So for those of you who haven't seen Sicko, the US is the only "western" nation that doesn't have socialized health care. As a result, our health care costs exceed 15% of our GDP (expected to increase to 20% GDP by 2017). That equates to over $6,000 per person every year. In…
Originally posted Monday, August 17, 2009 (3 years ago)
People opposing having a Government health care program often say that "People from every Country in the world come here to get treatment".
While it is true that rich people can do this and by-pass the wait times of a public system. It is also true that some Americans who can't afford health care will resort to identity theft to get free health care in Canada.
Quote
Pendleton recounted the case of William Skupowsky, a U.S. citizen who was arrested in Calgary in 2001 for using a Canadian passport that he had obtained by assuming the identity of a dead nine-year-old boy from British Columbia.
Police later determined that Skupowsky, a San Francisco resident who went by the name of Randy Klassen, had used his alias to get elective surgery at a Calgary hospital. He also confessed to belonging to a ring of bogus health-care claimants from that city.
He said, You people have free health care in Canada. That s pretty well known . . . I m part of an underground railway of people coming up from San Francisco to have their medical problems taken care of in Canada, said Pendleton.
If the current health care system is as good as the Republicans make it out to be, there wouldn't be a market for criminals to sell Canadian health care via identity theft.
There are also people who go to Cuba for operations. According to this website, 1 million poor people from 31 third world countries have had their sight restored in Cuba.
Originally posted Tuesday, August 18, 2009 (3 years ago)
Gotta love the WSJ... They make even the most insane argument sound reasonable.
Quote Americans are being urged to worry about the nation spending 17 of its gross domestic product each year on health care -- a higher percentage than any other country. Addressing the American Medical Association in June, Barack Obama said, "Make no mistake: The cost of our health care is a threat to our economy." But the president is mistaken. Japan spends 8 of its GDP on health care -- the same as Zimbabwe. South Korea and Haiti both spend 6 . Monaco spends 5 , which is what Afghanistan spends. Do all of these countries have economies that are less "threatened" than that of the U.S.?
No. So there must be other factors that affect the health of a nation's economy.
Mr. Obama has said that "the cost of health care has weighed down our economy." No one thinks the 20 of our GDP that's attributable to manufacturing is weighing down the economy, because it's intuitively clear that one person's expenditure on widgets is another person's income. But the same is true of the health-care industry. The 2.4 trillion Americans spend each year for health care doesn't go up in smoke. It's paid to other Americans.
The basic material needs of human beings are food, clothing and shelter. The desire for food and clothing drove hunter-gatherer economies and, subsequently, agricultural economies, for millennia. The Industrial Revolution was driven by the desire for clothing. Thus Richard Arkwright's water frame, James Hargreaves's spinning jenny, Samuel Crompton's spinning mule, Eli Whitney's cotton gin and Elias Howe's sewing machine.
Though it hasn't been widely realized, the desire for shelter was a major driver of the U.S. economy during the second half of the 20th century and the first several years of the 21st. About one-third of the new jobs created during the latter period were directly or indirectly related to housing, as the stupendous ripple effect of the bursting housing bubble should make painfully obvious.
Once these material needs are substantially met, desire for health care -- without which there can be no enjoyment of food, clothing or shelter -- becomes a significant, perhaps a principal, driver of the economy.
A little-noticed feature of the current recession is the role of the health-care industry as a resilient driver of the general economy. Health-care now accounts for 10.4 of nonfarm employment. Health-care employment grew by 19,600 jobs in July 2009, on a par with the average monthly gain for the first half of 2009, which was down from an average monthly increase of 30,000 in 2008. Remarkably, these gains occurred in a period during which total employment shrank by 6.7 million.
The U.S. health-care economy should be viewed not as a burden but as an engine of growth. Medical and orthopedic equipment exports increased by 65.1 from 2004 through 2008. Pharmaceutical exports were up 74.6 . The unprecedented advances expected to come out of American stem cell, nanotechnology and human genome research -- which other countries' constricted health sectors cannot support -- will send these already impressive figures skyward.
A study by Deloitte LLP has found that more than 400,000 non-U.S. residents obtained medical care in the U.S. in 2008, and it forecasts an annual increase of 3 . Some 3.5 of inpatient procedures at U.S. hospitals were performed on international patients, many of them escaping from Canada's supposedly superior health system.
"Inbound medical tourism," Deloitte stated, "is primarily driven by the search for high-quality care without extensive waiting periods. Foreign patients are willing to pay more for care within the United States if these two factors play a large role." The deficiencies of the foreign health-care systems the Obama administration wishes to emulate can be counted on to generate ever-increasing revenues for U.S. providers and employment for Americans.
In a 2007 study, Stanford University economists Robert E. Hall (who will take office next year as president of the American Economic Association) and Charles I. Jones reported that modeling they've conducted has found that mid-21st century U.S. health-care expenditures would optimally amount to 30 of GDP or more. They wrote:
"We examine the allocation of resources that maximizes social welfare in our model. We abstract from the complicated institutions that shape spending in the United States and ask a more basic question: from a social welfare standpoint, how much should the nation spend on health care, and what is the time path of optimal health spending? . . .
