Editore"s Note
Tilting at Windmills

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April 17, 2007
By: Kevin Drum

AARP ENTERS THE PRIVATE INSURANCE MARKET....Via Matt, AARP has announced that it will begin selling health insurance to people aged 50-64:

Dawn M. Sweeney, president of AARP Services Inc., the tax-paying business unit of AARP, said, "We will use our collective market power to negotiate" competitive prices for the new health insurance products.

....People ages 50 to 64 often find that health insurance is unavailable or unaffordable when they try to buy it on their own. AARP said its underwriting practices would be less stringent than those of many commercial insurers, but it reserved the right to deny coverage to some sick people ages 50 to 64.

To guarantee issuance of a policy to every applicant in that age group is "just not economically feasible," Ms. Sweeney said.

Great. Yet another powerful group with a vested interest in experience-rated private healthcare that works for everyone except, you know, the people who actually need it. That's just peachy.

One of the great arguments among universal healthcare advocates is whether to press for a system that continues to make use of private insurance companies or to press for a purer single-payer system that gets rid of insurance companies altogether. The argument for working with the insurance industry is a political one: if we try to eliminate a role for insurance companies they'll fight us tooth and nail, and that's the last thing we need. Universal healthcare has enough powerful enemies as it is. The argument for pure single-payer is mostly (though not exclusively) economic: in our current system, healthcare administration uses up about 30% of all healthcare dollars, compared to 10% or less in countries with national systems.

I waver sometimes, but basically I'm on the side of pressing for a pure national healthcare system that does away with private insurance except at the margins (i.e., filling in gaps that the national system doesn't address, or providing coverage above and beyond the basics). There are plenty of policy reasons for preferring this, of course, but the main reason is that I don't really believe the political argument for compromising with private insurers. I think they'll fight national healthcare just as hard no matter what the plan is, because the private health insurance industry is so big that even a reduced role means an enormous loss of revenue for them. What's more, I think they'll also judge (correctly) that even a reduced role is just the camel's nose under the tent that will eventually lead to the end of private insurance entirely.

So trying to make nice with the insurance industry is a mug's game. They just aren't ever going to be on our side, and frankly, I don't blame them. All that said, however, the fight against the entrenched interests of the insurance industry gets a lot harder when an organization that might have provided significant lobbying muscle for a single-payer system is depending on a private insurance business line for a big chunk of its revenue. It's definitely not pleasant news for the good guys.

Kevin Drum 12:29 PM Permalink | Trackbacks | Comments (134)

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Comments

AARP has been on the wrong side of this mess going back to their Medicare "compromise" of '03. They just don't get it anymore.

I smell a void forming for real elder advocacy. anyone wanna step up and knock off an ineffective AARP leadership?

Posted by: fromer on April 17, 2007 at 1:14 PM | PERMALINK

CLICK THE LINK. ALWAYS CLICK THE LINK.

William D. Novelli, the chief executive of AARP, said, In launching these initiatives, we are driven by our mission to create a healthier America.

They're trying to create a healthier America that won't involve the government seizing 15% of the GDP, then denying basic healthcare; that's what Canada has, and we shouldn't copy it.

The system we have works great. When I broke my arm, I never had a problem; I was repeatedly offered payment plans, even though I didn't need them. If our system was any better, we'd all be immortal. If you want universal healthcare, you clearly haven't been to the DMV lately.

Posted by: Al on April 17, 2007 at 1:17 PM | PERMALINK

With the glaciers and polar icecaps melting there'll be innumerable ice floes created. Should be plenty enough to put all the old and sick aboard and push them out to sea.

Posted by: steve duncan on April 17, 2007 at 1:19 PM | PERMALINK

Al wouldn't have such issues with arm breakage if he wasn't always patting himself on the back.

Posted by: steve duncan on April 17, 2007 at 1:21 PM | PERMALINK

Spot on, Kevin. George Bush called this "negotiating with yourself" and I think it's the only thing he was right about his whole time in office.

Posted by: Goldberg on April 17, 2007 at 1:25 PM | PERMALINK

So trying to make nice with the insurance industry is a mug's game.

DLC hooligans will not appreciate this explicit act of defiance to their beloved corporate benefactors.

Posted by: Brojo on April 17, 2007 at 1:25 PM | PERMALINK

Al: ... create a healthier America that won't involve the government seizing 15% of the GDP, then denying basic healthcare; that's what Canada has

No, Al dear, in Canada they only have to seize 10% of the GDP. Oh, and for the record, it's mostly done by the provinces, not the federal gov't.

