The Need for a Public Option
Opponents of health care reform have begun to focus their efforts on building opposition to a "public option." For those of you unfamiliar with health care policy debates, the phrase "public option" refers to a government health care plan that people would have the option of purchasing instead of private health insurance. It would be like Medicare, except that people of any age could purchase it. Opponents of such an option fear that it is a back door method of achieving a single payer system. As the Wall Street Journal put it today:
The truth is, there's no reason that a public system and private system cannot coexist. And even more importantly, there's no reason whatsoever to believe that a private system, on its own, can cover everyone. So there has to be a public option.
Perhaps the best analogy here is to our mail system. When it comes to delivering packages across the country, Americans have both public and private options. The U.S. Postal Service coexists and competes with private providers like UPS and FedEx. The private companies do quite well and are in no danger of being run out of business by the USPS. But there's no way that Americans' parcel delivery needs could possibly be met by private providers alone. Why? Because of inherent inequalities in geography. If the USPS disappeared, private providers would do a decent job of covering the needs of those who live in or near major metropolitan areas. But what about the folks who live in rural and remote parts of the country? If private providers were willing to service them at all, it would only be at a significant premium. And for obvious reasons. The costs involved in delivering a package to a remote address in rural South Dakota are significantly higher than delivering that same package to New York City. The efficiencies just aren't there. It's not economical to maintain the facilities, personnel, and infrastructure necessary to deliver an occasional package to some isolated, sparsely-populated location. There's no money to be made in doing that. Which is why the "public option" is the only one available to people who live in such locations.
The same exact thing is true with respect to health care, where health needs vary dramatically from person to person. The private insurers are more than happy to insure relatively healthy people. That's where the money is. But they don't want anything to do with people with pre-existing conditions, who are the health care equivalent of rural South Dakotans. The same is true of people trying to buy health insurance individually or in small groups. They don't have the same bargaining power as those who get their insurance through large company plans. Like the residents of tiny remote town, they don't have the economic pull of a major metro area. For such people, a public option is the only option that makes economic sense. The private market is not going to offer them any reasonable options.
This really isn't rocket science. Without a public option, there will always be lots of uninsured people.
This new entitlement -- like Medicare but open to all ages and all incomes -- would quickly crowd out private insurance as people gravitated to heavily subsidized policies, eventually leading to a single-payer system.Putting aside for a moment whether this prediction is accurate, it's worth pointing out that it's totally inconsistent with the standard conservative talking points on health care reform. On the one hand we're supposed to believe that government run health insurance is some horrible thing that no one would want (the people Canada are so miserable!). On the other hand, we're told that such a plan would be so overwhelming popular that it would destroy the private insurance industry. So which is it?
The truth is, there's no reason that a public system and private system cannot coexist. And even more importantly, there's no reason whatsoever to believe that a private system, on its own, can cover everyone. So there has to be a public option.
Perhaps the best analogy here is to our mail system. When it comes to delivering packages across the country, Americans have both public and private options. The U.S. Postal Service coexists and competes with private providers like UPS and FedEx. The private companies do quite well and are in no danger of being run out of business by the USPS. But there's no way that Americans' parcel delivery needs could possibly be met by private providers alone. Why? Because of inherent inequalities in geography. If the USPS disappeared, private providers would do a decent job of covering the needs of those who live in or near major metropolitan areas. But what about the folks who live in rural and remote parts of the country? If private providers were willing to service them at all, it would only be at a significant premium. And for obvious reasons. The costs involved in delivering a package to a remote address in rural South Dakota are significantly higher than delivering that same package to New York City. The efficiencies just aren't there. It's not economical to maintain the facilities, personnel, and infrastructure necessary to deliver an occasional package to some isolated, sparsely-populated location. There's no money to be made in doing that. Which is why the "public option" is the only one available to people who live in such locations.
The same exact thing is true with respect to health care, where health needs vary dramatically from person to person. The private insurers are more than happy to insure relatively healthy people. That's where the money is. But they don't want anything to do with people with pre-existing conditions, who are the health care equivalent of rural South Dakotans. The same is true of people trying to buy health insurance individually or in small groups. They don't have the same bargaining power as those who get their insurance through large company plans. Like the residents of tiny remote town, they don't have the economic pull of a major metro area. For such people, a public option is the only option that makes economic sense. The private market is not going to offer them any reasonable options.
This really isn't rocket science. Without a public option, there will always be lots of uninsured people.
posted by A.L. at 10:11 PM
68 Comments:
This is the best, most succinct explanation I have read about why a public option is necessary to reform our healthcare system. Few things are more satisfying than a good analogy, and this one really rocks.
Frankly, I don't know what conservatives even mean when they say we can reform healthcare without a public option that is available to everyone, not just the poor and the elderly. What they are really arguing for is a shiny gloss of fake reform on the status quo. And that is simply unacceptable.
If private insurance is truly the superior option, then the conservatives have nothing to worry about. Big healthcare will crush the public option.
What they are really afraid of is that the public option will prove just as efficient and as popular as Medicaid, and that everyone will enjoy the same government-run healthcare that members of congress enjoy, and that they will never, ever, be able to make it go away. They still haven't give up hope of getting rid of Social Security. They don't want to have to add the destruction of another wildly popular and effective government program to their to-do list.
One thought, though.
The USPS is self-funded.
Do you think this is feasible for a public health insurance option?
"The USPS is self-funded."
Only partially, though, right? The USPS runs at a loss every year, I think.
You may want to proofread your final sentence one more time...
The truth is, there's no reason that a public system and private system cannot coexist.
Yes there is. Hawaii tried a "universal" children's health care system. People who did have private health insurance (including employer-sponsored care) dropped it and went with the public option, overwhelming the system. Hawaii had to eliminate funding for it after 7 months. What this shows is that the "public" option has the ability to kill off the competition, even if the "public" option is implemented badly, as the one in Hawaii.
Perhaps the best analogy here is to our mail system. When it comes to delivering packages across the country, Americans have both public and private options. The U.S. Postal Service coexists and competes with private providers like UPS and FedEx...If the USPS disappeared, private providers would do a decent job of covering the needs of those who live in or near major metropolitan areas. But what about the folks who live in rural and remote parts of the country? If private providers were willing to service them at all, it would only be at a significant premium.
I just moved to rural Arkansas, and I mean rural. My doctor in Illinois was able to overnight, via FedEx, a package I needed without an issue. I've used FedEx to send other packages from Illinois to here. I don't think the analogy fits.
We do need reform, but not in the form of an expanded government health care option. We don't currently have a free market system in place in regards to health care insurance, and never did. It is already over-regulated at the state and federal levels, forcing health insurance companies to pay for emergency care and ordinary doctor visits in the same (or similar) way. That's nuts. If people didn't have to pay a premium to cover regular doctor visits, they could afford paying for the ordinary health care items (physicals, visits, etc.) themselves. In this case, deregulation would be better than the "public" option.
In another post, someone said that health care is rationed here in the U.S. That isn't true. Because of the Supreme Court, anyone who can't afford health care could get it at taxpayer expense now, even without having to sign up for Medicaid. On the other hand, rationing is the SOP for the not-so-great health care in Britain and Canada, with people waiting months and years for things they could get in the U.S. right away. That is what those supporting the "public" option are trying to push the U.S. into.
