Speaking of stuff I’m seeing on Twitter today, this just came in from Jim DeMint:
@JimDeMintJim DeMintAll Republican Senators have now joined to cosponsor the bill to repeal ObamaCare, S.192
And this reminds me…
Today at the Columbia Rotary Club, our speaker was George Zara from Providence Hospital. He started off by asking the 300 or so Rotarians whether they thought Obamacare was going to be repealed.
Let’s just say that there wasn’t exactly a sea of eager hands reaching for the Seawell’s ceiling. I saw a few, very hesitant, hands half-raised — as in, not above shoulder height. Most people knew better.
I wonder why Jim DeMint et al. don’t.
What a lot of energy spent just to make a make a point. What destructive energy. Personally, I don’ t have great hopes for Obamacare solving our problems, but I know that the solution’s not coming from people who don’t WANT a solution.
And it really ticks me off that they are trying to do everything they can to tear this effort down before it even takes effect. What else would be the point of making such a huge political gesture, when you KNOW you’re not actually going to repeal it?
Couldn’t they spend some of this energy trying to accomplish something, rather than trying to make sure no one else accomplishes anything?
I hope the Tea Party, for whom this is being done, appreciates this. Because I don’t.
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Well, the judge in Florida said today it was unconstitutional so its going to end up with the Supreme Court deciding anyway. If they say it IS unconstitutional, then you really must blame Obama/Reid/Pelosi for wasting all that time and energy, right? And it would make Jim DeMint 100% right to try and repeal it.
The mistake was going for the home run instead of taking it a single at a time. There was easy stuff that could have been passed with little opposition. Obama/Reid/Pelosi went for the Obama-legacy defining moment. Strategic error.
Huh. Call THAT a home run? Looks like a few fielder’s choice singles, walks, out-and-out errors married to a blooper reel.
But it does bring around a runner or two, which is why I’m inclined to see if it helps. But DeMint doesn’t want to let that happen.
As for the court cases. I feel exactly the same about the ridiculous lawsuits being brought by the state AGs. Playing politics instead of doing their jobs. I was very disappointed to see something a day or two indication that Alan Wilson considers fighting Obamacare one of his top priorities.
Yep, you can always get a bad decision by the court, which is why so many bad lawsuits are brought. But that doesn’t mean it’s laudable to try.
Also, it’s passing strange to see people who otherwise would insist upon laws being made by legislatures (as would I) seeking in this case to have the judiciary overturn the will of the legislature. That strike anyone else as odd?
So a Supreme Court ruling against the bill would just be “playing politics”?
The basic premise of mandating the purchase of insurance under the interstate commerce clause isn’t exactly a slam dunk. I’d love to hear the argument that will force a Christian Scientist to purchase insurance.
I don’t speak baseball (at least I got the sport right, huh?), but I think Doug is right. Obama, et al. tried to do too much, and yet, Brad is also right–they did too little. With the feds all locked up, they ought to have been able to freeze out the private insurers and go all public, and we wouldn’t have judges saying,”It’s not right to require someone to patronize a private business.”
Which doesn’t excuse the Right for its “I’m holding my breath until I turn blue” style of politics.
Zara also told about an Englishwoman who had emergency treatment while in London far away from her home and they were able to pull up all her records.
Why can’t we do what we already know is right, like have a smartcard with our medical records on it–or better yet, Google Health, accessible on the internet. Why do I have to try to make sure all my records are sent everywhere I go, and recall everything I’ve ever known about my health, while my insurance company doubtless has this all on its database?
You think they might want activist judges when the judge is active in the way they want?
Doug, the ruling only applied to the mandatory provision. That is something that has troubled me all along. But given that we are not going to do the sensible thing and pass single payer that was about the only fiscally prudent approach. The GOP is offering only a minimalist option that would cover about 3 million uninsured, leaving 47 million behind. And they’re only doing that as window dressing. What they really want is business as usual with all the big profits for insurance companies and big pharma. Pretty greedy if you ask me.
Brad is correct. This is the GOP version of an activist court. Where are all the GOP whiners about that now that we need them.
In case after case, the judiciary has stepped in and overturned ballot initiatives voted on by citizens exercising their rights. The judiciary has been an active participant in deciding laws from the beginning of our republic. Now, when the decision of a judge goes against the will of the judiciary who ignored the wishes of a majority of the people, suddenly they are wrong and have no place in deciding if a piece of legislation meets a constitutional litmus test or not.
I agree with Doug. Most games are not won with homeruns and Hail Mary passes, they are won with singles, doubles, triples, short bursts up the middle, screen passes, and smart game plans. It was not smart to insult the people with dumb-ass comments like the one Pelosi made. “But we have to pass the bill so you can find out what is in it.”
Activist judgery?
The judge even used Obama’s own words from 2008 to reject the bill:
In ruling against President Obama‘s health care law, federal Judge Roger Vinson used Mr. Obama‘s own position from the 2008 campaign against him, when the then-Illinois senator argued there were other ways to achieve reform short of requiring every American to purchase insurance.
“I note that in 2008, then-Senator Obama supported a health care reform proposal that did not include an individual mandate because he was at that time strongly opposed to the idea, stating that, ‘If a mandate was the solution, we can try that to solve homelessness by mandating everybody to buy a house,’” Judge Vinson wrote in a footnote toward the end of his 78-page ruling Monday.
I think my daughter has pneumonia. She’s in school, 26, has two part-time jobs…no health care.
It would be nice for her to have health care so that she could worry about her health and not how she’ll pay the doctor.
No, it’s not odd, Brad, it’s just typical. One thing that is exceptional about the American political landscape is the amount of whining politicians engage in. They all forget that even when they don’t get their particular way, they are still all part of the process (as are we). That should be the point, right?
