Yessssssssss. We want the last dollar!
Paul Krugman writing in the New York Times has a great article about the supposed benefits of the private health insurance industry. Ostensibly as part of defense of the movie Sicko, it’s a very good read.
The persistence of that myth puzzles me. I can understand how people like Mr. Bush or Fred Thompson, who declared recently that “the poorest Americans are getting far better service” than Canadians or the British, can wave away the desperation of uninsured Americans, who are often poor and voiceless. But how can they get away with pretending that insured Americans always get prompt care, when most of us can testify otherwise?A recent article in Business Week put it bluntly: “In reality, both data and anecdotes show that the American people are already waiting as long or longer than patients living with universal health-care systems.”
A cross-national survey conducted by the Commonwealth Fund found that America ranks near the bottom among advanced countries in terms of how hard it is to get medical attention on short notice (although Canada was slightly worse), and that America is the worst place in the advanced world if you need care after hours or on a weekend.
Hip replacement surgery in the US is more available than in Canada. But, there’s a little catch you probably didn’t know.
On the other hand, it’s true that Americans get hip replacements faster than Canadians. But there’s a funny thing about that example, which is used constantly as an argument for the superiority of private health insurance over a government-run system: the large majority of hip replacements in the United States are paid for by, um, Medicare.
That’s right: the hip-replacement gap is actually a comparison of two government health insurance systems. American Medicare has shorter waits than Canadian Medicare (yes, that’s what they call their system) because it has more lavish funding – end of story. The alleged virtues of private insurance have nothing to do with it.
Here’s one of his examples of health-care treatment through an insurance company;
This can lead to ordeals like the one recently described by Mark Kleiman, a professor at U.C.L.A., who nearly died of cancer because his insurer kept delaying approval for a necessary biopsy. “It was only later,” writes Mr. Kleiman on his blog, “that I discovered why the insurance company was stalling; I had an option, which I didn’t know I had, to avoid all the approvals by going to ‘Tier II,’ which would have meant higher co-payments.”
He adds, “I don’t know how many people my insurance company waited to death that year, but I’m certain the number wasn’t zero.”
One of the little discussed issues with private health insurance discussed is the cost it adds to businesses in the US. Countries with state health care allow businesses to pocket that expense directly, or add a supplementary insurance option for things that are not covered via universal coverage. In Soviet Cannuckistan, my employer offers medical benefits of pharmaceuticals and dental care. All my other needs are met by the universal medical care. And those costs are a fraction of the cost of complete health care. How much does a business save when they don’t have to foot the bill the government could and probably should? You may not like this source, but the facts are strong.
In 1988, Chrysler’s CEO Lee Iacocca reported that each car his company produced in the U.S. cost $700 in health benefits alone, while the same car produced in Canada by Chrysler cost only $233 in health benefits.
The situation hasn’t changed much since then. In 2005, General Motors of Canada’s CEO Michael Grimaldi reported that each U.S.-produced car cost $1,500 in health benefits, compared to less than $500 in Canada. And in 2006, the Conference Board of Canada reported that in the U.S., health care and pensions add between $1,400 and $1,800 to the price of each vehicle – a major reason Toyota cited for building its newest plant in Ontario.
The carmakers aren’t the only ones bearing the burden. Wal-Mart’s annual bill for health benefits is $1.5 billion, even though fewer than half of the company’s 1.3 million U.S. employees are actually insured.
One of the top advocates for public health care in the U.S. is Howard Schultz, the chairman of Starbucks. He has been outspoken about the “moral responsibility” of businesses to provide health coverage. But he also knows that this is one of the best ways for companies like his to retain employees. Given that 45 million people in the U.S. have no health coverage whatsoever, even a low-paid job slinging coffee is desirable if it includes health benefits.
>>it is already the case that all US hospitals are obligated
>>to provide you care.
Yeah, and if you have any money, they will suck you completely dry. If you’re destitute, you’re cooking with gas, because you don’ t have anything to lose to begin with.
