Thursday, May 21, 2009


Political Mayhem Thursday: Health Care

There are three basic models:

1) Private insurance with government regulation (the current plan)
2) Private insurance plus government insurance available (the Obama plan)
3) A single payer for all health care.

As between the first two, it's complex. We usually think that government is less efficient at providing things than the private sector, but that isn't true with health care. Medicare runs on about 3-4% overhead, while private health insurers have about 30-40% overhead.

So, what should we do?

Single payer is the only one that makes sense. Our current system is terrible. We have one of the worst systems in the western world.
Personally I think that access to basic medical care is an essential human right, so I say plan B, or any plan that provides people with a free or low-cost way to get basic preventative health care that they currently do not have.

And before people jump in and say that it's already available, no, it's not, for many many Americans. The emergency room does not count.
I will be on the road to Florida today so no time to really comment.

Just remember that when you have employer provided health care it is very hard to objective about the other options. Even if your portion is going up.

If you currently provide/pay your entire health care premium (I do) and it isn't tax deductible and the out of pocket is at catastrophic levels you have a very different opinion. If you have lost your employer provided insurance and go into COBRA (temporarily) and it's high premiums you may have a different opinion. And when you try to get your own insurance and have a pre-existing condition (perhaps recently remedy by Sen. Kennedy) - good luck.

Have a great day everyone!
Anon 12:53 AM:

"We have one of the worst systems in the western world."

Really? Would you prefer to be treated across our southern border?

Or, perhaps you would look for a less-terrible system accross our northern border? Canada's system works great -- unless you actually need healthcare.

Government run healthcare in other countries has killed (not hyperbole) members of my family. I am NOT in favor of handing over the system that will care for my wife and children's medical needs to the same dopes who run the DMV.

Look, our system is not ideal. I've been uninsured, self-insured, employer insured, dirt poor and middle class. It has problems, significant problems. But handing it to the government is like a jackrabbit asking a coyote to help him with his fox problem.

Option #1 is still the best (less bad) option available.
What about the model where you steal french bread from small children?
Thomas G Paine is absolutely correct.
How many millions have private insurance companies killed?
Having lived abroad (including England), I have to laugh when people proclaim Canadian, English, Swedish (name your basic godless socialist system) is inferior to our wonderful healthcare where 40 percent of Americans have NO health care.
Some people simply don't have all the facts.
No system is perfect. However, in the countries mentioned (and elsewhere), there is universal health care. And yes, in certain large urban areas (like London), it can take up to six weeks for a hip replacement.
Um, my mom has been waiting two months for surgery on her hand -- and she has a tumor.
I've waited three months to see a nephrologist.
Outside of a few isolated (sometimes flawed) surveys, most people in these countries are happier with their systems than we are with ours.
Children suffer the worst under a system that is dominated by insurance companies and HMOs.
I think there is a predicate discussion that we should have on what we want out of a healthcare system and in what order.
Obama's proposal - the second tier - is a bit of a cop-out in terms of cost and efficiency, but may be the only politically viable way to cover our nation's 40 million uninsured. While morally it is superior to our current system, it will still be a very costly system, with much overhead and multiple layers of private insurers and public bureaucracy.
Seems like there are always going to people who cannot afford health insurance and there are also ALWAYS going to be people who have money and feel they deserve better health care than "regular people." You know the types who say stuff like "Oh my nephew, he goes to Lance Armstrong's Doctor." that kind of stuff. I mean its like defense attorneys... Just because there are you know those high profile people out there... Alan Dershowitz/ Thomas Mesreau whatever - ON TV ALL THE TIME types out there (I am a recovering Court TV Addict -forgive me) does not mean that the world will never need public defenders.

I think a LOT of people would appreciate and use quality government health care that is supplemented or free or something but there will always be people who will want nothing to do with it, you know?

I just My Dad was a doctor and there was always this sort of snobbery about you know who as the best doctor and people always wanting to go to "the best" doctors around. There are so many people like that, people who need to even get their stupid flu shots (or whatever routine medical tratment you could easily get at Walgreen's) from "the best" one that they will never lower themselves to go to you know GOVERNMENT doctors.

Not that ALL doctors are GREAT. I mean, some of them do suck, but I think you're never going to "cure" this country from wanting more and more and more choices for everything.
I appreciate Bob's sober reminder that there are problems in every system, and agree that the problems in our own are more problematic than in Canadian/western European.

