In the US, we appear to finally be making some headway on health care reform. There are people who have legitimate concerns about funding, what it means for their existing insurance, how competition between private industry and government services can work, etc. However, these legitimate debates are being completely overshadowed by people that have been fearmongered by our right-wing media establishments, who are going to public debates on the issue and drowning out legitimate criticism by shouting out things like "Obama scares me!", "Obama wants to kill my grandma", etc., and simply booing.

I was curious if the rest of the world is hearing about this, and, if so, what you think about it, from the health care issues involved, to the "debates" themselves.

If Americans want to comment, I don't really mean to exclude you; I was just specifically interested in hearing outside opinions.

For what it's worth, I think that the disruptive element is being counterproductive. There are any number of legitimate concerns about changing health care (none of which I personally agree with), but all that we're seeing from the opposition is crazy people.

I also think that this current bill does not go far enough. For example, while the "correct" answer to how private insurance can compete against government insurance is "the government insurance plan has to be self-sustaining", my preferred answer is "the private insurance industry has screwed the US populace for twenty-five years; it's time for them to be screwed." (Of course the "correct" answer also has the benefit of pointing out that a taxpayer-funded insurance company would not reduce healthcare cost burdens on the taxpayer, which is part of the heathcare reform plan, and one of the parts of the debate currently not being heard, but that doesn't invalidate my philosophical point.)

Less glibly, it also still doesn't guarantee coverage to the entire populace. One still has to independently purchase health insurance, even if it (might) provide group plans to people who currently have no access to one, and provide subsidies to the poor. It's still an additional cost in time and probably money for many of those people who currently can't afford it, and I think some people will still not get it.

Also, in case you haven't heard about these debates/yelling matches, the "Obama wants to kill my grandma" thing is based on two points. One is that there was a provision to provide consultation on end-of-life care for elderly and terminal patients, which was misinterpreted to mean that the government was going to encourage people to die. (The misinterpretation may have been intentional, but it was made by a Republican congresswoman, Michelle Bachman, who has that same sort of vacuous lunacy that Sarah Palin has, so who knows?)

It's being reported extensively, and it's even spilled over into the UK health-care debate. Here, roughly speaking, socialised health-care was invented by the Left, and is now supported by both sides (to the extent that the Tories now describe themselves as "the party of the NHS") -- but accusations that the Right are only paying lip-service are a commonly-used stick for the Left to bash them with. As it happens, the leaders of both main parties have had children who required a lot of NHS care and, even so, died young; both have said that the experience left them with great admiration for the NHS.

I'm not sure that anyone thinks the UK system is perfect, but I think it's very widely seen in the UK as superior to the current US system.

Mischaracterisations of the UK system by US partisans also abound; from the comical (Stephen Hawking) to the merely misinformed (e.g. the false idea that private medical care outside the NHS system is unavailable in the UK).

Peter

What we're hearing in the UK is that our health service is being held up as an example, to you, of why you don't want a national health service like ours:
Ours has much right, and much wrong and no doubt cases of its failures are the ones that are being used to stir up dissent - subjectively, I can't speak highly enough of our health service as a patient: In two serious, and in one case life threatening, emergencies calling for hospitalisation, I've received nothing other than professional and cheerful support from people who clearly enjoy their work, I couldn't and wouldn't have got better had I gone privately through health insurance.
If I need to see a GP I can rely on being able to do so same day, possibly longer if I specify a particular doctor.
However, as a supplier to the health service in my business over many years, I can see so much wrong, so much waste, so much mis-direction and our politicians seem unable, unwilling or just plain too naive to tackle it. "We're giving £50 million in extra funding", when will politicians realise that just throwing money at these services, whether health or education, does not give greater efficiency or better results?

The whole thing has been very confusing for me. I freely admit that I don't understand the whole story, but surely for people who, up to now, haven't been able to purchase such policies, this is a good thing isn't it? I'm unsure as to how it affects people who already have insurance already, I presume it's those people who are bitching about it.

People are very critical of the NHS over here, but I have benefitted from their treatment over many years. I don't have to put my hand in my pocket to see a doctor and the drugs that she prescribes (if any) are a single price (£7.20). I do currently have private health insurance, but that's was an auto opt-in when joined the company so I didn't really think about it.

Until I retired, I had private medical cover, when I retired, I discussed it with my broker, who said: "Let's be realistic, you're a diabetic and whatever you come up with, they'll disallow it as being linked to your condition" - isn't that always going to be the problem with any insurance/health company scheme with profit at the head of the motivation?

Sadly, in most Canadian provinces, private health care that duplicates state-run health care is unavailable, due to vagaries of the specifics of their system. (I forget the details, but it has something to do with reducing the resources available to the government system.) And since many in the US like to conflate the UK and Canadian health care systems, even though they bear little resemblance, you frequently get stuck with that misapprehension.

Oh, no, I've gone political, I was much happier with the French traffic lights!

Yes; there is basically no practical downside for them. They might have political philosophies that are against it, but in real life (not that philosophies are unimportant) they will be better off. Currently, those who are unable to afford health insurance either pay through the nose for doctors visits, spend an inordinate amount of time at a free clinic, or wait until it's an emergency and go to an emergency room. (I think that's a trauma ward or A&E ward to you Brits.) And, generally speaking, those who don't have health insurance are poor and work hourly jobs, so time off of work to see a doctor not only means an expenditure they can't afford, but a reduction in their pay. Often, the public picks up the bill for these people when they can't afford their ER visit, either through bankruptcy, or through the hospitals and doctors increasing costs to cover their losses, or both.


Their arguments seem to be along the lines of (from least unreasonable to most, loosely) "private companies can't compete with government companies", "it's going to cost too much in taxes", "the government shouldn't be involved in health care", "you're going to come between me and my doctor", "you're going to make me change doctors", "this is just the first step towards a complete government takeover of health care", and "you're going to kill my grandmother".

Most Canadians can pay for private health care by driving just a couple of hours south, to the USA.

Our system here still works, but only just. Its major problem, and I really mean MAJOR problem, is our proximity to the USA. Personal profit motivations draw many of our doctors south, which leaves fewer up here in the public system. Which leads to delays in health care.

Similarly, our proximity to expensive paycare down south means higher wages and drug costs up here under the public plan -- higher than they'd be if a more lucrative market didn't exist so nearby.

Please join the rest of the world (well, most of it), and convert to public care. Then our own system here will resume functioning properly.

Cheers

Thank you Bitt, that's described the issue a whole lot better than anything I've read so far.

One of the arguments people have made, though I've not heard it recently, is that if the government takes over health care (again, not part of the current plan), that means that doctors will get paid less and fewer people will be motivated to become doctors.

My counterargument to that has always been: "wouldn't you rather be cared for by someone who wants to be a doctor, and not someone who's just in it for the money?".

I don't know how much doctors in the UK get paid. One would assume that the private practitioners on Harley Street still get quite wealthy, but I doubt that any other doctor is in the poor house.

According to BBC News the average GP's salary is £106,000.

Is that a common practice?

And that's one of the major arguments against public health care in the US: that the Canadian health care is so bad that Canadians have to come to the US to get MRIs.

I'd argue that it makes more sense to modify your system to make private heath care more available. I'm sure those people that travel to the US to pay for health care would much rather pay the extra expense in Canada than the US. After all, the problems you cite with the private insurance in the US drawing Canadians are the exact same problems that the "banning" of private insurance in Canada was trying to avoid.

I would say that Peter has hit the nail on the head for the general point of view here in the UK. I would certainly agree with that.

The NHS is always being discussed, you often get into conversations about it. It is easy to pick holes in the NHS, most people do, but when people really need it the story almost always changes to a positive one.

I have heard several stories about people from the UK needing treatment abroad and being amazed by having to pay for treatment, and surprised the emergency services were not on hand within 5 minutes. I think that's when it hits home that in it's goal the NHS is far and away a more advanced and fair method of apply healthcare to the population than many other systems around the world.

I think it is a sad reflection that our system is being held up as an example of how not to do things, a society who can afford it should apply equal access to health care to all that need it. As a country who has Christian values at it's heart I would have thought the US would have wanted to help all it citizens equally. I'm an atheist myself but have always thought the story of the good Samaritan could be told a little more often.

Cheers

Cris.

No, it's simply that having the profit-driven USA system so close to us, means that our health care workers are naturally drawn south. Which makes our system more expensive to run (we have to overpay the ones that remain), and difficult to staff (making for longer queues, which is what drives some patients south).

If we had some ocean (and VISAs) between us and the USA, like the UK does, then the effect would be greatly lessened, and the public system here would likely work as it was designed. Just like in the UK and other modern countries.

Cheers

Sorry, I didn't mean to imply that it was a valid argument. But that's one of the arguments being made, and since its facts are correct, and merely the conclusions wrong, it's much harder to refute than many of the other ones.

The parallel problems in the UK system, FWIW, are (1) private medicine pays much better than NHS medicine, though fewer jobs in it are available -- thus potentially causing a similar "brain drain" to Canada's, except without needing to emigrate; and (2) British demand for medical professionals exceeds supply, so we in turn brain-drain other countries, which is arguably not being a responsible world citizen.

Mind you, that last one has probably had a positive effect on race relations in the UK -- African, and before that South Asian, doctors were many white Britons' first experiences of other races. Which were thus positive experiences.

Peter

The "average UK GP salary" figures that keep being shouted about are misleading for a number of reasons. The average combines truly salaried GPs and also GPs contracted to provide a service.

In the case of the second type of GP the "salary" that they talk about isn't salary as such, it is the amount the GP is paid for the services they provide. Therefore the payment looks higher than one might expect because the GP also has costs in providing the service that a truly salaried GP does not.

The average also includes GPs that run an on site pharmacy and the earnings from that are also included in their "salary".