I think this whole thing about the far right rejecting the “mandate” thing is much more insidious than it’s being viewed as today. I mean, if Congress cannot require citizens to do anything, then why should they be able to have us do things like pay taxes? It’s an absurd argument. It is a bit strange to require everyone to acquire private health insurance – but we have that because that’s what you get when some people reject the idea of a single payer program. I thought people therefor agreed that the idea of a private, free market-based health insurance platform was what we would settle for. As a Republican I thought this was a good approach. As a citizen, I think that the idea of limiting Congress’ power to make law is a bad idea. And if the Supreme Court overturns the health care bill, then we will just be that much closer to a single payer system. Is that what the far right really wants?
@Mark
If you want single payer, you also have:
1) come up with a way to pay for it for those people who cannot and make the case that others SHOULD be responsible for paying the bill for them
2) come up with a way to compensate doctors, nurses, pharmaceutical companies, etc. at a level that does not influence them to decide to not participate in the system (don’t think this is a minor detail – there are MANY surgeons who will simply refuse to accept the government’s pay scale)
3) ensure that the tens of millions of Americans who are happy with their current insurance plan will not experience a drop in the quality of care.
If you were starting from scratch, single payer might work. Trying to overhaul 1/6 of the American economy will likely end in disaster.
Doug, the problem is the current system just simply does not work. So overhauling it won’t be a big problem. The vast majority of people who actually have to deal with private insurance are not happy with it. I would suggest that less than 10% of folks who file claims are less than completely satisfied. As for the doctors, the good ones will continue to practice medicine because it’s far more lucrative than their next best option. Besides, most probably don’t think about money as their driving force, a concept completely foreign to libertarians.
One obvious point that I missed. There are millions of people who receive medical treatment NOW that do not or cannot pay. With single payer we establish a formal way of dealing with this problem. Once we take the 30% “profit” surcharge out of the equation fewer people will cheat the system.
@bud
Your statement about private insurance is false. Polling data shows more than 70% of people are satisfied. Show me the data that proves otherwise. I am in the process of changing jobs now, going from a large multinational company with 60,000 employees to one with fewer than 100. The transition for insurance is basically a couple forms. It’s not an issue for tens of millions of Americans. Pretty much every government employee in this country has access to decent insurance. How many of them are unhappy? That’s a significant portion of the workforce.
And your statement about the people who do not or can’t pay doesn’t make any sense. Who is going to pay for them in your system? The same people who are paying now via higher insurance rates and higher taxes.
Your bogus 30% profit surcharge is meaningless. Where does that exist? You want a system where the government decides who gets care, what type of care they get, and how much the providers get paid to deliver it. That system will crash and burn before it gets off the ground because the providers will not take a pay cut to do the same thing. Or the best ones will opt out and continue with private setups to get around the lowball government pay.
Single payer is a pipe dream that anyone who spends a minute thinking about the details of how it would have to be implemented can recognize.
The case that other SHOULD be responsible for paying for them: a JUST SOCIETY.
Your health should not depend on when you were born (Medicare) or to whom (Medicaid), or what your employer’s insurance policies are, etc.
Not in this EXCEPTIONAL country.
Life expectancy in the USA is short compared to Europe and Japan. That’s the result of our poor health care system that costs too much and leaves millions out in the cold. Most people when asked in polls are strongly in favor of many aspects of Obamacare, especially those that mandate treatment of pre-existing conditions and young adults who do not go to school (via their parents plans). It’s simply not an arguable position to take that health insurance is easy to understand. I find that claim ridiculous. I never know what they will pay and why. Fortunately I don’t have to use it often.
You want a system where the government decides who gets care, what type of care they get, and how much the providers get paid to deliver it.
-Doug
That is happening now, just replace “government” with “insurance companies”. In fact Doug all your arguments defending the current system are basically just libertarian mantra that defends capitalism regardless of any facts. Just explain this one very simple fact, why do Americans die so young?
An exceptional nation should include the following elements:
. 100% healthcare coverage
. A small, profession military used only for defensive purposes
. A highly developed diplomatic corp that is used liberally to resolve conflict
. A generous humanitarian sector that resolves to feed, cloth and medicate the needy of the world.
. An understanding that all people are worthy and any interference in the affairs of other nations is unacceptable.
. An education system that is not controlled by any religious or political philosophy but seeks only to instill knowledge in our young minds.
. A government free of corruption and cowtowing to special interests.
. A well regulated capatalist economy that does not prey on the weak.
. An understanding that the wealthy are no better than anyone else and are wealthy for many reasons including luck and inheritance.
@Kathryn
Then start a charity called “Just Society Dedicated To The Assistance of Anyone Who Needs Free Healthcare”.
Get all those liberals who want others to pay for someone else’s healthcare to donate as much as they feel will make them feel good about themselves. Make the case for charity, don’t make it a legal requirement.
There are already plenty of paths to free healthcare right now.
And for those of you who want single payer, tell me exactly how much I have to pay for my free healthcare.
Is it a percentage of my income?
Is it based on my age, health, lifestyle?
Will I have copays? Will I have deductibles?
Tell me exactly how it will work. If you can’t, then let’s just stop pretending there is a solution out there.
Using the Medicare model would result in:
a) Millions of people who work for insurance companies to lose their jobs. Where do they go for work?
b) A large percentage of doctors refusing to accept the government payment structure. Are you going to force them to perform surgeries at whatever price the government will pay?
c) Decisions made by the government on which drugs will be available. You understand that, right? There will be a finite pool of money to spend.
Ya hear that, Canadians, Britons, Australians, Taiwanese…?! Doug Ross says your single-payer system (that you overwhelmingly approve of) is a pipe dream and cannot possibly be implemented. Of course, he must be right. I expect you will now dismantle your extremely popular single-payer systems immediately, now that you have been shown the light. And we can’t possibly emulate Canada’s (extremely popular) Medicare here, or England’s (extremely popular) National Health Service here, right? Pipe dream! Never mind that we’ve already implemented (extremely popular) single-payer systems in the USA already, i.e. Medicare and VA.