If you want universal healthcare, you clearly haven't been to the DMV lately.

In fact I have been to the DMV lately. Around here it's fast, convenient and courteous. Much better than any insurance company I've ever dealt with.

Posted by: alex on April 17, 2007 at 1:26 PM | PERMALINK

Is AARP an advocacy organization anymore, or a business masquerading as one?

Posted by: Fred on April 17, 2007 at 1:28 PM | PERMALINK

Steve-- Actually, I broke my arm working with a church to build housing for low-income families. Wrong place at the wrong time when somebody dropped some plywood.

Alex-- I must know where this mythical DMV is. I've moved around a lot (always chasing new career opportunities), and I've been licensed by at least twelve states. I've *never* run across a good one. And it takes a liberal to say that the government 'only' seizes ten percent of the income, and then turns around and spends it on bureaucrats.

Posted by: Al on April 17, 2007 at 1:28 PM | PERMALINK

I agree with Al! (And so does Kevin!)

There's no reason to "copy" another country's single payer system, whether it's Canada, France, or Sweden.

We should devise an All-American single payer system, specially tailored to this country's needs.

Surely Al trusts good old Ameican ingenuity, crafter of the Model T and the Remington, among other fine devices, to set up a single system that works for everybody, even better than systems designed by foreigners.

Or, Al, don't you trust America's can-do spirit?

Posted by: the idiot on April 17, 2007 at 1:29 PM | PERMALINK

We already HAVE national health insurance!!!

If someone is out jogging and they trip and faint then they are rushed to the hospital and go into the emergency room BEFORE anyone has a clue whether or not they have inusrance or the ability to pay.

Of course, once the crisis is over then it becomes critical if the jogger has ability to pay.

Should not the people who oppose national healh insurance also be against treating the uninsured? If a hospital treats the uninsured then they have to raise the rates that they charge me. That isn't fair!!!!

So either don't treat the uninsured or have national health insurance. Anything else doesn't make logical sense.

Posted by: neil wilson on April 17, 2007 at 1:31 PM | PERMALINK

Conservatives always point to Canada as though it were some black spot on the canvas of Public Health Care. shhhhh all the progressives whisper don't mention the 'C' word, otherwise the jig is up!

Canada's health system is great, but certainly not perfect. However, its blemishes stem not from lines, but rather, it's level of care.

Canada has what is called a 'liberal' welfare system (no, Al, not that kind of liberal). It provides the most basic emergency and preventative care, and more expansive care for children and the infirm. The logic behind this system is to bring people back into the market from the margins, but not to provide them complete, middle-class standards of care. The U.K.'s NHS is similar - very basic care to bring people back into the system so that they can be productive. In both Canada and the U.K., the population is much healthier per capita than in the United States, but they pay a fraction of what we do nationally.

My only problem with 'liberal welfare' (which is not to be confused with welfare-liberalism) is that its only purpose is to draw people back into the market - it is not concerned with human rights. Social-Democratic Welfare regimes (Sweden, Norway, Denmark) provides universal healthcare at (this part is important) middle-class standards to everyone. These states have the highest standards of living, human development indexes, and are much healthier for a lot less cost (in absolute terms).

There are also 'conservative/corporatist welfare' regimes (Germany, France, Italy, Spain, Portugal, Greece) in which the gov't works with civil society groups to provide care (Unions, Churches, Charities, etc), but these tend to limit women's rights, and miss those at the margins (but coverage tends to be better than in liberal-welfare cases).

Without going into all the causal complexities, it's pretty easy to atleast observe the correlations between expanded welfare and standards of living. Just google "UNDP" and "HDI" or "GINI", and look at the UNDP stats.

Posted by: Everblue Stater on April 17, 2007 at 1:35 PM | PERMALINK

The federal law Neal refers to is EMTALA.

Posted by: Blue Girl, Red State (aka G.C.) on April 17, 2007 at 1:36 PM | PERMALINK

Al, healthcare in the US already exceeds 15 percent of the GDP.

Other than your complete disassociation from the facts, you make a great argument.

Posted by: Chocolate Thunder on April 17, 2007 at 1:39 PM | PERMALINK

As Robert Micheles discovered, organizations trend to become agents for their leader's goals rather than agents for the goals of their members. AARP is not an exception his rule.

Posted by: Brojo on April 17, 2007 at 1:39 PM | PERMALINK

"Yet another powerful group with a vested interest in experience-rated private healthcare that works for everyone except, you know, the people who actually need it."

I'm fifty-seven years old and could retire in two to three years. I won't need health insurance then?