When GPs who aren't truly salaried are excluded, the typical GP salary comes out to more like £45k-£80k. Not exactly on the bread line, but also not the levels that the media keep banging on about.

I'm sure that my personal politics are influencing my explanation, so take it with a grain of salt.

Unfortunately, very few of the people who call themselves Christians are actually Christ-followers. If there were more, there would be little need for government involvement in health care because of the overwhelming amount of personal charity, which is really a more faithful interpretation of parable of the Good Samaritan.

That said, in our society where a very small minority of those who call themselves Christians actually practice what they claim to, government sponsored healthcare is the next logical step. This makes sense to me.

My only personal hangup after spending a career so far in the education industry is what a massive failure our government seems to be at running any large system in a remotely efficient and effective way. But just because our government has an extremely high failure rate, I don't suppose that means we shouldn't give them a fair shot at trying to get something right. I just wont be optimistic about it.

It'll be interesting to see how it all shakes out.

Well, the only things in the moving target of the current bill are that the government is supposed to have a direct hand in is a health insurance marketplace for everyone to have access to group health insurance, a possible self-sufficient health insurance GSE (though it looks like that might get nixed), and a medical records clearinghouse.

In my personal opinion, when it comes to paying my doctor, I'd rather have one where the bar to entry is quite high. The amount of time, money, and risk involved in being a doctor means that the reward needs to be equally high. My father's a surgeon. He was 35 before he was finished with school and began working. He had incurred several hundred thousand dollars in debt before seeing a dime. What this means is the system in place has a built in mechanism for weeding out those who are just in it for the money. There are better, safer ways to make more money. The LAST thing I'd want to see is the level of skill required to become a doctor being lowered because there is less competition in the field.

I know you didn't ask my opinion, but if they really want to fix our healthcare crisis, one HUGE step forward would be limiting medical malpractice lawsuits. My dad pays over 50% of his income to malpractice insurance, and he's never had a lawsuit brought against him.

Then again, I'm one of those kooks that believes socialism of any kind breeds mediocrity. If the reward for success disappears, the drive for excellence does as well.

As to how a national healthcare would perform, all I can say is how can you think they'll treat you any better than they do our veterans? Have you ever seen a VA hospital? Keep in mind, our VA in New Orleans is STILL shut down from Katrina.

Actually, it turns out that there's a provision in the bill that everyone is required to hold health insurance, on penalty of a financial … penalty, and there is a legal minimum coverage level for healthcare insurance. Personally, I think this is backwards. We should assume that everyone has that minimum level of health coverage, and people can purchase additional coverage if they desire to do so.

I'm sure the reason it is set up this way is to placate the fiscal conservatives. Ultimately, the government is going to end up spending the same amount of money, since those who can't afford the coverage will be subsidized, which is effectively the same as giving it to them for free, but with the added overhead of the patient having to deal with a lot of paperwork. It also name-checks "personal responsibility". And I suppose there is a potential real financial difference between a default level of coverage plus addons and being required to purchase something that has at least that level of service, though I think there would probably be ways to deal with that.

Anyway, my point is that people shouldn't have to worry about this mess to begin with.

And there's still the possibility of going bankrupt from your cancer treatment.

While I agree that there are a significant number of frivolous malpractice lawsuits, I cannot think of a way to limit them without raising the bar for those who do have legitimate complaints. That's why we have juries and judges.

That said, there can't be too many of them if your dad has spent 35 years as a surgeon without a single one being brought against him. Surgeons have the highest level of malpractice suits, which explains the high premiums.

And, then, that said, is the problem the lawsuits, or is it the malpractice insurance company that's the problem?


Your argument is internally inconsistent. First you argue that the current system is not affected by those just searching for money, and then you argue that removing the people that are just searching for money would be bad.

That said, I don't think that the enormous debt that medical students racks up weeds out those who are only in it for the money; it merely weeds out those who don't plan long-term. I'm not saying that these people are bad doctors; I'm just saying that, given the choice between the two, I'd rather be treated by the one compelled to help people.

I have non-medical relationships with a number of doctors, and the one thing they pretty much universally hate is our current insurance system. One left private practice to become an employee of a hospital specifically so that he could avoid dealing with health insurance. Another has a problem with migraines that keeps her from practicing regularly, and she cannot afford to pay malpractice insurance if she isn't going to be working basically every day. Yet another retired early because she was tired of kowtowing to the insurance companies and limiting her patient interaction in order to plow through enough of them. Another regularly worked at least 14 hour days until her retirement in order to both see enough patients and actually spend time with them.

I feel certain that at least some people looking to enter the medical profession encounter these situations and, based on them, change their mind before they ever get started. They probably go into veterinary medicine instead.

First, the government runs the entire military healthcare system, including the VA, from providers to facilities. The healthcare bill has absolutely zero provisions for the government to be making any significant medical decisions; they'll merely be facilitating the purchase of insurance and the distribution of patient records and mandating base levels of coverage.

Second, the reason that the VA doesn't work as well as it ought to is because it's underfunded. There isn't really anything to underfund in the current bill.

What I was trying to say is that the high risks and monetary input weed out those who are just in it to make a quick buck. The fact that there are those that apply and are turned down is a GOOD thing. There are plenty that WANT do be doctors, even if it weren't for the compensation. But if someone has to crack my chest open, I want him to be not adequate, but the best. To get the best, the mediocre have to be weeded out.

As to a government run program, I fail to see how this will make matters better. As we stand now, all the costs are currently payed for by the paying consumer. Our prices are higher than they would be if the hospitals didn't have to write off the high number of non-paying customers. All we're talking about is shifting the money around. They money still has to come from someone. That someone is still me. This time it's in the form of higher taxes, not higher medical bills. Only now, a normally paying customer will have no greater access to coverage (think transplants) than the non-payers.

I guess it all boils down to the disagreement we have that medical care is a RIGHT. Something that does not have to be earned. I do not believe this to be true.

As to your reference to your medical friends, it seems all four would have been worse off if they were compensated less. In order to make any decent money, all 4 would have had to work more to achieve the same results and all 4 seemed to be trying to work as hard as they could already. All the doctors I know are merely comfortable. Only moderately more so than me. The ones that I would term as rich are working 6 16 hour days a week to achieve this.

So let me be sure I understand you - you are saying that you think people who can't afford medical care shouldn't get any?

Can I ask people in the US a question. I honestly don't know the answer, and what interests me if my perception of your healthcare system is true.

Lets assume I am a US citizen, I am a very low paid worker and have no part of my income available for healthcare insurance or visits to the Doctor (I am assuming you have to pay to see a GP?).

If I had cancer, I may not know this of course, what treatment, help and support is available to me as someone who has no medical cover? And a what point would any state based help kick in?

Now my preconceptions would be that I would basically be left to die painfully unless someone would be able to scrape the money together to help me. Is this actually the case?

If it is, I find it hard to get my head around the fact that a modern society could deny any fraction of it's people the technology and knowledge to help in a situation like that.

Cheers

Cris.

A friend of mine fit you scenario exactly. He was a low paid worker with no health insurance.

He started complaining he had a pain in his shoulder. I recommended he see my primary care physician. He went to her and was immediately x-rayed and then sent to an oncologist. This is where his out of pocket costs basically stopped.

He was diagnosed with terminal lung cancer. At this point it really didn’t matter how much money he had he was going to die in 6-12 months. He elected to “fight” the cancer. In my opinion from there on out he got excellent care. Everything was either written off (and his chemotherapy was not cheap) by the hospitals, doctors or paid for my Medicare. He quit work as soon as he was diagnosed and social security immediately (he did have to make a few calls) kicked in and paid for his living expenses. He even moved to an on the beach lake Michigan rental.

I’m sure there are horror stories out there of poor care for the poor but I was amazed at what our current system supplied him with.

It isn't just VA that is a mess. CHAMPUS was absolutely horrific once you were outside a military installation. Healthcare on post/base was decent (that might be my perception because of my father's work), but once you left, all bets were off. The public just sees the VA, they don't see how broken parts of the rest of the system are.

I am much happier with my current healthcare than I ever was with CHAMPUS/Tricare. I don't think the government can run a healthcare program on a national scale, the military system gives evidence to that.

My argument was that I feel we would be better if doctors who are in it for the money were supplanted by people who were genuinely enthusiastic about practicing medicine. Your argument is that it's already weeding out the money-grubbers and that that's good, but, somehow, that weeding them out twice would be detrimental. I don't know how that makes sense.


We are not merely shifting money around. We are providing preventative care that people currently do not have. It's a cliché, but an ounce of prevention is worth a pound of cure. However, even if I didn't think it cost less, I still think it is positive to provide basic healthcare for everybody, both from a humanitarian basis, as well as a national infrastructure basis: a healthy population is more productive than a sick one, on average, if not necessarily on an individual level, and even for those lazy sods who will never do anything, I'd rather they be healthy to avoid them getting the rest of us sick.


First, organ donation is not based on ability to pay. For one thing, it is illegal to pay for donated organs, so they're free anyway. (This is actually not entirely true, as the wealthy have the ability to fly to a distant hospital at a moment's notice, so they can put themselves on multiple waiting lists.)

Second, I think it is reprehensible that you think the wealthy should have a greater right to live.

That's great.

But totally irrelevant to the health care reform that's been proposed. The government will not have any more control over doctors, hospitals, or any other healthcare providers than they do now. All they're talking about is having a marketplace for group health insurance for people who currently are ineligible for group health insurance, and subsidization of the premiums for those unable to pay for it.

The system will remain effectively the same, except more people will have access to it.

I'm sorry to hear about your friend.

To more completely answer Cris's question:

No healthcare provider is allowed to deny coverage for an emergency based on ability to pay. However, cancer does not qualify as an emergency.