It’s just a matter of will, and organization. If enough of us have the will to move to single-payer, it’ll happen. And as bud pointed out, if the COMPROMISE non-single-payer health reform achieved by Obama goes down in court, a single-payer system of some sort will congeal that much faster. Especially since there does not seem to be any other compelling vision for comprehensive reform of our healthcare delivery system, except “everything’s fine, move along, business as usual, we can’t, we won’t, dream small, nothing to see here, we don’t do big things, cancer? what cancer? I don’t see any cancer…”
Lindsey Graham has now jumped on the bandwagon (as he is known to do once the prevailing winds have been assessed):
Graham said 29 percent of South Carolinians would be eligible for Medicaid benefits under provisions of the health insurance law, scheduled to take full effect by 2014.
“That would require the state to come up with $1 billion more in matching funds,” Graham said. “Right now, we have to reduce the state budget by $850 million. This would put the state in an untenable position financially. It would mean higher taxes or reducing spending in other areas like education or public safety.”
Graham said his legislation and DeMint’s measure are part of a multi-prong Republican attack on the Democratic-backed health insurance law.
“I see what we’re doing as an all-of-the-above approach – in court, repeal it today and get states to opt out of it,” Graham said. “It’s kind of a three-front war.”
Read more: http://www.thestate.com/2011/02/01/1673430/graham-to-push-alternative-health.html#ixzz1CjxZIiby
So will Brad call out Lindsey for wasting resources?
@jfx
Did those countries you mentioned dismantle 1/6 of their economy to implement single payer?
Yeah, I didn’t think so.
I’ve been to Canada… for a couple months over the past two years. I read the papers while I am there. If you believe that single payer is better, do some research. When I was there in December, there was an article in The Globe and Mail about the government deciding that a specific breast cancer drug was too expensive to include in their coverage. You think that’s going to play in Peoria?
Here’s a story for you, jfx… let’s see you spin this one:
http://www.theglobeandmail.com/life/health/dementia/dementia-researchers-feel-blocked-by-ottawa-big-pharma-medical-dogma/article1712597/
“So last year the researchers decided to speak with one voice, by forming the Canadian Dementia Action Network (CDAN) – a plucky band of white coats ready to leave the lab and press the government to fund their urgent, daunting hunt for treatments.
We don’t really understand the intrinsic, basic mechanisms involved” in Alzheimer’s — Jean-Marie Leclerc, a vice-president and chief scientific officer of Novartis Canada
Yet despite 39 letters of support from international politicians and researchers, Ottawa has not been convinced. Neuropathologist Patrick McGeer says that federal Health Minister Leona Aglukkaq “has refused even to discuss it with us.”
Although work has begun slowly on a national approach, Dr. Chertkow notes, “Canada at the present time is the only technologically advanced country with no national strategy on how to fight and cure Alzheimer’s disease.”
===
We have millions of Alzheimers patients and families here in the U.S. Think they’ll be moving to Canada any time soon?
You all are blinded by the hype. Do some research. You think there’s some magic switch that can be flipped and it will be all better. Nobody ever bothers to dig into the details or think about the unintended consequences.
Here’s a link to a side-by-side analysis of Canada’s system with the U.S. done by the Globe and Mail.
It’s not the nirvana you imagine.
http://www.theglobeandmail.com/news/opinions/would-you-rather-get-sick-in-canada-or-the-us/article1553011/
Here’s some facts that may deflate your rainbows and lollipops visions…
Waiting times: While it will cost you more, you won’t wait as long. According to a 2007 Commonwealth Fund study, 42 per cent of Canadians had waited two hours or more in the emergency room during a visit in the previous two years, versus 29 per cent in the United States. And 57 per cent had waited four weeks or more to see a specialist, versus 23 per cent in the United States.
For that $70,000 knee replacement, recent Canadian statistics show that depending on the province, the median presurgery waiting time ranges from 112 to 291 days. In the United States, it can be a matter of days. U.S. patients have the second-shortest wait for specialists worldwide.
Survivability: Where are you safer? Canada has lower rates of unadjusted in-hospital mortality (1.4 per cent versus 2.2 per cent in the United States). If you are over 65, the United States has slightly higher surgery mortality rates. If you have colorectal cancer or childhood leukemia, or are getting a kidney or liver transplant, you chances are better in the United States, but if you have breast cancer, you are better off in Canada.
Infections: Hospital-acquired infections are a major problem in both countries, and have recently risen significantly in recent years. While there are few comparative studies, rates of drug-resistant Staphylococcus, a leading killer, are higher in Canada, were there are 5.2 cases per 1,000 hospital admissions, versus 3.95 in the United States.
The evidence just keeps mounting..
“Can you help me find a family doctor?” It’s a question I’m asked practically every day in the hospital wards where I work. No wonder. According to the Canadian Medical Association, four million to five million people don’t have a family physician.
The doctor shortage is a major problem with our health-care system. Unfortunately, it’s just one of many. Our patients wait too long for basic care. The system is plagued by too much bureaucracy. And despite a massive infusion of money – the Ontario health budget has roughly doubled in the past decade – we must acknowledge what no government official is willing to admit: Canadian health care falls short of what we deserve. “
Yep. Consider him included. Maybe it’ll make him an Jim feel all buddy-buddy, agreeing for once.
Now, by “call out,” does that mean pistols at 20 paces, or do I just have to say, as I always do, that he’s dead wrong on this?
It’s very, very rare to find something that I disagree with Graham, Lieberman and McCain on (usually, if all three of them are for it, odds are that I am, too). But this is one big one.
Can’t think of any more really big ones like that, but this is one.
Oh, and Doug…
Where did you get the idea that single payer would be “free health care,” or that bud or I thought it would be?
You’d pay for it just as you pay for the private insurance kind. Only you can never lose it.
That’s all I ask. I paid about $600 a month for mine at the newspaper, and I’ve always said I think it would be great if I could just pay that amount into a national health system, and get the kind of care they have in England.
And I could never lose it, no matter how many times I change jobs or what medical misfortunes befall my family. That’s the main thing.