"Viewed from every angle, our results support the proposition that both historical and future increases in the health spending share are desirable. . . . [W]e believe it likely that maximizing social welfare in the United States will require the development of institutions that are consistent with spending 30 percent or more of GDP on health by the middle of the century."
The administration's health-care plan is biased toward bean-counting rather than designed to maximize American physical and mental well-being. We need to ask ourselves whether there is truly anything more valuable to us than our loved ones and our own health and longevity.
In the signature radio sketch of Jack Benny, whose performing persona was laughably frugal, actor Eddie Marr snarled at him, "Don't make a move -- this is a stickup. Now, come on: Your money or your life." Benny didn't respond. The "robber" said, "Look, bud -- I said your money or your life!" Whereupon Benny shot back, "I'm thinking it over!"
Confronted for the first time in history with a constant stream of medical innovations that are marvelously effective but tend to be very expensive, our legislative representatives -- in particular, the Blue Dog Democrats -- would do well to stop "thinking it over" and to commit themselves to action that will preserve the ability of Americans to choose life over money.
---
Mr. Karpel is the author of "The Retirement Myth" (HarperCollins, 1995).
Credit: By Craig S. Karpel
Quote At this point, all that stands in the way of universal health care in America are the greed of the medical-industrial complex, the lies of the right-wing propaganda machine, and the gullibility of voters who believe those lies.
Originally posted Tuesday, August 18, 2009 (3 years ago)
I thought this was a really interesting site a friend of mine in Canada sent to me. It's more or less inspired by the welovetheNHS Twitter campaign and intended to combat the distortions being propogated by the anti-reform cherrypickers. Hope you guys like it.
Originally posted Tuesday, August 18, 2009 (3 years ago)
Just pass the public option already. It's clear the GOP is aiming for NO REFORM. The co-ops they have been touting up to now as a possible compromise? The locally owned, non-profit private pools? They just said that's a non-starter and called it single payer under another name.
Originally posted Tuesday, August 18, 2009 (3 years ago)
Quoted from "mousethief" Just pass the public option already. It's clear the GOP is aiming for NO REFORM. The co-ops they have been touting up to now as a possible compromise? The locally owned, non-profit private pools? They just said that's a non-starter and called it single payer under another name.
Kalman
Yeah, the Obama administration's lack of clarity about the importance of the public option has really gotten them in a difficult place. Now he's catching flak from both the right and the left.
Not sure if I've posted this already, but here's a very thoughtful HuffingtonPost piece on "The Character of Obama."
Some relevant quotes:
Quote "[Obama] has always had a reputation for being fair-minded -- a strength only attainable by someone who is (to begin with) minded. But the cautiousness of his first six months as president shows a pattern of accommodation that often lands him on the far side of actual prudence.
His instinct is to have all the establishments on his side: Wall Street, the military, the mainstream media; the most profitable corporations in all but the most signally failing industries; and that movable establishment (which disappears and reconstitutes itself), the quick-take pulse of popular opinion on any given issue. A president, ideally, wants all the establishments to support him, of course. You can't do without two or more at a time on your side; it is hopeless to set yourself at permanent enmity with even one. Yet to oppose the bankers on the question of bailouts, to oppose the military on drone assassinations, to exhibit non-pliability against the insurance companies and press for a public option in health care, to defy the slender majority of popular opinion that clamored for keeping Guantanamo open -- to have fought at least some of these battles need not have been hazardous for a president who came into office on a wave of revulsion against his opposite....
Obama cherishes the ideal of a frictionless transformation of society. It is a wish for aesthetic harmony, which he mistakes for a political goal. Its attainment would be a beautiful thing. But no matter how much he appeals for comity, Obama is certain to give offense to some. Better to choose your times and targets than allow others to force that choice....
Somewhere at the bottom of the missteps of the last few months is a failure to recognize the depth of the popular ignorance a president of the United States confronts on any issue. This complacency and the tactical errors that have flowed from it might be atoned for by other qualities in a parliamentary leader, whose majority and positions come with the job. But the Democrats have yet to prove that their majority means something solid; and their positions depend on no-one so much as the president. The party, for years, wanted a leader to assure their unity; they thought Obama was the one. Yet he has made it felt in many ways since becoming president that he would be disappointed to identify himself as leader of his party.
His political fortune will now depend on his readiness to reverse that posture. To take control of his presidency, he must give up the ambition to serve as the national moderator, the pronouncer on everything, the man with the largest portfolio. If the public option in health care reform is finally defeated, Obama will not soon recover his credit as a national, a party, or a general-issue leader. To avoid that fate, he will have to grant to politics, mere politics, an importance he has not allowed it thus far.
Quote Frustrated liberals have a question for President Barack Obama and Democratic lawmakers: Isn't it time the other guys gave a little ground on health care? What's the point of a bipartisan bill, they ask, if we're making all the concessions?