Way to go, gummint. Thanks for taking such good care of us. Oh well, at least you buy good armor for our troops. Woopsie…
#72
So your preference is to have an entire nation go over the cliff instead of one or two States? Oh yeah, that’s sound logic.
> Just pray you’re not one of the ones who
> dies from shitty health care in East
> Bumfuck while we “see how it goes”.
So what happens if you are injured in another country? Somehow that situation is handled both by Americans injured in other countries and citizens from countries with socialzied health care systems that get injured in the US.
From what you have described, we’re no better off now getting injured in the middle of nowhere then we would be if you are from a State that provides some form of health care benefits to its citizens and are injured in the middle of nowhere.
Nobody here has mentioned DCA. What do you guys think? Is DCA to good to be true? Is there really a conspiracy in the cancer treatment industry to suppress DCA because traditional cancer treatments cost so much? While something like DCA would not be under patent, and have no profit potential?
#60, you must have gotten confused somewhere, because I certainly gave no impression that I was in favor of contribution limits from individuals. My money is my property, and I should be able to give it to whomever the hell I wish to. Unions, corporations and trade associations are not people; however, and they have no inherent rights in the way you and I do, so limiting their ability to pump money into political campaigns is perfectly legitimate.
The reason why public funding of campaigns interferes with property rights is because you are compelling people, through the force of government, to contribute their property to a political process they otherwise are perfectly free to choose to not participate in. Or you are forcing them to contribute to individuals who they do not support, while also denying them the opportunity to financially support those who they do. And more dangerously, you are effectively giving the government sole domain over deciding who can run for office. Who in the government is going to get to choose who is and is not a legitimate candidate to receive these funds?
I honestly can’t understand why somebody who is so worried about the corruption of government is perfectly willing to take away the rights of individuals and place all of the power and control in the hands of that government.
There are a number of socialized and hybrid systems around the world. God forbid we just look at the ones in Cuba & Canada.
While living abroad, my boy had a hernia. I took him to the doctor in Helsinki, Finland. The doctor said I had two choices. I could wait 3 months for a free operation or visit him in his private clinic the next day and pay $200 (or something). My boys were born in Finnish hospitals, total bill each time, less than $3k.
After living in Europe for 14 years and coming back home, I can tell you the US private health care system is extremely difficult and much more expensive than the private systems within other countries.
I think there are a lot of reasons for that, a few include:
1. Little or no jackpot justice for malpractice.
2. The paper processing (especially private) was pretty simple.
3. They didn’t use the emergency rooms to treat the poor. The poor walked in the front door like the rest of us. But if they didn’t have money, they had to pay with time.
4. It appeared that it was very difficult for private business to game the system, so the businesses were earning economic rents from governmental health care (per the high US CEO pay packets mentioned earlier)
I love being back home, but the US medical system is for the birds. And I’m not sure, adjusted for medical costs, that total tax/medical outgo was that much different, especially, considering that I didn’t have to worry about catastrophic illness destroying me financially when I was abroad.
>>So your preference is to have an entire nation go over the cliff
>>instead of one or two States? Oh yeah, that’s sound logic.
No, Thomas, my preference is to have universal health-care coverage for all citizens, with a single payer whose overarching raison d’être isn’t sucking as much profit as possible out of healthy, sick, and dying people to fund the obscene salaries of their paper shufflers who do nothing but deny health care to those who should get it. Rather than “one or two” enlightened states providing this sort of coverage, and the others let folks fight it out on a case-by-case business to get treatment for stroke or diabetes.
The rest of your post is too nebulous to respond to. I’m not sure wtf you are saying.
>>I want to look out for myself, not everyone else.
Well, that’s nice. Just wait until you get cancer, have a stroke, get diabetes or leukemia, need a liver transplant, become depressed, get lupus, an aneurism, chronic fatigue, or have any one of the million other slings and arrows that the flesh is heir to. Assuming you have an individual policy (you must have been a very resourceful baby to have paid for that policy since birth yourself), they are going to DUMP your ass, or raise your premiums so high you might as well just pay for the liver transplant out of your own pocket. Then, you can become the 85,000,001st person without health insurance.