Yeah, I suppose there are people out there who can’t afford that, and we’d have to figure out how to configure their contribution to the system. But to me, the problem in American health care is less the people who can’t afford to pay premiums (and I’m talking reasonable, group-sized premiums, not the outrageous ones you have to pay as an individual), and more the fact that lots of us JUST CAN’T GET THE BLASTED COVERAGE. Well, that’s one of the problems. The rising cost of all of it is another. But it seems a whole lot more likely to me that a pool with 300 million people in it would be able to exert downward pressure on prices than we’ll ever get with this crazy quilt of private actors adding administrative and profit cost to each transaction.
Now Doug is asserting that we can’t restructure the nation’s healthcare structure because it would result in the loss of millions of insurance company jobs? That’s not very Libertarian, in my view. Isn’t the goal to maximize the efficiency of the capitalist system? If there’s that much wasted resources at play here, then that waste needs to be wrung out of the system.
I’ll just throw out another grenade here: Something like 70% of all healthcare dollars are expended during the last 18 months of life (Doug, don’t hold me to these numbers). Now obviously there are a large percentage of catastrophic accidents and creeping terminal illnesses, but at some point we are all going to need to individually begin to make more rational decisions about how much effort and resources are to be expended when our number’s up – we all need to realize that the burden really does fall on those who remain. If we don’t, then the great fear of the far right that there will be government “death panels” may need to become part of the deal in some form or another.
The main problem with our current healthcare structure is that it is not designed to keep people healthy; it’s designed to cure them of their illnesses.
Sorry, but I am never going to argue in favor of propping up a broken, irrational and bloated disaster of a healthcare “system” such as we have today. The status quo is not acceptable. It will never again be acceptable. I do not suggest that the new healthcare bill is the solution, nor do I believe that single payer is necessarily the best way forward. But I will strongly argue that going back to what was clearly beyond repair is the height of insanity.
@Brad
You also paid copays and deductibles, correct? How much money do you think a family needs to make in order to afford that? Probably at least $50K per year.
I’ll gladly sign up for $600 a month if that’s the rate we all pay. I think you underestimate the number of people who would refuse to pay $600 or expect someone else to cover it for them.
Read the facts I posted about Canada’s system. Doubled the spending over the past decade. Where’s the downward pressure there?
We need a profit driven provider also to hold down the fraud. Medicare is full of fraud because there isn’t the attention to oversight that would exist with a for-profit provider.
Simplest solution is to allow any person to purchase from the same set of plans available to federal workers. That would drive downward pressure on prices AND give us the oversight required.
@Mark
The system we have NOW is the closest thing to a capitalist system with the added drain of Medicare and Medicaid’s below market payment being covered by everyone else.
As for the end of life costs, that’s Medicare in the majority of cases. Which government agency will be in charge of telling Grandma that Grandpa’s end of life cost does not fit the business model?
Hey, I’d like to see people make healthier choices (me included). But I don’t expect the government to tell me how many pounds of broccoli I need to eat each week in order to keep my coverage.
@ Doug– I didn’t say “free”– I said everyone deserves equal access, and ability to pay should not enter into it in a just society.
Christopher Buckley, before he was a-kicked from his daddy’s magazine, said that just because an 80 year old can afford an organ transplant, doesn’t mean he should get one–the expensive extraordinary measures to keep the elderly alive, while children fail to receive cost-effective preventive care….boggles my mind, and that lefty, Chris Buckley’s.
I suspect the life expectancy of Americans has less to do with our health care system and more to do with our lifestyles.
Obamacare (meant as a compliment rather than a pejorative) does have the individual mandate, but the only penalty is a tax. Taxes are constitutional, and that’s what the final argument is going to be when it reaches SCOTUS. Does the government have the right to levy taxes on people who don’t buy health insurance? I think it probably does.
I believe we have begun a march toward single-payer regardless of how SCOTUS rules. We won’t be dismantling 16% of the economy because it’s not going to happen all at once. Single-payer systems are not ideal, but neither is our current system. I don’t want decisions about my health care made by individuals whose primary concern is the bottom line of the company they work for.
My mother had some serious health concerns last spring and summer that lasted for months. Had it not been for a combination of Medicare/Medicaid, the result could have been financial ruin for both my parents or worse if she had not been able to get the care she needed.
Access to quality, affordable health care shouldn’t be like a car or house where you get what you can afford. It should be, in a nation like ours, a fundamental right.
I’m with Norm on this one, I think – with one caveat.
I would like to see everyone covered under a fairly rudimentary single payer system – one that would be comprehensive without being expansive. You know, stingy. The kind people grouse about. Then, the marketplace can offer up whatever additional coverages people may want. The cost would be leveraged down for the more commonly desired coverages; and would end up being quite stiff for the “cadillac” belt-and-suspender plans.
I think that is what has led to the bloat that is now Medicare – it didn’t have a free market pressure relief valve and so more and more “services” end up getting tacked onto it. That’s human nature. So lets give people a free-market forum to indulge in their dreams of immortality. And the basic coverage to enable people to innovate and create free of the constraints of worrying about if they will be able to obtain insurance coverage for themselves or their family.
Touched a nerve, eh, Doug? That was a mighty impressive power-googling session you did up there. But I noticed you didn’t include much in the way of popular Canadian opinion. Strange, you were so keen to invoke such polling earlier in the discussion of American satisfaction with private insurance. Wanna head back out on the google-train and find out what most Canadians think about their national health service?
Yeah, I didn’t say Canadian healthcare was superior. It’s no medical utopia. But it’s still very good. As some of your selective googling attests, the US and Canada swap out on who’s better in some areas. It’s fair to point out the issues with wait times and specialists.
But I think you are missing the point.
If the Canadian citizen of modest means comes down with a major cancer, there is no selling of the house, and no bankruptcy. Yes, this is the nirvanic rainbow-colored lollipop. The pipe dream, as you say…
Anyway, I wonder, when they took that poll you mentioned, and 70% of those polled were satisfied with their private insurance…did the sample set for the poll include any uninsured? Oh, probably not. Because it’s a poll that only applies to the insured. The uninsured don’t count. And as we all know, the uninsured are generally deadbeats who don’t contribute anything back to society, and therefore don’t count. Amen brother.
