Editore"s Note
Tilting at Windmills

Email Newsletter icon, E-mail Newsletter icon, Email List icon, E-mail List icon Sign up for Free News & Updates

July 10, 2007
By: Kevin Drum

SELLING NATIONAL HEALTHCARE....Matt Yglesias on one of the upsides of a national healthcare plan:

There seems to me to be decent evidence that labor market flexibility leads to employment growth. It also seems clear that America's health care system generates substantial labor market rigidities as people with medical histories need to maintain a seamless web of insured-ness in order to remain insurable. [The] economic costs here seem potentially quite large, but obviously you'd need some really smart people to take a look at it.

I don't know the size of this effect either, but I certainly know of people who are basically stuck in their jobs forever because they have an expensive, chronic condition that wouldn't be covered during their first year at a new job. Policies vary, but it's not uncommon for pre-existing conditions to get limited (or no) coverage during an initial period under a new group health plan. As for taking a year off to go to school, or leaving to start a new business, you can just forget it if you have a chronic condition that's too expensive to risk losing coverage for.

It's this, by the way, not cost, that I think is the strongest argument for national healthcare. My own belief, based on looking at the numbers, is that national healthcare might reduce overall healthcare costs in America by a bit, but probably not by much (and maybe not at all). A French-style system that paid doctors and nurses at American levels, for example, would be only moderately less expensive than our current system. In the end, given the political realities of constructing a universal plan, we'd probably save some money on administration, spend some extra money to insure all the uninsured, and end up with total costs only a bit less than we have now.

Which is fine with me. A system that works better and doesn't cost any more strikes me as a huge win for everyone. Rather than overall cost, then, which doesn't matter to most people anyway (as far as most employed people are concerned, healthcare is essentially free right now) the selling point of national healthcare is freedom from the endlessly gnawing problems of our current jury rigged system. For example: HMOs that make it hard to see a specialist. High and rising copayments. Fear of losing coverage if you lose your job. Long waits for non-urgent care. New (and usually worse) healthcare coverage every time your HR department is told to find a cheaper plan.

And more: Small businesses that have a hard time attracting good employees because they can't afford to offer health coverage. Big business that are on the verge of bankruptcy because of skyrocketing health costs. Lack of choice in physicians because you're limited to whichever medical groups have signed contracts with your company's insurance carrier. Losing your longtime family doctor because your company switches insurance carriers and you can only see doctors on your new carrier's approved list.

And yet more: Fear that preexisting conditions won't be covered if you take a new job. The risk of financial ruin if someone in your family has a truly catastrophic illness. Crowded emergency rooms that have essentially become clinics of last resort for the poor. Being forced to go on strike year after year because your employer relentlessly tries to gut your healthcare benefits every time your union contract gets renegotiated. 43 million people who lack health coverage of any kind.

Reducing healthcare costs ought to be a goal of any national healthcare plan, and a truly national plan is probably the only way we'll ever accomplish that. But that's not the way to sell it. Freedom from fear, freedom from pain, and freedom of choice are the ways to sell it.

So: maybe I should take the afternoon off and finally see SiCKO? I think I might just do that.

Kevin Drum 1:30 PM Permalink | Trackbacks | Comments (66)

Bookmark and Share
 
Comments

Wishful thinking on Kevin's part

Posted by: Matt on July 10, 2007 at 1:36 PM | PERMALINK

I agree that there isn't going to be a huge savings in the aggregate, but many inefficiencies that we see today do impose other costs inside and outside the system. There is good reason to expect the US to be able to insure everyone for the same cost that government, insurance and individuals are spending on health care today. If we make sensible procurement reforms, the costs can be controlled a little better.

Long-term, we will save money with a strong policy of encouraging early action.

Posted by: freelunch on July 10, 2007 at 1:53 PM | PERMALINK

Allowing for-profit health care creates inefficiencies all through the economy. Whjat a trade-off. The solution is to make it impossible for health insurers to cherry pick; force them to use community rating and cover all conditions. And compete with a gov't-offered medicare-type plan. With the profit from denying services removed, most insurers would leave the business, and Kaiser and other not-for-profits, plus reasonable private plans, can pick up the slack, along with a gov't VA-style alternative. People who want extra special care can pay for it, but everyone gets the basic care available to state and federal workers and Medicare.