A few thoughts on your analogy. First, I would observe that the Constitution empowers Congress to establish post offices, not health care providers. Of course, establishing a public option would not be “unconstitutional,” in the modern sense of something that the courts would strike down, but for those who claim to be concerned with the Constitution’s actual meaning, it is worth noting.
Second, the USPS isn’t exactly noted as a model of efficiency, quality or customer service. If, following your analogy, one had to choose between “post office” and “fedex” healthcare, I am not sure too many Americans would opt for the former. And unlike with package delivery, they won’t have the option of using the post office for routine matters, and using for fedex for urgent/life or death situations.
Third, USPS doesn’t compete with private carriers on an even playing field. It has a legal monopoly on the delivery of regular mail. Absent this monopoly, it would not be able to survive without large taxpayer subsidies. Even with the monopoly, it is by no means obvious that it will be able to survive in an age of private competition and internet communications.
Finally, I have some trouble wrapping my mind around the analogy because the public option is not a service provider like the USPS. It is not even really an insurance provider. Instead, it is designed to provide public financing for health care costs for people that cannot afford them. If instead of delivering anything, the USPS reimbursed lower-income people for most of their mailing costs incurred with private providers, the analogy would be a tighter one. Of course, to do that, the USPS would need to regulate the amount the private providers could charge and would have to restrict how much mail its clients could send. Would that be a good idea?
"You may want to proofread your final sentence one more time..."
Ha! I just changed it. A pubic option is important, though.
This new entitlement -- like Medicare but open to all ages and all incomes -- would quickly crowd out private insurance as people gravitated to heavily subsidized policies, eventually leading to a single-payer system.such a plan would be so overwhelming popular that it would destroy the private insurance industry.Worth pointing out that those statements are themselves totally inconsistent with standard conservative talking points about economics, period. Love the little "heavily subsidised" bit, too, to hide the contradiction. Why not replace it with the actually accurate "government-run"?
The USPS provides a basic guaranteed service to deliver a letter or package from any address to any other for a low fixed price. FedEx provides a premium service of delivering letters and packages quickly at much higher cost. In this sense the USPS is like basic Medicare, while FedEx is like a private Medigap policy - optional, at additional cost, for advanced services. That is a public-private partnership model.
Despite having a basic single payer basic system, most Canadians I know also purchase a private "gap" policy to cover special situations (and/or to cover them while on vacation in the U.S.). Again, public-private with the public part guaranteed, basic, and cheap, and the private part optional, more advanced and expensive.
Even though I favor a single payer system, I believe a public-private plan of this nature could work fine for the U.S. Even if we could somehow force private companies to cover everyone, we'd never be able to afford it since a third of their revenue goes for profit and advertising. Medicare does not have that burden and is far more cost-efficient. It will be even more so when they are allowed to do bulk bargaining to lower drug costs.
The private sector is good for many things, but some aspects of life are too important to be left only in private hands. Health care is one such thing. If there is a public option I will sign up for it.
Argh. Formatting schmormatting. More readably:
This new entitlement -- like Medicare but open to all ages and all incomes -- would quickly crowd out private insurance as people gravitated to heavily subsidized policies, eventually leading to a single-payer system.
... such a plan would be so overwhelming popular that it would destroy the private insurance industry.
Worth pointing out that those statements are themselves totally inconsistent with standard conservative talking points about economics, period. Love the little "heavily subsidised" bit, too, to hide the contradiction. Why not replace it with the actually accurate "government-run"?
The USPS existed as a public service without private competetion for a long time. Since it began to have private competetion it has undergone a steep downhill slide, as the private business has "cherry picked" the attractive market and left the USPS with the unattractive, unprofitable market. As a public entity, the USPS has responded with ever poorer service and, for the past ten years, with decreasing reliablilty. I never send anything USPS when I have an option, usually first class mail on which they have a monopoly. Even their once-relaibel first calss mail service is now only baout 90% reliable in getting letters to their destination.
If a public health option is going to be anything like the Post Office, I want nothing to do with it. They will be killing people in droves.
most Canadians I know also purchase a private "gap" policy to cover special situations
I'm a bit sceptical about that "most".
And anyway, Canadians already have a perfectly good private "gap" option: the U.S. :)
a third of their revenue goes for profit and advertising.
Add to that atrocious administrative costs and inefficiencies (their own plus those they impose on health care providers).
The private sector is good for many things, but some aspects of life are too important to be left only in private hands. Health care is one such thing.
Not just that health care is one of those things that are too morally important to be left exclusively in the private sector's hands. It's also one of those things that the private sector on its own is horribly inefficient economically at providing.
Jayhawk, you're actually making an argument for single-payer (i.e. that private companies will always cherry pick the profitable sectors, so the only way to cover everything is to have a purely public system).
I wouldn't take the analogy too far, though. We're talking about a public insurance option (like medicare), not a separate service system (like the VA). The service providers (i.e. the hospitals) will be the same.
Farrapo:
The private sector is good for many things, but some aspects of life are too important to be left only in private hands. Health care is one such thing.
Where in the Constitution does that exist? Even the constitutionally-protected right to an attorney is in private hands as well as providing a public option (public defenders). The point of the Constitution and the rights guaranteed therein are to keep the government, as best as possible, from abusing the people. That's why defending the nation is something the government does, and should never be outsourced to a private company (yes, I disagree with the Bush administration in regards to its use of Blackwater).
The same goes with legal care. Health care, on the other hand, works better when in private hands, and has proven to do so day in and day out. Health care is expensive in the U.S. because it is the best in the world. You don't pay Yugo prices for a Cadillac, which is what Obama is trying to sell.
Even their once-relaibel first calss mail service is now only baout 90% reliable in getting letters to their destination.I read about these things sometimes and am always just amazed.
My company sends out a few dozen packages per week, split between FedEx (previously DHL) and the USPS, with a few going UPS. The USPS is slower, obviously, but its rate of lost packages is no worse, for us, than any of the private companies.
I think the USPS gets a terrible, and almost entirely undeservéd, rap.
We have the "best health care in the world"? Really? Having 45 million people without health insurance and risking financial ruin for even the smallest maladies is the "best" system in your eyes? Really?
I guess I don't really need to point out that the US has lower life expectency averages and higher infant mortality rates compared to countries with universal care. I guess that I don't have to point out that we get a lower life expectency, higher infant mortality, and 45 million uninsured while SPENDING nearly twice as much on health care than the single-payer countries.
Health care demand is inelastic. If you are sick or injured, your demand for health care doesn't change based on price.
Increasingly businesses of all sizes don't want to pay for healthcare plans or insurance. Sole proprietors and small businesses make up an increasing portion of our economy, yet are at a distinct disadvantage when purchasing healthcare. The days are long gone when the right could whine that lazy do-nothings "should get a (better) job, if they want healthcare."
It's hard for me to believe that those on the right still able (willing) to think, cannot imagine the damage to society, wherein the sick and injured cannot afford basic healthcare, let alone preventative care.
Health care, on the other hand, works better when in private hands, and has proven to do so day in and day out. Health care is expensive in the U.S. because it is the best in the world.
Up-is-downism and fact-freedom in its full glory.
Pete:
We have the "best health care in the world"? Really? Having 45 million people without health insurance and risking financial ruin for even the smallest maladies is the "best" system in your eyes? Really?