You made a good point about how some of the people employed by insurance companies will lose their jobs if we go to a single-payer system. Some of the call centers staffed with claim deniers will be gutted and closed. Cryin’ shame.
@Kathryn
What is the difference between “free” and “equal access” without caring about ability to pay? Won’t it then be “free” for some people and “not free” for others? You know, just like we have now?
Read the info about Canada. Then tell me it will be better in the U.S. when wait times for specialists go from days to weeks and surgeries take months to get scheduled.
The devil is in the details. You have an admirable goal. You just don’t want to accept the reality that implementing your vision will likely cause all sorts of consequences you haven’t considered.
And the single payer supporters just ignore the difficult questions. I’m still waiting to hear how you will force a surgeon to accept what the government says he must be paid for his work. That one aspect alone will kill single payer out of the gate.
Doug,
The insurance companies already dictate proceedure reimbursements and doctors – and hospital systems – grumble and go along with them.
A surgeon’s salary is the least of our system’s problems. I don’t see what the problem is; Washington has no trouble employing high-priced legal talent. Why would it be different with doctors?
Doug you cherry pick statistics to “prove” Canadian healthcare is less effective than ours but it’s hard to get around simple facts. Life expectancy in Canada is greater (80.7 vs 78.3 the same as Cuba source: Worldbook stats via wiki). Everyone has access to healthcare whereas we leave 50 million to fend for themselves. And goodness gracious the cost in the U.S. is by far the highest in the world per capita (6,096 vs 5,200 in Luxembourg the #2 nation and 3,173 for Canada). Cherry picking a few statistics and throwing out a few random quotes doesn’t change the bottom line.
Perhaps the Canadians could spend a bit more to alleviate some of the waiting issues but they manage to live longer than we do just the same.
@Jfx
I know its difficult to deal with facts and evidence when you’d rather deal with feel-goodism and fairy tales. But the facts are the facts. Doctor shortages, rapidly increasing costs, long wait times, reduced outcomes for some diseases. We won’t be able to pick and choose the good parts without accepting the bad parts.
“If the Canadian citizen of modest means comes down with a major cancer, there is no selling of the house, and no bankruptcy. Yes, this is the nirvanic rainbow-colored lollipop. The pipe dream, as you say…”
Yeah, if they have certain types of cancer, they have a higher chance of dying sooner. But at least they’ll have money in the bank.
It’s pretty simple – if we screw with the current system, there will be just as many people who will be unhappy with the decrease in service as those who may achieve marginal improvement.
I don’t pretend there is some pie in the sky solution. There are private solutions to all the ills you find with America’s system.
Start with letting anyone buy into the same system as the Federal government workers have access to. That could be accomplished very easily and I don’t see what the downside would be.
As for the millions of lost jobs, we’ll see how President Obama will do if he trades jobs for cheap colonoscopies. There’s a reason most of the tough stuff in Obamacare was pushed out to 2014. Because he knows it would be a job killer and that would seal his defeat next year.
I can’t quite figure out why bringing in 50 million new paying customers into the health care system would drive up costs, but then maybe someone else can explain it. Last time I checked, though, when more people buy something, the price goes down.
Just went to the doctor today; one of the best in his field. I pay out of pocket, though, because I can’t get health insurance. I was denied coverage because I lived in Europe. I must have mad cow disease. Can’t give blood, either.
To me, our discussion here always comes down to generalizing and sloganeering. For instance, European medicine is presented as “government run” all the time, when in most countries, there is a mixture of government regulation and free market investment. Germans have a choice of which company they join, and doctors have a range of prices they can charge.
And the field of medicine plays a role, too. The US is tops in areas of neurology; Germany is tops in the field of opthamology, for example.
All of this makes for the need of a much more complex discussion than just ‘us vs. them.’ Statistics are often spun the way that the writer wants; I’ve just looked at some of the discussion on the web, and they’ll quote America and Canada on one line, and compare America and France on the next, and on and on. And goodness knows where the polls were taken and the control groups.
I’m with Mark Stewart on this one, but one comment–it seems hard to get government to stick to a rudimentary system; the temptation is to want to put in more perks for more votes. Our government is more subject to public opinion than most European countries, too.
There are private solutions to all the ills you find with America’s system.
– Doug
Yeah right. I’m sure a completely private solution would have defeated the Nazis and put a man on the moon. I’m willing to listen to a good argument and even concede to some extent that the Canadian health care system could use some tweaking. But let’s not throw out nonsensical, libertarian blather. This is the kind of nonsense that caused me to abandon pure libertarianism back in the 80s.
@Bud
Do you understand that the demographic makeup of the United States is significantly different than Canada? How about getting us the life expectancy rates for white females? The overall U.S. life expectancy is brought down by lower numbers for blacks.
It’s ludicrous to even try and link the existence of single payer health care to life expectancy rates.
I didn’t cherry pick statistics. I provided a direct comparison between the two system done by the leading newspaper in Canada.
Your statistics aren’t even cherry-picked. They’re prunes.
Doug,
Could you clarify your suggestion that folks be allowed to buy into the federal system? Do you assume that this means they would take all comers — that is, no preexisting conditions can be excluded?
@ Doug Ross– Lots of people have “free” health care, besides the poor–like Congress!
Someday you may wake up to just how much privilege you have.
I’ll take Canada’s system any day. Or Britain’s. You can cherry pick horror stories in any system, and it wouldn’t be hard for Brad’s readers to come up with personal stories–in fact at least two have already, of having to ration their personal care or that of loved ones, because of ability to pay.
Does Britain’s plan come with a free English breakfast?
@Kathryn
I didn’t cherry pick “horror stories”. I provided factual evidence based on analysis done by the Globe & Mail. Read the article. It provides a much more balanced view of the two systems and
As for my “privilege”, it’s not just me. It’s tens of millions of Americans. It’s a benefit I received for the work I have done.