Social Security Disability Insurance provides a base level of income to those who have a medical condition that effectively prevents them from working.

Medicare is a national health insurance provided to those over 65 and those who have significant illnesses. You have to have been on SSDI for two years before you qualify in that case, though.

Medicaid is a national health insurance program run by individual states that is intended to help those who are poor and have serious illnesses. (I think eligibility varies from state to state.) I imagine that this is where your friend got his coverage from, and quitting his job was probably a prerequisite for him to be eligible. (Not that I'd want to continue working, either.)

I don't mean to exploit your friend's illness, I merely use it as an example, and cancer is an insidious disease that can have no symptoms until it's too late, so this may not fit his situation, but if your friend had had health insurance and had regular checkups with the doctor, his cancer might have been detected when it was still treatable. It's this sort of thing that bothers me.

Few, if any, people are left to die on the streets, but people are left to become sick enough to die.

People would be up in arms if these programs were abolished, but the notion of extending them to more people sends them into apoplexy, and the proposal doesn't even go that far.

Yes, my friend did have the kind of cancer that basically had no symptoms until it’s too late. I believe it was referred to as “small cell lung” cancer. It was caused by 30 years of smoking.

Like, me (even though I have average insurance coverage) he was of a mind set to only go to the doctor when you see a bone sticking out. That’s probably another reason men don’t live as long. They seem reluctant to go to the doctor.

There will always be people who just won't go to the doctor. There's not much to be done about that. But the number of people who would go if they could afford it is not insignificant.

Thanks for the answer, it has added quite a lot of clarity to the actual levels of care available. There is more than I thought. But it would bother me too.

My Mum has worked in the NHS most of her life, and has always said prevention is better than cure. It would be interesting to see if an NHS like system was introduced in the US that how much the overall cost to the country would change. I think there would be an argument for saying the cost could reduce as illness would be picked up much quicker and be much cheaper to treat.

Like Godfrey said earlier on, these days it's pretty easy to see your GP. I don't think the system is widely abused, of course there is some, I think there is something quite wrong to have to balance your own personal health with your own personal wealth. It doesn't feel very human to me.

Cheers

Cris.

What annoys me as well is that when an uninsured person does go to the doctor in many cases they must go to an emergency room in order to be treated in a timely manor.

Seems to me the cost of more free clinics could be balanced out by the savings of emergency visits. As well as the benefit of not plugging up the system with head cold patience’s that take resources away from real emergency patients. However I’m sure a lot of head cold patients would be screaming when they get turned away from the ER.

Many insurance companies here are pushing "wellness." They are offering 100% free checkup visits, weight loss programs and even in may cases free gym memberships.

Being a profit drive organization they see the light as well.

I assume you mean the ER is faster than a free clinic would be. Because a regular doctor won't see them at all without ability to pay. And it's not like the ER is fast.


I don't know what they're like elsewhere, but none of the free clinics here are run by hospitals. That cost would have to be passed through the government. Seems to me that doing it that way would be a waste of resources when you could use the same money to provide insurance to those people and they could see whatever doctor they wanted.


I don't think anyone prefers to go to the ER.

In addition, people are still triaged. The headcold patient will always be prioritized lower than the heart attack victim.

I haven't really followed this thread as closely as I should, mainly because I'm engaged in another healthcare debate on a mailing list I'm subscribed to. But I did want to address one portion of the discussion about the VA.



The canard that VA care is horrible is outdated. Read this article for the gory details, but here's an excerpt to chew on.



The article goes into the hows and whys, and I encourage you to read it to understand that the VA has gotten a lot better than it used to be.

The government doesn't have any control over the doctors, hospitals, or any other healcare providers once you leave base/post. That is the point of my post - it was fine when I was on a military installation, but once I left the medical coverage basically sucked ass. As I understand it, that is exactly what the national healthcare plan is looking at.

How about an opinion from an insider who's lived on the outside?

IMHO, as a Canadian living in the US, I'd rather live with the problems inherent in the Canadian system, than the problems inherent in the US system.

All the fear-mongering is a bit frustrating, and I think what it really boils down to is that the people stirring it up have learned how to avoid (or haven't encountered) the problems in with the US system. My father-in-law was visiting recently, and one of his biggest complaints was "the government is going to decide who gets cared for based on cost! People with kidney dialysis will be the first to go!" (Naturally, he listens to Rush Limbaugh religiously.) I cheerfully admit to not understanding that viewpoint -- under the current system, the insurance company decides based on cost (insurance companies are well known for dropping coverage for the expensive cases), based purely on realizing profit. I'd rather have the government saying "we can't afford that," than an insurance company saying "that doesn't bring us a profit." To me, the former is economic reality. The latter is... disgusting ethics.

Every time I talk about health care with an American, they inevitable ask "Don't you have to wait?" or "How long was it before you could get an appointment?" It's always interesting to watch their faces when I tell them I've waited longer to see a doctor, and get appointments in the US, than I have for similar care in Canada -- and my dad has had the same experience. Of course, that's not true for everyone.

Personally, I hope for success with the change -- with the unemployment rate as high as it is, people are starting to realize (unlike lectric's sentiment) that health care shouldn't be based on income (hi, here's your pink slip, and now that you have no income, here's an additional $1000/month bill for a health insurance policy), so the country has never been better primed.

However, despite my hopes, I have no expectation that this will ever succeed -- it's too politicized, by which I don't mean "there's a lot of highly charged debate over the value, or the solution," though there is plenty of that. Rather, it's too mired down in the existing US political process, which ignores the good of the people (you know, a government for the people, by the people?) in favour of lobbyists currying favour for their conglomerate backers. The political process needs to be fixed before anything else can be improved.

One of the guys on my hockey team is an ER doc. He once had a young woman come in because of some strange bumps on her tongue. They were her taste buds.

People go to ER because they know where it is, or it's late at night and it's the only thing open to treat their perceived emergency. edit: or they've let whatever it is fester so long it's become an emergency.

I'm totally reposting that anecdote to my LJ friends list. LOL.

Okay, I misunderstood. Are you saying that the off-base healthcare coverage you had worked more-or-less like private health insurance? That you went to "any" doctor and the government reimbursed either them or you? Or did the government pay for Blue Cross or Aetna or some other private insurance plan?

What was wrong with the coverage? Not enough doctors in the network? Poor reimbursement levels?


Without understanding your complaint better, I can't comment well. However, I think you said you have private insurance now from your employer. You won't be affected.

That said, when you were off base, would you rather have had the healthcare plan the government provided you, or nothing at all?

It was cumbersome and almost non-existant. I had to go to the ER once because it felt like I destroyed my knee when I was at school - couldn't put any weight on it at all and you wouldn't believe how badly it hurt. The ER took my insurance (CHAMPUS), gave me x-rays and said they couldn't see anything wrong with it and that was the limit of what they could do. Nevermind the fact that there was obviously something wrong based on the swelling, bruising, etc. They couldn't even give me a prescription for pain killers or crutches. I think the bill was around $400 for what was basically just a set of useless x-rays.

It was easier to drive the 2+ hours down to Luke AFB for healthcare than it was to use the insurance outside a military installation.


I'm not sure you can say people won't be affected. At the very least the service has to be paid somehow (until it becomes self-sustaining like they claim). Does that mean higher taxes or other pots of money get raided? Will that system end up cannibalizing private insurance that can't compete based on cost alone? In a time when companies are raiding pension funds, freezing 401k contributions, etc are they going to start dropping private insurance for the national system to save more money? I think it has the potential to affect a lot of people that at first glance you wouldn't think it would.

However, based on my previous experience with government sponsored insurance, I don't have very high hopes for whatever it evolves into.

I am not a doctor, but I have worked in health care for a few of years. I can tell you once government steps in and takes control of the whole system you can be sure the reimbursment rates will take a nose dive. This means doctors will necessarily see their income go down over time and so yes you will find doctors leaving the profession to do something they can make a decent living at and many who will be discouraged from entering the profession at all. Let's not forget that the current administration has an ever expanding bloodlust for regulating "excessive" pay. You don't suppose that public health care would dovetail nicely with efforts to stick it to those "greedy" doctors just like financial regulation gave rise to taking care of those "money grubbing" Wall Street types do you? It's all by design.


Nope. I'd rather be seen by the best which in a free market would be encouraged to participate in health care.

Stu

That sounds to me more like a lousy ER than anything to do with your insurance. If you were indigent, you should have gotten more care than that.


Sadly, that sounds about right.


Did you ever go to a doctor for a physical exam or anything like that?


Fair enough. I meant that the coverage you currently have won't be directly affected by the proposed plan.


Keep in mind that the additional services to be provided are to be provided by private insurance companies, and they will be paid with premiums from individuals, just like everyone else's insurance. The only cost outlays from the government are for subsidies for the poor and from the semi-private "public plan", which is required to pay for its own expenditures through premiums just like any other enterprise. It is explicitly not supposed to be funded by the taxpayer. It does have the potential advantage of getting potentially cheaper loans due to its supposed backing as a GSE or GSE-like enterprise.

This actually points out a big difference between this system and CHAMPUS. Under the reform bill, if you're unhappy with your insurance, you can switch to a competing provider. CHAMPUS was a monopoly.


Any company with a payroll greater than $250,000 a year that doesn't provide healthcare insurance for its employees is required to pay into the subsidy fund.

So that does mean that smallish businesses that currently provide no healthcare have increased costs. But the insurance marketplace also works for them, as small businesses have generally been unable to get decent group plans. And the small businesses that do choose to provide insurance for their employees will get a tax break.

I guess my point is, assume for a second that there is no public option at all. The reform bill is still significant in the creation of a marketplace for group health insurance that can be bought by anyone, and in streamlining medical recordkeeping. I, for one, am sick of filling out the same 8-page form at every doctor's office I go to.