Yes, by any standard. Read this story, which is a health care success story in the U.S., and you tell me differently.
I don't see "health care" strictly in dollars and cents. Besides, those 45 million people whom you say don't have health insurance can still get health care, and we (the U.S. taxpayers) have to pay for it. You all can drop that false "45 million without health insurance" meme.
karrsic:
It's hard for me to believe that those on the right still able (willing) to think, cannot imagine the damage to society, wherein the sick and injured cannot afford basic healthcare,...
What basic healthcare that the sick and injured supposedly can't afford are you talking about? Sick and injured people with colds, who don't need to see a doctor (since there isn't a cure, and the symptoms can be lessened with OTC medication)? Sick and injured people getting physicals (which is preventative care, something that is pointless for the sick and injured)? Explain, please. And remember that the U.S. Supreme Court has already mandated that nobody can be denied health care, especially emergency health care, even if the sick and injured can't pay for it.
I shouldn't even bother, but Steve's delusional assertions do require some rebuttal.
"Besides, those 45 million people whom you say don't have health insurance can still get health care, and we (the U.S. taxpayers) have to pay for it. You all can drop that false "45 million without health insurance" meme."
There's so much wrong with this. First, while it's true that ER's have to treat people, they still get billed exorbitantly for this service. Medical bills are one of the leading causes of bankruptcy.
Because of that, people wait until easily treatable conditions have gotten so bad that they can no longer be ignored. This ends up resulting in worse health outcomes and greatly increased cost (which, as you point out, the taxpayers end up covering the bulk of). Plus, the ER is a particularly expensive and inefficient way to treat people. ER docs always order every test because they don't know the patient's medical history and want to cover their ass. So costs of treating people in the ER are astronomically more expensive that just giving those people insurance.
We pay MORE for this dumb system than we would if we just provided coverage to the uninsured.
The suggestion that because ER's must treat people, people aren't really uninsured is proposterously stupid and disingenous. I'd encourage Steve to let his insurance lapse and try using the "ER policy" that he thinks is the equivalent to be insured. You'd be bankrupt pretty quick.
As for the system generelly, outcomes speak for themselves. Every other industrialized nation does better than we do in terms of health outcomes. And while it's true that people with good insurance generally get very high quality care, people with bad insurance or no insurance do not. Many HMO plans have very limited options and long wait times. They are much worse than Medicare. It all depends on what insurance you have. And if you happen to lose your job, good luck.
A.L.:
There's so much wrong with this. First, while it's true that ER's have to treat people, they still get billed exorbitantly for this service. Medical bills are one of the leading causes of bankruptcy.
Excuse me, but what you said is wrong as well. You forgot the part that said those who can't afford to pay for their treatment, usually at an ER, get their bills covered by the taxpayers. Either that or those performing the treatment eat the cost.
Because of that, people wait until easily treatable conditions have gotten so bad that they can no longer be ignored.
Which easily treatable conditions? Colds? Diabetes? A broken leg? Infections? How often does this actually happen? I know people who have insurance that ignore easily treatable conditions. Not because they can't afford it, but other reasons.
Plus, the ER is a particularly expensive and inefficient way to treat people.
No kidding. Plus, there are plenty of people who happily abuse this "treatment" method, and the government does way too little to stop it. Unfortunately, the law here is clear.
ER docs always order every test because they don't know the patient's medical history and want to cover their ass.
That's something else that needs to be reformed. I'd say nationalize legal care before health care, and disallow lawyers from over-inflating their own bank accounts on the backs of patients, doctors, and everyone else involved in the health care profession (remember, this is how John Edwards "made" his money, as a shyster).
Many HMO plans have very limited options and long wait times. They are much worse than Medicare.
HMOs are a failure. Yet, that is exactly what is being pushed, a national HMO plan.
Every other industrialized nation does better than we do in terms of health outcomes.
Which outcomes? How would you get to those outcomes in this country?
SteveAR: I read the article you cited, and in the context of your assertions, it begs several answers...1) The cost of the procedure was absorbed by the hospital that provided the care. That is wonderful for this woman. In return, the facility got the benefit of great (deserved) publicity, and the standard, more tangible "wash" of being able to cite a financial loss, enabling them to pass the expense on to other patients via higher costs. When the twentieth such case is presented, do you imagine that facilities will be able/willing to justify pro-bono work? 2) Is the facility also going to supply the patient with anti-rejection medications for the duration of her life? Such meds could be prohibitively expensive otherwise. 3) Do you imagine that an uninsured child with a more common injury (such as one who had been mauled by a dog, but with only superficial scarring and no loss of organ function) would be treated in the same manner?
Every other industrialized nation does better than we do in terms of health outcomes.Um, really?
http://3.bp.blogspot.com/_oKWxWOEilyQ/Se3IUnJ9AEI/AAAAAAAAAnk/kC816YeFNN0/s1600-h/five-year-cancer-survival-rates.JPG
Or are you speaking about life expectancy? If so, that's an incredibly dumb way to examine health care. After all, life expectancy varies from state to state, with Hawaii in first place at 80 years and DC in last at 72 years.
http://www.businessweek.com/bwdaily/dnflash/content/sep2006/db20060913_099763.htm
The average life expectancy in Minnesota, which has a lot of Norwegian Americans, differs from actual Norwegians by only 1.5 years.
This is not a defense of the current system, but an argument against reforming using a government-centered approach.
Oh, and the USPS is an excellent example of why we should never turn over health care to government. They can't even afford to maintain their stamp vending machines.
http://www.usps.com/communications/newsroom/localnews/ky/2009/ky_2009_0410.htm
Meanwhile Coke and Pepsi seem to have no problem maintaining their vending machines.
Fedex and UPS both manage to turn a profit. And yes, I am aware that their missions are not exactly the same.
People say that the private sector couldn't fulfill the USPS mission of delivering first class mail. Well, I'd like to find out. Why not end the monopoly on letters?
People knock the postal service but it's actually quite an impressive operation. You can drop a letter in any mailbox anywhere in the country and have it delivered safely to any address in the United States relatively quickly for less than 50 cents. That's impressive.
If there was no postal service, private companies would quickly fill the void and would likely do a decent job of covering the needs of people in metropolitan areas. But there a large swaths of the country that would be left out of the mail system, or at least would be priced out of it.
Markets are good at what they do, but they won't do things that are inherently unprofitable (like provide cheap mail service to remote addresses or cover people with pre-existing conditions)
People who don't acknowledge these realities have major blinders on.
Beth:
1) The cost of the procedure was absorbed by the hospital that provided the care. That is wonderful for this woman. In return, the facility got the benefit of great (deserved) publicity, and the standard, more tangible "wash" of being able to cite a financial loss, enabling them to pass the expense on to other patients via higher costs. When the twentieth such case is presented, do you imagine that facilities will be able/willing to justify pro-bono work?
I think this was a very unique case (for those who didn't read it, the woman had been shot in the face by her (ex?-) husband). Plus, I was answering those who only see the dollars and cents of U.S. health care. There is a lot more to it.
2) Is the facility also going to supply the patient with anti-rejection medications for the duration of her life? Such meds could be prohibitively expensive otherwise.
Good questions. I don't know. It'll be interesting to see if some arrangement has been made, as was the case with her surgeries.
3) Do you imagine that an uninsured child with a more common injury (such as one who had been mauled by a dog, but with only superficial scarring and no loss of organ function) would be treated in the same manner?