Then maybe you’ll see what the whole idea of pooling the risk is all about.
When they dump your body in a pit in Potter’s Field, you can have inscribed on your tombstone (not that you get one in Potter’s field, but what the hey) “Here lies a guy who opposed universal healthcare. He might be alive today, if his insurance company hadn’t kicked him to the curb. May God have mercy on his soul”.
>>never waited longer than a half hour in the emergency room.
Now I KNOW you’re bullshitting us. Either you only go to the emergency room after Dick Cheney shoots you in the face with a shotgun, or you ARE Dick Cheney.
You can walk into any emergency room in the country and ask “how many people have been here less than a half hour?”. The silence will be deafening.
Living in Australia. You may spend a couple of hours in an emergency room if it is busy and you are not in an urgent condition (you will have at least seen a triage nurse though). You will get seen and tended to quickly regardless of who you are and will leave with nothing to pay.
Elective surgery has long waiting lists if you want it for free, but you can go through a private doctor quicker if you pay or have insurance. Apart from that private insurance can get you a better room, but has no other effect on quality of care.
The only exception I have seen for this is dental which can have really long waiting lists if you can’t afford to pay.
#82 – MG,
For comparison, I walked into an emergency room with a cut finger, two stitches, nothing major, admittedly. It was more than half an hour to triage. And, the best part was that the triage nurse had everyone sign in when they got there and took us all in standard FIFO order. That’s not triage.
BTW, for my 5 minutes of actual care and two stiches, the total of the two bills (doctor and hospital bill separately here, kind of like going to a regular doctor and receiving a bill from the landlord, at least in my case where the only hospital equipment used was a bit of thread and a shot of novacaine), was … over $1,400!!
Worse, the insurance company actually approved all of the charges. They must be in cahoots. I think the charges were ludicrous and didn’t appreciate that my part of the bill was around $450.
Oh, and did I mention that they failed to give proper instructions for wound care? How are the immigration laws in Australia these days?
Mustard, I’ll agree with you about the drug companies, but to a certain extent that is true of all companies. People are in health care to make money, and you take away that option, the number of providers will drop.
I’d say the bigger problem is we really don’t have private insurance. Government mandates have made things more expensive. Why should insurance companies be required to cover mental health the same as physical health? This just raises the premium for people who don’t want that coverage. There’s hundreds of such mandates which are Congress deciding to run the insurance companies.
A bigger problem is the insurance companies just don’t compete very much since so much goes through employers. Everything is about denial of claims and cutting costs. Try getting covering for pregnancy after you’re pregnant. It is impossible to get private insurance that covers that. The auto insurance market is so much better. If you got that through your bosses too, then I’d bet you would have trouble getting your car fixed.
#79, misslavey
Also, I wish some of you boneheads would stop using the word “free” to describe universal healthcare. 15% of my income in taxes is not free.
I agree. 15% of my income in taxes is way too much to pay for healthcare.
HOWEVER !!!
If I am currently paying 20% equivalent to a private company to provide something less than good health care then 15% for good health care sounds like a bargain. Although I have no idea of where you came up with the 15% of taxes number. Maybe you know malren. Maybe you are malren in disguise.
Instead of paying premiums to private insurance companies, however, you would be paying the premiums to the government run insurance company. That is where the savings and quality increases come from. The easiest way to collect these premiums would be through current taxes instead of a separate tax.
So if my taxes increase $100 / month but I save $200 / month in insurance premiums then I, and everyone else too, are $100 / month ahead.
Sounds good, what’s the catch?
Well, there won’t be all those failed Doctors working for insurance companies justifying the refusal to pay for a service. There won’t be all those medically untrained call takers sending out refusal notices. There won’t be all those CEOs being paid tens of millions in compensation. You might not be able to finish that magazine article while you wait to see your physician because the doctor is on the phone trying to get the insurance to pay for a procedure for the last patient.
You are all full of it. National health care would put a lot of free loaders, those who provide no product or usable service, out of business. Insurance companies first, then the doctors who milk insurance companies next, followed by the lawyer leaches who milk the doctors insurance companies. The cost could be saved by eliminating the waste and greed from the above. Businesses in the country would benefit and the population would be healthier. So go suck shit, naysayers. You fit in one of the above groups or you would not speak outagainst it.