I feel like health care is in the same category as education, clean water, or security: these are basic things that every citizen needs in order to be able to participate fully in a democracy, to be free and autonomous subjects.

I think #2 miiiight work, but more likely it is the piecemeal approach that Obama's pushing for out of compromise rather than because it's the best. If it were possible, I'd say go for #3. As in Britain, there could be private hospitals, etc., for those who elect to spend their money that way, but -- as in Britain -- it should not be of superior quality to the public system.

An anecdote (most have one): I got pretty sick while at a conference in Germany because of some odd infection/bug bite. I went to the hospital, where they saw me within 20 minutes (in Dusseldorf, a big city), performed minor surgery, and saw me for a follow-up two days later. All for 40 Euros. For a non-citizen who was in the country for a few days. I know there are problems there too, but I'll take that system. (I'll also take the French system as fictionalized in The Diving Bell and the Butterfly -- great movie if you haven't seen it!)
Spoiler alert: This comment is hella long and many of you will disagree with it.

The efficiency problem with gov’t insurance isn’t just overhead and operating costs. Private insurance rates are what they are because A) there is some level of competition in the market and B) some people and/or claims don’t get covered—ie, companies don’t cover patients or procedures that don’t make actuarial and financial sense. I know, they’re all cold-hearted bastards, right? Contrast this to a gov’t insurance program, wherein the STATED GOAL is to cover everyone and everything.

If the plan is to pay for all sorts of healthcare out of the feds’ pocket, and then get some private firm to insure the gov’ts exposure to the risk of paying out, that is a viable (but costly) option. Not to mention that some congressman’s nephew’s firm is going to get to write the policy. But to use the gov’t itself as the insurer doesn’t jive. What’s being insured against? What’s the calculation of risk? There is none, because the gov. will pay for everyone, in every instance (elective stuff aside).

So, we come by our current system honestly, flawed as it is. We just have to tweak it, phase out employer-based coverage, and drive costs down so that it’s only Medicaid-eligible folks who need gov’t help to have coverage.

Remember though that ACCESS and COVERAGE are separate problems, with separate solutions. Anyone can walk into an ER and get care right now, no questions asked. You just have to be able to pay for it.
1 is socially irresponsible. 2 is a lukewarm cop out to powerful interests. 3 is the best option, but unlikely in a society as class-driven as ours.

There will be problems with anything, public or private. The difference is that public things are (or ought to be) transparent and democratic, whereas private companies are closed and autocratic.
I'm going for brevity, like Lane. Government run health care (which is what single payer is) will turn each and every American into a ward of the state. Susceptible to the whims of the state. Do you want that? Do we want to subordinate our current ability to make certain choices about health care to the state?

Do you want a Republican administration to attempt to refuse to fund abortions under the national health plan?

I know I don't.
Ward of state v. getting my lifelong disability repaired? (and when you're born with it, it's always pre-existing) Ward it is.
As an ICU nurse, all I can say is, a patient rolls in. I have absolutely no idea what insurance they have, if any, nor do I care. They all get treated the same way, which is to say, I do my best to keep them from dying. As nurses, we do everything we possibly can to heal the folks who are ours to care for. We turn them, bathe them, give their medications, brush their teeth, feed them, hold their hands, cry with them, laugh with them, and console their families when their loved one dies.

My time to care for these people is greatly diminished when I am required by insurance companies, Medicare, and other parties involved to scan barcodes for every medication I give, document what side they are lying on at a given hour, or how many chargable supplies I used during my shift.

Just a thought or two, from the bedside.

Mrs. CL
RRL, you assume that the State is some sort of omnipresent parent figure that is out to oppress you.

This is largely true in the context of a capitalistic society. It can be true of a socialistic society too.

Authoritarianism is the problem, not government in and of itself. The ward of a fascist state and the ward of a Stalinist state, for example, are equally oppressed.

The solution, therefore, isn't to entrust us to (gulp) private interests, because then only those of means will have the freedom to choose the best, and those without means will be forced to take the worst services. Or worse, we'll tie every thing up in insurance legislation where companies hire people only to find ways to deny coverage to sick people.

The best answer has to be one managed by a democratic government. Point of fact, no, I wouldn't like it if a Republican Congress made it so that the government wouldn't pay for abortions... but I wouldn't like it if a Republican Congress banned abortion in general. I don't stand to lose anything by having the government be the single payer for healthcare. I stand to gain a lot.
Republican administrations have ALREADY made it much less likely that the government will pay for abortions. We already live in that world, RRL.