I assume you're referring to Medicare/Medicaid reimbursement rates. The public option is explicitly not modeled after that and is intended to work as a private company.

That said, again, if the public option were to go away completely, which is a possibility, you're still talking about creating a marketplace that currently does not exist.


That's exactly my point. People who are enthusiastic about medicine (or any field) are likely to be the best at it, and many of them are being driven away by the insurance companies.

And a free market in health care currently doesn't exist. No one has anything approaching perfect information. Group health insurance is effectively a series of employer-sponsored monopolies. And it's not a simple commodity anyway, as insurance providers clearly deny their product to those they feel they can't make any money from.


I don't think that anyone thinks that doctors are, on average, exceptionally avaricious. Change that to insurance companies and you might have a case. A case that no one will defend.

And by "money-grubbing Wall Street types", are you referring to the people who took taxpayer money intended to bail out their institutions that they ran into the ground by defrauding each other and the populace and then paid for performance bonuses and parties with it? And then afterwards were told that if they wanted their companies to benefit off of the taxpayer that they were required to have a salary cap?

Why is it that you're all for companies getting taxpayer money and having them being able to squander it however they wish without restriction, but if that taxpayer money instead goes to individuals to try and make sure they don't get sick, you get all up in arms?

Not outside of the military installation. Routine stuff could wait until I got back home. My dad was (eventually) the NCOIC of Aerospace Medicine, so we got to deal with the Doctors that dealt with the pilots instead of the general practicioners. I think that is part of why my view of the care we received on base is so skewed - we got sort of preferential treatment.

I keep meaning to link to this four-page summary of the healthcare bill. It seems to be a good summary, if light on details here and there. Unsurprising given a 250:1 ratio. So there you go.

Yeah... I recently paid a $250 bill for three stitches. Three. Insurance covered the local anesthetic, though.

Given it's still government (more so) and it's bargaining power, I don't see why the public plan reimbursement would be any more generous.



Actually I was referring to the job market and the looming caps on pay for providers as well as the unavoidable reduction of their income if gov. health care becomes entrenched.



I don't have anything against it in principle. I don't believe the government should have used public money for the companies in the first place (hello Adam Smith?). The control over pay of executives of bailed out companies pay will make it that much easier for government to make the leap to private, non-TARP companies. Which is undoubtedly part of why the companies were "bought" in the first place.

Stu

Because it is intended to compete with private insurance companies. It is intended to negotiate rates with providers just like every other insurance plan. Sadly, the current text of the bill does not reflect that, and if that doesn't change, I definitely do not support that provision.


I can't attribute that to anything but pure paranoia.

Actually congress is pushing for non-negotiated reimbursment rates based on Medicare.




Tell that to Venezuela!

I just can't understand how anyone could be for a government running something that is as important as health care when everything else it touches goes to shit. I guess I'm too stupid to wrap my head around it. Medicare, Social Security, FEMA, USPS-why they're just such a model of efficiency and solvency. Yes please give me more government; it's done so much for us already.

Stu

I just can't understand how anyone could be for corporations running something that is as important as health care when everything else they touch is done with their own self-interest placed above those of the customer.

It doesn't have to turn to shit, just because the government touches it, but I agree, the odds aren't in our favour. Even so, I'm in favour of letting them try -- the current system is so broken, I'd consider nearly anything progress.

You have got to be kidding me. Yeah, there have been some notable problems of late, but life without those organizations would be far worse.

Social Security has come under fire for insolvency, but it has enough funds to pay full benefits through 2037, and after that something like 75% in virtual perpetuity. Only very minor changes need to be made to solve this problem.

Medicare is under a very real financial crisis, but it's because of the skyrocketing cost of medical care, which is growing far faster than inflation. Notably, the cost of Medicare is growing at a slower rate than healthcare in general, though still faster than inflation. A large portion of the healthcare reform is to bring those costs under control, and much of that has to do not with regulation, but with streamlining.

FEMA has been through some hard times, but that's what you get when you nepotistically hire a horse registrar to run an emergency management organization. But you don't decide to get rid of the fire department because it's not doing well enough.

And the postal service has hit on some hard times, too. They should have kept up with technology more than they did in order to remain competitive in package shipment in light of the reduction in first-class mail due to the internet. Still, you can send a letter across the country for 44¢ and have it get there in a couple of days. Fedex and UPS would charge you $15.

Anyway, if you don't want the government providing services for you, you can also fight your own fires, stop driving on our roads, deal with burglars and the other vigilantes yourself, and when China invades, you're on your own.

That's just the problem. There are some services for which the government is uniquely qualified to provide, some of which you've named, but we've long since gone beyond such services. And about China, not to worry, Obama is in charge now! We can all feel safe. In fact he is already promising the Chinese we will get rid of our nukes just so they'll like us more.

Stu

Okay. Just to be clear, can you explicitly say that you think that the ability to not die of cancer — hell, the flu — should be reserved for the wealthy?

No that is not my position. Your example is a bit of a hyperbole though. Yes insurance may deny your claim for some underhanded reason, but I'd rather deal with them than the government. At least with the insurance companies there are avenues for recourse with which I've had some success. I have worked for a health clinic in the past and saw first hand that patients without insurance (some so poor they couldn't afford the trip there) routinely received care for very expensive diseases inluding cancer and HIV without regard for ability to pay.

It makes no sense to throw out something that the vast majority of US citizens are satisfied with to serve a relative few only to worsen the care of everyone in the form of loss of freedom and diminished level of care.

Stu

A vast majority are satisfied? Really?

Explain these poll results then.



When you bring in comparisons between socialized programs like Medicare vs. private insurance, people are more happy with the government programs.



If you think I'm cherrypicking bad data, please show me polling that shows Americans love the system as-is.

It also seems a lot more cost efficient to enhance the current processes rather than throw them out.

You're still making the baseless argument that the government will be your healthcare provider. Yes, there may (or may not) be an insurance company that "is" the government, but it is only one of many.


That's great. Was anyone being treated, for, for example, pneumonia? Do you think that the common cold or flu that that developed from would have been easier to treat and less dangerous to both the patient and the people around him or more difficult and more dangerous?

And what about those people that really couldn't afford the trip that never got there at all, but could have gotten to their local hospital that doesn't have a free clinic?


Ignoring for a second Tony's point that the vast majority are not satisfied, what is your basis for saying that the current system is being "thrown out"? As far as actual insurance coverage, all that's being done is providing group health insurance for people who can't currently get any.

I can only answer that with this which states that 68 percent of Americans like that care they now receive.

Stu

I suppose it is baseless if you turn a blind eye to logic. The bill as it is written explicitly prohibits private insurers from issuing new policies to individuals starting the year in which the bill is put into law. This combined with the fact that the government plan will effectively undercut the "competition" with an unlimited money supply courtesy of the US doesn't leave much to the imagination as to what the end result will be.




Yes they were actually. Of course just as many contracted it in the hospital, but poor or not how many actually go to the doctor for the flu or cold?



There was transportation provided to those needing it.

Stu

No, what the poll says is that, of people who have health insurance, 68% rate it as good or excellent. I think. He's clearly talking about that poll, but the numbers don't quite add up. I guess that there's some rounding error.

There are reasons that no one but Fox uses Rasmussen polls, like that he misinterprets his own data, and that it's always an outlier to the conservative side. (That said, once you account for that bias, they seem fairly accurate.)

In the same poll, only 48% rate the US heathcare system as good or excellent, with 49% rating it as fair or poor. And another 4% who don't know. Which adds up to 101%.

No, it states that 68 percent of Americans have insurance coverage that they rate good, or excellent.

I fall into that category, but only because I elected to go on COBRA, after losing my job, and the only reason I elected to go with COBRA is because the government subsidized it. (For the non-Americans, health insurance is typically provided as a benefit by employers. If you quit, or lose your job, the government stipulated that you have the option of continuing to carry that policy for a limited time, provided you pay the full premiums. Without the subsidy, I think the cost of our coverage under COBRA would come to just over $1000/month.) Come November, when my ability to be on COBRA goes away, I don't know what I'm going to do. I don't think I'll be able to continue to afford the insurance premiums on a similar policy. For what it's worth, I have no vision or dental coverage, either -- we dropped those due to cost.

So basically the way health care here works for us, is that we lose both sources of income within a month, and, because our health care was tied to our employer, get to enjoy a brand new (large) monthly bill. Obviously, we'll pay that with the money we're not earning now?

Am I satisfied with the care I receive? Yes, absolutely. The doctors we see are great. Am I satisfied with my insurance coverage? Mostly (see my above post about getting stuck with a $250 bill for three stitches). Am I satisfied with the coverage for how much I'm paying? Only because it's currently subsidized by the government. Am I satisfied with the US health system? Hell, no. Not even close.

Yes. Individual, non-group policies. This is to protect the new group policy marketplace. Right now, if you aren't eligible for group insurance, your only recourse is to buy individual coverage, which restricts pre-existing conditions, is deniable, and often very pricey, except for the few who are in perfect health, for whom it is generally marginally less expensive than a group plan. However, if everyone who can get it less expensively does, then you're left with only sick people in the group plan, so the rates will skyrocket. The reason that insurance companies make group plans is on the bet that there are a significant number of healthy people mixed in with the unhealthy ones. If they knew that everyone was unhealthy, they wouldn't be interested.

So yeah, there are a few people whose potential healthcare costs would go up: those people who would get good individual rates but who currently don't have an individual policy. But the existing policies won't get cancelled, so those people are all set.

Of course, your argument is going to be that their rates will go up to subsidize the new group. But the new group marketplace is based on competition. It's dumb for Aetna or BCBS to sell policies that lose money, and there's no reason for them to do it.