#87, they don’t have a choice because if lawmakers don’t require a particular item to be covered, some jackass sues their insurance company and gets the court to force them. Yep, that’s how a free market works.
>>Yep, that’s how a free market works.
That’s the problem. Single-payer universal health care: that’s the solution.
#78
> No, Thomas, my preference is
> to have universal health-care coverage for all citizen
Then the right way to accomplish that is the require each State to provide some sort of coverage for their citizens but let the States determine the form of that system. The type of system that works best for the people of Vermont is not necessarily (in fact not likely) to be the same system that works best for a State like California. Frankly, the best way to screw up the system is to give it to the Federal government.
Was the rest of my post really that difficult to understand? You seem to think that if we have 50 different systems for providing coverage to each State’s consitutents that when citizens travel it will break down or people will not be able to get care. Clearly that does not happen when people travel to other countries (or from other countries to here) so there is no reason to think it would happen when they travel between States. Who pays for the care and whether you can get care in another State are two entriely different subjects. “Universal” coverage relates only to the former.
#90 – Thomas,
Why exactly do you think that each state can get it right but the fed cannot?
Do you think it will be cheaper to have 50 government administrations than one?
What exactly do you think is different in the biology of Vermonters than Californians?
Do you think that the vast majority of the health care dollars in California are spent on surfing injuries and shark bites? Do you think that the incidence of skiing injuries is that much higher in Vermont due to icier ski slopes?
I completely and utterly fail to see the differences you assume are so obvious.
Sorry, I should have said 54 state government administrations of course to include DC, Puerto Rico, the Virgin Islands and Guam. Having done a lot of coding for municipal bonds, I can’t imagine how I forgot those.
#80-81, Mister Mustard..
You think I’m lying about my emergency room waiting time? You’re more than welcome to know exactly which hospital and emergency room I go to here in the suburbs of Cleveland.
I was insured since birth, and I decided to continue with them when I could no longer be under my parents policy. I suffer chronic conditions, and I have never had any limits on my treatments, nor been refused any treatments. My premiums haven’t gone up because of them either.
#85, Mr Fusion,
I got the 15% from my boyfriend, who has moved to the US from Australia.
Here’s an issue.. some people DO NOT want insurance, and they do not want to pay for something they will not use. My boyfriend is an example of this. He’s 21 and in perfect health, and he has no desire to get health insurance. I’ve told him the benefits of being insured, but I respect his views on it.
And just for the record, I’m a Libertarian. Thought I’d mention that before someone blurted out the term “neo-con” in my direction.
>>Then the right way to accomplish that is the require each State
>>to provide some sort of coverage for their citizens but let the
>>States determine the form of that system.
Yeah, but what if the “form of that system” in some states if “fuck you” or “eat shit and die”? I bring you back to letting states decide what to do about slavery. Remember how that worked out? It started a war.
I’m not so concerned about the logistics of traveling from state to state and trying to get the insurance to work as I am with the (justified) fear that some states just won’t do jack shit.
In either case, what’s the difference? The state, the feds, it’s all the gummint. Are you some kind of states’ rights nut? I’m all for self-determination, but fuck. Each state shouldn’t have to create its own army, national guard, or social security system. There are some things that the federal gummint should be doing, and providing the right to decent health care to US citizens is one of them.
>>You think I’m lying about my emergency room waiting time?
Not necessarily. I’m just saying that in almost fifty years of going to emergency rooms, taking my kids to emergency rooms, and accompanying friends and relatives to emergency rooms, I can’t recall having a waiting time of less than 30 minutes. Of course, I haven’t had the opportunity to accompany any shooting or stroke victims to the ER. Broken bones? You’re there for a minimum of 1hr. Unless the bone severed an artery and you’re bleeding out on the floor.