Ideally I would like a single-payer system. I think it's simpler, fairer, and it's been shown to work in other democracies. The notion that having health insurance is tied to having a job--i.e. having one's employer pay, or help to pay, for health insurance as a job perk--is really strange, when you think about it. Why would employers want to do that? And why should people have to be employed to have health care? It must be a relic of the days when people worked for the same company their whole lives.

I'm extremely pessimistic that we'll ever get to a single-payer system in this country. The current system is much too entrenched; there are too many factions who benefit from it. And change of that magnitude is just very, very hard to achieve in a big country. The situation is bad now, but I don't know if it's bad enough for people to push for a radically different system.
"RRL, you assume that the State is some sort of omnipresent parent figure that is out to oppress you."

This is absolutely true. I do assume that. And I assume it because it is true. And Lane, you assume that Harry Reid and Nancy Pelosi are apparently devoid of greed, selfishness, and completely driven by an interest in helping every single person without any view to their own self-interest.

There is only so much power to be had, and it is a zero-sum game. So, every bit of power that the government takes is less power for the people. This is mitigated somewhat by living in a democracy, but it is a representative democracy, which means that I'm still handing power to a select group that can make decisions largely unfettered by the body politic.

Stalinist Russia and Hitler's Germany are two of the many examples of what happens when a government gains too much control over people's lives. And the results are not pretty.
No system is perfect. We live in a real material world with all sorts of flaws.

What is needed is not the ideal, but a pragmatic solution.

The best solution is a single payer system which mandates access for everyone.

So, it means that we have to raise our taxes? Please, do.

Large employers can no longer afford to pay for health insurance plans which leads them to reduce or eliminate benefits or to ship jobs overseas. In the case of small employers, there is no way that they can cover the cost of insurance.

The shipping of jobs overseas has been happening with skilled labor, let alone non-skilled labor, for years and with globalization it will continue to happen.

White collar positions will fare no better. Why should a business shell out fifteen or twenty thousand per annum for a family health policy in the US when they can just as easily ship the job to Indonesia, India, or China?

The United States is the ONLY western industrialized country without a National Health System.

American exceptionalism is a sad remnant of a misreading of America's errand into the wilderness circa 1620. Why do we still cling to this idea as an organizing principle for our nation?

The market, for all of you free market libertarians, turns a profit through denying coverage to people with pre-existing conditions.

Poor people will qualify for Medicaid, but the working poor and the working class often go without any health care, or at best, predatory sub-standard health care.

People do not choose to get sick and people's lifestyles are not always the contributing factor to any illnesses which they might be suffering. Every sick person is not a five pack a day smoker who dines on hershey bars and McDonald's.

For instance, the thirteen year old boy does not choose to get cancer.

The forty year old mother of two does not choose to get Lupus.

But, there are many fine insurance comapnies in the U.S. that deny these people coverage or drop them from the rolls once they get sick.

Who can afford a cancer drug that costs fifty thousand dollars a year or more?

Why do we still tolerate a fragmented system of healthcare which denies access to people and punishes people for being sick?

There are 47 million people in the United States who are uninsured. When you account for the underinsured, the number is much higher.

National Health Care is no more of a socialist grab than a large standing military is or the largesse of corporate welfare which is holding up the financial institutions.

People from across the ideological spectrum, speak of the importance of spirituality or faith, they speak of American values.

Where is the value in not caring for our neighbours and their well-being?
Posters such as Thomas Paine who inevitably always mention close friends or relatives who have died waiting for care in countries with "socialist" medical care plans (as painful as that is) never seem to mention the individuals who die from lack of care in countries who have health care systems such as in the US...and yes, it does happen, from people who are denied treatments from their insurance carriers, cannot afford primary care (because the insurance doesn't cover it), so treatable diseases are missed until it is too late, etc.

As one of the previous posters mentioned, every system has its flaws. Rightly so, as human beings with human flaws are in charge of all health care systems.

But I find it fascinating that consistently, when polls are taken about public satisfaction with their current "socialized" health systems, Canadians, Spanish, French, etc., pretty much consistently show roughly 70+ per cent of citizens overall satisfied with their health care...

Good luck with finding any poll in the US that has a satisfaction rate anywhere near that high for our current system.
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