Posted by: Mimikatz on July 10, 2007 at 1:53 PM | PERMALINK

It also seems clear that America's health care system generates substantial labor market rigidities

Which is a good thing and why it should not be changed. If the labor market became less rigid, then workers could more easily quit and get new jobs. This would mean employers would have more problems hiring new workers and they must raise wages in order to attract new workers. This leads to inflation which hurts the economy. It also leads to employers hiring less workers, and therefore greater unemployment, because employers are unwilling to pay higher wages. So a national healthcare plan would be bad for the economy.

Posted by: Al on July 10, 2007 at 1:53 PM | PERMALINK

Yep, we would have been a lot better off if Truman had never advocated policies which tied health insurance to employment.

Posted by: Will Allen on July 10, 2007 at 1:55 PM | PERMALINK

Check out the CNN vs Michael Moore brouhaha and the subsequent fact checking of CNN 's expert

Posted by: Mike on July 10, 2007 at 1:55 PM | PERMALINK

Funny, I was thinking this very same thought today, only more: business has a vested interest in not having employees looking around for new jobs, don't they? Employees will put up with a lot more grief if they're afraid of losing their insurance.

And I was remembering my friend, who discovered a lump in her breast about the same time she'd taken a new job, after being out of work for months.

She waited, not saying a word to anyone, until her insurance kicked in, then played dumb with the doctor she finally saw.

Posted by: KathyF on July 10, 2007 at 1:56 PM | PERMALINK

Well it might be wishful thinking today. But, what about X years from now when 100 million don't have health insurance? Or when 150-200 million don't have it? That's the trend, isn't it?

At some point no one will be able to deny the obvious: That we have to have a national health care system.

And the longer they wait to implement it, the more radical it'll have to be to catch up. Today they could get away with just opening up Medicare (with no changes) to everyone. But once the tipping point happens and most employers can't afford coverage for employees, then they'll have to come up with the real-deal.

Posted by: katiebird on July 10, 2007 at 1:56 PM | PERMALINK

Here's a 2 step program to fix our system:

1. insurance companies cannot turn down an applicant for any reason.
2. insurance companies cannot charge different rates for different people.

Voila. What do you have? The Swiss health care system.

Posted by: evermore on July 10, 2007 at 1:57 PM | PERMALINK

But if any brain-dead dittohead like Al can make up some lies about Canada or France, we definitely should not change.

Posted by: Gore/Edwards 08 on July 10, 2007 at 1:57 PM | PERMALINK

overall, removing the market rigidity would create a huge cost savings for our economy and would have to count as a savings for Universal Health Care.

Posted by: D. on July 10, 2007 at 1:58 PM | PERMALINK

And Al is right -- if there were a free market for wages, it would be BAD!

Posted by: Gore/Edwards 08 on July 10, 2007 at 2:00 PM | PERMALINK

Ah, Kevin.

Yeah, go see Sicko. G_d forbid you actually dare outside your echo chamber. Go have your preconcemptions soothingly validated.

Cue Kevin Drum coming back later today to talk about how Micheal More is the greatest moviemaker ever, even better than Speilberg and Lucas. And then load us up on a bunch of socialist medicine hokum.

Hey, Kevin, maybe I can write your blog now, since I have you down to a tee.

Posted by: egbert on July 10, 2007 at 2:00 PM | PERMALINK

.... we would have been a lot better off if Truman had never advocated policies which tied health insurance to employment Will Allen at 1:55 PM
Truman advocated a national healthcare system.

... The most controversial aspect of the plan was the proposed national health insurance plan. In the November 19th address, President Truman called for the creation of a national health insurance fund, to be run by the federal government. This fund would be open to all Americans, but would remain optional. Participants would pay monthly fees into the plan, which would cover the cost of any and all medical expenses that arose in a time of need. The government would pay for the cost of services rendered by any doctor who chose to join the program. In addition, the insurance plan would give a cash balance to the policy holder to replace wages lost due to illness or injury.
Harry S. Truman's health proposals finally came to Congress in the form of a Social Security expansion bill, co-sponsored in Congress by Democratic senators Robert Wagner (N.Y.) and James Murray (Mont.), along with Representative John Dingell (D.-Mich). For this reason, the bill was known popularly as the W-M-D bill. The American Medical Association (AMA) launched a spirited attack against the bill, capitalizing on fears of Communism in the public mind. The AMA characterized the bill as "socalized medicine", and in a forerunner to the rhetoric of the McCarthy era, called Truman White House staffers "followers of the Moscow party line".* ...