@SusanG
Yes, no pre-existing conditions. Everyone should have access to the same plans at the same cost. Those were the simple things Congress could have done.
@herb
“Last time I checked, though, when more people buy something, the price goes down.”
The problem, Herb, is that more people won’t be buying something. More people will be getting access but the question remains as to whether they will be buying it or someone else will be paying for it. In the latter case, the cost will rise for those who are paying for the ones who don’t pay.
The only way for the price to go down will be to pay the providers less. And then they will exit the system, creating a shortage.
Everything is simple until you actually have to think through the details.
Nobody has dared answer my tough questions yet:
In single payer, will you force doctors to work for the government at the rates determined by the government? Do you think there will be a negative response from the top surgeons? Will the government cover all the costs of malpractice lawsuits if the doctors work for the government?
The overall U.S. life expectancy is brought down by lower numbers for blacks.
-Doug
That’s because they tend to be the poorest and LEAST LIKELY TO HAVE HEALTH INSURANCE.
OK, so no refusing a person for preexisting conditions, right? They would have to take all comers at the same rates that fed employees pay.
Now my question is, wouldn’t the federal employee premiums start going through the roof, because then no one would have to get insurance until they’re sick, and when they get it, the insurance company incurs the costs, but not the ongoing premiums?
I don’t see how you can not allow the insurance companies to refuse coverage for preexisting conditions and at the same time not require people to have coverage. I’d be glad for insurance companies to do it this way, but it’s not feasible.
So help me out here — how would that work?
@SusanG
You mean the insurance companies shouldn’t factor expected health costs for the entire pool when setting the rates? I’m sure there would have to be some rate bands based on a number of factors (as there should). But isn’t that how it should work? An obese smoker at age 50 with diabetes should pay hire rates than a 21 year old non-smoker with no health issues. The smoker would have access to insurance but pay for it proportionally based on the expected cost of treatment.
I thought the issue was about access to insurance for those who don’t have it? Access doesn’t mean it must be cheap. And I’d be fine with the government setting up its own self-funded insurance company to compete with the private insurance. I’d be fine with that because I know it wouldn’t be able to do it as well.
@bud
Take a trip over to Wikipedia to read up on Canada’s system. You may be forced to read factual information that will raise your blood pressure, though, so consult a doctor before proceding.
“About 30% of Canadians’ health care is paid for through the private sector. This mostly goes towards services not covered or only partially covered by Medicare, such as prescription drugs, dentistry and optometry. Some 65% of Canadians have some form of supplementary private health insurance; many of them receive it through their employers.[34] There are also large private entities that can buy priority access to medical services in Canada, such as WCB in BC.”
What? PRIVATE INSURANCE IN CANADA? BUYING PRIORITY ACCESS TO MEDICAL SERVICES? Why, that is positively Un-Canadien!
I find it hilariously hypocritical that the same people who screamed about activist judges when they were on the losing end of the decisions are silent in the face of judicial activism that favors their agendas.
@Doug,
No, I’m not saying that. Please read it again.
I’m talking about the fiscal impossibility of not denying coverage for preexisting conditions without requiring everyone to have insurance. That’s an issue whether it’s done in the private sector or the public sector. This and the issue of cost (both issues of individual access/premiums and our total healthcare burden) are the driving issues of the debate. If your ideas don’t deal with these two issues, then they’re not serious solutions.
Also, group plans today do not differentiate premiums based on personal characteristics (smoking, etc). This also is true in both the public and private insurance market.
I think you actually know these things, because you’re a smart guy, and so I wonder if you’re not being intentionally obtuse?
(And I understand this forum really leans more towards sort of water-cooler entertainment than real discussion, but I’m every hopeful….)
@Susan
“Also, group plans today do not differentiate premiums based on personal characteristics (smoking, etc). This also is true in both the public and private insurance market. ”
Not true. There are surcharges for tobacco use on the SC state plan.
“Tobacco Surcharge
A surcharge will be added to the health insurance premiums of tobacco users covered by an EIP-sponsored health plan. If you, or anyone you cover under your state-sponsored health plan, smokes or uses tobacco, you will pay the surcharge of $40.00 per month ($20.00 per payroll) for subscriber-only coverage or $60.00 per month ($30.00 per payroll) for subscriber/spouse, subscriber/children or full family coverage. You will be automatically charged the tobacco-user premium, unless you certify no one covered under your health insurance uses tobacco and no one has used tobacco within the past six months. When you complete your enrollment paperwork, you will be given a certification form to indicate your tobacco usage. For more information, please refer to the enclosed flyer or visit EIP’s website at http://www.eip.sc.gov.”
I’m in the process of switching over my insurance this week so this is current information.
And that’s the way it should be.
@SusanG don’t hope too much, because I fear that some people really don’t want to get it, and wouldn’t admit it if they did.
Mort Zuckerman wrote in US News a few years ago the same thing that you just explained to Doug, so even some analysts who didn’t like the new health care bill at least were willing to see the problem.
I’m glad that Obama had the courage to push through some reform. Even if it does eventually get tweaked, at least somebody had the guts to try and move us in the right direction. The Republicans were happy to keep the status quo, keeping a lot of us excluded from insurance.
Now maybe Obama, if not now, perhaps in a second term, will have the courage to push for legislation that moves us away from dependence on foreign oil. If anyone has the courage to really tackle that, they’ll be really gutsy.
@Doug,
I almost didn’t include that statement, since I thought while I know a fair amount about health plans (since I’ve been choosing them for our company for 10 years), there’s probably one out there that has a surcharge.
And I figured you’d glom onto that instead of dealing with the real issue in my post.
So, I’ll give you that I don’t know about every health plan out there.
Now, will you address the main issue of the post? That’s much more important.
@Herb,
My brother-in-law, who is a Libertarian, openly just says we shouldn’t cover pre-existing conditions, and if a person chooses not to buy insurance for themselves, then oh well, that’s just too bad for them. They’ll have to do the best they can with charity. (I believe Mike Huckabee took the same position, using having one’s house burn down without insurance as an example).