If the child's parent(s) can't afford to pay for the treatment, the taxpayers cover it (as I mentioned earlier). Besides, the treatment for a dog mauling (after having been mauled by a cat once myself) that doesn't involve organ loss would be antibiotics, possibly a tetanus shot, and stitches, provided the dog is known to have had a rabies vaccination (if the dog wasn't vaccinated for rabies, then more needs to be done).
People knock the postal service but it's actually quite an impressive operation. You can drop a letter in any mailbox anywhere in the country and have it delivered safely to any address in the United States relatively quickly for less than 50 cents. That's impressive.Impressive compared to what? Given that they have a monopoly it is difficult to know what to measure against.
If there was no postal service, private companies would quickly fill the void and would likely do a decent job of covering the needs of people in metropolitan areas. But there a large swaths of the country that would be left out of the mail system, or at least would be priced out of it.Given that you can ship a package pretty much anywhere in the world and have it tracked online I am sure that letters can be delivered. Would the costs go up? Sure, but that's the price you pay for living out in the sticks. It isn't my job to subsidize them. Is postal service some kind of right?
Besides, from an environmental perspective we should want more people living in cities.
Would the costs go up? Sure, but that's the price you pay for living out in the sticks. It isn't my job to subsidize them. Is postal service some kind of right?I love it when people forget why the analogy was raised in the first place. Colin, can't you see how this beautifully this illustrates my point? You're response is that people are free to choose where they live. I suppose that's true to some extent.
But in the health care context, you don't get to choose whether you'll get cancer or some other expensive to treat condition. Thus you can be rendered uninsurable through no fault of your own. The market just won't cover you. You need a public option.
And I think that few people would have a problem with a public option for those who have no other options. Indeed, that's why we have Medicaid.
The problem with a public option in the context of what you are proposing is that as a political animal it wouldn't be subject to market forces. It wouldn't have to break even. So people would gravitate towards it because premiums would likely be much lower (low premiums=votes).
The private insurers would be forced to compete with an entity that can lose gobs of money.
The better option is to abandon the insurance model altogether and move towards fee for service, which would force consumers to shop around. This is why Lasik costs have held steady or declined while quality has improved.
You don't use auto insurance to pay for an oil change, why do people use health insurance to pay for a checkup? Insurance should be used for events such as cancer. it is also absurd that insurance is linked to employment.
Moving away from the insurance model is the real bold move on reform.
Every other industrialized nation does better than we do in terms of health outcomes.Um, really?
Find the elementary logical non-sequitur: the fact that the U.S. performs best on one single category of health outcome (according to one study) makes it false that every other developed country does better on health outcomes in general.
But then I thought we were talking about health care in the U.S. being the best in the world. And how that -- according to some mystical conservative version of economic theory that none of us are privy to -- explains why it's so expensive relative to other countries.
Or are you speaking about life expectancy? If so, that's an incredibly dumb way to examine health care. After all, life expectancy varies from state to state, with Hawaii in first place at 80 years and DC in last at 72 years.
The average life expectancy in Minnesota, which has a lot of Norwegian Americans, differs from actual Norwegians by only 1.5 years.
Hilarious. Average national life expectancy is an "incredibly dumb" measure of health care because life expectancy varies from state to state. Of course, it only varies between regions in the U.S., and not in other countries, which is why we should be comparing the average life expectancy in Minnesota to the average life expectancy of Norway as a whole.
But then, of course, the fact that five-year cancer survival rates also vary from state to state must make that an "incredibly dumb" measure of health care.
if we are concerned about our saftey in regards to foriegn enemies (terrorists and so forth) and we are willing to spend trillions to try and thwart their nefarious plots (insert snarky guffaw here) then why is public healthcare such an issue? as a "blue collar" worker with inaduite insurance who has been dragged through the cleaners by my wife's illnesses (she had no insurance and now we are bankrupt, yet she remains uncured and uninsurable).
when i hear about poor services or long lines i think what people miss out on is that for me and my wife we would prefer poor services and long lines to no serviecs and no lines to stand in.
we both work, and work hard, we are careful with our money and responisble, but she has to die, in pain, so the "free market" can live. well fuck you to those pull-yourself-up-by-the-bootstrapper's out there. one day it could be you, a family member, or a friend.
I generally do not respond to those who attempt to hijack A.L.'s postings into other areas through obfuscation and deliberate misinterpretation. I will elaborate, however, on my prior comment that some things are too important to be left to the private sector, which is the exact opposite of the right's mantra that everything should be in the private sector.
My point is not at all about constitutional law (obviously), but rather an opinion that some important things are better done collectively so that everyone is included and efficiencies of scale are obtained. In the case of health care I think that can be a public-private mix as I explained before.
In the spirit of A.L.'s good use of analogy, I'll illustrate this with another one: what would happen if firefighting were left exclusively to the private sector? Presumably they would only respond to fires at homes of those who paid for coverage. Maybe they would refuse to cover apartment buildings unless everyone took a policy. Or maybe they would deny coverage to smokers. Probably they would avoid small towns altogether. They would lobby heavily to limit their own liability in the event of negligence, naturally. And they would vigorously oppose volunteer firem organizations as an interference in the "right to profits" (also not in the constitution, btw).
The rich would pay to protect their mansions, but maybe millions of others would have no coverage (like health care) either because they couldn't afford it or were denied it.
Health care, like firefighting, is something of basic importance where everyone should be covered - as is the case in all other civilzed countries. Lack of health care or firefighting can in fact lead to serious injury or death.
If you leave it to the private sector they will cherry pick for easy profits and millions will be left out, to the overall detriment of society. Some things in life are too important to be treated that way. The private sector cannot, will not, and does not solve all problems. When life and health are at stake there should always be both public policy and public options.
I think Colin has it right:
You don't use auto insurance to pay for an oil change, why do people use health insurance to pay for a checkup? Insurance should be used for events such as cancer. it is also absurd that insurance is linked to employment.
Moving away from the insurance model is the real bold move on reform.
Farrapo:
My point is not at all about constitutional law (obviously), but rather an opinion that some important things are better done collectively so that everyone is included and efficiencies of scale are obtained. In the case of health care I think that can be a public-private mix as I explained before.
Some things are better left for the collective to pay into (defense, police protection). Health care isn't necessarily one of them. I think the potential for threats to protected rights (and don't start about the Bush administration) are too great to leave the government in more charge of health care than it already is.
what would happen if firefighting were left exclusively to the private sector?
As I mentioned before, I live in a very rural area of Arkansas. I pay a fee every year for fire protection from a volunteer fire department (which isn't attached to the nearby city). When I lived in the Chicago suburbs, I got regular fire protection through my taxes. Which is better? I've never had to call the fire department in either Illinois or Arkansas. But it's definitely cheaper here in Arkansas. Yet, a full-time fire department is needed in the suburbs. A full-time government-controlled fire department isn't needed here where I live in Arkansas because there aren't nearly the number of people or homes under threat. So the answer to which is better, it depends.
If you leave it to the private sector they will cherry pick for easy profits and millions will be left out, to the overall detriment of society.
That's ridiculous.
The private sector cannot, will not, and does not solve all problems.
And the public sector ends up making problems worse rather than solving them. The track record is undeniable.