Posted by: Mike on July 10, 2007 at 2:01 PM | PERMALINK

I've been wanting to go independent for a while, but I can't - no reasonable health insurance.

I think as far as big business is concerned, this is a feature, not a bug. They make it much harder to move between jobs or go independent and thus can pay people less and treat them poorly.

It also cuts down on people starting new small businesses that might actually compete with them.

Seems to me we can use a new frame. The right has the 'welfare mother' and the 'trial lawyer'. We need the 'corporate vp', busily mistreating workers so he can get a new condo in Aspen.

Posted by: tom on July 10, 2007 at 2:06 PM | PERMALINK

Who effing cares? Screw your inane wonkery of economic analysis what an obscure benefit of national healthcare.

Try telling that to someone forced into foreclosure because of a life-threatening injury or illness.

Access to a modicum of reasonable healthcare for a human being is not a privilege. One of government's primary functions is to provide for cohesive public health and safety.

Having 47 million people having to rely on emergency rooms for healthcare is obscene.

Corporate profiting on the backs of the sick is obscene.

Bankrupting people's lives's due to illness is obscene.

This conversation is, forgive the pun, sick.

Posted by: Simp on July 10, 2007 at 2:07 PM | PERMALINK

And every labor strike seems to be more about proposed changes to the health care component of the contract than wages.

Posted by: Dave on July 10, 2007 at 2:10 PM | PERMALINK

I've said this over and over again -- the reason that Europe is innovating in design and the arts (and those are areas that are driving the culture -- are leading industrial designers are coming here from Europe, we just aren't producing in that department) is because designers are often independent freelancers. Outside of the heavily unionized hollywood freelancers -- that means that these people have to cover their own health insurance. There is no good way to do that in the U.S. and so we are losing our most creative individuals or potential for creativity. And letting Japan and Europe excel and set the the aesthetic pace for the world. As the world of business is increasingly about the marriage of design and business -- we are again outsourcing a key component of the innovation-based competitive edge.

Posted by: DC1974 on July 10, 2007 at 2:10 PM | PERMALINK

Al: "If the labor market became less rigid, then workers could more easily quit and get new jobs."

Always looking out for the boss, eh Al? Now, if you actually had a job, we might take you more seriously. But probably not. Since your present vocation is being the biggest joke around.

Posted by: Kenji on July 10, 2007 at 2:12 PM | PERMALINK

Over the week-end I realized the US has universal national defense care. Everyone is equally protected by this public good, and most everyone pays their fair share for it without too much resistance. Too bad healthcare is not considered a public good.

Posted by: Brojo on July 10, 2007 at 2:14 PM | PERMALINK

There was a comment upstream that stated that Washington Monthly is in the habit of deleting or editing comments. The comment appears to be gone (or the portion mentioning this was edited out - I'm not sure). The comment wasn't rude, and other than the aside about comments being edited or deleted it wasn't off topic. It was certainly more relevant than fake Al's silly rant. Was the comment deleted or edited, and if so why? I can see deleting certain comments, but do some of them really get edited? That doesn't seem kosher to me. What's up?

Posted by: Common Knowledge on July 10, 2007 at 2:19 PM | PERMALINK

Will Allen -

As I recall, the employer-provided healthcare benefit was implemented during WWII as an approved way around wage and price controls.

Posted by: freelunch on July 10, 2007 at 2:24 PM | PERMALINK

Kevin, actually Michael Moore does make the argument that our health care system (and student loans, for that matter) do tend to force workers into a system of dependency on their employers.

Posted by: vacuumboots on July 10, 2007 at 2:38 PM | PERMALINK

Al's right about how market rigidity works to keep employers from facing the stresses of employees actually excercising choice and free will by pursuing happiness and fulfillment in their work lives. Think about how many of us -- myself included -- would dump the corporate rat race to devote our lives to nonprofits and public service if we didn't have to worry about healthcare costs, and thus could afford to take those relatively low-paying jobs.

But don't tell Al he's right, even if for the wrong reasons. I think it would give him a migraine.

Posted by: Constance Reader on July 10, 2007 at 2:38 PM | PERMALINK

A little bit of misrepresentation here, Kevin.

If you've been continuously employed, you can switch to a new job and have existing illnesses covered even within a "pre-existing conditions exclusion" policy. The HIPAA federal law guarantees this, if you were covered in a previous job (a limitation, to be sure).

