OK, it’s official:
COLUMBIA, S.C. — Gov. Nikki Haley told the federal government Thursday that South Carolina won’t set up a state health exchange, saying President Barack Obama’s re-election did not change her stance…
Under the law, states that can’t or won’t set up exchanges will have theirs run by Washington…
The attitude behind this still ticks me off. Saying “we won’t play” to the one chance at healthcare reform in this generation, just because it’s associated with Barack Obama, is infuriating. And really unforgivable. It’s just so pouty-childish. Like a passive-aggressive, totally ineffective version of nullification.
But I suspect we’ll all be better off with this thing run by the feds, rather than by people who want it to dry up and die.
The bizarre thing is that Ms. Small Gummint prefers for this thing that will affect so many South Carolinians to be run by the federal government rather than the state. But I guess expecting it to make sense is expecting too much.
This kind of reminds me of our anti-union governor advocating to have our children driven to school by members of the Teamsters Union. Which is what you get when you privatize school buses…
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Haley made the right choice. For all the wrong reasons. Still, we don’t usually get that lucky with her…
If she supervised it, our medical data would be as public as our financial data!
It figures. Governot Haley is incapable of doing heavy lifting. From what I read on FitsNews, she directed the Health Planning Committee to find it impossible to implement a healthcare exchange; and that was funded with a one million dollar grant.
She says that the committee held several public meetings. Who wants to file a FOI request for those meeting minutes?
Here we go again. Ms. State’s Rights punts to the feds rather than assuming responsibility in keeping with her claimed philosophical inclination.
Next thing you know Ms. Private Enterprise will be filling up state jobs with her relatives. Oh, yeah.
I have far less problems with state’s rights than I do with officeholder hypocrisy.
Problem is that the big old R hides way too many issues.
We’ll be better off.
Classic case of the blind hog stumbling upon the occasional acorn.
of course she and others like her can now continue to complain about federal interference even though thousands of uninsured south carolinians will finally be covered
Health exchanges for small business started in greenville years ago. nothing new except to haley and her ostrich breathern
Maybe our information will be safer NOT handled in-state.
Having the Feds run the exchange is probably for the best. Haley would have most likely screwed it up or placed some unqualified campaign donor in charge of it.
Plus being in a regional Fed-run exchange instead of just a statewide exchange will mean more options and more competition for consumers.
“The bizarre thing is that Ms. Small Gummint prefers for this thing that will affect so many South Carolinians to be run by the federal government rather than the state. But I guess expecting it to make sense is expecting too much.”
The AFA is still tough for me.
When it passed I was like many. It scared the crap out of me and felt like a huge over step in fed govt.
Maybe it was 9 1/2 years of Navy handle things on the lowest level.
Lately I read alot of Frank Knapps work for the Small Business council explaining the pro side from a small biz perspective.
Just looking around with the blinders off we NEEDED some form of health care reform. At least this was SOMETHING albeit horribly complex.
To sorta bring it around if its this hard for me, a small time political moderate, its got to be next to impossible for Haley to “play ball” with a gov program she despises at the core.
The sad truth is if the state ran an exchange the legislature would just muck it up anyways. Im sure they would make an entire new arm of govt that they would make a bunch of nepotistic appointments and probably commission a study from their allies to tell them the friends and family appointees suck. Im sure a committee would be involved somehow as well.
So we are better in the end just letting the feds handle it.
It’s almost like she’s standing on principle or something.
Wouldn’t it save money to set up one federal exchange instead of 54 state and territorial exchanges?
Given the way our local governments have been governing this may be for the best (in the best of all possible worlds).
“Silence”‘s question gives Haley’s decision serious merit. In addition to cost, other efficiencies (and lives, of course) are also at stake.
Who better to manage such a boondoggle according to its declared goals (‘Patient Protection and Affordable Care’) than anonymous, partisan utopians whose utopian dream it was, is, and will forever be.
Sure, Silence, just like it would save money to have a single payer. It was political compromise. We get sausage, not steak.
Hmmm, let’s turn the healthcare exchange over to the State of SC, since their recent track record is so strong.
SCDOR hacking, Appointing the Richland County Elections Commission, etc. etc.
@Kathryn,
When you are hungry, sausage tastes just as good as steak and if that is all you can get, it is better than nothing.
After reading Haley’s decision to let the feds handle ACA for SC, I am in agreement, the state is probably much better off and when, not if the act ends up being another government fiasco, at least the states who opted out in favor of the feds can’t be held responsible.
After listening to an ever widening circle of business people, large and small, and the way they are approaching the ACA mandates, their actions will bring the US to the inevitable single payer that supporters have hoped for.
When the federal employees hired to administer ACA in SC start showing up and having the final authority over the program, one can only imagine the howling that will come from the governor’s mansion when she and her successor finally realize just how much control they voluntarily handed over the the federal government.
I still remember when 18 year olds were given the vote and John Denver hosted an event for it. He made a comment that has stuck with me and I still adhere to it with strong conviction. “If you don’t vote, don’t bitch”. In this case, when you turned control over to the federal government Governor Haley, don’t bitch or complain about it, you had your chance and blew it.