Both my wife and I have been to the doctor for the flu in recent years and been given Tamiflu. (Which really seems to help, by the way.) More to the point, if they went to their doctor for a normal checkup, they would have been that much more likely to get a flu vaccine and never have gotten it at all. And there have been recent flu vaccine shortages where it was rationed to the young, elderly, and those with immune problems: those people who are more likely to develop into pneumonia. And only a doctor can really say that a patient is immune compromised.

The article I linked to specifically states that "68% of American voters have health-insurance coverage they rate good or excellent" which would mean that 68 percent of Americans have insurance and rate it as excellent. It does not say of those with insurance, it says American voters. You can argue that the guy doesn't know what he's talking about but his polls tend to more closely reflect reality.

Stu

I don't feel like I responded to this adequately.

There are a variety of illnesses that are easily detectable and treatable in their presymptomatic stages, but become difficult to treat and potentially fatal once someone notices that there's something wrong. Prostate cancer, for example.

Since the uninsured poor cannot afford to see a doctor on a regular basis for a checkup, those illnesses fester until they are huge problems.

And affording is not limited to the cost of the doctor. Free clinics tend to have huge waiting lines, and, while I'm sure that they would be happy to provide an exam to patients, changes are that they are going to spend a full day at the clinic, if not more, in order to get it done. These uninsured poor people are far more likely to be working jobs for low hourly wages, which means that they're also losing money by going to the doctor. It can honestly sometimes be a decision between healthcare and food.

If they had insurance, though, they could schedule an appointment with a doctor for a specific time, one likely to be closer to their home or workplace than wherever the free clinic is, and only lose an hour or two of pay.

So, to repeat, are you saying that the poor should die because they can't afford to get screened for preventable illnesses?

As I stated previously, between individual policies becoming illegal and the unfair advantage the gov. plans will have, the writing is on the wall for private insurance.


That is naive as hell to say. Suppose you move out of state or wish to change your coverage? Well you're on the government plan then because you can't have a new private policy. People do change plans or at least they used to be permitted to do so.


I'm glad you made it through okay, but that doesn't mean everybody thinks like you. Just because they can avail themselves to a doctor visit after every sniffle doesn't mean they will.

Stu

No it would make sense to allow them get preventative care, but you're making an assumption that is not warranted- namely that because it is available to them that they will take advantage of it.

Stu

From the article:


From the (apparent) actual poll:


Now tell me you come to the same conclusion. The only logical conclusion is that Mr. Rasmussen is misinterpreting his own poll, or at least misspeaking.


I just realized that I was conflating Rasmussen and Zogby. Rasmussen is definitely reputable, if slightly conservative leaning. So I take back what I said about Rasmussen's reputability. He's still misrepresenting his data in this instance, though. Unless he's referring to a different August 1-2, 2009 poll he made of 1000 likely voters about healthcare issues.

I still contend that the government plan(s) will not have an unfair advantage, but I understand your point, in general. I do wish that an official amendment would be made so we had more to base this on than a months-old proposition. I have two questions, though:

If the government plans were definitively not included — that is, say, the bill contained a provision that it was illegal for the government to provide health insurance directly — are you still opposed? I realize that this is theoretical; I'm just trying to see where else you sit, ignoring that particular issue.

Also, on one hand, you say that the government is incapable of providing good resources: FEMA, Medicare, etc. On the other hand, you say that the government health plan will be so good that it will totally destroy any other private option. Those seem like opposing viewpoints to me. Can you explain?


That's a fair point. I'd totally be down with making it legal to provide individual plans to those who currently have individual plans. Basically grandfather those people permanently.

Not much we can do about people who refuse to see a doctor. But I think it's equally unwarranted to assume that people would not take advantage of it.

An n of 1000 is hardly unique.

Stu

I don't follow. Are you saying you think there is another Rasmussen poll conducted on August 1st to 2nd, 2009 of 1000 likely voters about their perception of quality of healthcare, and that he's basing his statement on that other poll?

If they came up with something that truely reduced costs, expanded availability and had no potential to limit my own choices and anyone else happy with what they had that would be great. Unfortunately, the true intent of this bill has been craftily veiled with health care reform to give government more control over our lives. As such, meaningful, effective legislation will not be forthcoming.



I don't contend that it will be good, anything but, but the plan will take over using force via coercion and economic realities via employer-paid coverage passed on to the government plan.

Stu

I'm saying the source from the WSJ article could be different from your cited poll since I don't see any of the numbers in the article in the poll.

Stu

Let me quote again from the article (emphasis mine):

Here is what looks to be the poll on RasmussenReports.com. The demographics match, the topic matches, and the dates match.

Individual and group (i.e. via employer) private health-insurance schemes manage to co-exist in the UK (and alongside, of course, free health-care for all paid for from general taxation); I'm not sure how we avoid the trap you describe, but perhaps it's through tax incentives for employers to operate the group schemes?

All the UK companies I've worked for which were big enough to have group health-insurance schemes, were US-owned, which might have influenced how important they viewed the offering of health insurance as a perk. Several co-workers (possibly including me -- I can't even remember) opted not to take it up, though, because it's a benefit in kind but is subject to income tax in real money -- which means that, as an employee, even if you're getting it "for free", you're effectively still paying 40% of the price.

Peter

I don't think 1000 samples is enough to form any kind of conclusion from. That, and polls/surveys can be worded/prompted for the response they want either in the words or the prompting of the person giving the poll/survey.

I'm sorry. I even downloaded some diagramming software, but I just can't parse that sentence.


Okay. How about if one of the plans was to guarantee coverage for tinfoil hats?

Pollsters would disagree with you, but fine. Stu was the one that said the vast majority of Americans liked the current system. When presented with polls that showed the opposite, he came up with another that still showed his statement to be untrue, but which had been misreported.

If you don't think that polls are accurate, we can throw out all polls and all argument based on popularity, at least until someone goes around and asks the entire populace.

I thought this was nicely done.

Peter

By my understanding, private insurance in the UK is supplemental to NHS coverage. You might never use it in practice, but you don't relinquish it either. Basically, having NHS coverage is the default state below which you cannot fall.

Not ever having worked in the UK, I can't know this for certain, but I'm going to make a guess:


It seems to me that providing group health insurance is a perk, akin to a free gym membership: something that you might say "ooh, that's nice" in reference to.

Most of us in the US would simply refuse to take a job that didn't provide health insurance. It's a virtual requirement for an employer to attract any qualified employees. Notably, this leaves out positions for which there are little to no qualifications, like minimart clerk, or burgerflipper.

You can have that competition in the UK because it's not really a big deal for someone not to have access to group coverage and also be denied for or priced out of individual coverage.

But it is a big deal in the US because we don't have that base level of care. And that's the problem we're trying to solve, but the proposed solution is not to have an all-encompassing NHS-like service, because it's politically unfeasible.

The current proposed solution is to make the entire US populace a group and let them choose from amongst competing plans, just as if your employer provided multiple options, which many, especially the larger ones, do. However, a large portion of these people don't have individual insurance for a reason: that they're a bad risk. If you let the good-risk people get individual plans, you have an all-bad-risk group left, and that means that their premiums would be very high, and the costs would be unaffordable, and more people would have to be subsidized, costing the taxpayers that much more. So if this tenet wasn't in the legislation, we'd have people (probably the same group of people) complaining that it'll cost too much.

I feel like I'm not making my point well. Let me know if that makes sense or not.

Just to add a different perspective here... Not all insurance is created equal. I am not poor, and I have health insurance. My health insurance, which is tied to my pension, is practically useless. I don't have the words to express my dumbfoundedness (is that even a real word) when I found out, was told in these exact words, that my insurance does not cover preventative care. The last time I had a routine physical exam, my out-of-pocket expenses were in excess of $600. Things like cholesterol tests, PSA tests, the doctor's examination fee: not covered. And something like a colonoscopy, not in your wildest dreams. How the insurance company can imagine that they will be money ahead by spending half a million dollars on someone with advanced colon cancer rather than $1200 to catch it early is beyond my comprehension.

Or maybe it's not. Let's do the math. The risk of someone contracting colon cancer in the US is about 7%. So out of 1,000 people, 70 will develop the disease. If those thousand people followed the common screening guidelines (colonoscopy every 10 years starting at age 30, every five years starting at age 50) and they lived to age 70, that would be seven colonoscopies per survivor, at a total cost of about $8400, times 930 people who don't get the disease plus at least some screenings for the people who do, and you're looking at (in round numbers) about eight million dollars in expense for preventative care. So, if the cost of treating colon cancer is less than $110,000 per person (and it may well be, I have no idea) then it would be cheaper for the insurance company to let people get sick and die.

Go figure.

tanstaafl.

I think they screwed up one very important point:

This is ridiculous. If the insurance companies profited less to insure more people, then they would profit more to insure fewer people, and the best profit-making decision for an insurance company would be to shut down.

I'm not saying that premiums won't go up, but it's not an inextricable law that more people means higher premiums. Assuming that the currently uninsured populace is significantly worse-risk than people under existing group coverage, then it follows, but no one's shown that. And I wouldn't be surprised if that were the case (after all, they've had almost no medical attention), but I don't think you can make that assumption without at least stating it, and preferably offering some real evidence.

It also fails to note the long-term cost (that the taxpayer currently pays) of failing to provide preventative care.

You had a good idea, but your premises are wrong. Notably, your insurance is "tied to [your] pension". Assuming an average retirement age of 65 and that people will live to be 70 (to match your numbers), that's two colonoscopies per person, for a cost of $2,400,000 to (hopefully) prevent treatment for 70 colon cancers, so it has to cost less than $35,000 for it to make sense.