In addition, you have the right to continue group health insurance under COBRA, meaning that even with a few months out of the labor force, you're allowed to continue paying group health insurance rates & therefore stay insured.

So for most salaried jobs at the kinds of businesses with group health plans, health insurance is NOT going to stop you from changing jobs.

Small businesses, self-employment, and long spells of unemployment are different, though. One of the many holes our system doesn't cover.

Posted by: polthereal on July 10, 2007 at 2:43 PM | PERMALINK

The strongest argument for health care reform that provides insurance for everybody is one that I've never heard mentioned. In the event of a pandemic (SARS, bird flu, terrorist attack, etc.) we're going to want every person with early symptoms to get treated, quarantined or at least counted. How likely is this when 1/3 of the population is looking at significant costs every time they visit an emergency room? Having a large % of the population living without preventative health care is hardly a concern for the wealthy today. That changes in the event of a fast-moving contagion. I fear we're going to regret not bringing everyone under the health care umbrella before a catastrophe like this occurs.

Posted by: Rick Alber on July 10, 2007 at 2:44 PM | PERMALINK

A person might want to take a part-time job, particularly to allow more time take care of a family member (such as a child), but does not qualify for benefits unless she (you know it's a woman) is full-time.

Posted by: Shamhat on July 10, 2007 at 2:44 PM | PERMALINK

Take a Republican to see Michael Moore's Sicko, you will be surprised at the results.

Posted by: deejaayss on July 10, 2007 at 2:46 PM | PERMALINK

Also, polthereal, there are the jobs that put new employees into a trial period or training period during which they are not available for benefits.

Posted by: Constance Reader on July 10, 2007 at 2:47 PM | PERMALINK

Kevin,
As much as I hate insurance companies, and think that they should all be destroyed, crushed, their accountants and executives torn apart by wild animals in an arena on Pay Per View - - I do think that you're on the right track here.

The single worst aspect of our current system is the whole pre-existing condition crap-ola, and the tie to employment. All the bargaining power is in the hands of the Insurance Companies, and the cronically healthy - who don't NEED insurance (for themselves) (but who need insurance for their countrymen - if they want to reap the benefits of living in a nation of healthy people).

Posted by: osama_been_forgotten on July 10, 2007 at 2:51 PM | PERMALINK

THANK YOU THANK YOU THANK YOU

And thank you again. I have been pounding this particular drum in comments here & at MY's place & Ezra's, and can't seem to get anybody at all interested in the problems with linking healthcare to employment.

Posted by: Brautigan on July 10, 2007 at 2:51 PM | PERMALINK

polthereal,
other problems with COBRA - if your old company goes out of business, your coverage is gone too.

HIPAA base insurance is insanely expensive. (I know, I priced some 4 years ago. By now, it's likely even crazier.)

And for those who have employer based insurance, you often have to pay for family above what is covered for the employee. And some very important services are not covered: hearing aids for the hard of hearing.

That's $5000 out of pocket for my family.

Dental work. That also comes out of pocket. If you had a rotting bone in any other part of your body, you go to a hospital and your health insurange covers it. But a rotting tooth - sorry, SOL, pay for it yourself.

Posted by: MobiusKlein on July 10, 2007 at 2:58 PM | PERMALINK

Sell it as a union-busting tool: "See, with national health care one of the major reasons people go hankering after unions just disappears!"

Posted by: Davis X. Machina on July 10, 2007 at 3:00 PM | PERMALINK

Some people here are misunderstanding Kevin. He's not saying that the main reason for supporting UHC is economic; he's saying that it is the best argument for winning this battle. It doesn't matter how good Sicko is or if Bush woke up tomorrow and announced he's now for health care for all (that would actually be a bad thing), the forces lined up against it are large, rich, and unfeeling. If you can present arguments how GM can actually compete with Toyota or how social organizations can better do some tasks that government does with the removal of insurance expenses, we might actually win this. All we get now is a mere shaking of heads and a shrugging of shoulders.

Posted by: yocoolz on July 10, 2007 at 3:08 PM | PERMALINK

NOT going to stop you from changing jobs.

But it might stop you from quitting your job to start a business or go back to school to learn new skills.

Posted by: Brojo on July 10, 2007 at 3:13 PM | PERMALINK

Kevin, how can you possibly say "Rather than overall cost, then, which doesn't matter to most people anyway (as far as most employed people are concerned, healthcare is essentially free right now)"??