Universal single-payer is great, but until that time I'll take what works for me.

Punditbot

Posted by: Punditbot on April 17, 2007 at 1:43 PM | PERMALINK

IT in healthcare is about as fragmented and ass-backward as any industry. There are very specific reasons that administration in healthcare eats into the money and that's primarily because the paperwork is a nightmare that has resisted automation. Productivity in back office functions in healthcare is at a virtual standstill in comparison to virtually every other business.

It will always be very slow to reform because of all of the regulations associated with administration of hospitals, and because there are generally very few payers in any hospital's market, the incentives are reversed. It's very close to the weirdness we've seen in welfare where cost are basically made to be what insurers will pay.

Putting this in the hands of a government bureacracy will break the system faster than it will reform it. That's the best argument you can make for nationalized healthcare, because only when it's truly broke and people are waiting 10 months to schedule a natal delivery (as happens in Canada) will Americans really fix the system.

Posted by: cobb on April 17, 2007 at 1:43 PM | PERMALINK

[deleted]

Posted by: Rectuma on April 17, 2007 at 1:44 PM | PERMALINK

Cobb -

God forbid they prioritize based on something other than ability to pay. Jesus Christ, these are peoples' lives.

Posted by: Everblue Stater on April 17, 2007 at 1:45 PM | PERMALINK

I have never had a bad experience at the Secretary of State's office to renew my sticker or my license. You don't even have to stand in line: take a number and they call you. And they're quick, efficient and pleasant.
Dealing with a health insurance company is exactly the opposite: you're dealing with a group that is trying their damnedest to avoid serving you. Efvery step of the way, they're either trying to deny yourclaim or delay it--because it means money on their investments every day they delay.
Even with a sour-faced, nitpicking bureaucrat who insists that everything be in order, I'll take that every time over someone I'm paying to be my enemy.

A liberal is a conservative who's had to deal with a health-care insurer.

Posted by: pbg on April 17, 2007 at 1:46 PM | PERMALINK

If you want universal healthcare, you clearly haven't been to the DMV lately.

I've been to the DMV lately. What's wrong with it? I went in, filled out the form, waited on line a bit and was done. The whole thing took less than an hour, and was a hell of a lot easier than the endless hours of negotiating with insurance companies I've had to do.

Posted by: Stefan on April 17, 2007 at 1:47 PM | PERMALINK

The AARP was always on the side of private insurance. AARP was started by Colonial Penn Insurance Company to sell insurance to seniors. Over the years, AARP has been a lot more successful than Colonial Penn.

Around 30 years ago, a court held that AARP was effectively the marketing arm of Colonial Penn, so they were not a non-profit organization. In order to maintain their non-profit status (and avoid income tax), AARP had to put their endorsement out to bid. They moved from Colonial Penn to Hartford Insurance Company. This was a disaster for Colonial Penn, but that's another story.

Back to the topic. In short, AARP was created to sell insurance in the private market and it has never deviated from that role.

Posted by: ex-liberal on April 17, 2007 at 1:48 PM | PERMALINK

Al: I must know where this mythical DMV is.

Amityville, NY works for me (BTW, that's the Amityville of "Amityville Horror" fame, but the DMV is better).

And it takes a liberal to say that the government 'only' seizes ten percent of the income

Perhaps it takes a "liberal" to realize that 10% is less than 15%.

and then turns around and spends it on bureaucrats

Actually, Al dear, in health care the US spends at least 3x as much on bureaucrats as our poor misguided Canadian neighbors.

Posted by: alex on April 17, 2007 at 1:50 PM | PERMALINK

AARP was always on the side of private insurance. AARP was started by Colonial Penn Insurance Company to sell insurance to seniors. Over the years, AARP has been a lot more successful than Colonial Penn, which is why we've all heard of AARP, but not their creator, Colonial Penn.

Around 30 years ago, a court held that AARP was effectively the marketing arm of Colonial Penn, so they were not a non-profit organization. In order to maintain their non-profit status (and avoid income tax), AARP had to put their endorsement out to bid. They moved from Colonial Penn to Hartford Insurance Company. This was a disaster for Colonial Penn, but that's another story.

Back to the topic. In short, AARP was created to sell insurance in the private market and it has never deviated from that role. It was never going to be an ally in moving to single-payer health insurance.

Posted by: ex-liberal on April 17, 2007 at 1:50 PM | PERMALINK

I'm with you on bypassing insurance company opposition.