I live in a rural area, where terrorism and foreign army attacks are unlikely, and crime is nil. I have no children. Why should I pay for antiterrorism efforts, the military, and law enforcement, and education for other peoples' children? Oh, yeah, now you're asking me to pay for their health care too?
Find the elementary logical non-sequitur: the fact that the U.S. performs best on one single category of health outcome (according to one study) makes it false that every other developed country does better on health outcomes in general.If you have data that proves otherwise I'd like to see it.
Hilarious. Average national life expectancy is an "incredibly dumb" measure of health care because life expectancy varies from state to state. Of course, it only varies between regions in the U.S., and not in other countries, which is why we should be comparing the average life expectancy in Minnesota to the average life expectancy of Norway as a whole.
But then, of course, the fact that five-year cancer survival rates also vary from state to state must make that an "incredibly dumb" measure of health care.Wrong and wrong. The fact that life expectancies vary within the US is evidence that life expectancy is not a good proxy for health care systems since vast differences do not exist between US states. These differences are more easily explained by demographics and behavior patterns.
As for the Norway example, if you are going to play this silly life expectancy game then let's play. I personally see little value in such comparisons but I offer it up to those on the left who tend to place extreme importance on such things.
I live in a rural area, where terrorism and foreign army attacks are unlikely, and crime is nil. I have no children. Why should I pay for antiterrorism efforts, the military, and law enforcement, and education for other peoples' children? Oh, yeah, now you're asking me to pay for their health care too?Not apples and apples. Security is a non-rival, non excludable public good. Health care is not.
Education is another matter. I favor ending government-run education, which on this blog probably marks me as a terrible person that wants to return to the country to a dark age of vast ignorance.
Well, I'm just so impressed with the reasoning here: "The average life expectancy in Minnesota, which has a lot of Norwegian Americans, differs from actual Norwegians by only 1.5 years." What about the Swedes? And the Finns? And Germans?
What is "government-run" education? I thought the problem was all the unions, not the government. Would you guys get your story straight?
Hey, stripping this down to its essentials, life expectancy and quality of life are determined by:
a) DNA.
b) lifestyle
c) luck
d) healthcare
with a complicated dance occurring between them.
Modern medicine can do amazing things, if there's money, to extend a person's comfortable life a few years. This isn't useful for society, of course. By the time somebody needs that care, their productive life is likely over.
On the other hand, without treatment, the last few months of life aren't going to be pleasant.
This is why inexpensive, readily-available euthanasia is the logical conclusion to the position outlined by Colin. And SteveAR, although he's undoubtedly going to deny this.
Of course, for the wealthy, the extra years are available.
i want stevear and others to look into the eyes of a sick child or mother or husband or brother et al.... and tell them that we have enough money to have elective wars but not enough money to help them with their cancer, lymphoma, mental divergencies, and so forth. can you do that? what fuck all this articulate debate and tell me if your sister or mother or wife or someone you love was in pain or needed medical help you would give a shit about the private vs the public? you rightys are cold hearted motherfuckers, as wanda sykes said, i hope your kidneys fail.
"Putting aside for a moment whether this prediction is accurate, it's worth pointing out that it's totally inconsistent with the standard conservative talking points on health care reform. On the one hand we're supposed to believe that government run health insurance is some horrible thing that no one would want (the people Canada are so miserable!). On the other hand, we're told that such a plan would be so overwhelming popular that it would destroy the private insurance industry. So which is it?"
I believe the answer is that while you have a choice whether to participate in a public health plan, you don't have a choice whether to purchase it. Given that, a lot of people would take a mediocre public plan that they're basically forced to purchase (at least in large part) over a better private plan. Seems there's better ways to insure the 30M or so American citizens who aren't insured (and of course, a substantial portion of that 30M are perfectly capable of purchasing health insurance, but don't).
C2H50H:
Modern medicine can do amazing things, if there's money, to extend a person's comfortable life a few years...Of course, for the wealthy, the extra years are available.
Then go figure out how to make some money so that you can stop using your envy as an argument in this discussion.
Don't worry about me, SteveAR, old boy. I've got both good insurance and an HSA. (Why do wing-nuts assume that, because you lean left you must be poor?) Worry about where you are going to get quality medical care in the back country.
Fedex may deliver to your neck of the woods, but good luck finding a top-notch neurologist. Here's hoping you don't need one.
A couple of points I haven't seen addressed here, at least not succinctly:
The reason private payer health insurance is just a bad idea is that, if you set up a system in which some people profit by allowing others to die by refusing to pay for services etc., the inevitable outcome is that some people will die so that others can make a few more dollars.
It's just a bad idea, much like privatized prisons - set up a multi-billion industry with lots of lobbying money to throw around, and see how long it takes before they are fighting to impose ever more draconian criminal penalties upon us, the people funding their industry. Because it's good for the bottom line. Or like making certain boards and commissions elected rather than appointed positions - I'm sure that voters would enter into a spirited debate over who would be the best candidate for highway commissioner, district 5, and fully vett all comers, and there's no chance that the candidates would be put up and funded by say, the trucking industry.
I think a lot of people on the anti-public insurance choice side would like us to forget that as recently as 5 years ago, the health industry as a whole was lobbying hard to limit their exposure in lawsuits to something like $500,000. So if your health insurer dragged its feet or denied coverage for the $2 million liver transplant and ongoing care you would die if you didn't get in the next 3 months, their attorneys could drag it out 3-1/2 months, for a net savings of $1.5 million for the company. Plenty of people have died both before and since the tort battle thanks to capricious denial of coverage; it's just that capping the insurers' liability would generate even more profit.
Some things are just stupid ideas. Private health insurance without a public option is one of them, because it leaves people nowhere to turn.
All of this talk about people needing to pick up their own insurance is all fine and good, but the fact is, there are people that the private insurers REFUSE to insure, at any price. Say a guy runs a small business, a single guy, he develops a health condition, gets dropped by or has to drop his health coverage due to being away from work dealing with his health issues...he has two choices going forward: he can close the business and go to work for someone who provides a group plan, or he can marry someone who has group health and hope she never loses her job. Or, he can go without insurance and just wait for another relatively minor medical issue to take everything he's worked to build - business, home, investments - all of it.
Why in god's name would any conservative be approving of the notion that a handful of private health insurance company bureaucrats be allowed to constrain the free market in such a way? Because make no mistake, our private-only system hugely deforms the function of the free market. Right now, if you have a child born with diabetes or another chronic health condition, his career path is pretty much decided already - he can only be self-employed if he marries someone with group health. So much for the opportunity to build your own thing, eh?
Last, as to the point of who pays when an uninsured person shows up at the ER: it depends. If it's a private hospital, first they're going to take everything they have, and if that doesn't cover it, the hospital will mark up all their materials, services, and rooms across the board. If the person doesn't have anything to take, that stuff will get marked up more. Then your private insurer will get a higher bill when you go in for gallbladder surgery, which they will pass on to you in the form of higher premiums - plus 30% for profit, of course. So the uninsured guy in the ER is first gonna cost something like 800% more to care for in the ER than if he had access to regular medical care, and then the rest of us are going to pay 130% of that amount in higher insurance premiums.
Dumb. Dumb, dumb, dumb. You're already paying for it, but you demand that it cost MORE, for no apparent reason other than it makes you feel good to see others go without. It's no way to run a country.