Originally posted Wednesday, August 19, 2009 (3 years ago)
Quoted from "Deacon Jones" People opposing having a Government health care program often say that "People from every Country in the world come here to get treatment".
While it is true that rich people can do this and by-pass the wait times of a public system. It is also true that some Americans who can't afford health care will resort to identity theft to get free health care in Canada.
And there are also people I know personally who have gone to eastern Europe for surgery (I don't remember what country specifically, but it was a poor one that had inferior facilities.) Apparently, even with the cost of the flight, it's cheaper there, no identity theft necessary. Personally, I can't see choosing a place that actually does have such inferior technology, but I guess when you're living paycheck to paycheck, you do what you have to.
Originally posted Wednesday, August 19, 2009 (3 years ago)
Quoted from "Deacon Jones" People opposing having a Government health care program often say that "People from every Country in the world come here to get treatment".
While it is true that rich people can do this and by-pass the wait times of a public system. It is also true that some Americans who can't afford health care will resort to identity theft to get free health care in Canada.
There's welfare in this country too, which some other countries don't have - but you can't simply come here and get it.
I would imagine that if they finally get a Government health care program running here, it would operate in the same way that it works in other countries - you have to prove you're a resident and/or citizen to be able to use it, except on an emergency basis (even now, they won't leave you dying after a car wreck because they can't locate your insurance card). Like with every system for every thing, you will have people who will find loopholes and use them to their personal advantage.
And if they finally get a Government health care program, rich people will still be able to pay for private health care, which will enable them to pick and choose which specialists they want to see, which hospital they want to be treated in, and allow them to bypass the "line" to get service. But a government health care program will at least ensure that everyone CAN get affordable healthcare, as well as routine health maintenance to hopefully head off more serious conditions that can develop when initial symptoms are ignored.
"Change your thoughts, and you change your world" - Norman Vincent Peale.
Originally posted Wednesday, August 19, 2009 (3 years ago)
It all dances around the dark reality that, when it comes to health care, the capitalistic free market competition method we apply to most everything else simply falls flat. In most fields making money aligns with the interests of the people. That's just not the case with health care.
There is no profit to be had in healthy people. They don't require anything. There is no product or service you can sell them that can come even remotely close to the profit to be made when they are sick. ...Except for insurance...there is huge profit to be made by "insuring" healthy people in case they get sick or injured, at which point they aren't profitable anymore and so it's in the insurance company's best interest to find any means necessary to invalidate or otherwise drop the customer's insurance.
Whoever is the "insurance" company MUST accept all people, reguardless of current health, and charge them all equally for the same service. That is the ONLY way in which it will be in the insurance company's interest to keep you healthy and thus fight for preventative care advancements. Under such conditions that's the best way to maximize profit (healthy customers). As soon as they are allowed to deny coverage or charge an unequal amount the best way for the business to max profit is to pick and choose who is healthy and drop or overcharge the rest. Sure, that means that "healthy" people will get charged a bit more to cover the costs of the "sick", but that's the entire point of how an insurance business functions - averages.
The easiest way to do that is a single payer system that accepts everyone equally.
But it's not the only way. The same "accept everyone equally" regulation applied to insurance companies would largely have the same effect. They would be force to compete and profit by who can keep you the healthiest at the lowest cost, rather then who can select and drop customers the most efficiently.
Originally posted Wednesday, August 19, 2009 (3 years ago)
This could equally go in the fox thread. But Maddow points out how Republicans get their news from Fox by and large, and fox is not giving them accurate information...which is clear by the polls which establish how those who get their news from fox, disproportionately believe the myths that are simply not true.
Originally posted Wednesday, August 19, 2009 (3 years ago)
Quoted from "WSJ article" The unprecedented advances expected to come out of American stem cell, nanotechnology and human genome research -- which other countries' constricted health sectors cannot support -- will send these already impressive figures skyward.
This is my favorite part. Let's cite a government funded project (which, incidentally, enjoys international funding) as a reason not to have government health care.
Quote Pearlstein (Washington Post) is confusing health insurance reform with health care reform. If we only get reform that requires insurance companies to provide coverage to everyone who applies, charge everyone the same premiums, and end their discriminatory practices, that would be great insurance reform, but it s not, as Pearlstein writes, health care reform.
...
I believed that government could help expand coverage and control costs then, and the overwhelming majority of Americans believe it today. If the August recess has taught us one thing, it s that Republicans have ended all serious conversations about reform and will oppose reform whether it includes a public option or not. They want to make the choice for the American people instead of letting Americans have their own choice of coverage. And if Democrats follow their lead, they will have to face the voters choice come November.
Originally posted Wednesday, August 19, 2009 (3 years ago)
Looks like even Rahm is on board. The Dems will have to go it alone.
The Dems can't afford to lose the progressives in the House, which means that they will have to push it through using reconcilitiation, knowing that they will lose Baucus, Lincoln, Bayh, Lieberman and Nelson. The Dems can lose 10 senators and still pass it with Joe Biden - 51 votes.