As for the politics, we should be able to get both corporate and small business support for a plan that gets employers out of the business of brokering and paying for health insurance. I’m not sure why most of them aren’t already screaming for a government takeover. Probably just a reflexive aversion to large government programs in general.

Another selling point that I haven’t seen mentioned in this debate is the savings to state and local government, especially schools. I work for a school district, and we spend $3 million a year providing health insurance to our employees. A universal non-employer based system would effectively be an immediate 6% increase in school funding, without increasing state and local taxes. The federal cost would be far greater than that of course, but combining the savings to everyone (schools, local government, small business, corporations, individuals with private or inadequate employer-based insurance), the overall savings would be broad-based and significantly greater than any federal tax increase.

We need to be building what seems like this natural coalition NOW, and working on this framing NOW, so that we can get some momentum and overwhelm insurance company and anti-tax/anti-government opposition in the next Congress. It could make all the difference when the inevitable round of “Harry and Louise” insurance ads come out. Is anyone with influence starting to work on this with the media and the business community, and if not how can we get it going?

BTW - ignore Al.

Posted by: Common Knowledge on April 17, 2007 at 1:51 PM | PERMALINK

what ex-liberal said. y'all must be pretty young if you're not getting bombarded with AARP's insurance offers every month.

Posted by: paperpusher on April 17, 2007 at 1:52 PM | PERMALINK

If you want universal healthcare, you clearly haven't been to the DMV lately.

Now imagine that we ran the DMV the same way that we ran health insurance: first, you'd have to have your driver's license provided by your job. If you quit or lost your job you'd lose your license, and couldn't get a new one until you got a new job. (Of course, there'd be an option to get private coverage for your license, but that would cost you hundreds of dollars a month).

In addition the license wouldn't be universal: the license issued by one job would only let you drive Fords, while the license issued by another job would only let you drive Toyotas, for example. Some licenses would let you drive any type of car, but not more than 20 times a month, while other licenses would only let you take a car out twice a week. Specific interstates and toll roads wouldn't accept certain types of licenese, so you'd have to find an alternate route to go around them.....

Posted by: Stefan on April 17, 2007 at 1:53 PM | PERMALINK

"I broke my arm working with a church to build housing for low-income families. Wrong place at the wrong time when somebody dropped some plywood."

Whilst helping an old lady across the street and reading to blind cancer victims, no doubt.

A plywood house, Al? What, the liquor store was fresh out of cardboard boxes that morning?

Posted by: Matt on April 17, 2007 at 1:53 PM | PERMALINK

[deleted]

Posted by: Silas Marinara on April 17, 2007 at 1:54 PM | PERMALINK

cobb: people are waiting 10 months to schedule a natal delivery (as happens in Canada)

That must explain all those Canadian women heading south of the 49th parallel. And here I thought they were smuggling beach balls under their shirts.

Posted by: alex on April 17, 2007 at 1:58 PM | PERMALINK

Perhaps a federal law mandating community rating and not allowing anyone to be turned away due to pre-existing conditions. But anything between that and a full federal single payer system without the private insurance industry doesn't seem feasible. More and more it seems it might be worth the effort to fight really hard for single-payer and to abandon the private industry entirely. I wonder whether this AARP move is pre-emptive in nature (by the industry) to derail those type of efforts.

Posted by: Doc at the Radar Station on April 17, 2007 at 2:00 PM | PERMALINK

I am loathe to defend Al, and indeed can't believe I am about to, but I can't stop my fingers...

House construction does use a lot of plywood. It goes on the outside of the studs, then the Tyvek goes on, then whatever siding is to be hung. Also, roof decks are plywood, then felt paper then shingles.

(When we built our country place, we passed on plywood and used fiber-board made from epoxy and hemp.)

But he's still nuts about healthcare.

Posted by: Blue Girl, Red State (aka G.C.) on April 17, 2007 at 2:04 PM | PERMALINK

The fact is, this is a necessary business decision from an insurance perspective - if you don't discriminate between the healthy and unhealthy by acceptance criteria or pricing, and everyone else in the market does, guess who you'll wind up writing?

Your pricing will then have to rise to avoid bankruptcy - and soon you will be only writing unhealthy folks, and your pricing will have to rise still more.

Effective antedotes? Single payer is a good one, obviously. Take all comers laws would be another, and laying out clearly how insurers can price and how they can't. You will have to watch them carefully in this instance, though. Finally, there's the idea of government subsidies or having a subsidised insurer of last resort.

But in the present system, AARP is doing what it has to do to survive.

(BTW, loved Stefans point about how drivers licenses would work if it were run like out health care system. Funny and truthful stuff.)