So you’re saying that you took out an INDIVIDUAL POLICY w/ Kaiser Permanente, chronic conditions and all, and they didn’t 1) kick you out, 2) raise your premiums until you couldn’t pay or 3) just refuse to cover your expenses? Fuck. I’m moving to California. Can you get ME one of those policies???
93:
“they do not want to pay for something they will not use.”
People’s views should be respected when they know what they’re talking about. Otherwise, it’s just being polite.
By definition, most people will not “use” insurance. The purpose of insurance is to protect the buyer from a low probability event. If everyone “uses” it, then it isn’t insurance, it’s a payment system.
Whether they understand that or not, they have simply made the decision that if they have a catastrophic medical event, they’ll either pay for it themselves, through friends and family, the government (Medicaid) or by throwing themselves on the tender mercies of public charity.
#93 – misslavey,
Libertarian is a position I can respect. I don’t agree with it and tend to sum it up as “freedom to starve”, but can respect it. Me, I’m a liberal, so have similar views on social issues but very different views on finances. However, being willing to pay more in taxes still makes me more fiscally conservative than the current generation of borrow and spend republicans.
That said, if people shouldn’t have to pay for things they don’t use, then I don’t want to pay for nuclear weapons, subsidies to oil companies, the Iraq war, and a long list of other things. I also AM willing to pay for children’s education, despite the fact that as a Darwinian failure, I will never make use of it.
So, we don’t really get to choose which government programs we fund and which we don’t. Taxes aren’t levied for the benefit of the taxed. Nationalized health care is something I would fund and be willing to pay higher taxes for even though I already have health insurance. I think the benefits to myself may be significant or may not be, but the benefit to society will be enormous.
#94
> Yeah, but what if the “form of that system” in some states
> if “fuck you” or “eat shit and die”? I bring you back to
> letting states decide what to do about slavery
If you lived in such a State that enacted such a solution then either move or vote for new representatives that put in a better system. This is not close to analagous to slavery. We aren’t talking about enslavement of human beings. We are talking about the best solution for not creating a cluster-!@#$ of a system.
Whether States do “jack shit” or not has nothing to do with people that live in States that actually do jack shit which is the ENTIRE point. Who cares if Alabama decides to implement a crappy system. If the people Alabama don’t like then they should change it but at least it doesn’t drag down everyone else.
> Each state shouldn’t have to create its own army,
> national guard, or social security system.
Frankly, yes they should and do. Every State has its own National Guard and many have their own retirement plan. Yes, I’m a States right nut because that is a core principle on which the country was founded: separation of power. We are in the United *States* not the one State.
> There are some things that the federal
> gummint should be doing, and providing the right
> to decent health care to US citizens is one of them.
See the flaw in your logic is the “decent health care” I’m assuming that when a government puts together a system, the odds are incredibly high it will suck at first or eventually suck or both. Thus, it is better to isolate the issues so that over time we can see what works best in the various implementations and what does not work. For the same reason that if Britain’s system sucks it does not affect France so to should we isolate the systems in this country.
#99 – Thomas,
If we have 54 or even just 51 systems, it is a near guarantee that many of them will suck. If we have one, we can work on making it a good one. It may suck initially, though I find it hard to imagine it sucking worse than our current system, but at least we’ll have a shot at getting it right.
And, for the wealthy, we can always keep our existing sucky insurance companies to provide extra care above the federal system. I think though that having 51 or 54 systems guarantees that poorer states will have poorer health care. Is that morally acceptable? Not to me. As it is, we already have that situation with schools, giving a huge education discrepancy between the states. Why would we want that with our health care as well?
#99 & 100
Why not a hybrid system. The Federal Government already sets certain standards for education, road construction, and other areas of state jurisdiction. They usually do this with monetary incentives. If the state doesn’t want the federal dollars they don’t have to meet the federal standards.
I for one would much rather have our State run any health insurance scheme for the simple reason they would be much more responsive to problems then would be a much more massive national scheme. The Federal Government could set the standards though. They could also contribute some of the money so poorer states such as Mississippi and Arkansas could afford the same insurance plans as the richer states.
#101 Mr. Fusion,
I have to think about that. My first take is that it is not working for education. My second take is that it means double the red tape.