Indeed, AL. Great post as always. I lived in Spain for a year, which has a universal public system that was instituted by the socialist government in the early 1990s. Because I was a foreigner, however, I had to buy private insurance, which many Spaniards opt to do as well, as there are at least 3 very good plans to choose from. Here's the key: because the public system covers everyone who wants it, there is no large, uninsured pool to drive up costs, so the private plan I chose was incredibly cheap and comprehensive, about $1500 for a year of coverage for a family of 3, with copays of something like $1.50 each. The care my family and I received was excellent, and the one time my son had to go to the emergency room, we were in and out in 30 minutes! Proof positive that there can be public and private plans in healthy coexistence.
joanofarc:wow. well put.
oh, and you notice stevear and others never address actual sick people who need help. 30 million 'could' get insurance? right, i have health insurance and they wont cover a sleep study so i can get a cpap machine for my apnea. due to this ongoing mdical condition i have gained weight and developed acid reflux. the insurance company's position is that i 'should' have been diagnosed with sleep apnea (because i "had all the symptoms prior to coverage") so it is a 'pre-existing conditon'. the stupidity of this is that i am and continue to develop other health problems because this one isnt addressed and these will have to be paid for by the same insurance company that wont insure my sleep study!! stupid, stupid, stupid!!
so when i hear about "some politician" standing between me and my healthcare i wonder what to do about the pencil pusher in the cubicle somewhere currently not allowing me to get proper services so he can get a bonus for magaing his "bottom line"
I live in Australia, where there are parallel public and private systems. I have also been treated in a US hospital after a car accident. Luckily, my Australian (private) insurer picked up the (unbelievable) tab. From what I have seen and read, Steve's arguments simply do not hold up to scrutiny - so much so that I wonder if they are advanced in good faith. It is pretty funny as a resident of another industrialized western democracy to hear those on the US right wing insist that American health care (or democracy, or education for that matter) is the "best in the world". Sorry, but that claim is ridiculous. The Australian system has its problems but our public and private expenditure on healthcare is much lower per capita than the US and our healthcare is every bit as good, if not better, than care in the United States - and everyone in Australia has access to it. If I am on a low income and have an infection in my foot from stepping on a nail, my local doctor will see me without much of a wait, treat the wound, give me a tetanus injection, give me a prescription for antibiotics, and send me on my way. I will pay nothing for that service and the cost of the prescription is often paid for as well. In the US, many people in this situation wait until they have tetanus or septicemia, present to the ED and are admitted for emergency treatment, at a massive cost. Not only that, but the ED, which should be handling car accidents etc, is clogged up with preventable conditions. Ask any ED doctor - this inefficiency is killing Americans every day. For this reason, I have no time for so called conservatives who want to apply their junior high school level understanding of economics (which they call "free-market principles") without reference to the plentiful evidence available in real markets all over the world.
Colin said:
The problem with a public option in the context of what you are proposing is that as a political animal it wouldn't be subject to market forces. It wouldn't have to break even. So people would gravitate towards it because premiums would likely be much lower (low premiums=votes).
There is no reason that it couldn’t be mandated by law that the public plan would have to break even. It would still have an advantage over most private plans though, because it would not have to make a profit.
SteveAR said:
Health care, on the other hand, works better when in private hands, and has proven to do so day in and day out. Health care is expensive in the U.S. because it is the best in the world.
I actually kind of admire the way you simply make things up and then assert them to be facts.
C2H50H:
Don't worry about me, SteveAR, old boy.
I don't. I just think the use of envy in an argument, as you do frequently, is invalid.
As I mentioned earlier, I think Colin has it right when he said, "Moving away from the insurance model is the real bold move on reform." Auto insurance doesn't cover tune-ups or oil changes, or more expensive items like new tires. Health insurance, either public or private, shouldn't be used for things people need to do on a regular basis. Public plans are worse because they allow for abuse. Again, government isn't known for actually fixing problems, no matter how much people want them to.
Of course I'm making an argument for single payer. What is being discussed in government and in the media right now is not about health care and it's not reform. It's about health insurance, and it's about making minor revisions in the existing system.
Single payer is health care provision for those who are ill. It's the way civilized and well governed nations do it.
Health care is expensive in the U.S. because it is the best in the world.SteveAR, what statistics can you give us to back up your "best in the world" claim? Infant mortality? Life expectancy? Cancer rates? The last time I checked we weren't close to the top in any of those categories, yet we spend more per capita than any other country and still leave 50 million people uninsured. So please, do enlighten us as to how our health care system qualifies as "best in the world"?
SteveAR said:
Public plans are worse because they allow for abuse.There's plenty of abuse in the current system, if you hadn't noticed. The public face of the anti-public insurance forces at this time is a guy who used to be CEO of Columbia back in the early 90s, before he was forced to resign thanks to the company's practice of overbilling Medicare and other abuses. You seem far more concerned that a few hypochondriacs will get more doctor visits at low cost than you are about the abuses that we know are going on right now, in the current joke of a system we have.
Right now, people go bankrupt every day because of the various outs and gaps in coverage the insurers have specifically designed for maximizing profits. In any other business, not providing the service for which you have been paid is known as "fraud." In American health care, it's known as "business as usual." And the people who just go broke are the lucky ones - as noted before, a lot of people have died thanks to their insurer refusing to pay for live-saving medical care. In any other business, this would be called "negligent homicide" or "negligent manslaughter" at the very least. In American health care, it's just "business as usual." It's been allowed to go on this long for one reason only - some people are getting very, very wealthy by abusing the rest of us. While there may not be anything in the Constitution guaranteeing us access to affordable medical care, there sure as hell isn't anything in there about how the government owes one particular business legal sanction to prey upon and abuse the rest of us in the quest for higher profits. Given a choice between the two, I know which one I find to be more in the spirit of "of the people, for the people, by the people" and it ain't "protecting the right of a health insurance CEO to take home a $100 million paycheck."
I've been self-employed and insured for 15 years, and during that time have made it a policy to avoid going to the doctor whenever humanly possible (I think I've been perhaps 3 times during that period), for the simple fact that, in order to maintain an individual policy, my medical records need to stay clean. I'm one relatively minor health incident away from having to go to work for an employer, because the first time my insurance company gets presented with a bill of any size, they'll either cancel the coverage or, if they don't, dramatically raise the premium to the point that I'll have to drop it - and then no one else will insure me.
Think I'm exaggerating? 2 years ago the construction company I was contracting with decided to try to help get 7 employees and contractors set up with Blue Cross for individual coverage policies. Out of the 7, I was the only one offered coverage. Why? Because there's nothing in my medical records because I don't go to the doctor - I have to keep that insurance in case I get hit by a bus or get diagnosed with some serious condition. So instead of providing me with a reasonable level of preventative care/health maintenance, my insurance instead provides a perverse incentive to avoid seeking medical care unless I'll die without it. It's entirely possible that I currently have some serious medical condition that, once it becomes acute, will cost the insurance company hundreds of times more to cover - but thanks to their refusal to cover anyone who's ever had a scraped knee, that's exactly the outcome they've incentivized.
Out of the other 6 who applied, there were a couple of them who had had serious or semi-serious health issues at some point in the past or had spouses who had, and the other 4, well, no one knows why they were turned down. These were all people in their late 30s - 40s - still relatively young, and all reasonably healthy (they do physical labor, for crying out loud) and yet they were deemed "uninsurable" by the company.