Posted by: Fides on April 17, 2007 at 2:04 PM | PERMALINK

Fromer, hasn't AARP been squishy even before that, like way back on the old, old Medicare catastrophic?

That said, Kevin, a voucher-based system of national healthcare with private insurers can and does work. Just look at Germany. Now, whether it would work in the U.S., who knows.

OTOH, you never stake out your final compromise position in public from the start, so I'd rather start from a single-payer system and negotiate as needed.

Posted by: SocraticGadfly on April 17, 2007 at 2:10 PM | PERMALINK

I just feel bad for Canadians. Imagine having to schedule deliver before becoming pregnant. All babies must be born in the parking lot. Is that how it works Cobb?

Posted by: bushburner on April 17, 2007 at 2:12 PM | PERMALINK

Stefan's DMV analogy above hit the nail on the head.

The idea the the sainted private sector always provides better and more efficient service than the public sector is a myth worshipped by a bunch of paunchy guys in granny glasses who are still watching their old Milton Friedman "Free to Choose" tapes.

Anyone who has had many dealings with plumbers, electricians, building contracors, auto repair shops, not to mention insurance companies, knows just what a myth this is.

Posted by: Virginia Dutch on April 17, 2007 at 2:13 PM | PERMALINK

Thanks Blue Girl, for being intellectually honest despite our differences. I suppose there are some houses that don't have any plywood in them, but most do. And for low-income housing, it's invaluable. As you implicitly pointed out, in the finished product, the plywood is generally hidden.

Matt-- I never said I was a saint. There are selfless and self-interested reasons to participate. The selfless one is obvious. Self-interested: Building houses is a viable alternative to gym membership. It won't give quite the same all around workout that a gym can, but it's a great way to stay in reasonable shape... for free. It is a bit harder to find similar projects in the winter months, of course.

Posted by: Al on April 17, 2007 at 2:16 PM | PERMALINK

Been to the DMV?!

Geez the troll arguments are dated. Hell, I recently went to the Post Office and got good service.

Automatically assuming a public service will be awful is so, like, 1980's Limboesque.

Get with the times, trolls!

Posted by: Tripp on April 17, 2007 at 2:17 PM | PERMALINK

Al, we spend more than Canada's 10, not 15, percent when you look at private insurance plus federal programs combined. Get your weak sh** out of the lane and take it back to the NIT.

Everblue, excellent post. The GINI is a quick, easy-to-understand, 0-100 scale of economic equality. (In the low 40s, we do rank ahead of "Communist" China, but far behind Europe.)

Ever, also a good breakdowns on the different types, scales, goals and background of public insurance. A Scandanavian type system is never going to be realistic, but, if Fortune 500 companies arms could be twisted enough, we probably could move beyond Canada and the UK to a German-French level of social concern.

Posted by: SocraticGadfly on April 17, 2007 at 2:21 PM | PERMALINK

Yes, the DMV is great IMO. After many years of not experiencing the DMV-I went recently toward the end of the month (should have been horrors!)and was pleasantly surprised-and this was with the new Birth Certificate requirements! The IT systems that are now in use make it much easier.

Posted by: Doc at the Radar Station on April 17, 2007 at 2:21 PM | PERMALINK

A major problem, that has not been acknowledged very often, is that surgeons are paid at once by HMOs, but physicians, such as internists, psychiatrists, and neurologists, go through long haranguing correspondence with the HMOs, to try to collect payments for services rendered to insured patients. The correspondence with HMOs to try to recover funding by the physicians is voluminous, because the HMOs always keep writing back that the physicians must prove that the patient did not have the condition before they purchased the insurance. After six months or so of haggling, the physicians often give up, and receive no payments at all, or if they receive payments, the HMOs have kept the physicians from earning interest on the income, and the interest on the physicians’ income is collected instead by the HMOs.

Posted by: Post-Toll on April 17, 2007 at 2:23 PM | PERMALINK

Post-Troll makes a valid point. I dropped my hospital coverage at the end of June when I left my job (I have military coverage forevermore) and I am STILL negotiating for payments for an internist. The surgeon who did the biopsy and lumpectomy has been paid - the oncologist and internist, still haggling.

Posted by: Blue Girl, Red State (aka G.C.) on April 17, 2007 at 2:31 PM | PERMALINK

Anyway Canada is not the model. France and Japan have more efficient systems.

