologies, like CAT scans, MRI's and arthroscopic surgery.

2. It's entirely optional, and basically a convenience (not even cosmetic, as you can wear contacts). If it costs too much, just wear glasses or contacts. This is in stark contrast to life saving technologies, where there's much less of an option.

3. Because it's optional, you can take your time and shop around. Wait a few years until the price drops some more. It's more like buying a big screen TV than it is like most medical procedures.

Well, gosh, notthere, as soon as I brought up outcomes, you dismissed them as irrelevant to the quality of care given, which leads me to believe that you really don't wish to discuss the matter in good faith, as much as you want to stand on a soapbox and engage in self-congratulation. Your nonsensical suppositions about matters that you are in a state of abject and total ignorance of, like the degree to which I have felt deprivation (you really have no idea), confirms that you want to engage in a smug, preening, demonstration of your supposed moral refinement, as opposed to the matters at hand. Go engage in your masturbatory sideshow elsewhere.

Ah, Kevin.

Let me tell you a little story.

When I was in college, I was in the gym spotting for one of my powerlifter friends. The guy was pounding them out, but on his fifth and final one, the guy blew out his rectum. Let me tell you, if you've never been on the receiving end of one of those blowouts, more power to ya. Mess was everywhere.

Guy went to the hospital, got it taken carry of. Mommy and daddy took care of his insuransce.

Six months later the guy was back to power lifting, even though doctors begged him not to.

Why do I bring up this story? To illustrate one of the very real dangers of insurance: moral hazard. If my friend didn't have health insurance, he'd have been a lot less likely to risk another accident because it'd be his own money, not some hardworking corporation.

This is the difference between you ivory tower liberals and us down here on the ground floor of realtity. You guys like to theory about people as if they were angels. The rest of us have to deal with the clean up. And it's costly.

You hit on a point that is key to why National Health Insurance will result in a boon to our economy. Just think of the number of people who are fearful of starting up companies, or taking risks simply because of the need for healthcare. How many people do you know that keep their job solely because of the insurance? The answer is a lot. Not only do I see National Health care as a potential savings for our countrya as a whole, but it seems to me that it will increase people willint to take risks.

Well, gosh, notthere, as soon as I brought up outcomes, you dismissed them as irrelevant to the quality of care given, which leads me to believe that you really don't wish to discuss the matter in good faith, as much as you want to stand on a soapbox and engage in self-congratulation....

Posted by: Will Allen on March 27, 2007 at 10:47 PM | PERMALINK

Well, not at all. Believe me, there's no self congratulation here. I could never be that smug!

It's you that confined yourself to a narrow outcome (over 80) and hinted at a superior outcome that plainly is not in line with the facts. What about all the people who died before 80?

Yes, you are right that I have no idea about your life, but your prim earlier response reinforced by this one that doesn't answer any of the other points I raised and misunderstands your own statement leads me to believe you have a somewhat skewed view on healthcare.

You didn't answer any of the wider questions, only the personal. Interesting.

egbert, you old? foolish poster,

One of the biggest frictions to job mobility is lack of health insurance continuity. What is the reason for this? Purely so insurance companies can recharge joining fees and reappraise coverage. It gives them the chance to not cover pre-existing conditions and to refuse or limit coverage.

Are there ANY countervailing securities for the insurance consumer? Any?

Most sane people do not reimpose pain on themselves. Sort of built in. Your friend probably had some self-worth and mental issues that were not dealt with at the time, especially if this weight lifting was not tied to an athletic achievement goal; sort of like the male perverse to female bulimic (though males are too).

Any ideas? For a change.

Notthere why would you be compelled to speculate about the nature of someone's personal life, a matter about which you are completely ignorant, unless you wished to avoid the matter being discussed? That pretty much defines the sort of ad hominem stupidity that is far too common in forums such as this. Why do you have a prefrence for stupidity?

Now, as to your other idiocies, I brought up the life expectancy at 80 study because it A)is readily available, B) demonstrates that people in that age group, and close to it, likely are, on average, getting good health care, and C) they are a politically powerful group which will thus have an interest in sustaining the status quo, which carries significant political ramifications. You, in your ignorance, choose to use this as an excuse to begin speculating about people's personal lives. What an utter and complete ass.

Will Allen.

Talk about a complete ass. You isolate the longevity of US citizens above 80 years old from all others. The longevity of US citizens as a whole is definitely less than a whole number of other advanced economy, universal healthcare countries -- by a significant difference. Maybe you don't understand overall statistics? Maybe you don't want to?

As I admitted earlier, I have no idea about your life. I pointed out that you took the personal points and never answered any of the other statements. I note that this is still true.

Any actual factual answers?

No, notthere, I didn't isolate the longevity of US citizens at age 80. The New England Journal of Medicine did. Why do you suppose they did? Had some extra cash laying around, so they decided, "Hey let's do this study just for the hell of it!"? Or perhaps, just maybe, good gracious, golly gee, they thought this information might have something to tell us about the quality of care such people get in the U.S.?

Yes, let be noted that you admit, in an indirect fashion, to be the sort of nitwit who engages in ignorant ad hominem remarks instead of discussing a topic honestly. Congratulations.

Now, read carefully, you illiterate imbecile. I make no representations about ages much younger than that. I merely used this information to establish that a politically powerful demographic, the middle class elderly, might have substantial reason to think that the care THEY were receiving matched up pretty well compared to other places, and thus might have an interest in maintaining the status quo.

Will Alen:

I don't know how to say it more clearly.

The 80 plusses in the form that you describe (and I see no links to go to and check) are a fraction of of the (ex-)population. Glad you think everything is hunky when the over 80s have a better life expectancy than every other member of the US nation when natives of other advanced economies have a better life expectancy overall. And, conversely, the life expectancy of US citizens as a whole is lower than those same nations, thus, on average, they live less long.