I recently was employed in a position that was "contract-to-hire", meaning I was a contractor for a period of time, so the company could evaluate me before hiring me permanently. I had a decent salary, roughly equivalent to the salary I had at my previous job, but zero benefits. I chose to pay for health care out of my own pocket. Guess what ... I was employed, and cost mattered to me. Even after I was hired as a full-time employee, my company covered $200 a month of health care costs, leaving me to pay hundreds more out of my own pocket.

Do you know how many people are hired as contractors with zero or minimal benefits? Do you know that businesses use contractors more and more and more because it saves them money?

Even if you could guarantee me employment from now until the day I retire, that's not the same as guaranteeing me health care coverage, and yes, to many many employed people, the cost of health care is a huge burden.

Posted by: Paige on July 10, 2007 at 3:20 PM | PERMALINK

Hey, Kevin, maybe I can write your blog now, since I have you down to a tee.
Posted by: egbert on July 10, 2007 at 2:00 PM | PERMALINK

Go start your own blog. I'm sure we will all visit everyday. We will probably make it our home page.

Posted by: Michael7843853 G-O in 08! on July 10, 2007 at 3:25 PM | PERMALINK

My hunch is that while there won't be a lot of cost savings in the first decade or so, single-payer universal health care would do a lot to prevent the expected escalation of health care costs over the long haul.

The reason for this is only partly getting insurance company profits, and all the billions they pay people to cherry-pick customers and deny care and claims. (We'll get that benefit from the start.) And it's only partly the efficiency that will come from unified electronic medical recordkeeping.

But my hunch is that the real long-term cost payoff will be in prevention and early intervention strategies that make overwhelming economic sense in a single-payer system. Not just medical checkups and treatments (though they will make a huge difference), but stuff going way beyond that.

Right now, for instance, our farm subsidies go to grain and cotton. If the government's paying for healthcare, it might see the sense in subsidizing the production of fruits and vegetables, in order to keep their prices low at the supermarket, which would result in more people buying and eating those veggies.

Or take the tobacco industry. Right now, it would probably be roughly a break-even deal, over the long run, for the government to buy out every form of tobacco manufacturer, importer, and distributor, ban new entrants into those businesses, and keep on running those businesses as they are - except for getting rid of their marketing and promotion departments altogether. Cigarettes, cigars, pipe and chewing tobacco would continue to be available as before, but nobody would be promoting its use anymore. Consumption would decline, as would smoking-related diseases.

And there's the kicker: if the government's paying for care and treatment of smoking-related illnesses, buying out the tobacco industry becomes a big long-term winner.

The government could attack obesity in a host of little ways, from subsidizing health club memberships to requiring restaurants that serve soft drinks to offer, say, one sugar-free soda for every two sugared sodas. Short-run savings? Minimal. Long-run? Huge. :-)

You get the idea. If government's going to be paying for everyone's healthcare, government's going to have major motivation for keeping people healthy. And my bet is that it will be pretty successful at this - enough to make a big difference in health costs 30-40 years down the road.

Posted by: low-tech cyclist (formerly RT) on July 10, 2007 at 4:10 PM | PERMALINK

Hey, Kevin, maybe I can write your blog now, since I have you down to a tee.
Posted by: egbert on July 10, 2007 at 2:00 PM | PERMALINK

Egert: I don't even like Kevin that much. Posts here are way down. He deletes comments far more than they do on even the most conservative blogs. (I for example, have at least one computer whose IP address has been blocked from posting here.) He uses affected words like "apropos" way too much. Having said all that, Kevin could eat a bowl of alphabet soup and shit out a more interesting and thoughtful narrative than you are capable of writing. Nice thought, though.

Posted by: Pat on July 10, 2007 at 4:11 PM | PERMALINK

National Health Care needs to be presented as capitalist Freedom. The freedom to have your own business, to be an entrepreneur without the baggage of who you hire. The Freedom to change jobs without the mystery or mirage of the new health insurance situation. The Freedom to go out on a limb with new ventures. The Freedom to entice Toyota to build their plants in our country. The Freedom to plan ahead. The Freedom to stay home and raise a family or care for others. The Freedom to go to school, to improve yourself. The Freedom to marry someone not in perfect health. The Freedom to live with dignity when ill. The Freedom to have medical hope no matter who you are.