Posted by: Nemesis on April 17, 2007 at 2:36 PM | PERMALINK

I know someone whose ambulance bill for a ride in the middle of the night from one hospital to another was denied by Medicare. They wanted to pay their bill so they sent the ambulance company the amount Medicare would have paid, about $500 on a $900 bill. The ambualance company wants all of the money and have turned the balance over to a collection agency.

Posted by: Brojo on April 17, 2007 at 3:11 PM | PERMALINK

There have been efforts in Oregon (http://wecandobetter.org) to reform health care by using (among other funds) Medicare dollars. Throughout the development of the proposed legislation AARP publicly remained neutral. Now that the bill is in committee, AARP has publicly testified that it neither supports nor opposes the bill, but they've privately made it known to legislators that they don't even want it getting out of committee if it even has the possibility of touching Medicare. Now it's incredibly clear why they feel that way.

Posted by: Chris G on April 17, 2007 at 3:11 PM | PERMALINK

One of the great arguments among universal healthcare advocates is whether to press for a system that continues to make use of private insurance companies or to press for a purer single-payer system that gets rid of insurance companies altogether.

A quick reminder: nobody but the communist governments gets rid of insurance compnies altogether, and of course some miscreants like perhaps Zimbabwe's "government". In Germany, Switzerland, Canada and some others, the private health insurance industry is growing.

Posted by: MatthewRMarler on April 17, 2007 at 3:15 PM | PERMALINK

Actually, the states are making more progress than the national government.

Actually, I am therefore pleased that Mitt Romney is doing so well amongst Republicans because he has proven that he is serious about healthcare. That trumps other issues, in my books. (Except, perhaps - but only perhaps - Iraq.)

While I disagree with many aspects of Romney's plan, it is real, which is more than I can say about the "incremental steps" and "for the children" posturings of many Democrats.

Posted by: Thinker on April 17, 2007 at 3:17 PM | PERMALINK

(When we built our country place, we passed on plywood and used fiber-board made from epoxy and hemp.)


I wouldn't tell everyone that, the next thing you know you will have a Drum circle of hippies trying to smoke your house. B)

Posted by: vampire77666 on April 17, 2007 at 3:25 PM | PERMALINK

Nemesis,

I agree, in part, with your assertion that Canada is not the model. But neither is France, necessarily.

1) I would prefer a French/German style plan simply because it offers more comprehensive coverage in terms of quality (closer to middle class standards than the Canadian system). However, the decentralized Canadian system is more likely to take hold in the United States given our Federal arrangements and the difficulty in passing sweeping reform at the Federal level. Once large states (by population) like California, New York, Massachussets, Washington, and Connecticut start offering Universal coverage (subsidized by the Feds via tax refunds for out of pocket expenditures), other states will follow suit to remain competitive and to prevent brain-drain.

2) Unfortunately, the French/German/Italian models work primarily through Labor and Trade Unions which have been weakening in the United States in terms of membership and political clout. Publically funding healthcare through Labor, Churches, and business groups becomes difficult when labor, church, and civil society membership numbers are low. Also, these strategies tend to work with heads of households (most often men), and limits the ability of married women to maintain financial independence (in aggregate). If we were to adopt such a scheme, it makes it more difficult for women to leave unhealthy marriages - it's more important, I believe (and this is a normative judgement) to work with individuals than, say, families or other social structures, as this would prevent sub-standard (or absent) coverage for those on the margins (self-employed, laborers, homeless, the infirm).

So, a solution? Given the political realities of the United States, a universal Scandanavian (Social-Democratic) structure from the top-down is unlikely. However, a corporatist regime (like the French and German models) are also not likely to work given the weakness of those middle-man institutions in the United States. I think it is more likely that the Canadian model would be adopted - a basic health plan which coveres everyone universally, which is administered by the States, and still leaves room for private insurance to provide coverage for cosmetic and other specialty (important, but not life-and-death) procedures. Companies may opt to offer such coverage as a way to attract more talent (Microsoft and Boeing, for example, offer amamzing coverage for their employees so that they can attract the highest quality staff). This way, everyone has basic 'survival' care, but still have incentives to move on to better companies to gain broader coverage.

Just a though.

Posted by: Everblue Stater on April 17, 2007 at 3:29 PM | PERMALINK

vampire77666: I wouldn't tell everyone that, the next thing you know you will have a Drum circle of hippies trying to smoke your house.

Fat lot you know. The Drum circle of hippies smoked the leaves and flowers before they turned the stems into fiber board. Unlike you blood suckers like you, they weren't too stoned to figure that one out.

Posted by: alex on April 17, 2007 at 3:37 PM | PERMALINK

I should think the epoxy would discourage that...but yeah, I'll be passing on revealing the location now.