I can't make it plainer how wrong you are.

Let alone, as stated before, as to how much better the poor are cared for elsewhere.

notthere, you moron, I never once stated that I "think everything is hunky when the over 80s have a better life expectancy than every other member of the US nation when natives of other advanced economies have a better life expectancy overall.", if I can make sense of what you wrote fairly ungrammatically. In fact, I specifically wrote that I made no representations regarding other age groups. Can you even read? How stupid are you?

Read EXTREMELY slowly, you cretin. I was referring only (do you know what the meaning of the word "only" is?) to what the political implications might be of the fact that that there is good reason to think that that ONLY (got it, idiot?) the middle clas elderly, a politically powerful group, are receiving good care, compared to other nations.

You cannot possibly be this dumb, can you?

This is nuts, of course, but it's inevitable in any system of private healthcare.

It's not inevitable in a "private system of healthcare" aided by government reinsurance and/or assumption of uninsurable risks (ie., those with preexisting conditions). We've already gone down this road a certain distance: we quite sensibly don't rely on the private sector to insure old people, because no private firm will insure an 87 year old at any cost. We should do the the same for a 45 year old with type 2 diabetes, or a 24 year old with multiple sclerosis. Under such a system, we could actually make community rating work, and require all people to possess reasonably robust health insurance (which would include, inevitably, subsidies to those who can't afford it). It wouldn't be cheap to do, but it would cost the government less than insuring everybody via single payer, and it would be a lot more politically feasible, because such a plan wouldn't double as a death warrant to the health insurance industry. Heck, it might even leave us with a system looking rather suspiciously similar to that of France.

Because somebody asked (I think it was Blue Girl Red State):

$150/mo is 100% catastrophic coverage for accidents, but only 80% coverage for everything else, with a $500 annual deductible. I'm 32 years old.

Will Allen, both I and Stefan have refuted your views and you have given no reasonable answer, only vibuterative cant. See:

J Bean, most people who advocate large reform... 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....

Posted by: Will Allen on March 27, 2007 at 7:03 PM | PERMALINK

ThAT IS WHAT YOU SAID.

And, as pointed out, your assumption does not hold. Stefan answered that explicitly. You're assumptions do not hold. You are a wind bag.

Answer with facts and cites, please.

Yes, you illiterate dunce, I made an assertion regarding the quality of services to the elderly alone, and did not do so regarding other age groups, except, in a post to stefan, when I referred to an extremely narrow subset, the quality of care in trauma centers in large urban
areas in the U.S..

You really cannot read, can you?

Are the figures quoted by Extradite Rumsfield & Ron Byers right? US$800-$1500 pcm for basic family coverage? That's incredible. With conversion rates for US-Australian dollars that works out at (Aus)$960-$1800pcm/$11,520-21,600 pa...! In Ausralia, individual private cover ranges from $50-$80pcm ($600-960pa) family $120-360pcm or $1440-$4320pa, with a 30% rebate from the Government for the privately insured!

Australia is generally regarded as having on of the 2 or 3 best healthcare systems in the world in terms of world class treatment quality, accessibility & affordibility. It's far from perfect, but given the prices Americans are paying, the huge number of uninsured/under-insured & the demographic timebomb of aging boomers, maybe the US should look closely at something like the Australian model.

As in most of the industrialized world we have universal healthcare providing 'free' basic medical care for everyone. That's funded by a 1.5% tax on incomes over $22,000pa. For that you get free doctors visits, free hospital stays & cheap (semi-subsidized) pharmaceuticals under our PBS (Pharmaceutical Benefit Scheme) which ensures that, once approved for listing, no essential prescription ever costs more than $4-$12 to fill. The government uses its' huge 'one desk' PBS purchasing/listing clout to force BigPharma to sell medicines here more cheaply, with stiff competition from generic drugs applying further downward pressure on prices. If the price differential between a namebrand medicine & comparable generic becomes too great, the name brand is de-listed from PBS & then starts costing the sort of prices US consumers pay. Needless to say BigPharma hates the PBS model & is desperate to not see it replicated elsewhere.

Notthere cited the UK problem of waiting lists for elective/non-emergency surgeries & that can be a real problem here too for those solely reliant on Medicare. Medicare only patients also don't always get to choose their hospital or doctor, with resultant problems in continuity of care. For that reason & to take pressure off the public system, the Govt has encouraged the public(with a 30% rebate) to augment their universal care with private coverage. Those individuals who do pay the $600-1000 a year extra can have their elective surgery, treatments, etc at the hospital& with the doctor of their choice, without delay. So, as almost everywhere, the link between wealth & health remains. Significant problems also remain for those in remote communities, particularly Aboriginals.

Nonetheless, on balance, it's an excellent system that has treated me & mine magnificently through car accidents, ordinary ill health & some very serious disease. The prestige of the public system also ensures that many of the nations best doctors & surgeons work in public hospitals, most of which are aligned with universities. As an example a friends mother, an elderly pensioner, received her triple bypass from the same surgeon, in the same OR that the week before performed the same op on Autralia's richest man. She recuperated in a ward, he in a private room in the ritzy adjacent private hospital, but otherwise their care was reasonably identical.

Americans, both as indivduals & employers, are paying so much more than everyone else in the world for a system that is enriching insurers & BigPharma while failing to deliver either universal care or equitable coverage for the expensively insured. Sorry, but for a country with many of the best doctors & hospitals in the world, you guys deserve a lot better.

http://en.wikipedia.org/wiki/Take_Up_Thy_Stethoscope_and_Walk

I'm in bed, aching head
gold is lead
choke on bread
underfed
gold is lead
jesus bled
pain is red
dark doom

gruel ghouls, greasy spoons
used spoons, June Bloom

music seems to help the pain
seems to contemplate the brain
Doctor kindly tell your wife that I'm alive
flowers thrive
realise
realise
realise!