Originally posted Wednesday, August 19, 2009 (3 years ago)
Quoted from "Zenin" It all dances around the dark reality that, when it comes to health care, the capitalistic free market competition method we apply to most everything else simply falls flat. In most fields making money aligns with the interests of the people. That's just not the case with health care.
There is no profit to be had in healthy people. They don't require anything. There is no product or service you can sell them that can come even remotely close to the profit to be made when they are sick. ...Except for insurance...there is huge profit to be made by "insuring" healthy people in case they get sick or injured, at which point they aren't profitable anymore and so it's in the insurance company's best interest to find any means necessary to invalidate or otherwise drop the customer's insurance.
------
Whoever is the "insurance" company MUST accept all people, reguardless of current health, and charge them all equally for the same service. That is the ONLY way in which it will be in the insurance company's interest to keep you healthy and thus fight for preventative care advancements. Under such conditions that's the best way to maximize profit (healthy customers). As soon as they are allowed to deny coverage or charge an unequal amount the best way for the business to max profit is to pick and choose who is healthy and drop or overcharge the rest. Sure, that means that "healthy" people will get charged a bit more to cover the costs of the "sick", but that's the entire point of how an insurance business functions - averages.
The easiest way to do that is a single payer system that accepts everyone equally.
But it's not the only way. The same "accept everyone equally" regulation applied to insurance companies would largely have the same effect. They would be force to compete and profit by who can keep you the healthiest at the lowest cost, rather then who can select and drop customers the most efficiently.
I think that your analysis is correct for expanding coverage. But that is the easy part. The harder part, in my opinion, is how to contain costs. A big problem is that demand for health care, especially for those seriously ill, is almost unlimited. This is partially cultural. I think that Americans are less fatalistic than some other cultures, less willing to accept a terminal diagnosis, more questioning of authority, and more willing to perhaps try experimental treatments. We spend a lot during the last year of life. I don't blame people for this. It's totally understandable. But somehow we need to reform the health care delivery system (not just the insurance system) to get cost under control.
The fact is, every health care system involves some sort of rationing. In our current system, the rationing involves leaving 40 million people uninsured and allowing insurance company bureaucrats to ration care (to preserve their profits). I really do think that that a key part of reform that Obama has been touting but where there are no specifics involves changing how we compensate doctors, moving away from pay for procedure, and giving incentive to reorganize how care is delivered. That is really where the cost containment will come from. I'm a bit worried that this part has been lost in the larger debate.
I don't think just having a public option will be enough to control costs. I'm not convinced it will either (a) be a strong enough competitor or (b) avoid underpaying doctors like Medicare/Medicaid leading to cost shifting and distortions.
Originally posted Wednesday, August 19, 2009 (3 years ago)
Quoted from "Catlike" I don't think just having a public option will be enough to control costs. I'm not convinced it will either (a) be a strong enough competitor or (b) avoid underpaying doctors like Medicare/Medicaid leading to cost shifting and distortions.
Catlike,
I used to hesitate a lot about it because of (b) too. (As for (a), I just keep seeing too many studies & calculations by organizations I respect saying the contrary for that to ever have been a concern of mine.)
I used to feel this way because my mother and used to complain all the time about Medicare/Medicaid underpayments to her.
However, that has changed as a "how much Medicare pays" complaint. (If you factor in her complaints about the her state not delivering the payments, then "Medicare" does still exceed the private insurer complaint frequency.)
I now hear her complain equally about how little the private insurers pay her as I hear her complain about how little Medicare/Medicaid pay her.
And once I realized this, well, I don't worry so much for Mom's pay under an expanded Medicare. It sounds like the private insurers are going to be the big ones Mom complains about the payment rates of all the time within another 5-10 years at the rate things are going, because they are doing whatever they want and simply...will...because they want the money themselves, it seems...
Anyway, my mom's just one voice out of many, but there it is, for what it's worth.
Originally posted Wednesday, August 19, 2009 (3 years ago)
Zenin-
Your understanding of the insurance industry is completely wrong.
Take two hypothetical individuals. One is 21 and is a triathlete. The other is 61, 60 pounds overweight, and a chain smoker.
If insurance companies are permitted to charge different premiums, the chain smoker will need to pay a lot more than the younger person. An insurance company can make money off of either one of them. It receives lower premiums from the younger person, but pays lower claims. By being able to charge the chain smoker more money, the chain smoker becomes an equally attractive customer.
It is possible that the insurance company will not charge the correct differential in premiums, but that would be its problem. An insurance company without good actuaries goes out of business, and a company with better actuaries will take the business.
Suppose that the insurance company is required by law to charge everyone the same premium. The premium to people in their 20s and 30s will be higher than a market rate, and they will be tempted to try to drop insurance. If they buy insurance (by choice or by government mandate), they will be subsidizing older people. [Do all of you in your 20s really want to subsidize the baby boomers?]
The insurance companies will do everything they can to attract younger customers because that is where the money is and do everything they can to avoid insuring older people because that is where they lose money. If the ratio of old to young is too high (which is called adverse selection), the insurance company either goes broke or stops providing health insurance. Requiring insurance companies to charge everyone the same premium is a good way to drive them out of business, which I assume is what you really want.