Actually, good sausage often tastes better than steak.
I find steak to be a hit-or-miss proposition. You’ll think you’re about to eat something really good, and it’s blah or worse. Of course, sometimes it’s great, but that seems to me to occur too seldom to justify the price.
Sausage is more reliable. If a certain kind of sausage is good once, it’s always good.
@ Bart – How much control are the states really ceding here? Insurance companies are still still regulated on the state level, and we’re not exactly talking about anyone making programmatic decisions about what will be offered or what the cost will be. States that don’t want to set up their own exchange can always decide to run them at a later date – at least that’s what the feds are saying right now.
I think some of this nontroversy stems from a misunderstanding of what the exchanges will be – They will basically be a webpage and a decision tool that will guide consumers to make a reasonable choice about who will provide their health insurance. From Medicaid all the way up to the most expensive and comprehensive private insurers. How are the needs of SC consumers so different from GA or NC residents? Why do we need a different portal, and why should we assume that our local one would be any better or worse than a federal one? Is MSN.com a better homepage than Yahoo.com? Is ABC News any different really from CBS News?
The exchange is just a shell, it’s what is in the shell that is going to matter. Think of it as a shopping mall full of insurance stores. Why should SC pay an architect to design Dutch Square Mall when the feds have already bought the plans for Columbiana? BCBS, Coventry, Medicaid, Humana, Kaiser, whomever, they can all set up in either exchange- just like Belk, Dillards, Sears, and Macy’s can set up inside any empty anchor slot in a mall.
Given what we do know about our state government’s competence and capacity to execute, why should we assume that we’d end up with “filet mignon” from a state exchange? More than likely we’d end up getting our personal data sold off to Eastern European gangsters. I’ll take the federal kielbasa.
Much ado about nothing if you ask me. It’s just another way to bash Haley for her anti-Federal stance.
Go ahead, tell me I’m wrong.
“When you are hungry, sausage tastes just as good as steak and if that is all you can get, it is better than nothing.” BW
When regional hospitals are forced to closed to contain costs and reduce duplication of services guess what? Rationing of medical services by forced waiting and burdonsome travel requirements for many (even indigent ER habituées.
Liberals will claim they could not see it coming, or it was the Republican’s fault.
The Patient Protection and Affordable Care Act was not, KF, a political compromise by any stroke of a cogent imagination and rationing will come home to roost sooner rather than later (except for our permanent political class).
Actually, Bart said that about sausage. I followed it up by saying it was often better.
Juan – DHEC already regulates the location, distribution and delivery of hospital services. The decisions are already overly politically influenced. Therefore Lexington County got its heart hospital.
“Much ado about nothing if you ask me. It’s just another way to bash Haley for her anti-Federal stance.
Go ahead, tell me I’m wrong.”…Silence
Well Silence, I won’t tell you that you are wrong. What I will say is that apparently I didn’t make my point clear enough and for that I apologize.
Crux of the matter. Haley opted out. Haley turned ACA over to the feds. Now, Haley cannot bitch about how it is handled, whether we get “sausage” or “steak”, or anything else. What if it turns out to be a really bad version of that Hawaiian delicacy, “Spam”? You know, the canned meat Hawaiian’s keep stored in mass quantities in warehouses.
I know about Haley’s anti-Federal position, it is not a surprise at all.
In SC health care is $30+Billion business that directly employs 235,000 people but leaves approximately 1M folks on the outside looking hoping to get inside and receive care before they are acutely ill.
Currently the only reliable access for these folks, many who work and many who are middle class but have pre-existing conditions, is charity clinics or hospital emergency rooms. Hospital emergency rooms are not a health care system. ERs are expensive.
ER care is a hidden unfunded mandate. Who pays for this sporadic disconnect care? We all do through higher insurance premiums or taxes. Hospitals are just the middlemen playing three card monty on this.
Next time you eat out, check out at the grocery store, buy a lottery ticket, shop at WalMart chances are you’re looking at an uninsured South Carolinian. They are everywhere.
Health care is something a civil society provides its citizens or at least most industrialized developed countries do. Remember they are our competition and they get better results and pay less than we do.
Massachusetts has 1% uninsured SC has 20+% uninsured. The exchange and expanded Medicaid made that possible.
The real reason we don’t have a state run exchange is that we’ve had to contract out its development and operation because we lack the managerial (brain power) capacity to develop and run it. The law prevented us from subcontracting it to BCBSSC. We are better off with a Federal Exchange.
Don’t kid ourselves, health care is and will remain expensive. Getting folks access is just the beginning of fixing our dysfunctional system. If you have health insurance you’re blessed.
Brad – prefer sausages to steaks, eh? Alphas get steak, Betas prefer sausages.
“Alpha children wear grey. They work much harder than we do, because they’re so frightfully clever. I’m really awfuly glad I’m a Beta, because I don’t work so hard. And then we are much better than the Gammas and Deltas. Gammas are stupid. They all wear green, and Delta children wear khaki. Oh no, I don’t want to play with Delta children. And Epsilons are still worse. They’re too stupid to be able to read or write. Besides they wear black, which is such a beastly colour. I’m so glad I’m a Beta.”