What's really incredible about this whole discussion is that skeptics act as if single-payer or some sort of national health care is this wacky, far-off leftist utopian experiment that could never work in the real world. IT WORKS IN EVERY OTHER DEVELOPED COUNTRY IN THE WORLD. People in Europe, Australia, Canada and Japan may admire (sometimes) things about America, but our health-care system is definitely not one of them. It's as if we were to go to a country where people had household water delivered by truck to their house each day and paid $50 a day for the privilege and half the time the driver wouldn't even show up and they'd go without showers or drinking water. You might suggest that their town might get together, float a public bond, and build a water facility and lay the pipes and construct a reliable infrastructure for water. If the person replied that that was a highly dubious concept, and that how could "city government" be relied upon to deliver fresh water each day and that the private water delivery firms were so much more efficient with their high-tech tanker trucks and all, you'd think they were pretty stupid. Well, that's how just about everyone else in the world thinks about us.

Dan, I realize that you said the Australian system was not perfect, but politically speaking, it goes much further than that. The OECD study "Tackling Excessive Waiting Times for Elective Surgery: a Comparision of Policies in Twelve OECD Countries", which included figures for Australia, reports that in 2001 the percentage of patients waiting for elective surgery for more than 4 months in Australia was 23 percent. The corresponding figure in the U.S. was 5 percent. A lot of these procedures were precisely the ones that the middle class retired receive in large percentages. To move to the Australian system, a politically powerful constituency would have to give up something that they have come to enjoy rather much over the past four decades; largely unrationed health care. What are the odds of that happening?

For a fair comparison, Will, compare the Australians with private insurance to the US citizens with private insurance.

US citizens without private insurance will not be waiting for elective surgery, since they simply can't afford it. As all Australians can receive elective surgery, you are comparing high-income Americans with all Australians.

slightly peeved, I am making a comment about the political implications of trying to change health care delivery in the U.S.. The most sought-after electoral group in the U.S. is Medicare recipients, and Medicare recipients enjoy, by international standards, very low levels of rationing, especially for people in that age demographic. Nearly any move to another system (stats in all countries are hard to come by) appears to carry with it a high likelihood of increasing the rationing for an electoral group whose votes are highly sought, and who have come to think over the past 40 years that rationing is mostly for other, usually poorer, people. This is politically problematic, and it does no good to reply that waiting an extra 12 weeks for a joint replacement surgery is not that big of a deal. In politics, what matters is what is considered a big deal to the person whose vote is highly sought.

People who wish to change the health care delivery system in this country, and I may be one of them, depending on what the proposal is, would be better served with frankly acknowleding this political conumdrum, and discussing how to deal with it, as opposed to pretending that it doesn't exist.

Exactly right slightly_peeved. The 50% of Australians who have private cover do not wait for their elective procedures. The 4 month waiting lists quoted in the survey are only applicable in the public sector. Middle class Australians don't wait any longer for their knee or hip-replacements than middle class Americans. But they, & the nation as a whole, pay a helluva lot less for them.

Dan, the report does not seem to make clear what you are claiming, that the waiting period cited applied only to those Australians who are poorer than middle class, but perhaps I'm just missing it. The results were obtained by telephone survey, and did not seem to dilineate by socioeconomic class.

It's noteworthy that the parts of health care NOT covered by insurance nor government are the most efficient. E.g., the price of lasek surgery has dropped by a factor of 5 to 10 in the last few years.

Rate of price decrease is not the same thing as efficiency. Yes, the newest techniques tend not to be covered by insurance or government programs, which tend to wait till they are proven techniques. And, yeah, those same new techniques tend to have rapid price drops as they move toward more widespread use and acceptance, as there are more providers trained to employ them, etc., the equipment drops in price because of manufacturing improvements, more of the durable equipment is already in the hands of providers who are more confident in their ability to use it over the long term and more willing to spread its cost over a longer term, etc.

The cost decreases may correlate with, but are not caused by (and do not cause) the absence of government or insurance coverage.

Will, there are NO waiting lists for Australian patients with private health cover seeking elective surgery. In some cases there may be a slight scheduling delay of a few days for the particular private hospital or doctor of your choice, but NO waiting lists as such in the private sector. The private sector is more than keen to take your (or your insurers) money & operate whenever you'd like! I can personally assure you that this is the case having availed myself of elective surgery within the private system several times in the past few years, without any delay whatsoever. There ARE certainly waiting lists, in some cases even longer than the 3 months you cited for the 50% of patients without private cover. However, these public system patients will all get their surgery, eventually, completely free.

I know that the low costs & relatively high efficiencies of a combined Universal healthcare with supplementary private sector benefits can seem too good to be true to many Americans, but I assure you in most of Europe, Australia, New Zealand, Canada & much of the Pacific rim, this is the standard we've come to expect. The Australian PBS system for prescription medicine is unusually cost effective, but other than that Australia's healthcare system is characteristic of the universal/private mix typical in OECD countries.

I accept your point that many US voters, particularly the crucial middle-class, middle aged demographic have been effectively alarmed & deliberately mis-informed about the consequences & costs of much needed US healthcare reform. BigPharm & BigInsurance are among the most effective lobbyists & ruthless propogandists on the planet. That's a shame, because you guys are paying way too much for treatment & medicine & for the price you should have something much much better than the woefully dysfunctional & harshly inequitable system you tolerate. Furthermore expecting employers to fund this exorbitant inequity necessarily makes US businesses less competitive.