#100
> If we have one, we can work on making it a good one. It may
> suck initially, though I find it hard to imagine it sucking
> worse than our current system, but at least we’ll have a
> shot at getting it right.
Whether any system sucks worse than the current system is not the issue. The core issue is whether a monolithic solution is better than a distributed one. The moment you add a bureaucracy it is incredibly difficult to change it and it gets harder to change the bigger the bureaucracy gets. Putting a system in at the Federal level will be even harder to improve IMO than at the State level.
> I think though that having 51 or 54 systems guarantees that
> poorer states will have poorer health care. Is that morally
> acceptable? Not to me.
The quality of health care is orthogonal to the topic. The issue is quality of *coverage* for health care. A universal health care system *only* relates to coverage not the quality of care when you get to the hospital or doctor’s office.
Frankly, that there are poorer or poorly managed States is a good example of why we should have separate solutions. It may very well be the case that poorer States devise solutions that help them save on costs. A huge monolithic solution means that States that are better off (and thus the people in those States) end up having to pay more to make up for poorer States. How is that fair to the people who happen to live in “wealthy” States (whether they are wealthy or not)?
The Federal government works best when it sets standards and allows the States to devise solutions to implement those standards.
> Not to me. As it is, we already have
> that situation with schools, giving a huge
> education discrepancy between the states
Again, that is an excellent reason FOR separate education systems. Rather than it being the case that every education system is awful, it is only awful in select States. If you live in a State where it is poorly managed you can either A: move to a State where it managed well, B: get involved in politics and have it changed or C: do nothing.
#103 – Thomas,
The quality of health care is orthogonal to the topic. The issue is quality of *coverage* for health care. A universal health care system *only* relates to coverage not the quality of care when you get to the hospital or doctor’s office.
Actually, this is incorrect. Doctors are limited in the care they can provide by the coverage they get from the insurance. My own doctor has repeatedly changed (i.e. reduced) the number of companies from which he accepts coverage because, as he states, he “cannot provide good care” under certain insurance companies. I am not sure why he cannot say to a patient, you need such-and-such a test but your insurance does not cover it. He may actually be restricted from doing so.
Frankly, that there are poorer or poorly managed States is a good example of why we should have separate solutions. It may very well be the case that poorer States devise solutions that help them save on costs.
We will have to agree to disagree on this point. I find that position morally unconscionable. I believe similarly about your statement on schooling. It completely violates my sense of fair play to give worse education and worse health care to people because they happen to be on the wrong side of a state line.
People need an acceptable level of basic health care, which they do not currently get. People need an acceptable level of basic education, which they do not currently get. These things need to be fixed. We can’t simply say that it is OK for a state where people are overly religious, for example, to deny a decent science education or to allow children to die because treatment is against the religion of their parents. Similarly, we cannot allow people to receive bad education and bad health care because the state in which they live has less money than other states.
>>If you lived in such a State that enacted such a solution then either
>>move
Ah, we can vote with our feet? Is that it? Is this 1980? Seems like deja vu all over again. As you may or may not be aware, those who are most affected by the current “systems” (speaking loosely here) are the ones LEAST likely to pack up and move from Beverly Hills to the Upper East Side. More likely if they move, it will be from Compton to Inglewood, or from Jerky Falls to East Bumfuck.
>>We aren’t talking about enslavement of human beings.
Unfortunately, no we are not. We’re talking about essentially putting people to death early, because they don’t have enough leverage to get adequate medical care paid for by the Health Care Denial industry
>>We are talking about the best solution for not creating a
>>cluster-!@#$ of a system.
It may have escaped your notice, Mr. Train, but we ALREADY HAVE a cluster fuck of a system.
And requiring each state to work this critical issue out in isolation, 50 times over (or 51, or 54, or whatever) would guarantee a cluster fuck * 50.
Kinda like having a well, vs. city water. If something goes wrong with your well, you’re just fucked. You work it out on your own. (Or move some place with a good well). If something goes wrong with the city water, it’s a problem for everybody, and everybody has a vested interest in seeing that it gets fixed.