At this point in the game, if you are still arguing that this is not a serious problem, you've already lost the debate. And if you don't have an answer for providing coverage for all the uninsured people the insurers refuse to cover, which from my anecdotal experience is the vast majority of them, you're not being serious.
In my experience, people that argue against a publicly-funded healthcare system believe in one or both of the following
- some people flat out don't deserve healthcare, for whatever reason. Maybe because they're poor or bad people, or they don't want to pay for it.
- It's a much greater travesty to provide too much care to people who don't deserve it than provide less or none to those that do. Thus the preoccupation with fraud.
To me, and I may be talking to myself here, providing basic medical care is a moral issue. As in, it's immoral not to provide it, especially because this country certainly has the means to do so.
To all you "liberals" expressing "concern" about the "travesty" of health care via the free market, I imagine almost all of you are pro-abortion (or any of the other euphemisms used), including abortion-on-demand as a form of "birth control", and having the government (the taxpayers) pay to kill about a million humans a year. I'm not impressed by your "concern".
Wow, SteveAR, change the subject much? I understand that you don't have an answer for the real issue here, that is, that the "free market" in healthcare has failed to deliver on any different numbre of measures, but to fail to admit that and instead attempt to change the discussion to one about abortion...well, that's just pitiful.
I'll take your transparent diversionary tactic as an admission that no, you aren't being serious, and yes, you've already conceded the debate.
There is no reason that it couldn’t be mandated by law that the public plan would have to break even. It would still have an advantage over most private plans though, because it would not have to make a profit.This would most assuredly be a first. Amtrak doesn't break even. The US Post Office doesn't. Medicare is headed for a fearsome reckoning.
But this public option would be different? It defies belief.
Colin - alright, then, what's your alternative proposal?
Can the government mandate that private insurers cover everyone at an affordable price? Because if not, what's your solution to providing coverage for the 45 million who don't have it? Keep in mind that you're paying for them already, often at much greater cost than if we simply gave them free insurance which would also produce a better health (and economic) outcome.
If the government even could mandate such a thing to the insurers, how would such a half-measure be less onerous or expensive than just setting up a public, non-profit health insurance alternative?
Dollars are dollars, whether they come from taxes or out of your pocket. It would seem to me that the primary goal here is to provide the best care to the most people at the lowest cost. Thus far, no opponent of a public health insurance alternative has offered any idea about how to do it better for everyone at a lower cost. If you have an idea of how that could be done, by all means, put it out there.
SteveAR, there must be a photo of you in the dictionary next to "red herring." Who ever said anything about abortion? I know it's comforting to fall back on GOP talking points, but how about answering my question, which I'll repeat:
What statistics can you give us to back up your "best in the world" claim? Infant mortality? Life expectancy? Cancer rates? The last time I checked we weren't close to the top in any of those categories, yet we spend more per capita than any other country and still leave 50 million people uninsured. So please, do enlighten us as to how our health care system qualifies as "best in the world"?
usps doesnt "break even"? where do you get your facts...your ass? usps famously is the only government agency that runs in the black and always has. furthermore who said anything about abortion? fuck you stevear and colin, i hope you get and/or a family member or close personal friend become ill and find themselves terribly under covered. assholes.
In response to my prior remark:
"If you leave it to the private sector they will cherry pick for easy profits and millions will be left out, to the overall detriment of society."
Steve AR responded:
"That's ridiculous."
Actually that's precisely what has happened with private-only health care which was the point of my analogy. The private health companies cherry pick for healthy people, exclude anyone they can identify with a prior condition that might require care, and deny or delay paying reasonable claims if they can get away with it. This is extremely bad for society as a whole (not to mention those who are excluded).
Fortunately the great majority of Americans now understand these simple facts and change is coming.
usps doesnt "break even"? where do you get your facts...your ass? usps famously is the only government agency that runs in the black and always has. furthermore who said anything about abortion? fuck you stevear and colin, i hope you get and/or a family member or close personal friend become ill and find themselves terribly under covered. assholes.http://www.14wfie.com/Global/story.asp?S=10342310
You were saying?
I lived in Spain for a year, which has a universal public system that was instituted by the socialist government in the early 1990s. Because I was a foreigner, however, I had to buy private insurance, which many Spaniards opt to do as well, as there are at least 3 very good plans to choose from. Here's the key: because the public system covers everyone who wants it, there is no large, uninsured pool to drive up costs, so the private plan I chose was incredibly cheap and comprehensive, about $1500 for a year of coverage for a family of 3, with copays of something like $1.50 each. The care my family and I received was excellent, and the one time my son had to go to the emergency room, we were in and out in 30 minutes! Proof positive that there can be public and private plans in healthy coexistence.Well, I have an anecdote as well.
My girlfriend is Spanish. She's also a physical therapist. She says that insurance is cheap in Spain because it has to compete with the government. Now, many of you will read this and see it as confirmation of the need for a public option. However, she said that because the hospitals are compensated so little by the insurance companies -- and after all, you get what you pay for -- that they were encouraged to see many more patients to make up the money in volume. When the same amount of resources are spread more thinly the quality goes down.
This is one reason why she works in the US now at a hospital in DC and says that if a European style system is implemented that she will likely go back to Spain.
Colin - alright, then, what's your alternative proposal?I have a few ideas.
First, end the link between employment and health care. I think even leftwing experts agree with this. Eliminate the tax deduction.
Instead force people to buy their own insurance. This will drive competition and lower costs. We need to move towards a fee for service model with insurance reserved for catastrophic events.
Another step would be to review licensing requirements. My girlfriend, a physical therapist, cannot practice in California for example. When she came to the US from Spain she had to take all kinds of classes to be certified in Colorado despite having the proper education and work experience. For this she had to take classes at the local college on things like Colorado history and other unrelated subjects. Complete waste. We need to remove such barriers that restrict supply and increase cost. Also, not every procedure needs to be taken care of by a doctor.
Lastly, re-examine medical malpractice. While I am not sure this is the massive cost driver some people think, it should be given a close look.
These won't solve everything but would be a good start.
Colin,
I left my magic wand in my other life, so you'll have to implement your own "solutions" to the problem of the cost of health care:
Don't worry, though, as you've laid it out, all you have to do is:
1. wave your wand and make all the state AMA, nurses' associations, and other interest groups all accept the weakening of the licensing requirements. While you are at it, how about doubling the size of the medical schools, faculty, staff, buildings, equipment, and students? Or maybe we can just get them from Grenada or India.
2. After that, it should be a simple snap of the fingers to prevent companies from offering medical insurance. After all, people don't need it anyway, right? I believe you'd need perhaps a federal law forbidding companies from doing this.
3. Once you've done that, simply forbid any insurance company from offering anything but catastrophic care insurance, forcing everyone to purchase their ordinary care ala carte. I'm sure they'll all immediately gravitate to the cheapest source, once you've done that.
Shortly after that, we'll all be living in a health-care utopia, with doctors at street corners offering to perform appendectomies for food, and internists taking people's temperature at gas stations while they're filling the tanks.
I can see, with such deep thinking, why SteveAR thinks well of you.