Regards.

The only people without a healthcare/insurance crisis are those over 65 on Medicare.

People who wish to change the health care delivery system in this country, and I may be one of them, depending on what the proposal is, would be better served with frankly acknowledging this political conundrum, and discussing how to deal with it, as opposed to pretending that it doesn't exist.
Posted by: Will Allen

Yes, indeed. This is supposed to be a reality based community and Will Allen has been pointing out a crucial fact with regard to the extraordinary political power vested, far out of proportion to their actual numbers, in the government's most vocal clients: affluent retirees.

When Medicare was first enacted the over 65 demographic was significantly poorer than the other niches. Their working lives had been scarred by, among other things the Great Depression and WWII. They had very little access to medical care and their pensions were grossly inadequate.

Now, however, we find that enormous wealth has been sequestered in households headed by persons over 65. The beneficiaries of a period of real wage gains and economic expansion. They retired, for the most part, before private defined benefit pension plans were looted and converted in defined contribution plans.

Benefits to this demographic have risen steadily. Part of the reason for the wealth accumulation is that they receive medical care which is heavily subsidized. Their social security benefits and private pensions still, in many cases have COLA's and therefor rise as the wages paid to the workers who support them have been eroded by inflation.

They also now account for the enormous increase on the torrent of Medicaid money into nursing homes. Congress, in its never-ending list of sweeteners to this demographic recently passed an amendment that you could have $750k in equity in your home and still be eligible for longterm care under Medicaid. A program designed for the poor. I do not find any among the poor who have three quarters of a million socked away into equity.

Additionally, Congress keeps raising the amount that can be taken tax free on the sale of housing.

Meet America the Virtual Gerontocracy.

'A gerontocracy is a form of oligarchical rule in which an entity is ruled by leaders who are significantly older than most of the adult population. Often the political structure is such that political power within the ruling class accumulates with age, so that the oldest hold the most power. Those holding the most power may not be in formal leadership positions, but often dominate those who do.'

Now check out the ages of the people controlling Congress' most powerful committees.

You may not agree with Mr. Allen's political views, but he is making an entirely valid point, in my estimation, as to one the thorniest political issues which confront us as we consider how to reform our appalling health care morass.

cfs

'Designing remedies is not terribly difficult. The hard part is generating support for reform. The people who benefit most from America's tax expenditures and social regulations have considerable political power. They vote more often, give more money to campaigns and belong to more interest groups than people who benefit a little or not at all from these programs. A number of influential third-party providers -- pension funds, home builders, health insurers -- also have a vested interest in the status quo. The same is true of organized labor, since unionized workers tend to have good health and pension benefits.' Christopher Howard, Democracy: a Journal of Ideas.

“Most of it involves transfers from the young to the old. Down the road, most medical care will be for people over age 65, and most of the payments will be from taxes on younger people.” - Victor R. Fuchs, economist, Stanford

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.

It's as if we were to go to a country where people had household water delivered by truck to their house each day and paid $50 a day for the privilege and half the time the driver wouldn't even show up and they'd go without showers or drinking water. You might suggest that their town might get together, float a public bond, and build a water facility and lay the pipes and construct a reliable infrastructure for water. If the person replied that that was a highly dubious concept, and that how could "city government" be relied upon to deliver fresh water each day and that the private water delivery firms were so much more efficient with their high-tech tanker trucks and all, you'd think they were pretty stupid. Well, that's how just about everyone else in the world thinks about us.

That is an absolutely fantastic analogy -- but you left out one part: not only do people have to go without showers in the private system, but some people can never afford the water at all and so wind up dying of thirst.

Actually privatization of water supplies is a booming business. With help from the likes of Wolfie over at the World Bank.

http://www.prospect.org/deanbaker/

'The projections of massive future deficits and tax burdens are all driven by projections that health care costs will continue to explode. If these projections prove true, then the economy will be wrecked regardless of what we do with the public sector health care programs. It is misleading to imply that these huge deficit projections indicate fundamental budgetary imbalances, as opposed to the fact that we have a serious problem with our health care system. In particular, combining Medicare and Social Security to imply that the projected budgetary problems are primarily demographic in origin is basically lying.' - Dean Baker

will allen, we all know that reform will be politically extremely difficult. Personally I think the whole system will have to have a catastrophic meltdown before it happens. But your repeated dissemination of bullshit right-wing talking points- most recently about Australia- marks you as a concern troll rather than someone attempting to make an actual contribution to the debate.

Steve, please explain when an OECD report became a right-wing talking point. I've cited an OECD report, and Dan responded with an unsupported rebuttal. Now, it is possible that the surveys involved are skewed because the poorest people in America don't get elective surgery. However, if this comprised a significant portion of the population, then we would likely see lower rates of such surgery in the U.S., on a per capita basis. We don't, so it is not unreasonable to conclude that waiting times, especially for the most unrationed sector of the U.S. population, Medicare recipients, is quite favorable compared to the rest of the world.

MsNThrope, gerontocracy is not a wholly inaccurate description of our political culture, and it's features really do play a very large role on a whole range of issues. Pretending it doesn't exist is not useful. Health care delivery, in particular, cannot be improved without facing this reality, and failure to do so may very well lead to "reform" which makes matters worse. Of course, given the craven nature of the people elected to Congress, it is hard to be optimistic, which, in the end, gets us right back to where we started, which is whose votes are most heavily sought. A republic with democratic processes very, very, likely is the best form of government, but that's a long way from saying that it is without serious flaws.

Will, I can read. I see not one of your claims in this thread that hasn't been thoroughly refuted in subsequent comments. People with direct knowledge of the Australian system have already exposed your selective and misleading use of the OECD data. (Just "citing" something is not some kind of magic talisman, you know.)

aw, shoot! I missed a Will Allen Show...and from the looks of things, it was a corker!