Insurance companies don't charge the same premium for home, auto, life, or disability insurance. They shouldn't be charging the same premium for health insurance.
Originally posted Wednesday, August 19, 2009 (3 years ago)
Quoted from "Wino" ... Insurance companies don't charge the same premium for home, auto, life, or disability insurance. They shouldn't be charging the same premium for health insurance.
Totally agree with you. People make lifestyle choices which have consequences - the greater the risk, the greater the premium.
"Change your thoughts, and you change your world" - Norman Vincent Peale.
Originally posted Wednesday, August 19, 2009 (3 years ago)
Quoted from "Wino" Take two hypothetical individuals. One is 21 and is a triathlete. The other is 61, 60 pounds overweight, and a chain smoker.
If insurance companies are permitted to charge different premiums, the chain smoker will need to pay a lot more than the younger person. An insurance company can make money off of either one of them.
I disagree. The 21 year old may be a Jock that tends to go on drinking bilges in College and might be more likely to drink and drive, to bungy jump or engage in risky sexual behavior.
The overweight smoker may have a quieter sedentary lifestyle and may not develop health problems for several years.
Smokers are a greater risk for home fires though.
I had a colleague who liked to base jump, liked to go parachuting and bungy jump. No insurance company wanted to insure him even though he didn't smoke.
Originally posted Wednesday, August 19, 2009 (3 years ago)
Quoted from "OpeningMinds"
Quoted from "Wino" ... Insurance companies don't charge the same premium for home, auto, life, or disability insurance. They shouldn't be charging the same premium for health insurance.
Totally agree with you. People make lifestyle choices which have consequences - the greater the risk, the greater the premium.
I disagree. Sure, lifestyle choices have consequences, but I don't think it's wise to assume that all disease is related to this. Anyone can get sick or injured for reasons that have absolutely nothing to do with their lifestyle decisions. Infectious diseases, genes, environmental toxins, industrial accidents, natural aging, etc. Yes, personal responsibility is important, but lots of random stuff happens as well. I'm mean cyclist Lance Armstrong got testicular cancer, and he was one of the fittest individuals on the planet.
I'm okay with giving some sort of modest incentive/insurance discount to maintain a health weight range or to stop smoking, but taken too far, I think this price discrimination defeats the purpose of risk pooling.
I'm also okay with paying a bit more when I'm young, because I know at some point (hopefully) I'll be much older and I'll be paying less than what perhaps my risk level is. It's called lifecycle smoothing.
Right now we have the opposite problem--some young people who can afford coverage but are free riding. Sure they have better odds of staying healthy, but they also engage in riskier behavior that can lead them to the emergency room, where we end up paying for their care.
Originally posted Thursday, August 20, 2009 (3 years ago)
Quoted from "Wino"
Suppose that the insurance company is required by law to charge everyone the same premium. The premium to people in their 20s and 30s will be higher than a market rate, and they will be tempted to try to drop insurance. If they buy insurance (by choice or by government mandate), they will be subsidizing older people. [Do all of you in your 20s really want to subsidize the baby boomers?]
So, based on your argument, we should charge the elderly an arm and a leg for their health care. Their odds of needing health care are quite high. Are you in favor of abolishing Medicare?
Originally posted Thursday, August 20, 2009 (3 years ago)
Quoted from "catlike" I think that your analysis is correct for expanding coverage. But that is the easy part. The harder part, in my opinion, is how to contain costs. A big problem is that demand for health care, especially for those seriously ill, is almost unlimited. This is partially cultural. I think that Americans are less fatalistic than some other cultures, less willing to accept a terminal diagnosis, more questioning of authority, and more willing to perhaps try experimental treatments. We spend a lot during the last year of life. I don't blame people for this. It's totally understandable. But somehow we need to reform the health care delivery system (not just the insurance system) to get cost under control.
A very large part of the last year of life cost problems are exacerbated by unhealthy lives before. Obesity, smoking, etc create a cascade of problems that not only lower quality of life and life expectancy, but add huge, growing expense to deal with.
Shifting the focus to preventative medicine should go a long way to helping address this. Spreading the costs among all should get us the rest of the way there with very little if any per-person increase.
If the insurance company (public or private) must take all comers and charge them all equally, they will have a very natural incentive to promote preventative medicine. They won't have an option to simply ration: A private company would lose customers to companies that don't ration, a public option would lose voter support and vote down people/bills that attempt to ration.
This of course would also need to mandate insurance; No free-riding 20 year olds.
Quoted from "Wino" >snip nonsense<
Having only a single leukemia (even relapsed) on a company's rolls will cause the insurance company to slap the company with a million dollar a year surcharge for that fact alone. If that person wants to find individual insurance (since they probably got fired due to the surcharge), they'd better be able to pony up a million a year themselves.
Your "good actuaries" when it comes to health insurance really mean:
1) Don't cover the high risk at all (or demand a charge so extreme they can't afford it, same effect).