On the other hand, even that premise is wrong. If you don't check for it, you don't know you have it until you're months from certain death. It's probably a lot cheaper to pay for palliative care for those few months than actual cancer treatment for what (the patient would hope) would be a lot longer.

Excuse my hastily constructed sentence; some of us have work to do. I hope you don't think that advances your argument. Please allow me try to conform to standard sentence structure. Anyway, here goes (fingers crossed):

The plan will take over the private system using force in the form of coercion and the economic realities employers will face.

Stu

Okay, gotcha.

Can you be more precise about the coercion involved?

By economic realities of employers, do you mean that it will be cheaper for them to pay into the public fund than provide their own group health insurance? I'd say that for small businesses, probably 15 employees or fewer, you're probably right. But these tend to be the businesses that also don't currently provide any coverage.

Sure. I was specifically referring to the provision regarding making private insurance illegal. Forcing those whose changes in life necessitate obtaining new coverage to a) enter the government plan or b) pay the IRS penalty for not carrying a qualifying plan (catastrophic coverage is evidentially penalized as well even if you had it before the bill) is coercion in my book.



I'd say it's true for businesses large and small. For small business it's a means of staying afloat since they will be forced to either pay a fine or pay for government run employee insurance (many will still go under as a result). The first medium and large businesses to adopt the government plans would gain competitive advantage over competitors still paying for their own. Over the course of time the natural tendency would be for the other businesses to follow suit just to remain competitive with the early adopters.

Stu

Who said those were the only two options. Individual plans as we know them -- open only to healthy people -- will end. In their place will be plans where anyone must be allowed to join, and pay the same premiums regardless of health. Insurance companies will be able to offer these plans, and perhaps the government will operate one which must have premiums matching expenses eventually.

UPS and FedEx compete every day with the post office, and win hands down. The DMV in California is plenty efficient to communicate with by mail, lets you make appointments online, and if it weren't for our obstructionist minority party, would be operating just fine. Our military seems to operate just fine though it's never seen the need to try and cut costs as it's always fully funded.

Yes. Having private health cover allows you to jump the queue for certain elective procedures, and gets you in a nicer-appointed hospital in certain circumstances, but you'll never be denied NHS care because of it.



Pretty much. I don't know what kind of encouragement that companies get to offer it, but either it's just something that you do to attract people -- i.e. it's an expected part of the benefits package, like employer-matched pension contributions, or the company figures that healthy people get more work done.

That said, I didn't sign up for my company's scheme, partly because (as Peter says) I'd end up paying extra tax, and partly because I can never get past the "how much do you drink per week?" question on the application form.

The company I work for has contracts with the USPS. I forget why, but we needed them to mail us something. It came via FedEx.

Fully funded might be a matter of perception. There are a bunch of things that I know of (working mainly with one branch) that were available for them, but they weren't able to afford it.

Shoot, one of the guys I work with (former F-16 pilot) tells horror stories of losing flight time because his squadron didn't have the money to replace canopies when they needed to (the canopies are prone to abrasion and need to be replaced occasionally). The Army could have had fully integrated Level 4 UAV control in the cockpit of their attack helicopters ages ago but didn't have the money (it was first demonstrated in 1998 or 1999). Special Operators (SEALs, Special Forces, Marine Recon, etc) often buy their own equipment because their units can't afford the stuff they need (which is specialized and different from the rest of the unit).

Ugh, I could go on forever about this topic

Can you admit that, at least initially, the options offered are more than just a "government plan"?

Yes, the marketplace will be set up by the government, but the majority of the options offered are from private companies. It's like the farmer's market. The government pays rent on the land where the farmers can come and sell their products, but it's still the farmers making sales.

Also, it's important to note, providers are not required to accept all insurance plans, just like they're currently not required to accept all insurance plans, including Medicare. People would then be forced to get reimbursed directly, and, if they didn't like the reimbursement amount, they would be free to change plans.


Businesses with a payroll under $250,000 are exempted from both requirements, and businesses with a payroll under $400,000 are not required to pay as much. Given that this is only an issue for companies that don't currently provide insurance, and companies that don't provide insurance almost universally have low-wage employees, a $250,000 payroll is likely equivalent to at least eight employees (twice minimum wage at 2000 hours a year).


It's not free. It still has to be paid for.

That said, I'm unclear on how businesses are intended to interact with the insurance exchange. My guess is that they can choose as many plans as they want to provide to employees. Since they're required to contribute a certain percentage of the premiums, they might choose not to include more expensive plans.

"In 2001, FedEx cemented a groundbreaking deal with the USPS to deliver all of the post office’s overnight packages and express deliveries. In turn, FedEx was allowed to put its drop boxes in post offices around the country."

Most of my recent USPS "saver" orders from Amazon ship first via FedEx. In fact, the USPS tracking numbers don't even work on the USPS site until just before delivery. Basically the packages are carried most of the way by FedEx and then, at least the documentation/tracking, is handed off to USPS at delivery time.

Here's an interesting link regarding the recent health care talk...
http://daringfireball.net/linked/2009/08/10/ibd-hawking

I laughed when I first read the Hawking bit. I wish you guys in the US sincere luck and good fortune in this process. Canada isn't without its faults, minor and serious, with its own healthcare systems (my experience being specifically with Ontario's)

Yes. Peter linked to that story in the third post in this thread.

Does that mean I get a free link now? The Onion, as ever.

Peter

Bitt,

As you mentioned, you weren't excluding anybody from the US, but I didn't want to jump in prematurely.

Now that the topic has drifted down a bit I figure it is safe now to say this. Health care reform in the U.S.A. is Dead. I wanted to Hope (TM), but the more I think about it, the more I believe that it has been dead for quite some time.

I don't think it's dead. The lack of a public option in this scenario isn't fatal. You're still giving people access to group coverage that they don't currently have, and there is still a lot of administrative reform that, I believe, will help.

The way to bet the future is that every employer, currently offering health care, would make a rush to dump their employees into the government system. This in spite of what Obama said about being able to keep one's current plan.

Here in Canada, employers still offer/provide supplementary health care benefits, on top of the government baseline.

I imagine that kind of concept would continue to exist in your country as well.

Don't get me wrong. I believe that some months from now, somebody in the government will hold aloft a charred cinder and declare victory for health care reform. But it won't be anything I would recognize as reform. The boundaries of the political discussion were so narrow, and the range of the corresponding media coverage so limited, that they precluded that. The main thrust for Obama -- I'm going to start calling him President Hope -- has been to make sure that the drug companies and insurance companies don't get upset. In that respect President Hope is no different from any of the other zillion US politicians on their payroll. I don't know this gent Taibbi, but a friend forwarded his (long) piece in Rolling Stone:

http://www.rollingstone.com/politics/story/29988909/sick_and_wrong

The best summary paragraph, I think from page 6:

"But Reich's comment assumes that Obama wants to give the bill coherence. In many ways, the lily-livered method that Obama chose to push health care into being is a crystal-clear example of how the Democratic Party likes to act — showering a real problem with a blizzard of ineffectual decisions and verbose nonsense, then stepping aside at the last minute to reveal the true plan that all along was being forged off-camera in the furnace of moneyed interests and insider inertia. While the White House publicly eschewed any concrete "guiding principles," the People Who Mattered, it appeared, had already long ago settled on theirs. Those principles seem to have been: no single-payer system, no meaningful public option, no meaningful employer mandates and a very meaningful mandate for individual consumers. In other words, the only major reform with teeth would be the one forcing everyone to buy some form of private insurance, no matter how crappy, or suffer a tax penalty. If the public option is the sine qua non for progressives, then the "individual mandate" is the counterpart must-have requirement for the insurance industry."

I am perhaps neither as cynical or optimistic as he. Revolt? Ha.

There are a few ways to interpret that.

If you mean that the companies would stop offering healthcare altogether, then they have pay a tax penalty based on their payroll. Smaller companies might do that. Maybe. But they're likely to either not currently be offering health insurance at all, in which case they're probably small enough that the penalty won't apply to them, or, if they are offering it, their costs are probably pretty high. I fail to see a downside in this situation.

If you mean that the companies would stop coming up with their own plans and instead offer the plans that are available in the government-sponsored marketplace, but still share the costs with the employees, I don't really see how that's different from the company simply finding a new plan, and, as a point of reference, I've worked for my current company for about 2.25 years, I have had three different health plans, and that seems not out of the norm based on prior experience and conversations with other people, so I don't see how that's much different either. The point being, your employer is already likely inclined to change insurance plans every year; what difference does it make if that plan was defined by some HR rep or someone else?

Personally, as someone who's interested in the welfare of the United States and its people, I couldn't give a flip about the "public option" (as far as I can see, the only thing that the "public option" supposedly provides is competition for the other insurance companies, and I think it makes more sense to deal with that via antitrust laws, though that is, admittedly, a more underminable approach), and I believe that healthcare reform without a requirement that everyone have some base level of health care is worthless.

I'd personally rather see single-payer with the assumption that everyone has a government-defined base level of coverage rather than wasting time verifying coverage, etc. I rather like the British system where that's the case and then those who want to can buy "enhanced" coverage if they want. But that's not going to happen, because the American public is afraid that they'll have to wait six months for that free hip replacement that they currently can't afford at all. But that's neither here nor there.

In January, I argued with a friend over coffee, saying that Obama was crazy to launch a full-throttle effort on health care reform. With this being such a hot-button issue for the right and their media surrogates. I argued that Obama needed to build up some cred points first (fix the economy, show progress in Iraquistan). The fact that he launched into this I ascribed to ineptitude, hubris, whatever. Maybe Ted Kennedy's last wish. I predicted that Obama's reform initiative would die the death of 1000 cuts. I told my coffee friend that if Obama mentioned the term "single payer" once in 2009 in any sort of affirmative sense (like "We are looking at that"), I would give my friend $100 cash.