The matter is further complicated by the presumptive heirs to all that accumulated wealth who do not wish to see it eroded by paying for health care, nursing homes and such.

Allowing for so much gain on the sale of housing to be completely untaxed wholly ignores the massive subsidies to housing at the most affluent levels, those 12% or so who can and do file an itemized 1040.

Again the presumptive heirs have a vested stake in that money, thus the enormous amounts now allowed to escape estate taxes. Also without reference to the multiple subsidies in the tax code which contribute to capita formation - being able to deduct the cost of acquiring and maintaining investments.

Some reasonable recapture on these appreciated assets at disposal is not unreasonable considering the vast sums in 'tax expenditure' which went into the accumulation.

'Tax breaks for company health and pension plans have been around for decades. In 1980, these provisions cost $12 billion to $15 billion each. This year, subsidizing corporate health benefits will cost an estimated $100 billion in lost tax revenues ($115 billion if one includes similar tax breaks for individuals and the self-employed). The cost of subsidizing private pensions is greater. And all the tax breaks for homeowners -- deductions for mortgage interest, property taxes, and capital gains -- now exceed $100 billion, up from $20 billion in 1980. These subsidies dwarf everything spent on rental housing for the poor (all these figures come from the Joint Committee on Taxation; other analysts and organizations, using different assumptions and techniques, put the cost of tax expenditures even higher).' - Christopher Howard, Democracy: a Journal of Ideas.

Steve, an anonymous person makes an unsupported assertion (that's a refutation?), and the citing of an OECD report is what what constitutes a misleading post? Please quote more fully from the OECD report, in order to establish that I've attempted to mislead here. I've already conceded that it is possible that I missed something in the report, and thus invited dan to show me where I did. The same invitation is extended to you. If you simply prefer to toss out insults, or make suppositions of someone's personal life, well, that sort of writing isn't unusual here.

Irony alert: Will Allen complaining about unsupported assertions...

MsNThrope, a 100% tax on all estates valued at more than $50,000, with a ten year look back period, until all Medicare and Medicaid benefits paid were recovered, may be useful in many ways. Of course, it would also be fought like the Battle of Stalingrad. It would be entertaining, however, for wealthy and middle class old people to explain why their assets shouldn't be used to pay for their health care, even after they have died.

"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."

tbroz brought up that oecd study long ago, and looking into the definitions it was clear that meaningfull comparisons between the universal healthcare countries and the US were impossible because of the definition of waiting time. Waiting time was defined as the time between scheduling a person for treatment and thier receiving treatment. In the universal coverage countries this would probably be nearly equivalent to the time from diagnosis to treatment. In the US it is very common for there to be long delays between diagnosis and scheduling of treatment. People have to save up for thier surgery, borrow money, get along without as long as they can stand, go without forever, find new jobs with better health insurance, etc. It is also very likely that there are longer delays between noticing a problem and getting a diagnosis in the US on average because americans are more likely to delay going to the doctor for financial reasons.

So mostly it's just a definitional problem, "waiting time" in the study doesn't mean what people might think it means without reading the definition and pondering a moment. The author's did not do this intentionally, that is simply the interval that was easy to measure (treatment centers have records of it). It is also seems that it is a good way to compare waiting times in universal coverage countries, which is what the study was really trying to do.

yes, Jefff, but I am not referring to the uninsured percentage of the U.S. population, in terms of what is politically most relevant. I am referring to Medicare recipients, who, if anything, have shorter waiting times than what the OECD cited in their phone surveys. This is the key point: it is Medicare recipients' concerns which largely drive the health care debate in the United States, and as long as that is the case, useful reform is almost impossible.

Will - I live in Australia & directly interface with both its' public & private healthcare system. My sister is a senior medical administrator. I gave you, in good faith, examples of my genuine personal experience regarding access & waiting lists for elective surgery. I know what I'm talking about & I happen to be telling the truth. If that is "an unsupported rebuttal", so be it.

It's interesting to note however that the OECD report you cited emloyed questionable data & distinctly dubious methodology. According to you:
"The results were obtained by telephone survey, and did not seem to dilineate (sic) by socioeconomic class."

Information regarding elective waiting lists would more logically be obtained from the appropriate Federal & State Health Departments, not through some sort of phone polling(!).

Furthermore, I wasn't saying participation in the private sector was strictly a factor of socio-economic class. Clearly, people with more disposable income are likelier to pay extra for private cover, but many poorer Australains have opted for private cover (at $600-$960 pa it's hardly prohibitive) & some wealthy Australians have chosen to rely solely on the public system. As a generality, most middle-class, middle-aged Australians with families have opted for some private cover, but with a 50% participation rate across the entire population, private coverage is spread across all classes.

I'm sorry you consider my recent, personal & very direct experience of Australia's healthcare system as "unsupported" information, but somehow, someway I'll cope...

Regards

It would be entertaining, however, for wealthy and middle class old people to explain why their assets shouldn't be used to pay for their health care, even after they have died.
Posted by: Will Allen

I'd pay to watch.

I haven't had time to read all of the posts, but I'd like to add my $.02. My family and I (3 of us all told) have a high deductible plan through my employers insurance program. We pay the first $6k of our medical expenses, no co-pay and everything goes towards that premium. Everything routine and preventive is 100% covered. Believe it or not, if we go through all $6k in one plan year it is only marginally more expensive then paying the premium on a $500 deductible plan.