2) Cover the high risk person, but only for problems they don't already have (same as option 1, they just won't insure actual risks)
3) In the event the company gets burned by something like leukemia, do whatever they can to invalidate the "insurance" policy. Site "wrong" information on the forms, etc, whatever is needed.
Quote If they buy insurance (by choice or by government mandate), they will be subsidizing older people. [Do all of you in your 20s really want to subsidize the baby boomers?]
That is exactly what needs to happen. That is exactly what every other first world nation on the planet has come to conclude. That is the only option either morally or financially. Those 20 year olds will be 60 year olds before long.
When it comes right down to it the only reason to bother with private insurance companies at all is to appease big business. It's a completely parasitical business that simply has no right to exist. Much like tax preparation businesses (bad tax code maze) and the California prison union (retarded 3 strikes laws and mandatory sentencing), the existence of health insurance companies is little more then a side effect of a horribly designed system.
I'll tolerate them in a debate about health care reform only as a matter of pragmatism. So long as they must exist however, reform must incentivize them to promote better health of the people and not just enable yet another way for them to leach off the people.
Honestly a single-payer is the most efficient, simplest, and easiest to swallow. No dancing around insurance companies trying to find a way for them to maximize a profit of the suffering of people, no resentment from 20 years about how they have to buy health insurance they don't feel they need.
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National Public Health Care Option Activism Thread
So for those of you who haven't seen Sicko, the US is the only "western" nation that doesn't have socialized health care. As a result, our health care costs exceed 15% of our GDP (expected to increase to 20% GDP by 2017). That equates to over $6,000 per person every year. In…
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People opposing having a Government health care program often say that "People from every Country in the world come here to get treatment".
While it is true that rich people can do this and by-pass the wait times of a public system. It is also true that some Americans who can't afford health care will resort to identity theft to get free health care in Canada.
http://www.canada.com/topics/bodyandhealth/story.html?id=9c52e77b-7198-43e6-9097-46958e01e631
If the current health care system is as good as the Republicans make it out to be, there wouldn't be a market for criminals to sell Canadian health care via identity theft.
There are also people who go to Cuba for operations. According to this website, 1 million poor people from 31 third world countries have had their sight restored in Cuba.
http://www.caribpro.com/Caribbean_Property_Magazine/index.php?pageid=377
Yes, I agree (and that's just what I was getting at in the other thread but not as succinctly as Tom Wise did). Thanks for sharing.
When you said it, I wanted to comment but I just didn't have the energy.
( My dad passed last week. It was totally surreal having him come to his end in a hospice while all the death panel stuff was going on. )
Anyhoo, when I saw that, I thought it was perfect.
Gotta love the WSJ... They make even the most insane argument sound reasonable.
Here's an excellent Op-Ed from the NY Times. Turns out our proposed public option is no where near to Britan, Canada, or France . . . it's like Switzerland.
Website and Blog: ickeroo.com
There is a website here that goes through the list of right-wing lies about the health care program:
I thought this was a really interesting site a friend of mine in Canada sent to me. It's more or less inspired by the welovetheNHS Twitter campaign and intended to combat the distortions being propogated by the anti-reform cherrypickers. Hope you guys like it.
http://www.rtortell.com/pluralofanecdote/
Just pass the public option already. It's clear the GOP is aiming for NO REFORM. The co-ops they have been touting up to now as a possible compromise? The locally owned, non-profit private pools? They just said that's a non-starter and called it single payer under another name.
Kalman
Yeah, the Obama administration's lack of clarity about the importance of the public option has really gotten them in a difficult place. Now he's catching flak from both the right and the left.
Not sure if I've posted this already, but here's a very thoughtful HuffingtonPost piece on "The Character of Obama."
Some relevant quotes:
Liberals tired of health care compromise
Website and Blog: ickeroo.com
http://www.msnbc.msn.com/id/26315908/vp/32469091 32469091
Rachel Maddow comes up with the perfect metaphor for the past 7 months of Obama's presidency.
Barney Frank tells an "Obama is Hitler" person exactly what he thinks.
--edited to add: oops, Wexie just posted this in the Mob thread. D'oh.
Martinis do not contain vodka. —Rachel Maddow
I thought this was interesting too:
Health Care is a fact-based argument for liberals, and an emotion-based argument for conservatives.
Website and Blog: ickeroo.com
And there are also people I know personally who have gone to eastern Europe for surgery (I don't remember what country specifically, but it was a poor one that had inferior facilities.) Apparently, even with the cost of the flight, it's cheaper there, no identity theft necessary. Personally, I can't see choosing a place that actually does have such inferior technology, but I guess when you're living paycheck to paycheck, you do what you have to.
-- Rachel
That's true for a lot more then just health care.
There's welfare in this country too, which some other countries don't have - but you can't simply come here and get it.
I would imagine that if they finally get a Government health care program running here, it would operate in the same way that it works in other countries - you have to prove you're a resident and/or citizen to be able to use it, except on an emergency basis (even now, they won't leave you dying after a car wreck because they can't locate your insurance card). Like with every system for every thing, you will have people who will find loopholes and use them to their personal advantage.