This will strengthen marriages, lessen the financial strains, and eliminate half the bankruptcies. It will lower auto insurance and homeowner liabilities rates, and reduce lawsuits, since we’ll all get the care without costing each other.
It will lower public liabilities, such as schools and parks.
It will equalize the country = same basic boat = freedom to be decent

Posted by: Richard W. Crews on July 10, 2007 at 4:13 PM | PERMALINK

This is why I think the bill should be called the "David Allan Coe Health Freedom Act".

Because Johnny Paycheck gets all the credit, but he wrote the song - Take this Job & shove it"

Posted by: Downpuppy on July 10, 2007 at 4:18 PM | PERMALINK

You can have a "free market" for health care, or you can have a free market for the rest of the economy. You can't have both.

Posted by: x on July 10, 2007 at 4:25 PM | PERMALINK

But Kevin this would violate the conservative interpretation of the Constitution: for the owners everything, for everyone else nothing.
Anything less would be unAmerican, right?

Posted by: Northern Observer on July 10, 2007 at 4:35 PM | PERMALINK

Hey, Kevin, maybe I can write your blog now, since I have you down to a tee.
Posted by: egbert

Not likely, egghead, you'd have to learn to read and write.

Posted by: MeLoseBrain? on July 10, 2007 at 4:43 PM | PERMALINK
Rather than overall cost, then, which doesn't matter to most people anyway (as far as most employed people are concerned, healthcare is essentially free right now)

Neither the money that comes out of my (wife's, actually, since her employer offers a slightly less bad plan for us than mine does) paycheck is not "essentially free".

Neither is the money we pay up to our plan deductible on top of that.

Neither is the 20% of most doctor, lab, etc., costs we pay after the deductible.

Neither is the cost of prescription drugs.

Even when we had an HMO plan the substantial payroll deduction and prescription drug costs were not "essentially free", though one might argue that the HMO copays were, at least compared to the "traditional" insurance we have now, "essentially free".

And both the payroll deductions and the other costs seem to go up each year.

I find it unlikely in the extreme that most employed Americans have anything reasonably described as "essentially free" healthcare now.

Posted by: cmdicely on July 10, 2007 at 4:50 PM | PERMALINK

"The selling point of national healthcare is freedom from the endlessly gnawing problems of our current jury rigged system. For example: HMOs that make it hard to see a specialist. High and rising copayments. Fear of losing coverage if you lose your job. Long waits for non-urgent care. New (and usually worse) healthcare coverage every time your HR department is told to find a cheaper plan."
Add to this the problems when the doctors who were in your plan drop out and the specialists still remaining do not look so good. Then if you want to continue with the doctor who knows you, you are stuck going out-of-network (if your plan allows it); and then you have a new set of problems: a large deductible before the insurance kicks in, significantly higher co-pays,etc. not to mention that the amount billed by the doctor is often disallowed as too high by the insurance company, so they cover only a part of it.

I think a one-payer system that is modelled on Medicare would be a huge improvement. For one thing, you could go to the doctor of your choice.

Posted by: Myrna on July 10, 2007 at 4:58 PM | PERMALINK

Trust me on this. Just came back bruised from a family reunion...

Arguing cost with a bunch of conservatives just takes you down the rabbit hole of "market efficiencies." Doesn't matter if the market is actually more "efficient" in getting us to our goal of a healthier society, it just matters that there's an easy catch phrase to parry the argument. The landscape was such that no one, no one would buy the argument of "cheaper."

But just about every member of the family had a story about their pain-in-the-ass insurer and creeping costs. Ultimately, the conservative argument on this ground broke down to, "sure, private insurance sucks, but National Health Care sucks more."

I started asking questions: Bob, how's the diabetes as you near retirement? Are you covered? What's the basement on your plan?

Mary, as you fight abortions, wouldn't it be nice for you to cover the pregnant mother and the born child, no questions asked? Think that might change the minds of some desperate mothers?

Steve, your kid is graduating from college next year. Tell me, is he insured between the time he graduates and the time he gets his first job? You don't know? Better get on hold with your HMO.

Uncle Randy, you own a business, wouldn't you like to stop messing around with health care to focus your energy on big, noisy, yellow machines that maul the Earth? Wouldn't that be better?

The only counter to that was, "Daniel, it's still wrong." And that came from people whose minds I wasn't going to change anyway: the dead-enders.