And actually, I respect that position because it is honest with respect to the realities of insurance. I don’t happen to agree with it, but I do understand it.
But I don’t understand how one can have a system where pre-existing conditions are not excluded and still have a working insurance system. So I’m interested in anyone taking that position explaining to me how that would work, exactly.
SusanG is spot on. It’s the same argument for corporate or gov’t. plans – one is either in or out.
To me, I don’t care whether we have a private supplemental market, a single payer plan, or a free market approach. And I don’t care whether costs are allocated by broad risk groups. As much as I hate to say it, I don’t even care what the cost would be (as I know it would end up being less than my current situation).
I care that coverage be available to all and that it be portable. If the first premise is everyone will have the ability to be covered, then everything else is just details… Does that drive you nuts, Doug? Just details?…
@Susan
We’re not talking about some minor health plan. It’s the plan that covers the majority of workers in this state. It’s what should be part of any large pool plan.
As for your question:
“Now my question is, wouldn’t the federal employee premiums start going through the roof, because then no one would have to get insurance until they’re sick, and when they get it, the insurance company incurs the costs, but not the ongoing premiums?”
No, I don’t believe so. For three very simple reasons:
1) You couldn’t just pick and choose the date you want to start insurance. You’d have the same small window every year to commit. And that first year that this option was available there would presumably be millions of people, both healthy and sick, who would get on board. Do you think really think the majority of people who have don’t have access to insurance now will wait on the sidelines until they get sick and then wait up to a year more before they can get coverage? You think parents with kids would take that risk? I don’t.
2) Wouldn’t someone with a pre-existing condition be willing to pay more for insurance just to have the coverage for the catastrophic costs that might occur that would be shared across the entire pool? and have access to the doctors who will accept the insurance?
There are two separate issues: access and cost. I am suggesting an alternative that provides access to everyone who doesn’t have insurance. Providing access and not allowing to deny for pre-existing conditions removes two of the huge issues today. The other issue then becomes paying for the insurance who cannot afford it. For that, we can stop invading Afghanistan. Done.
@Doug
I didn’t mean to imply that plans with a tobacco rider were minor –just that I wasn’t aware of them. Can’t know everything – that’s why I’m glad there’s people like you to ask.
I think your point related to a once-a-year commitment sounds reasonable. I’m interested in whether the insurance companies would agree with you. I mean, couldn’t an insurance company make this exact offer today? Once a year signup of all comers, no pre-existing conditions exclusion, that they treat as a pool that keeps costs down? And yet they don’t. If the market doesn’t do something, there’s usually a reason.
@Mark
I agree wholeheartedly about the portability! I hate that my health care is tied to my employment, and that it is such an issue when starting a new business venture. Oh, and that when I hire someone in a small business environment, I’m stuck with the quandry of not hiring based on disability vs the fact that that one person’s health issues could make healthcare unaffordable for everyone else. I also could care less as to how we get this done — just get it done!
@Susan
And the reason would be that they don’t make enough money doing it. If there were money to be made, they would have been doing it a long time ago.
So the bottom line is, without that dreaded government intervention and prodding, it won’t happen. The Democrats had to move something; I just hope that people like Huckabee don’t get their way and torpedo it completely.
Certainly there is room for savings in the military; I’ve got relatives serving in the military who would be the first to say that. But withdrawing from Afghanistan is not an option right now; we need to invest in Afghanistan/Pakistan in a big way to bring about some degree of global stability. Otherwise we are going to have nukes going off in our own front yard. Petraeus is the best leader we have in that regard, too, but now I’m way off the subject.
@SusanG
They don’t do it because there is no requirement to do it. Insurance companies are fundamentally risk-averse to the core. If Congress mandated open entry once a year, they would analyze the data and come up with rates. There is no reason for them to expend the resources to do that unless they have to.
This is why I believe single payer is the worst option. We need as many options available as possible AND allow for yearly portability between insurance providers. Competition will drive down prices. And having different prices based on lifestyles will hopefully drive healthier behavior.
That’s why Obamacare could have been as easy as:
1) If you want to have access to federal workers insurance coverage, you must offer the same plans to individuals.
2) Open enrollment every year
3) No denial of coverage
4) Increase Medicare tax by 1-2% to provide vouchers to people below some multiple of the poverty level
5) Set a maximum award for medical malpractice and make it much more difficult to sue over simple mistakes versus gross negligence
Tell me that wouldn’t have changed the landscape of insurance coverage in this country.
“…an EIP-sponsored health plan. I’m in the process of switching over my insurance this week so this is current information.” – Doug
Am I reading this right? Are you about to go on the government payroll?
@libb
No.
Awhile ago Doug said…”There are private solutions to all the ills you find with America’s system.”
Then a discussion arose where Doug and Susan argued the merits/feasability of letting anyone join the federal plan with no exclusions, which is Doug’s suggested solution.
And Susan said, “I think your point related to a once-a-year commitment sounds reasonable. I’m interested in whether the insurance companies would agree with you. I mean, couldn’t an insurance company make this exact offer today? Once a year signup of all comers, no pre-existing conditions exclusion, that they treat as a pool that keeps costs down? And yet they don’t. If the market doesn’t do something, there’s usually a reason.”
And then Herb said, “And the reason would be that they don’t make enough money doing it. If there were money to be made, they would have been doing it a long time ago.”
And then Doug said, “They don’t do it because there is no requirement to do it. Insurance companies are fundamentally risk-averse to the core. If Congress mandated open entry once a year, they would analyze the data and come up with rates. There is no reason for them to expend the resources to do that unless they have to.”
So Doug, I’m having trouble reconciling your initial claim that there are private solutions to these problems with these later revelations. Do these statements not seem contradictory to you? You yourself basically just said above that the private companies won’t make these offers if the government doesn’t make them. So how is that a private solution.
If the private sector is motivated by profit and there is no money to be made serving the poor, how can the private sector ever solve the problem? Just please explain that part.