And if they finally get a Government health care program, rich people will still be able to pay for private health care, which will enable them to pick and choose which specialists they want to see, which hospital they want to be treated in, and allow them to bypass the "line" to get service. But a government health care program will at least ensure that everyone CAN get affordable healthcare, as well as routine health maintenance to hopefully head off more serious conditions that can develop when initial symptoms are ignored.
"Change your thoughts, and you change your world" - Norman Vincent Peale.
It all dances around the dark reality that, when it comes to health care, the capitalistic free market competition method we apply to most everything else simply falls flat. In most fields making money aligns with the interests of the people. That's just not the case with health care.
There is no profit to be had in healthy people. They don't require anything. There is no product or service you can sell them that can come even remotely close to the profit to be made when they are sick. ...Except for insurance...there is huge profit to be made by "insuring" healthy people in case they get sick or injured, at which point they aren't profitable anymore and so it's in the insurance company's best interest to find any means necessary to invalidate or otherwise drop the customer's insurance.
Whoever is the "insurance" company MUST accept all people, reguardless of current health, and charge them all equally for the same service. That is the ONLY way in which it will be in the insurance company's interest to keep you healthy and thus fight for preventative care advancements. Under such conditions that's the best way to maximize profit (healthy customers). As soon as they are allowed to deny coverage or charge an unequal amount the best way for the business to max profit is to pick and choose who is healthy and drop or overcharge the rest. Sure, that means that "healthy" people will get charged a bit more to cover the costs of the "sick", but that's the entire point of how an insurance business functions - averages.
The easiest way to do that is a single payer system that accepts everyone equally.
But it's not the only way. The same "accept everyone equally" regulation applied to insurance companies would largely have the same effect. They would be force to compete and profit by who can keep you the healthiest at the lowest cost, rather then who can select and drop customers the most efficiently.
This could equally go in the fox thread. But Maddow points out how Republicans get their news from Fox by and large, and fox is not giving them accurate information...which is clear by the polls which establish how those who get their news from fox, disproportionately believe the myths that are simply not true.
This is my favorite part. Let's cite a government funded project (which, incidentally, enjoys international funding) as a reason not to have government health care.
-- Rachel
Howard Dean, former chairman of the DNC and outspoken supporter of the public option, speaks out on ThinkProgress.
Website and Blog: ickeroo.com
Looks like even Rahm is on board. The Dems will have to go it alone.
The Dems can't afford to lose the progressives in the House, which means that they will have to push it through using reconcilitiation, knowing that they will lose Baucus, Lincoln, Bayh, Lieberman and Nelson. The Dems can lose 10 senators and still pass it with Joe Biden - 51 votes.
Kalman
I think that your analysis is correct for expanding coverage. But that is the easy part. The harder part, in my opinion, is how to contain costs. A big problem is that demand for health care, especially for those seriously ill, is almost unlimited. This is partially cultural. I think that Americans are less fatalistic than some other cultures, less willing to accept a terminal diagnosis, more questioning of authority, and more willing to perhaps try experimental treatments. We spend a lot during the last year of life. I don't blame people for this. It's totally understandable. But somehow we need to reform the health care delivery system (not just the insurance system) to get cost under control.
The fact is, every health care system involves some sort of rationing. In our current system, the rationing involves leaving 40 million people uninsured and allowing insurance company bureaucrats to ration care (to preserve their profits). I really do think that that a key part of reform that Obama has been touting but where there are no specifics involves changing how we compensate doctors, moving away from pay for procedure, and giving incentive to reorganize how care is delivered. That is really where the cost containment will come from. I'm a bit worried that this part has been lost in the larger debate.
I don't think just having a public option will be enough to control costs. I'm not convinced it will either (a) be a strong enough competitor or (b) avoid underpaying doctors like Medicare/Medicaid leading to cost shifting and distortions.
Catlike, I used to hesitate a lot about it because of (b) too. (As for (a), I just keep seeing too many studies & calculations by organizations I respect saying the contrary for that to ever have been a concern of mine.)
I used to feel this way because my mother and used to complain all the time about Medicare/Medicaid underpayments to her.
However, that has changed as a "how much Medicare pays" complaint. (If you factor in her complaints about the her state not delivering the payments, then "Medicare" does still exceed the private insurer complaint frequency.)
I now hear her complain equally about how little the private insurers pay her as I hear her complain about how little Medicare/Medicaid pay her.
And once I realized this, well, I don't worry so much for Mom's pay under an expanded Medicare. It sounds like the private insurers are going to be the big ones Mom complains about the payment rates of all the time within another 5-10 years at the rate things are going, because they are doing whatever they want and simply...will...because they want the money themselves, it seems...
Anyway, my mom's just one voice out of many, but there it is, for what it's worth.
Zenin-
Your understanding of the insurance industry is completely wrong.
Take two hypothetical individuals. One is 21 and is a triathlete. The other is 61, 60 pounds overweight, and a chain smoker.