Instead force people to buy their own insurance. This will drive competition and lower costs.Ok, so you're going to mandate that insurers must cover all applicants. I'm sure they'll be down with that. Are you also going to dictate the limit of what they can charge for premiums? And how are you going to "force" people to "buy their own", particularly if it's priced out of their reach? What's the mechanism for that? Isn't it highly likely that within short order, even more people would be uninsured, and those who were buying their own would be underwriting care for 50% of the population instead of the mere 20% they pay for now, and very quickly they wouldn't be able to afford insurance?
I don't think you've really thought this through.
Just like you pay higher auto insurance rates because of that uninsured jerk who ran the stop sign and totalled your car, you'll still be paying the freight for everyone who doesn't buy the health insurance, plus you'll be paying an additional 30% to make sure your insurer remains profitable. This will happen as night follows day. Why? Because there are always people who don't do what they're supposed to do, and that's not going to stop because we can't afford to hire a nanny for everyone to follow them around all the time and make sure they're keeping up their insurance premiums. A good many of the people currently insured are only insured because their employer set it up and withholds premium co-pays from their check (and unlike you, I don't assume that employers do not also "shop around" for the best deal in insurance; anyone who's ever worked for someone that provides insurance knows that policies and carriers often are changed annually. The net result? Prices haven't gone down.)
Like I said, you haven't really thought it through.
Senator Charles Grassley of Iowa is the main proponant an all-private-provider health system today. You can help put some pressure on him by sending a contribution to his Democratic opponent, Bob Krause at PO Box 2075, Fairfield, Iowa 52556. Check out Bob's web site at www.krauseforiowa.com
Colin said:
When the same amount of resources are spread more thinly the quality goes down.Colin, if you are arguing that the quality of health care in Spain is worse than in the U.S., then why is it ranked thirty places above us in the WHO report?
http://www.photius.com/rankings/healthranks.html
SteveAR:
1) The cost of the procedure was absorbed by the hospital that provided the care. That is wonderful for this woman. In return, the facility got the benefit of great (deserved) publicity, and the standard, more tangible "wash" of being able to cite a financial loss, enabling them to pass the expense on to other patients via higher costs. When the twentieth such case is presented, do you imagine that facilities will be able/willing to justify pro-bono work?
I think this was a very unique case (for those who didn't read it, the woman had been shot in the face by her (ex?-) husband). Plus, I was answering those who only see the dollars and cents of U.S. health care. There is a lot more to it.
Of course there is—there’s moral imperative (but that has always seemed to be the point made by liberals who are asking for universal healthcare, so I think it unlikely that you were approaching from that perspective). There’s also research, which I think is more likely to be your focus. If you do a very basic search, I think you will find that there is a wealth of research published yearly by Canadian physicians, British physicians, indeed physicians from any large nation, socialized medicine or not. If I’ve missed your point, kindly clarify—but NOT seeing the dollars-and-cents portion has gotten us where we are now.
2) Is the facility also going to supply the patient with anti-rejection medications for the duration of her life? Such meds could be prohibitively expensive otherwise.
Good questions. I don't know. It'll be interesting to see if some arrangement has been made, as was the case with her surgeries.
Again, I’d ask how this is to be covered in our system on a wider scale—that was one patient, but patient 20 will likely not receive pro bono care, nor meds. Our knowledge and abilities far outreach our payers’ ability to cover cases like this. Solve that problem, and people will cease to call for nationalized healthcare.
3) Do you imagine that an uninsured child with a more common injury (such as one who had been mauled by a dog, but with only superficial scarring and no loss of organ function) would be treated in the same manner?
If the child's parent(s) can't afford to pay for the treatment, the taxpayers cover it (as I mentioned earlier). Besides, the treatment for a dog mauling (after having been mauled by a cat once myself) that doesn't involve organ loss would be antibiotics, possibly a tetanus shot, and stitches, provided the dog is known to have had a rabies vaccination (if the dog wasn't vaccinated for rabies, then more needs to be done).
I try to use precise words, but I’ll rephrase. Treatment for a dog bite (or a similarly devastating cat attack) might certainly be antibiotics, a tetanus shot, and/or stitches. Treatment for a dog mauling (a term I generally hear in reference to repeated bites/tears inflicted during an attack) may involve all of the above, but generally will involve them again, and again, and again, in conjunction with reconstructive surgeries, regardless of whether the animal is rabid. (Seldom does that seem to be the case, incidentally.) In posing the question, I was referring to children whose families cannot cover the expense of such treatment, and my point was that more common situations (without the necessity for groundbreaking transplant surgery) are less likely to attract such an eager response from the financial services department at a hospital that is already overburdened with non-paying clients. Certainly, the acute phase of a mauled child’s care would be provided by any American facility to the best of its ability, regardless of payer status—but the non-acute, post-discharge, reconstructive phase (during which the injuries may no longer be life-threatening) is not guaranteed.
As regards superficial scarring and loss of organ function, a patent nasal opening (without a structurally normal-looking nose) can still function as an airway, albeit less efficiently. An eye that is incompletely/improperly covered by an eyelid, but not actually injured itself, can (with proper attention to lubrication) still function as an eye. A mouth that lacks portions of lip can still be used as a mouth if what remains can be approximated during speech/ingestion of food. The emotional scars of any of these injuries can be extraordinary, and facilities are not obligated to treat them if the patient’s condition is no longer acute. (Please note the attached article—occasionally, even insured patients must fight as payers balk at the ongoing expense. http://seattletimes.nwsource.com/html/localnews/2008254586_dogbitevictims11m.html)
Our current system is exceptional for patients in acute situations—you will be treated (must, by law, be treated) if your condition is life-threatening, regardless of your insurance status/ability to pay. The expense of that obligation is crippling all but the largest hospital systems nationwide. Even without the prospect of ongoing treatments, we have a financially-unsustainable situation. I know that the utopia depicted in Michael Moore’s film isn’t realistic, but I promise you that my Canadian cousins wouldn’t trade their healthcare plan for mine. It’s not perfect, and they freely admit it, but they’ve never deliberated over whether to buy meds or pay a gas bill, and they’ve certainly never wondered whether they might lose their homes to pay bills associated with a hospitalization. There are situations in which certain treatments might not be available to them, but I would point out that our system seems to be based on the hope of immortality; there very limited acknowledgement of death as inevitability, so we chronically spend unholy amounts of money on (often-painful) procedures that (physicians freely admit among themselves) will only briefly delay the demise of patients. Certainly, that isn’t the answer, either.
(PS--Sort of lost me on the abortion rant, SteveAG...did it tie in with the conversation at hand?)
I am a Medicaid eligibility worker. I think the current system leaves a lot to be desired, but I'm not sure how a public option system would work. There are always unintended consequences.
Most conservative and liberal analyses of our healthcare system are distorted. They contain some of the truth, but they leave a lot out too.
Medicaid eligibility is a farce. There are people who aren't poor by any reasonable definition, but they still qualify for Medicaid. Like a 16-year-old girl who lives with a parents and gets pregnant. She can qualify for SOBRA Medicaid to cover her pregnancy, and her parents income isn't considered. Even if her parents are mega-rich. Why should taxpayers have to pick up the bill for that? Or for "undocumented" immigrant women who get in the U.S. illegally and qualify for "emergency services" Medicaid to pay for the delivery of their baby.
I'm afraid that if we get "public option" medical care here, we'll have even more poor immigrants flocking here and bogging down hospitals and ER's.
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