Posted by: Blue Girl, Red State (aka G.C.) on April 17, 2007 at 3:40 PM | PERMALINK

alex:"Fat lot you know. The Drum circle of hippies smoked the leaves and flowers before they turned the stems into fiber board. Unlike you blood suckers like you, they weren't too stoned to figure that one out."


Alex have you tried Sanka?

I====I>>>>>>>>>-------


Posted by: vampire77666 on April 17, 2007 at 3:46 PM | PERMALINK

Chris G:
Medicare works. My brother spent over 5 years dealing with both Medicare and private secondary insurance for our mother. Medicare billings were prompt, easy to understand, and complete. Medicare administrative costs are something like 3% versus something like 18% for private insurers, and physicians with even small practices have to hire billing professionals to deal with the myriad different rules, systems, coverages, and on and on and on.

In our case, there were actually three different secondary insurance companies in the course of a decade, serially hired and fired by the employer for incompetence and/or malfeasance. Sometimes they would delay issuing my mother an id card for 6 to 8 months and then deny a claim because she "wasn't in the system." Often the statements were incomplete, late, perversely obfuscatory, or simply dishonest--it is well known that many private insurers automatically deny any claim once or twice, only to turn around and pay when pressed, on the correct assumption that many people will give up after a single denial. Often their paperwork requirements were so arcane the physicians' offices made mistakes that could take over a year to resolve. Most people would have said ah, the hell with it, but my brother kept meticulous records and made it a point to get everything that was coming to my mom; it was the equivalent of a part-time job.

Posted by: Claire on April 17, 2007 at 3:48 PM | PERMALINK

What I wonder, in discussions about how to combat or neutralize the private insurance industry, is: how much would it cost to simply buy them out??

Hundreds of billions of dollars, certainly. But it would be worth it, in order to get universal health insurance.

Posted by: RT on April 17, 2007 at 3:48 PM | PERMALINK

vampire77666: Alex have you tried Sanka?

No. Have you tried hemoglobin free?

Posted by: alex on April 17, 2007 at 3:49 PM | PERMALINK

A Canucker responds:

...that won't involve the government seizing 15% of the GDP, then denying basic healthcare; that's what Canada has, and we shouldn't copy it.

Not just wrong - this is Rush Limbaugh/malicious propaganda wrong.

Canada has what is called a 'liberal' welfare system ...[snip]... to bring people back into the market from the margins, but not to provide them complete, middle-class standards of care.

Canada's Health system is often mischaracterized as 'welfare' or 'socialist'. It is only socialist in the sense that low-income citizens pay a lower monthly premium, the most destitute nothing at all. In this way, it is comparable to a progressive income-tax regime.

Otherwise it's an insurance plan. We pay monthly premiums for guaranteed access to most medical services. Over the years, *anecdote alert!* I've paid in far more than I've taken out but last fall my wife developed a herniated disc and required first an MRI and then emergency surgery. She was successfully treated by one of Canada's top back specialists and received plenty of follow-up care. She is now about 95% back to full health and mobility. For all this, we paid no extra fees above our monthly premiums and that is how it's supposed to work.

and people are waiting 10 months to schedule a natal delivery (as happens in Canada)

Well, bushburner (at 2:12 PM) has already cracked some snark at this goofiness, so I'll just say that of course our system isn't perfect. There are problems with wait times and funding shortfalls and finding enough doctors (especially in booming Alberta) and the government does bolster healthcare budgets with general revenues but most citizens are on board with this approach. Only a tiny few rabble-rousing, right-wing ideologues ever suggest scrapping it all for a US-style private system.

Posted by: skeg on April 17, 2007 at 3:55 PM | PERMALINK

Skeg says: Canada's Health system is often mischaracterized as 'welfare' or 'socialist'.

I don't think you understand what I mean by liberal.

Forgive me, but I am a poltical scientist by training and tend to use the language of the field. When I say liberal, I am refering to Classical Liberalism (in the same sense that Reagan and Thatcher were neoliberals); more specifically, economic liberalism (Milton Friedman, as opposed to say, Keynes). When I say that the U.K. or Canada has a liberal welfare program, I mean that its program is driven largely by the desire to bring people into the market from the margins, and provides basic healthcare such that they can contribute to national production (in aggregate). This is in contrast to Scandanavian, Universal programs which offer middle-class standards of health care, and Conservative/Coroporatist regimes which are Conservative in the same way that Edmund Burke was conservative, not say, George Bush or Ronald Reagan (although, there are parallels). I would never characterize Canada's health system as Socialist.