If insurance companies are permitted to charge different premiums, the chain smoker will need to pay a lot more than the younger person. An insurance company can make money off of either one of them. It receives lower premiums from the younger person, but pays lower claims. By being able to charge the chain smoker more money, the chain smoker becomes an equally attractive customer.
It is possible that the insurance company will not charge the correct differential in premiums, but that would be its problem. An insurance company without good actuaries goes out of business, and a company with better actuaries will take the business.
Suppose that the insurance company is required by law to charge everyone the same premium. The premium to people in their 20s and 30s will be higher than a market rate, and they will be tempted to try to drop insurance. If they buy insurance (by choice or by government mandate), they will be subsidizing older people. [Do all of you in your 20s really want to subsidize the baby boomers?]
The insurance companies will do everything they can to attract younger customers because that is where the money is and do everything they can to avoid insuring older people because that is where they lose money. If the ratio of old to young is too high (which is called adverse selection), the insurance company either goes broke or stops providing health insurance. Requiring insurance companies to charge everyone the same premium is a good way to drive them out of business, which I assume is what you really want.
Insurance companies don't charge the same premium for home, auto, life, or disability insurance. They shouldn't be charging the same premium for health insurance.
Totally agree with you. People make lifestyle choices which have consequences - the greater the risk, the greater the premium.
"Change your thoughts, and you change your world" - Norman Vincent Peale.
I disagree. The 21 year old may be a Jock that tends to go on drinking bilges in College and might be more likely to drink and drive, to bungy jump or engage in risky sexual behavior.
The overweight smoker may have a quieter sedentary lifestyle and may not develop health problems for several years.
Smokers are a greater risk for home fires though.
I had a colleague who liked to base jump, liked to go parachuting and bungy jump. No insurance company wanted to insure him even though he didn't smoke.
I disagree. Sure, lifestyle choices have consequences, but I don't think it's wise to assume that all disease is related to this. Anyone can get sick or injured for reasons that have absolutely nothing to do with their lifestyle decisions. Infectious diseases, genes, environmental toxins, industrial accidents, natural aging, etc. Yes, personal responsibility is important, but lots of random stuff happens as well. I'm mean cyclist Lance Armstrong got testicular cancer, and he was one of the fittest individuals on the planet.
I'm okay with giving some sort of modest incentive/insurance discount to maintain a health weight range or to stop smoking, but taken too far, I think this price discrimination defeats the purpose of risk pooling.
I'm also okay with paying a bit more when I'm young, because I know at some point (hopefully) I'll be much older and I'll be paying less than what perhaps my risk level is. It's called lifecycle smoothing.
Right now we have the opposite problem--some young people who can afford coverage but are free riding. Sure they have better odds of staying healthy, but they also engage in riskier behavior that can lead them to the emergency room, where we end up paying for their care.
So, based on your argument, we should charge the elderly an arm and a leg for their health care. Their odds of needing health care are quite high. Are you in favor of abolishing Medicare?
A very large part of the last year of life cost problems are exacerbated by unhealthy lives before. Obesity, smoking, etc create a cascade of problems that not only lower quality of life and life expectancy, but add huge, growing expense to deal with.
Shifting the focus to preventative medicine should go a long way to helping address this. Spreading the costs among all should get us the rest of the way there with very little if any per-person increase.
If the insurance company (public or private) must take all comers and charge them all equally, they will have a very natural incentive to promote preventative medicine. They won't have an option to simply ration: A private company would lose customers to companies that don't ration, a public option would lose voter support and vote down people/bills that attempt to ration.
This of course would also need to mandate insurance; No free-riding 20 year olds.
Having only a single leukemia (even relapsed) on a company's rolls will cause the insurance company to slap the company with a million dollar a year surcharge for that fact alone. If that person wants to find individual insurance (since they probably got fired due to the surcharge), they'd better be able to pony up a million a year themselves.
Your "good actuaries" when it comes to health insurance really mean: 1) Don't cover the high risk at all (or demand a charge so extreme they can't afford it, same effect). 2) Cover the high risk person, but only for problems they don't already have (same as option 1, they just won't insure actual risks) 3) In the event the company gets burned by something like leukemia, do whatever they can to invalidate the "insurance" policy. Site "wrong" information on the forms, etc, whatever is needed.
That is exactly what needs to happen. That is exactly what every other first world nation on the planet has come to conclude. That is the only option either morally or financially. Those 20 year olds will be 60 year olds before long.
When it comes right down to it the only reason to bother with private insurance companies at all is to appease big business. It's a completely parasitical business that simply has no right to exist. Much like tax preparation businesses (bad tax code maze) and the California prison union (retarded 3 strikes laws and mandatory sentencing), the existence of health insurance companies is little more then a side effect of a horribly designed system.
I'll tolerate them in a debate about health care reform only as a matter of pragmatism. So long as they must exist however, reform must incentivize them to promote better health of the people and not just enable yet another way for them to leach off the people.
Honestly a single-payer is the most efficient, simplest, and easiest to swallow. No dancing around insurance companies trying to find a way for them to maximize a profit of the suffering of people, no resentment from 20 years about how they have to buy health insurance they don't feel they need.
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