I didn't have to worry about my $100. I think Obama pretty much banned the utterance of that term anywhere within 10 miles of the White House. And he jumped so fast and so high to assuage the anxieties of Pharma and Insurance, that I could no longer conclude that this was simply a new president getting buffeted by the consequences of his premature effort. This is simply a fact that, as Taibbi says, this was in the cards all along. And I should have no more illusions about President Hope. Who won't get get my vote in 2012.

We spend way too much on health care but leave millions without care and exposed to financial ruin. Our health care outcomes and metrics suck compared to countries we often take the chance to deride.

Whether explicit or implicit, all health care systems impose some form of rationing. Ours just happens to do that by leaving people without care. If we expect to provide care for more people without increasing overall costs, we'll need to figure out how to drive costs out of the system. Other than muttering about "competition" none of the half-baked, half-hearted current allusions to "reform" seem to do anything I can understand that really addresses the cost issue. On the contrary, the body politic including President Hope have worked very hard to make sure that the 31% cut of the take that is more of less wasted on insurance-related administrivia is institutionalized for the next 100 years. But the insurance companies are very relieved. Still on their guard, but relieved a great deal.

So I'm with Taibbi. I think the fix of the special interests was in all along.

I have been a provider and a patient im military acute care settings and a patient in the VA system. Now there was certain stilted quality to some of the standardization of procedure in those settings, but they got the job done. I got pretty darned good care, something that was more than once noted by civilian docs and dentists down the road years later.

Now the VA has taken some knocks and had its problems, but you would think that many folks familiarity with thinks like "universal" military coverage and Medicare would make folks more comfortable with the notion of some big evil single payer system like Canada's or the UK's.

Some of this I think is tied to the great American value of individual versus collective good. I worked on a hospital-based research study and travelled to study centers in, among other places, the US and Sweden. This was a totally non-invasive study. A 30-minute standardized interview about medication history and medical conditions. In the US, you'd spend 20-30 minutes explaining the study and about 1 in 5 people would agree to the interview. In Sweden, informed consent took about 10 minutes and more like 4 out of 5 would agree. Doing something for the general good of others. Not high on the list here in the US.

But I think this is really something that politicians and the media leverage. The general distrust of institutions and the "What's in it for me?" factor. The primary problem standing between welfare and the people of the United States is that in this single-party democracy all of the key players have already been bought and paid for by special interests. Your welfare doesn't figure in.

No one will ever get any positive credit for the economy or the war. Might as well wait for Godot.

Of course there's no mention of single-payer. That would be a death knell for any reform at all. So many people are so vocally opposed to it that having the government touch health care at all sends them into a tizzy, god forbid that the government do something useful in that space. So I chalk that up to simple pragmatism.

The only thing I require from this is that all Americans have basic health insurance. I want them to be able to go to the doctor when they get sick. I want them to not have to worry about whether they can afford medicine or not. If that involves using existing insurance companies, fine. I don't really care. They do a reasonable enough job now for those of us lucky enough to be able to afford it. (Not that there's not room for improvement.)

The rest of the stuff, as far as I'm concerned, is icing. Yeah, I'd prefer to get rid of the administrivia with a single-payer system. I'd certainly like to see some more oversight of insurance so that people aren't rejected for things they should be covered for. I'd like to see an effort to reduce duplicated effort and general waste. I'd like to see doctors be able to practice medicine and not be paper-pushers. And most of those things (barring the single-payer system) are being addressed in the current proposals.

The insurance and pharmaceutical industries are certainly being deferred to to some extent, but those industries employ a lot of people, and the last thing we need to do in this economy is put more people in danger of losing their jobs. I don't relish the idea of the duplicated effort involved in having all these companies doing the same thing, but that duplicated effort does employ people. I'd be happier about it if it were hundreds of small companies rather than a handful of huge ones, but there's still some benefit in having redundancy, as far as employment goes. I also don't relish the thought of lining the pockets of the already superwealthy with taxpayer money, but if that's what it takes to get healthcare to everyone and avoid losing more jobs, tell me who to make my check out to.

I meant to make this point earlier, but I find it laughable that all of these self-described "progressives" are all over this idea of the government providing competition being a panacea. "Capitalism: yay!" is a talking point that they would lampoon in any other situation.

That's sort of a broken-window argument, though, at least regarding the insurance "industry". You could pay for a lot of unemployment benefit for former medical-insurer employees with the overall cost benefits of (say) the NHS over the current US system, and the NHS is far from a model of efficiency. Or, alternatively, they could all get jobs doing something productive instead.

I agree with you that the priority is getting healthcare for all -- and that whether this happens through general taxation, or through public insurance, or through private insurance, is a detail Congress can decide on whichever way they like. But if they go down the private insurance route, I don't think Barack Obama will get his wish to be the last president to have to deal with the mess.

Peter

That argument just won't fly in the US, for a variety of reasons. People decry the so-called "welfare state", so it won't work politically. Unemployment insurance in the US is a gigantic pain in the ass for everyone involved, and it's already overtaxed. Not to mention the fact that it's just bad juju to put more people out of work than already are. US unemployment is at something like a 25-year high, double what it was just a couple of years ago. Add on to that that it's administered by the states and not by the federal government, and that's just a recipe for disaster.

I could argue that what you're suggesting is a broken-window argument, too, that by breaking the window of insurance industry employment, there are net benefits.

What I think we can all agree on is that whatever course is taken — whether it be government-controlled insurance or private insurance, or we do nothing at all — there's still a broken window.

This thread got off on the wrong track, though. I guess what I really wanted answered, put more bluntly, is: are we in the US complete laughingstocks on the world stage?

Laughingstocks would be too strong a word. (Unlike that whole Gore/Bush hanging chads thing; you were laughingstocks then.) Really it's more like a tragedy than a comedy: the Aristotelian flaw of self-interest leading unexpectedly but inexorably to a catastrophic outcome. Even those of us who are pretty sure that you'd be better off with state healthcare (or, for different examples, without pork-barrel politics or without the Second Amendment) can't easily see a politically-viable way of actually getting to those beneficial outcomes starting from the corner you're now painted-into.

In a way (and this is probably a lefty's rather than a general view), the example of the US is like a shepherd moon steering us away from "capitalism without compassion" just as the Soviet Union steered us by example away from "socialism without opportunity".

Peter

Politically, it makes some sense to try to avoid killing insurance companies altogether. That guarantees that they will pull out all the stops to try and kill the legislation.

On the other hand, when you start talking about mandatory enrollment with mandatory plans and benefits, now the insurance companies can run the actuarial numbers and sort out that they don't necessarily get killed. That's more-or-less how the Swiss system works. Insurance companies will happily sell you extras, above the mandatory minimums (e.g., would you like a private room the next time you're stuck in the hospital?).

I'd be perfectly happy if the U.S. ended up with Swiss-style healthcare. Much better than what we've got now.

Bitt, sorry if the thread is gone awry. I did consciously wait until it was down on page 3 or 4!


On the contrary, I think if Obama did not get ensnared in this fake town hall battle for the health care right-of-center, his popularity ratings would be higher now and they could be even higher next year if unemployment bottomed out and started to improve. For what other reasons have his ratings gone down?


Maybe death knell in 2009-2010. But the guy wasn't even able to utter or acknowledge or study what is far and away the most rational, greatest-good-for-greatest-number solution.


I think the counts of screaming crazies at town hall meetings are too high. "So many people are vocally opposed to it". Well I think a lot of that has to do with how you start and develop the discussion and who you ally with.


I like to think of myself as a pragmatist and I hear this a lot in the recent context, but when politicians go on and on about being pragmatic, it sounds like excuses to me. And special interest money sloshing around in their pocket.


I'd get prepared to be disappointed. I want all the same things, but you aren't going to get more care for the same money without driving cost out somewhere.


Where you put this as a preference, I have to say again: 31 percent of cost.


I didn't watch him last night, but apparently Obama made a point of no denial of care for pre-existing conditions. Great (really). All other things being equal that means more care and that increases costs.


I'll have to look harder, but I'm not seeing it. I'm seeing an illusion with 1300 insurance companies casually keeping the Potemkin village in place until this minor storm passes.


Pharma people aren't going to lose their jobs and this otherwise really doesn't seem like a good argument. Tobacco companies employ a lot of people. Plus, if we really took the long view and planned to phase out primary private insurance in 2013-2014 in favor of single payer, all of those insurance executives would have time to get retrained as nurses. They wouldn't be unemployed for long!

But special interests and payola have again won the day in the USA. I can't really decide if it is better to be a laughingstock or a tragic figure.

Perhaps to realign this thread somewhat with it's original outreach goals, I could ask:

Hey, Canada! Hey, UK! How did you do it?

How come you could do it and we can't?

What transformations do you think would be needed if this tragi-comic country is ever to do it?

I wasn't blaming you.


I'm not talking about reality. I'm talking about perception.


This is based on the fallacious argument that insurance companies cannot make money by insuring people. This is clearly an insane argument, as insurance companies are currently making money doing just that. I think that's one of the complaints. And, although I haven't seen any studies, I don't think that you'll find that the uninsured are significantly sicker than the insured; there are huge numbers of people who are healthy but can't afford insurance.


Fuck cost. I want people to have the opportunity to be as healthy as possible.

Personally, I'd rather have something flawed that has a chance of getting signed into law than a perfect solution that will never happen.