Posted by: daniel on July 10, 2007 at 5:08 PM | PERMALINK

The best reason to have national health care is because it is the right thing to do!

Posted by: Captain Dan on July 10, 2007 at 5:10 PM | PERMALINK

Wouldn't a single payer national health plan invigorate business start-ups.? It would greatly encourage the growth of small business. I wonder if corporate retail would be for it even with reduced costs since although it would take one of employers greatest costs off the table, it would also encourage competition from below.

Medicare for the rest of us is all we're asking for.

Posted by: dan on July 10, 2007 at 5:30 PM | PERMALINK

COBRA provides continued coverage for limited time and insured must meet certain qualifying criteria. Not good to blithely throw out reference to COBRA as a decent option.
Reallllllly easy to Google. Sheesh.

Posted by: Mellors on July 10, 2007 at 6:46 PM | PERMALINK

The Social Security Trustees report includes the financial information about the trend lines (there are 3 cases) for Medicare as well as SS. On average, the gov't takes in between 17% and 21% of GDP and currently runs substantial deficits. In the latest report, by 2040, IIRC, Medicare will cost around 18% of GDP.
Universal healthcare is necessary but unless the plan incorporates definitive ways to reduce excess cost growth, it will require tax rates to rise to where what the gov't needs to operate will exceed 30% of GDP, almost double the 16.9% currently collected.

Posted by: TJM on July 10, 2007 at 7:17 PM | PERMALINK

al:

"Which is a good thing and why it should not be changed. If the labor market became less rigid, then workers could more easily quit and get new jobs. This would mean employers would have more problems hiring new workers and they must raise wages in order to attract new workers. This leads to inflation which hurts the economy. It also leads to employers hiring less workers, and therefore greater unemployment, because employers are unwilling to pay higher wages. So a national healthcare plan would be bad for the economy."

al, as usual is right. This is why when Adam Smith wrote the Wealth of Nations, he included a whole chapter on the necessity of tieing workers down with health insurance. And it is why the U.S. economy performed so poorly until employer-provided health insurance became common during World War II.

Posted by: bobo the chimp on July 10, 2007 at 7:20 PM | PERMALINK

as far as most employed people are concerned, healthcare is essentially free right now

I have to agree with the folks who have already called you on this comment, Kevin. Your other arguments make some sense, but this really betrays a lack of understanding of the costs of health coverage, even for those who get it through their employers.

Posted by: Elegius on July 10, 2007 at 7:46 PM | PERMALINK

The pre-existing conditions argument is mostly false... Thanks to Ted Kennedy, if someone moves to another GROUP health care plan from a GROUP health care plan, then they cannot have pre-existing conditions excluded... it's a sliding scale, based on how long you've gone without insurance in the medium, but a straight job change will not affect things. Now, this applies to group insurance policies only.

I'm glad you mentioned the "freedom" ascpect.. that's how Reagan sold tax cuts... it's how we sell our plans now!

Thanks,

Mike

Posted by: lord_mike on July 10, 2007 at 10:06 PM | PERMALINK

Small businesses, self-employment, and long spells of unemployment are different, though. One of the many holes our system doesn't cover.

The majority of jobs in America are with small businesses.

Posted by: Constantine on July 11, 2007 at 12:14 AM | PERMALINK

In addition, you have the right to continue group health insurance under COBRA, meaning that even with a few months out of the labor force, you're allowed to continue paying group health insurance rates & therefore stay insured.

Yes, my health plan kindly allows me to pay my share, my former employer's share, and a 10-15% "administrative" markup. What a great buncha guys.

Still, the $300 I pay per month is half of what I would pay if I got a personal policy through the exact same health plan.

Posted by: Mnemosyne on July 11, 2007 at 12:39 AM | PERMALINK

I'm a U.S citizen working in Norway. The biggest difference I noticed is the absence of fear in the work place. Part of that is laws protecting workers from arbitrary dismissal (which are probably a bit too kind to people who don't bother to show up to work), but the key factor is that no one worries about health insurance. The whole concept of the U.S. health care system is inconcievable to Norwegians - until they work in the U.S. for a couple of years and they are appalled. Innovation? Do a study on software written for the oil industry in the past 5 years and identify the percent of the market which originated from products introduced by small European companies. Medicare? My parents are on Medicare and they spend more per month than what I spend on health care in a year for my family. Oh, and didn't a large Japanese car manufacturer close a plant in the South and move to Canada to avoid paying employee health costs? The U.S. needs to wake and realize that the U.S. health care system is a competitive disadvantage.