I think people assume a lot of things about what universal healthcare will look like. One is that it will be a low deductible plan. Although our insurance situation is difficult (we don't make a lot of money so paying those expenses is still hard) I see the benefit of making the costs of healthcare more transparent. I am all for a bedrock benefits system where everyone can see the doctor for checkups, toothcleanings, regular vaccinations, lady's care etc...I am against a system that pays for botox and tummy tucks and where everything is "free."

One final note, I think the way to fix all of this is to abolish insurance all together, either government or privately run. Let everyone pay cash and see what happens then. Every doctor I've ever talked with about this bellyaches about having to take all of these crazy insurance programs, all the paperwork, etc...see how they like it when the market actually determines how much they can charge, greedy fucks...

Dan, we are all anonymous here, so anecdotal stories aren't especially helpful. If you have some non-anecdotal data which indicates that the segment of the population which I am asserting is most politically relevant, non-poor retirees, experience no more rationing in Australia than in the U.S., I'd be happy to look at it.

If you want to assert that the OECD report is of dubous value, fine, but it still would be useful to look at any non-anecdotal data you may have. I really am asking in good faith, because country to country comparisons on these issues, in terms of statisically relevant studies, are not easy to obtain.

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.
Posted by: luci on March 27, 2007 at 2:55 PM

Well.. what if we can guarantee access AND choice and *still* spend 16% of GDP and remain the top global medical innovators AND have little or no rationing or waiting for care? I wouldn't have any trouble with that. So, we spend a little less on imported consumer goods, big deal.

However, if this comprised a significant portion of the population, then we would likely see lower rates of such surgery in the U.S., on a per capita basis.

Cite, please. Link preferable.

We don't, so it is not unreasonable to conclude that waiting times, especially for the most unrationed sector of the U.S. population, Medicare recipients, is quite favorable compared to the rest of the world.

We're not comparing ourselves to the rest of the world -- we're comparing ourselves to the developed world.

Every doctor I've ever talked with about this bellyaches about having to take all of these crazy insurance programs, all the paperwork, etc...see how they like it when the market actually determines how much they can charge, greedy fucks...
Posted by: Andre D'Elena

Cash. Not credit cards.

I think people assume a lot of things about what universal healthcare will look like.

No one has to assume -- as others have noted here time and time again, we have concrete examples of how it already works right in front of our faces when we look at Canada, Japan, Europe, Australia, New Zealand, Europe, etc. Pretty much across the board those countries manage to deliver more health care to more people and at a lower cost than we do.

Pretty much across the board those countries manage to deliver more health care to more people and at a lower cost than we do.
Posted by: Stefan

Not just more health care. More quality health care on average. No perverse incentives to deliver poor care at higher prices.

'Indeed, the notion that Americans live better than everyone else is part of our national mythology. Although many Americans reside in spacious (and heavily mortgaged) houses and, by incurring massive debt, own lots of "stuff", citizens of several European industrialized nations live, on average, healthier, more secure lives and work far fewer hours than most Americans.' - The Docile American: The Nexus of God, Labor, Health Care and the Fear to Strike
by Zbignew Zingh

Stefan, as a matter of logic, if the relatively high percentage (compared to other developed countries) of the population which is uninsured in the U.S. are significantly less likely to obtain elective surgery at all, and thus not be included in waiting time stats, then the per capita rates of such elective surgeries in the U.S. would likely be lower, because a larger percentage of the population would not be getting elective surgery.

Now, it is theoretically possible that the insured population of the U.S. obtains elective surgery at such a high rate that it overcomes the fact the uninsured in the U.S. don't get such surgery (and are thus excluded from waiting time stats), thus bringing up the U.S. elective surgery rate, but I haven't seen anything which indicates that. It is also possible, as Jefff noted, that the uninsured do obtain such surgery on a cash basis, but their waiting times are recorded as shorter than they actually are, due to how the stat is defined. As I said to jefff, however, this has no impact on my point, which is that it is the relatively unrationed health care that Medicare recipients receive in the U.S. which is the primary political factor.

Yeah, the physician's and medical school cartel in the U.S. is not helpful, either.

Yeah, the physician's and medical school cartel in the U.S. is not helpful, either.
Posted by: Will Allen

That's another interesting story. The vast public subsidies to the medical schools. I haven't made an exhaustive study of these particular issues since the early 80's. At that point the cost per MD graduated was around $3.5M (in 1980 $$$). And the AMA's 'guideline' for pricing of physicians services was it should place them in the upper 2% of the population from which their patients were drawn.

Doctors, of all people, jumping up and down and screaming about the 'free market' while operating within a heavily state subsidized and state regulated monopoly (the key being the right to prescribe - though there are other very important 'gatekeeper' functions) is irony raised to the nth degree.

Stefan, as a matter of logic,

I didn't ask for a matter of logic. I asked for a cite and a link.

By 'cost' I mean direct public investment.

Stefan, if logical inferences made from assertions of fact are of no interest to you, fine. It's a free country. However, such processes are fairly widely accepted as a legitimate tool of intellectual inquiry.

I didn't ask for a matter of logic. I asked for a cite and a link.

From Will Allen, Stefan? That's the funniest thing I've read at WM all day, and I've just come from your kicking Red State Mike around on the (appropriately enough) Republican implosion thread.

Stefan, if logical inferences made from assertions of fact are of no interest to you, fine. It's a free country. However, such processes are fairly widely accepted as a legitimate tool of intellectual inquiry.

I'll concede that Will Allen is widely accepted as a tool. But the flaw in his premise here, of course, is the validity of the assertion of fact. Ol' Will is long on assertions and short on validity, of course, so Stefan is quite right to question the bona fides of Will's so-called "assertions of fact." ]

Will's failure to put up, of course, surprises no one. Such processes are fairly widely accepted as a legitimate tool of intellectual dishonesty.