@Susan
I don’t know how else I can say it:
They don’t do it because they don’t have to do it and it would be very expensive just to figure out how they COULD do it if they wanted to. Go back to what I said about being risk averse. What they are doing now they understand very well. Change is not something insurance companies do well.
But here’s a simple example. Obamacare allowed parents with uninsured kids to keep them under coverage until they are 26. This surely increased costs and they figured out the best way to spread that cost over the entire pool. It took them several months to do it, but it happened. How is that different than what would happen if the government mandated allowing access to the same plans as federal workers? They would figure out a cost and set their rates and hope that a competitor didn’t have a better pricing model.
Expanding the pool will also force them to incur significant overhead costs: more call centers to handle customers, more IT resources to process claims, more fraud investigators, etc. So they aren’t going to begin that process until there is a reason to. But I guarantee you that private companies will be able to do it better than the government can.
@Susan
And the other simple fact is that there are plenty of private insurers covering the majority of Americans under the age of 65 who do it well and have customers who are happy with the service they receive.
Single payer fans have to be able to convince those of us who are happy with their coverage (most people who have it) that single payer will be cheaper, more efficient, not introduce longer wait times, etc. Otherwise, why should we accept an inferior solution. Medicare can’t compete with private insurers: they pay below market amounts for services, many doctors will not accept Medicare patients, and even Obama admits the system is rife with fraud. And some people want to make that the standard???
Maybe some people with great insurance (we have Blue Choice) care about more than their own pocketbooks. I want everyone to have adequate care even if it costs me more time and money.
Yes, some people with good coverage will not look beyond their own skins, and that presents a challenge politically, but not necessarily an insurmountable one.
@kathryn
But you care more about MY pocketbook than yours. Otherwise you would,organize a charity to collect money for people without insurance instead of waiting for the,government solution.
There has never been a charity big enough to address this problem, and never will be. Beyond that, there are issues involved here that can only be addressed by changes in law.
You either build this into the fundamental infrastructure of society, or forget about it.
You can no more turn to charity to provide universal health coverage than you can expect charity to provide our roads…
@ Doug– I’m kinda busy with all my other volunteer activities.
There’s plenty of stuff that can be dome while we wait for the real solutions.
http://www.newyorker.com/reporting/2011/01/24/110124fa_fact_gawande
Maybe if we reframe the discussion, as Dr. Gawande has.
“done”
I spent today in Toronto. Talked with a colleague of mine who lives here. She mentioned that her husband who had macular degeneration must get a shot every three months to help slow the condition. She said it costs $2000 for each shot. I said “That must be nice how it’s covered by the national health plan”. No, she said. It is not covered and that’s why both she and her husband have private insurance to cover the costs of those shots.
Hmmmm… so what happens if you don’t have the insurance? Well, you’re out of luck.
I then asked her how much she paid for the national health plan. She said she didn’t know because it was just bundled in with her general taxes.
The more I learn about Canada’s system, the more I am certain we will never see a similar plan here. It’s not everything that those who buy into the hype think it is. And if the new system is worse for a large percentage of Americans, it’ll never happen.
You want to give healthcare to people who don’t have it? Decide what the priorities are for the country and make choices. More taxes isn’t a choice, it’s a copout. A few less bombers, a few less foreign military bases, a big cut in foreign aid, a cut in farm subsidies…. the money’s there now but the desire to do it isn’t.
Well, I know plenty of Canadians, and they love the health service.
Do we know if this shot is experimental or what? Of course you can’t just go and get whatever whenever–my insurance won’t cover everything, either!
@Kathryn
But how is it better if you still need both husband and wife to have private insurance?
And I know plenty of Americans who are happy with the current system. Are you going to guarantee a better system under your plan?
And nooone has yet to tackle my question about whether you will require doctors to participate in a single payer system at the rates determined by the government.
You don’t have to require doctors to do anything. But if all of their patients are in the system, and that’s the way those patients pay, what are they gonna do?
Now, you can say, “I’m not gonna take any Medicaid patients.” With single payer, their only options are to work with the system, or not take ANY patients.
@Brad
You mean you would not allow people to pay for healthcare themselves if they chose to?
And you realize that if you somehow were able to force doctors to accept only single payer rates, that many of them would move off into other more lucrative elective practices thus lowering the quality of care available.
Take Dr. James Andrews. He’s the leading sports medicine surgeon in the country. Any major league pitcher with arm trouble will probably drop in to get a consult from him these days. You think Dr. Andrews is going to start taking paychecks from the government to treat Jane Doe’s tennis elbow while some major league pitcher waits for a Tier 3 Medicare Analyst to approve his MRI?
The single payer fantasy collapses under the weight of reality. It’ll never happen.
Doug,
It’s better because everyone is covered at a basic level. If people can and want to pay more for extras, that’s fine. If fancy pants sports doctors only want to see fancy pants sports stars, that’s fine. But it’s better because everyone else can get the basic care they need. Does that guarantee a better system? – in my mind, yes.
If you are in the upper echelon, I suppose your opinion on if it’s a better system or not may depend on how much you care about the welfare of your fellow man.
I’m still waiting to hear how the private sector is able to solve every problem in the system in situations where there is no money to be made in the venture – i.e. serving the poor.
@scout
It always seems to come back to how horrible a person I am and that I don’t care about my fellow man. Simply untrue. And then the next phase of attack is to shift to class warfare, blaming people for being successful.
I’ve already stated that I would be fine if the government made a choice that provided health care ahead of fighting wars. I even suggested raising Medicare taxes (shocker!) to provide vouchers to the poor to buy private insurance.
I am against setting up a 100% single payer system for one basic reason: the government cannot do anything well. Medicare is a fraud infested joke that only survives because it is mandatory AND because the majority of the costs are shifted to privately insured younger patients.
If you want an average health care system for everyone, pursue single payer. If you want the best system, let profit driven markets respond to consumers with the least amount of government intervention. Vouchers + free market would result in a much better system overall.