Posted by: Everblue Stater on April 17, 2007 at 4:06 PM | PERMALINK

Claire writes: "Medicare works."

I don't dispute that Medicare works for those it covers currently. As the Baby Boomers start getting into Medicare its costs are going to skyrocket. The plan from wecandobetter.org is to try to use the same public funds that are in the health care system, reallocate them, and provide coverage for everyone. Our health care system is in a precarious position, and should seize the opportunity to help secure health care for everyone for years to come.

As for AARP's objections to the plan in Oregon, it would be one thing if they were strictly advocates for those on Medicare. "Our members like Medicare just the way it is, thank you." Unfortunately their position is muddied by the fact that they make a whole lot of money in the Medicare business (Medigap and Medicare Part D plans), and now they've announced that they'll do even more business with Medicare. It's not clear if AARP is more interested in its members' concerns or in the financial benefit of the organization.

Posted by: Chris G on April 17, 2007 at 4:24 PM | PERMALINK

OK, sounds nice, maybe. BTW, how good is Medicare itself for those >= 65? A lady asked me if she needs to buy supplemental ins. as well, what do I say?

Posted by: Neil B. on April 17, 2007 at 4:35 PM | PERMALINK

Hi, Everblue...

Thanks for responding. I get the 'liberal' distinction (I have a smattering of PoliSci) but I was speaking more to your statement about not providing complete, middle-class standards of care. As a Canadian I felt compelled to point out that under our system the rich, the middle-class, the subsidized and the destitute all receive the same standards of care when they show up at the hospital or the doctor's office.

Those with 'the ability to pay' can in certain cases jump the queue (if one exists) by seeking out a private clinic. These clinics are starting to spring up throughout the land and they do skew the effectiveness of the system in favor of the wealthy but most provinces are trying to keep a lid on this phenomenon.

Generally though, Canadians expect, and for the most part receive, equal access and equal care.

Posted by: skeg on April 17, 2007 at 4:39 PM | PERMALINK

Skeg,

Thanks for the clarification. I feel a little silly making judgements (empirical, normative, or otherwise) about places with which I have little (non-academic) experience, but like us all, I strive to better understand. Canada has always been facinating to me - it's this strange nexus between the United States and Europe that seems to (in a idealized sense) embody the best of both sides of the Atlantic.

Also, I just like Vancouver lot. :)

Posted by: Everblue Stater on April 17, 2007 at 4:56 PM | PERMALINK

Also, I just like Vancouver lot. :)

Ah, Vancouver. I grew up there. There's a lot to like.

Youthful restlessness caused me to leave - I went and found work in Calgary and here I've stayed.

For my part, I'm a bit of a USAophile. Whatever we think of your current political masters, there something about the energy and dynamism of American culture that can make our own efforts seem a little hollowed-out and amateurish sometimes.

We do have the CBC, though.

Posted by: skeg on April 17, 2007 at 5:37 PM | PERMALINK

AARP has never been an elder advocate, I dcided that when I found out there was not even a mechanism to contact them about policies. No elections, no complaint lines, just a way to peddle stuff to foggies.

Posted by: Walter E. Wallis on April 17, 2007 at 6:43 PM | PERMALINK

Skeg,

The CBC is a national treasure, to be sure. I live 20 miles south of the BC/Washington Border and much of our peripheral local/community channels are Canadian. CBC, CTV, etc. Depending on border conditions, it is often more convenient for me to goto Vancouver if I need access to a major metropolitan area than it is for me to make it down to Seattle (in whose metropolitan area I grew up). It's a great city. I'm a particular fan of the Dr. Sun Yatsen Memorial Gardens, and Stanley Park.

Posted by: Everblue Stater on April 17, 2007 at 6:52 PM | PERMALINK

Chris:
Sorry, I misunderstood your point, though it is hard to see how reallocation on a small (state) scale would be sufficient to cover enough people.

Neil B., Medicare pays 80% of the things it covers, which is much but by no means all. So depending on one's medical needs, supplementary insurance can be a Godsend if one has the time to do battle with the poltroons in charge.

Posted by: Claire on April 17, 2007 at 7:12 PM | PERMALINK

AARP sold out LONG ago.

I hope even more people tear up their AARP cards and send em in.

Better still, if you haven't joined, don't.

Posted by: Clem on April 18, 2007 at 6:24 AM | PERMALINK

I thought I had heard all the arguments against public health. It had never occured to me that it was necessary to reimburse insurers for loss of victims.

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