Well, when we did it, it was 1946. We were (economically as well as literally) rebuilding the entire country from the ground up at that point anyway, having expended not just the entire country's, but the entire Empire's wealth and resources on fighting the war. So there was essentially no entrenched rich lobbyist class to protest against the welfare state; Labour, promising to implement the Beveridge Report's recommendations on setting up a welfare state, had been swept in with a huge majority (ousting Churchill from Number 10!), and the Health Minister most associated with setting up the NHS was one of 10 children and left school at 13 to work in a colliery. The medical profession fought him every step of the way; he claimed (says Wikipedia) to have eventually won them over when he "stuffed their mouths with gold". This presumably works less well on mouths already stuffed with gold.

How you arrange for similar circumstances in the US I don't know. The Great Depression might have been a good opportunity, but this current depression, painful as it is among everyone up to and including the merely comfortably-off, is unlikely to wipe the slate of the very rich clean like World War 2 did here. And in the US, with a few Old East Coast exceptions such as the Kennedys, political power has always inhered in wealth rather than in birth as in the UK.

One other thing that did occur to me: you (that's "you" the US in general) have voted Democrat majorities into the House and the Senate, Democrats most or all of whom presumably stood on a platform of health-care reform. You then voted a Democrat president into the White House, who very definitely stood on a platform of health-care reform. Yet despite a clear majority of you voting for it twice, meaningful health-care reform is still not looking likely. Something is not working properly in your democracy.

Peter

Ah, but the Kennedys were fabulously wealthy. Their father, Joe, amassed a huge fortune, mostly through real estate (though seeded with some, uh, seedy ventures in the '10s and '20s). And, unlike that of many of the prominent philanthropic businessmen of the 19th and early 20th centuries, most of that money was passed on to his children, rather than going towards charity. Then again, being devout Irish Catholics, Joe grandfathered 30 children, so that money got spread out pretty quickly.

In addition, Joe was somewhat obsessed with getting into politics. His own aspirations to high office were torn asunder when he sprouted a defeatist attitude early in World War II, when he was ambassador to Britain. He then started grooming his eldest son Joe, Jr., who was killed in (odd) action late in WWII. Then he started grooming his next oldest, John. I imagine that obsession got passed to the other two sons, too. However, only a few of the grandchildren are politicians, and currently only one. Might have something to do with those few being the few that knew their fathers past age 10.

Many of the Kennedys are activists, some political, some social, but I doubt we'll see many more Kennedy politicians.


That would be an incorrect presumption. Many of the Democrats elected into Congressional office in 2006, when they regained majorities, have serious problems with the idea, and they are a big part of what is holding it back. The Democratic party of the last thirty years has been one of the most disjoint parties ever to be in existence. It's nearly the equal of a European-style coalition party. If we were to go by pure party numbers, Democrats could pass anything they wanted to right now. (Or could, before Ted Kennedy passed away.) But it's just not that unified here.


Yep. The same thing that fails to work right in every large collection of people: the squeaky wheel gets the grease.


There's no way you could know this, but, FYI, the accepted adjective is "Democratic". (In reality, the name of the party is the "Democratic Party", and "Democrat" as a noun is a backformation already, albeit an accepted one.) In recent years, Republicans have started using the word "Democrat" as a diminutive adjective — kind of a pseudo-subtle epithet.

Ah, so there's no equivalent of the whip system? or it doesn't work in the same way? Over here defying the party whip is reasonably rare; it's (in US terms) as if the DNC (or RNC) could say to members of Congress, "vote yes on HR676 or we'll suspend or eject you from the party". Not having that form of party discipline, as it's called, seems... better, actually. More democratic. Though it will tend to lead to logjams such as the current one.

I actually wrote "Democratic" first, but then changed it to make it clearer (especially in the phrase "Democrat{,ic} majority") that I meant the party, not the abstract idea. I suppose the capital "D" flags that difference too; we don't really have that problem over here, as Labour aren't very conservative, and the Conservatives aren't that interested in labour, whereas in fact both US parties are democratic and (in the British/Australian sense) republican. (Though, of course, in Northern Ireland, "Republican" means something else again.)

Peter

There is, but it's not as strong as it is in the UK.

My understanding of the UK election system is that while you're technically voting for an individual, you're really voting for the party. Whereas in the US, you're definitely voting for the individual, and their party affiliation is almost more of a shorthand for the things they're likely to support rather than an ironclad rule.

Virtually no one votes with their party 100% of the time. Statistics on the current session of Congress show that party loyalty ranges from 98% to 58%, with a median of about 92%, for the Senate (the upper house) and 99% to 64% with a median of about 95% for the House of Representatives (the lower house).

No one is kicked out of a party in the US. Compliance is enforced through reelection support, committee assignment, and general assignation of relevance. There are, however, caucuses in Congress that are unofficial groups of congressmen that often function as a bloc and can help defend their more junior members.

It's an uneasy mixture of both, really, but skewed towards the party thing, especially as the prime minister is (essentially) voted in by Parliament rather than from a separate popular vote. So even if your favoured party's local candidate is a bit of a doofus, you pretty much have to vote for him or her if you want your party to form the government. (And because there's no such thing as primaries in the UK -- only paid-up party members get to participate in selecting candidates -- it's not your own fault if your local candidate is a doofus.)

Just for completeness I should add that not quite all votes in Parliament are the subject of a whip. Ones that aren't are called "free votes", and the convention is that Parliament is given a free vote on "issues of conscience", or in other words moral or ethical issues that don't necessarily divide on party lines: abortion, the death penalty, that sort of thing.

Peter

That's because our government isn't a democracy. It's a republic, thank goodness. Add to that the fact that we are quite restricted in our choices, either Democrat or Republican. While we do have other parties, our system is really set up for only two. As such, one has to pick the person that they most agree with. It does NOT mean that they agree with everything that party stands for, just that they tend to agree with them more on the issues that matter most. It is certainly possible to be pro-choice AND anti nationalized health care, but there is no way to express this belief at the voting booth.

While I'm currently registered as a republican, I really lean more toward libertarian. I typically vote republican, but I am never 100% on board with their platform. They're just a lot closer to my views than the democratic party and the libertarian candidate never has a snowball's chance in hell of actually winning.

No, it's both. In their desire to point out the differences between the American system of government and the ancient Greek form, our civics classes have done us a disservice in incorrectly defining "republic". A republic is merely a form of non-monarchical government where at least some of the people have at least some influence on government affairs.

The most precise term for the American system of government is a "constitutional republic", which is a form of "representative democracy".

And it's full of lawyers who obfuscate things behind three or four layers of related crap until the original concept is no longer obvious to most observers.

Exactly. A true democracy would be a very scary thing indeed.

I was just being preemptively apologetic! It can suck when a worthy thread gets buried by tangents and I am very interested in your original subject.


I think I am, too. In terms of Obama popularity/mandate, we have all of this other huge stuff going on like bailout bonanza and Afghanistan and Iraq, but the teabaggers didn't seem to have *that* much traction until their outrage over socialist health care demons took over the news cycle.


Insurance companies *definitely* make money by insuring people!!! That isn't the same as getting care to people. And the insurance companies have done great by cherry picking populations, denying claims for preexisting conditions, et cetera.


I haven't kept up in many years, but I think that there are tons of studies in this area and many at least show that the uninsured delay seeking care for longer periods, are sicker when they show up (in the ER) and cost more to fix. And sure there are plenty of healthy people both insured and uninsured, but the insured ones aren't maybe averse to seeking care and aren't so much at risk of getting a $16.000 bill liek a relative of mine.


OK, you can blow off cost if you want. But you can't. Cost is key. All health care systems ration in some way to restrain costs. The question is how you do that and where does that limited pot of money go. People in the U.S. *with* insurance have come to believe that the pot is infinite.


I'd rather have something good that gets passed. But I think too much has already been given away for that to happen.

I knew some of this, but thanks for the exposition!

As this decent article notes, FDR did have a go, but it was dropped from Social Security. Defeated by the AMA and the even-bigger-then spectre of commies. And I think several other factors figured: medical technologies were less developed, overall costs relative to GDP were lower, and patient bonds with family and community physicians were stronger. Like in the movies

Thirty-plus years later, LBJ managed Medicare, but we somehow can't interpret what it provides as a Good Thing unless it is for old folks. So socialism is OK unless it is for young people


I always enjoy calm understatement.

Special interest money, special interest money, special interest money.

People want to try to make the case about how the Democrats really differ from the Republicans. Maybe the occasional Kucinich differs, but just look at where they all get their campaign contributions. Not very different.*



(*once again I plug Kevin Phillips' _Wealth and Democracy_)

You're moving the goal post. (What are you, a Republican?) The point is not to get insurance that's better than what we have now; it's to get some level of coverage to people who have none.

Insurance companies definitely go out of their way to avoid paying for expensive things. We all have that specter hanging over our heads of getting cancer and our insurance getting cancelled because we didn't report that ingrown toenail we had twenty years ago.

However, until that happens, I'm still able to pay $30 for a month's medication instead of $500 or more. I'm still able to make an appointment to see a doctor for $10. And that's far better care than the uninsured are getting now, because they're getting none.


While that's a perfectly reasonable way to interpret what I said, that's not what I meant.

What I meant is that the whole population of people who are currently uninsured shouldn't cost the insurance companies (significantly) more per capita than the set of people who are. Yes, the sick uninsured are likely to be more expensive than the sick insured due to their conditions festering, but the ratio of the sick uninsured to the healthy uninsured is likely to be about the same as the ratio of the sick insured to the healthy insured.


Yes, including the one those of us with insurance currently have, and which is self-sustaining. I fail to see why adding a new group of people to it is wildly expensive. Yes, there will need to be subsidies from the government for the poor, but we're subsidizing them now when they go to the emergency room.

Yeah, you can tell they're exactly the same based on the way no Republican has expressed support for any health care reform bill, there are nine sponsors of HR3200, the private market plan bill that most everyone is talking about, all Democrats, and eighty-seven Democratic sponsors for HR676, the single-payer bill.