Posted by: expat on July 11, 2007 at 1:02 AM | PERMALINK

I think Kevin greatly underestimates the savings to be had with a national health care system. Just giving the government the ability to negotiate bulk purchasing discounts on drugs alone should save hundreds of billions of $$$. (Look at the price of drugs here vs. everywhere else in the world....)

Posted by: Jim in Chicago on July 11, 2007 at 1:12 AM | PERMALINK

"...National Health Care needs to be presented as capitalist Freedom. The freedom to have your own business, to be an entrepreneur without the baggage of who you hire. The Freedom to change jobs without the mystery or mirage of the new health insurance situation. The Freedom to go out on a limb with new ventures. The Freedom to entice Toyota to build their plants in our country. The Freedom to plan ahead. The Freedom to stay home and raise a family or care for others. The Freedom to go to school, to improve yourself. The Freedom to marry someone not in perfect health. The Freedom to live with dignity when ill. The Freedom to have medical hope no matter who you are..."
Posted by: Richard W. Crews on July 10, 2007 at 4:13 PM

Yes, Hallelujah Brother! Let's get back to this concept PLEASE. I used to be self-employed many years ago and enjoyed that immensely, but "needed" to start finding an employer with "decent health benefits" sooner or later. Now I work with many others who are basically enslaved to their jobs because of the health benefits. And it is NOT just people who have "pre-existing" conditions. It is people who are afraid to take the RISK of changing jobs or becoming self-employed because they are afraid that they will BECOME sick and they can't trust the system.

Posted by: Doc at the Radar Station on July 11, 2007 at 1:34 AM | PERMALINK

I would like to quit my current job and start a progressive organization but I have a family member with a chronic condition so I can't quit my job unless unless my health coverage is guaranteed. Unfortunately it wouldn't be. Of course, Repubs consider this a feature, not a bug.

Posted by: Stuck Like Chuck on July 11, 2007 at 12:18 PM | PERMALINK

Which is a good thing and why it should not be changed. If the labor market became less rigid, then workers could more easily quit and get new jobs. This would mean employers would have more problems hiring new workers and they must raise wages in order to attract new workers. This leads to inflation which hurts the economy. It also leads to employers hiring less workers, and therefore greater unemployment, because employers are unwilling to pay higher wages. So a national healthcare plan would be bad for the economy.

Fascinating. Has there ever been another time when Al said MORE rigidity helps the economy? Seems to be the opposite of what guys like him usually say. Seems the "Free Market" is only good when employers can use it to put their boot on employee's necks.

It's something most of us sentient beings have known all along, but it's great to see a True Believer admit it.

Posted by: Joshua on July 11, 2007 at 4:10 PM | PERMALINK

I recall that last year a Japanese car company considered starting a new manufacturing plant in the U.S., but then decided to go to Canada.

Their reasons included the virtual illiteracy of American workers, for whom they needed to develop pictoral operating manuals in other plants, and the lack of a national healthcare system.

In spite of state-sponsored incentives on taxes, land and regulatory oversight, the company preferred the Canadian site. They did not want to be burdened with the additional overhead of providing a health plan, when Canadians had one already in place.

Having to arrange employee health benefits has become equivalent to building your own roads and sewers. Healthcare is part of the state infrastructure in the rest of the industrialized world.

Posted by: Daniel Kim on July 12, 2007 at 8:51 AM | PERMALINK

Getting the employer out of medical care would equally solve this problem.

Posted by: Alex Perrone on July 17, 2007 at 10:07 AM | PERMALINK

Lamentably, the answer is often a labor that is so painless it would simply take a precise period of time to secure into position, but is generally left out.

Posted by: Debt Advice on February 27, 2009 at 11:03 AM | PERMALINK

Y6NktJ comment4 ,

Posted by: Gfnttcqk on June 25, 2009 at 2:16 AM | PERMALINK

It is the coolest site, keep so!

Posted by: can tramadol cause trouble urinating on July 2, 2009 at 3:19 PM | PERMALINK




 

 

Read Jonathan Rowe remembrance and articles
Email Newsletter icon, E-mail Newsletter icon, Email List icon, E-mail List icon Sign up for Free News & Updates

Advertise in WM



buy from Amazon and
support the Monthly