Will - OK try this link:

www.aihw.gov.au/hospitals/waitingtime_data.cfm

It confirms the inaccuracy of the less current OECD data you quoted. In the public system the waiting times for elective surgery, across all types were on average only 30 days.

Significantly, you'll also note that the private system is SPECIFICALLY EXCLUDED in ALL of the discussion of elective surgery waiting lists because inclusion of non-figures would be meaningless. Private patients only PAY in a country with universal healthcare because they don't want to be on a waiting list & they do want to choose their own doctor & hospital.

I'd love to give you statistics on waiting lists for the private system, but such data simply isn't available for the logical reason that waiting lists don't exist for those with private coverage. Why would they? With average waiting times for elective surgery officially quoted at only 30 days in the public system, one of the very few selling points the private system has is NO WAITING LIST.

Statistically the reason for not including a private sector zero sum in the data is to avoid artificially lowering the figures on actual waiting times for those who really DO have to wait. Surely you can see that.

Of course, gregory, I did cite the OECD report, and I've cited the New England Journal of Medicine report. Now, of course, if you or stefan wish to refute the logic I employed, you are percectly free to do so. What you and stefan are usually intrested in, however, is hurling invective at anyone who has the temerity to sound a discordant note in the melodies you play in your head.

Gregory, I was making logical inferences regarding facts that others had asserted, that waiting time stats for elective surgeries in the U.S. were artificially low because uninsured people were not receiving such treatments.

With average waiting times for elective surgery officially quoted at only 30 days in the public system, one of the very few selling points the private system has is NO WAITING LIST. - DJO

Whereas it took my Mom 10 days to get a lung biopsy. That's not 'elective surgery'. Her lung had collapsed. She has both Medicare and private coverage from Lucent (thought that's in doubt with take over by that French company).

What you and stefan are usually intrested in, however, is hurling invective at anyone who has the temerity to sound a discordant note in the melodies you play in your head.

Not really, Will, just pompous asses like you.

Thanks for confirming my point, gregory.

Thanks for confirming my point, gregory.

Thank you for confirming mine, Will.

Stefan: We're not comparing ourselves to the rest of the world -- we're comparing ourselves to the developed world.

There you go, moving the goalposts again. Do you doubt that we have better health care than Somalia?

Dan, thanks for the infomation. I'll note that what was cited was median waiting times, not average, but I'm not sure that is significant in the context of what we are discussing, which is the political relevance. It is mathematically possible for both reports to be accurate; that is that the median waiting time is 30 days, while 23 percent of patients have waiting times in excess of four months.

I'll also note that the median time, in the study you cite, for orthopaedic procedures, is more than 50 days. A very significant concern of the politically dominant subset of the population I am discussing, U.S. Medicare recipients, is the time they have to wait for procedures like joint replacements. Now, in a quick scan (content.nejm.org/cgi/content/abstract/331/16/1068), I see U.S. Medicare recipients have a median waiting time of 21 days for knee replacements. Now, perhaps all the non-poor retirees in Australia are getting their joint replacements in private hospitals, so the waiting times cited don't apply. I'd be happy to look at the data. There still seems to be significant reason to believe, however, that the politically dominant subset of the American electorate has rational reason to resist change.

There still seems to be significant reason to believe, however, that the politically dominant subset of the American electorate has rational reason to resist change.
Posted by: Will Allen

Indeed.

How about this: Willing to trade your capital gains tax cuts and mortgage/property tax deductions for UHC?

Well, I'm not opposed to dismantling both the U.S. tax code and the U.S. health care system. Heck, I'm not opposed to Al Gore's proposal to replace FICA and/or income taxes with an emitted carbon tax, as long as it was accomplished via the amendment process, thus avoiding the Federal Government expanding it's tax revenues significantly from it's current percentage of GNP.
My major concern with any significant change in health care delivery is that it does not greatly reduce the incentive for private capital to be invested in the area of medical technology innovation, and that we don't end up having Congress heavily involved in the direction of medical technology innovation, in the manner it is with military technology innovation. It would be terrible if Trent Lott or Robert Byrd ended up with as much power over the pace and direction of medical technology investment as they do over the pace and direction of military technology.

WA: thus avoiding the Federal Government expanding it's tax revenues significantly from it's current percentage of GNP.

It's a distributional issue.

From what I've read MsNthrope, it may be that something approximating the French system would accomplish this, but issues of scalability are not insignificant, among other concerns. Of course, given the political obstacles you and I agree are so deplorable, it is difficult to even have a useful inquiry.

Gregory, I was making logical inferences regarding facts that others had asserted, that waiting time stats for elective surgeries in the U.S. were artificially low because uninsured people were not receiving such treatments.

No, you made a specific assertion of fact regarding per capita rates of elective surgery in the US when you said at 11:19 AM:

Now, it is possible that the surveys involved are skewed because the poorest people in America don't get elective surgery. However, if this comprised a significant portion of the population, then we would likely see lower rates of such surgery in the U.S., on a per capita basis. We don't, so it is not unreasonable to conclude that waiting times, especially for the most unrationed sector of the U.S. population, Medicare recipients, is quite favorable compared to the rest of the world.

Your "we don't" seems to indicate that you know for a fact that we do not see lower rates of such surgery. How do you know this? What is the basis for this assertion? I asked specifically for a cite and a link to your source, and you have still refused to provide one.

Will, we are all anonymous here, so unsupported assertions of fact aren't especially helpful. If you have some non-anecdotal data which indicates that elective surgery per capita is not lower in the US than in other developed nations, I'd be happy to look at it.

Right now we've got a distribution which privatizes gains and socializes the cost.

This model is at the breaking point and difficult choices must be made. I see you guys arguing about how many angels can do the polka on the head of a pin.

What is the basis for this assertion? I asked specifically for a cite and a link to your source, and you have still refused to provide one.

I'm sure you just dropped to the floor in shock over the fact, too, Stefan.

MsNthrope, I think much of the screaming and shouting as to whether the top marginal income tax rate should be in the low 30s, or low 40s, or perhaps even high 40s, for extraordinarily high incomes, is of little real economic import, although I certainly think negative supply side effects eventually kick in, if the top marginal rate gets high enough. I think the constant tinkering with a very complex tax code is economically harmful, despite what ever narrow benefit might accrue to those who lobby with skill. I also think that the system by which we use payroll taxes to transfer wealth from the young working poor to the affluent elderly is both economically and morally disastrous.

If these paradigms can be changed without greatly increasing the size of the federal government, in terms of gnp percentage, I'm willing to listen.

WA: I also think that the system by which we use payroll taxes to transfer wealth from the young working poor to the affluent elderly is both economically and morally disastrous.

We are in complete agreement there.

Stefan, in your first quote of my post, you did not include the statement "We don't", until after you had requested a cite, so I didn't realize that this is what you were referring to. In any case this oecd report:

www.oecd.org/dataoecd/15/52/35028282.pdf

....includes this statement....

"It is also interesting to compare volume of activity for individual surgical pro-cedures. Available evidence on nine surgical procedures in year 2000 suggeststhat countries with no reported waiting times have on average higher levels of activity." Note that the OECD tables include the U.S. as a country in he category "no reported waiting times". It certainly seems as if the U.S. rate of elective surgery is no lower than other countries such as Australia.

Will, I gave you the data you requested. These are the facts:

For the non-poor, middle-aged demographic you consider politically relevant, seeking a knee replacement, in Australia they can either:

1) Use the private system & endure a waiting list for a couple months, but get their operation COMPLETELY FREE
or
2) Pay $600-$960 Australian annually (US $480-$740 pa) for private coverage & get their knee surgery without any waiting list at all.

(Their post-op meds will be capped at Aust $4-$12 / US $3.20-$9.60 per prescription)

Now, I can understand why some of this (non-poor, middle aged) demographic might be resistant to waiting for a couple months even though their eventual operation will be completely free. Therefore, I'd imagine like most middle aged, non-poor Australians, they'd pay US $500-750pa & get their operation when they want with the doctor & at the hospital of their choice.

Yet, you still think this "politically dominant subset of the American electorate has a rational reason to resist change"? That resistance (which you cite but don't substantiate -is that- GOSH! anecdotal?) doesn't sound particularly rational to me.

Tell me Will, how much would this putatively resistant, middle aged, non-poor American be paying in annual private insurance for no-waiting list, elective orthopedic surgery with the doctor/hospital of their choice? If they're paying more than US$750pa, their reasons for resisting change are irrational. Such unfounded fears are also fanned, very deliberately by BigPharma, BigInsurance, who are making obscene profits out of a system designed for their benefit. It is their ruthless effectiveness as a lobby group & as propogandists, rather than the irrationality of Americans that will be the fiercest obstacle to healthcare reform.

Dan, you gave me a study which did not contradict the OECD study. A thirty day mean waiting time does not conflict with the notion of 23 percent of the patients waiting more than 4 months for a procedure. Also, I was not referring to the middle aged, unless you consider middle age to start at age 67. If you have a cite referring to what a 67 (and older) year old Australian citizen typically experiences, I'd be happy to look at it.

Doing the Pissing match over angels on the head of a pin polka.

*flings head back-laughs gaily*

Ooompah-pah! Ooompah-pah! Ooompah-pah!

Second verse; same as the first.

Ooompah-pah!

I disagree with Kevin. I think they are evil. The people who run these corporations know the effects of their practices. They know they are denying care and deliberating allowing people to suffer or die. When this health care mess gets straightened out, the CEOs should be held accountable through a series of very public trials for each murder-by-paperwork they committed. These are crimes against humanity, not "just another way of doing business".

Ex-Liberal: "the price of lasek surgery has dropped by a factor of 5 to 10 in the last few years."

What Alex said.
+: Maybe I can teach you something, if you want to speak of Lasik, not Lasek?
I got one 14 years ago in France, I paid for both eyes about 500$.
You bet it can´t be divided by a factor of 5 to 10 times...
It was a public hospital, waiting time for at that times a quite new procedure was something like 4 weeks for each step.
2 further bits of information:
-A private practice in the same city tried to sell me it to me for more than twice the price. He was faster (no wonder: the public hospital had a very good reputation and was costing half so much)
- At that times, Germany with the system closer to the wish of Ex-liberal was the most expensive country in Europe for Lasik; it is still now, slowly coming down to the level of the others. I know, because I enquired then and still notice now when friends speak about, because that was my first encounter with free market in health care and it shocked me.

My personal conclusion:
-it was the first and last time in my life so far I could really act as an informed price conscious consumer of health care, and it is not for not trying.
- even in such a rare case, the best offer was where a public organization was putting a ceiling onto the market, bringing down the whole price.

I will let you draw your conclusion, but mine follows.
The only efficace control of health care costs is by putting a significant public offer in the market. Did you know that the world cheapest quality healthcare according to some comments I read (peter scheaffer) is in Singapore, where 80% of hospital beds are in public facilities?
And I slowly come out of the socialist closet : my personal experience through 3 european countries and hearing from america (I have close relatives in the US) has me quite convinced you get the better outcome when the state controls a bing chunk of the prices of private practitioners through mandated reimboursed prices, and pharma prices too.
Don´t worry, governments fall on healthcare if mismanaged, and Doctors can defend themselves from communists politicians in Europe. They get a free education, by the way.