– Brad Warthen’s Brave New World, Chapter 2.
Sorry Bart, I didn’t mean for that entire comment to be calling you out, just the first line questioning how much control we are really ceding.
I do agree with you though, that the ultimate plan of the Obamacare backers is to get us far enough down the single payer path so that we can’t turn back.
Let’s suppose that pushing everyone into the insurance pool does not reduce premiums. What if costs go up in the short term due to supply/demand and lots of expensive pre-existing conditions being covered.
Let’s suppose that a lot of employers drop coverage and just pay the penalty instead, because maybe it’s cheaper just to pay. This pushes even more folks onto the buying individual policies on the exchanges – or individuals also choose to pay the penalty and wait until they are sick to sign up and start paying for the expensive insurance. Let’s say that insurers can’t make money by starting to cover people after they get sick. This would further drive rates up, and push more folks onto public plans, rather than private plans. In my mind, that’s not a bug – that was a feature instituted by the designers of this plan.
They’ll push the cost up so high that eventually we’ll hit a tipping point where the vast majority are getting single payer courtesy of the U.S. Treasury/Federal Reserve tax/borrow system.
And if single payer is Obama’s aim, and this gets us there, hurrah for Obama…
Personally, I think Obama’s aim is to bankrupt or nearly bankrupt the US (and the west in general) to punish us for the sins of Colonialism and attempt to even the international playing field. Single payer healthcare and European style social programs are merely a means to this end.
Dreams from his father, indeed.
Let’s suppose that pushing everyone into the insurance pool does not reduce premiums. What if costs go up in the short term due to supply/demand and lots of expensive pre-existing conditions being covered.
-Silence
That is the most ridiculous of all the criticisms of Obamacare. Costs for healthcare have been going up at an astonishing rate for decades in part because folks do not have insurance and MUST use more expensive options like the ER.
But even if the cost increases are not slowed more people will be covered and that is a good thing.
Personally, I think Obama’s aim is to bankrupt or nearly bankrupt the US.
-Silence
Really? Such a cynical attitude. Of course George W gave us a pretty good headstart on the road to bankrupcy. Since taking office the annual budget deficts have actually declined slightly each year from the last Bush budget. If that’s his goal he’s doing a … poor job of it.
Wow, Silence. Are you kidding?
“Juan – DHEC already regulates the location, distribution and delivery of hospital services.” – Silence
Yes, but only for the brief time being only.
@bud & Kathryn – He’s not alone. Many others are thinking the same thing, if true would explain a lot. And when you have a lot of people with the same questions. Obama has nothing to lose these next four years.
And bud’s not going to drop “it’s Bush’s fault”. Bush hasn’t been President for the last four years, we had another incompetent idiot sitting in the Oval Office.
Silence, SDII, and bud,
Have fun arguing ridiculous nutcase conspiracy theories: Bush and the Republicans pledge allegiance to Grover “Drown it in a bathtub” Norquist and want to destroy our country, and meanwhile Obama and the Democrats pledge allegiance to Jeremiah “God damn America” Wright and want to destroy our country.
The facts say that Bush and the Republicans love our country, and that Obama and the Democrats love our country. And the moderates and independents love our country, too.
So again, have fun, but don’t expect anyone to take you seriously — and that goes even more so if you’re anonymous.
Well, yes, there are plenty of people who lap up Faux News, Limbaugh, etc., and plenty who think we never landed on the moon, too.
Msnbc calls this the conservative entertainment complex. Blames the need for rating for the repub panacea of badding polling from the right and if the general dismissiveness of anyone that said othefr as liberal bypass.
I know I bought into it. I thought the race woulde be a squeaker and inside the margin of litigation.
@Michael – Why do you need a PhD to teach 9th grade algebra? Have you heard the latest, where Obama wants to restructure retirement programs and go after individual 401k’s… because poor people can’t afford retirement programs?
@Kathryn – Is that what they’re saying on NPR or CNN? Maybe you got it straight from the mouth of Ed Schultz.
Haley and Republicans go after Vincent Sheheen for being conspicuously silent on this topic. I think it is a valid point – Sheheen rarely makes a public statement that would suggest he is a political leader of his party. He can’t say Haley is right and he is afraid of the backlash if he says Haley is wrong.
If he wants to be Governor, let’s hear how he would govern when faced with the decisions a Governor has to make. I’d like to hear whether he would have vetoed any portion of the last budget.
http://www.thestate.com/2012/11/18/2524285/the-buzz-yes-the-sc-guvs-race.html#.UKkF0Ybk32s
The best reason to be happy about the feds running the SC exchange is they will likely do a far better job than people who don’t believe in the thing they are doing. There is a theory that conservatives sabotage government by purposely putting unqualified people in charge in order to fulfill their thesis that government is incompetent.
But it is not inherently so.
I believe the exchange will have a better chance of working the way it is supposed to work with the federal government running it rather than Haley or anyone she would appoint.
Dunno, Scout. Maybe Lillian McBride could be persuaded to run it!
I prefer that the feds run it. I expect they will do a better job than state-level officials would. And if this pushes us closer to single-payer, I am all for it. It’s where we should be.
What I am more concerned about (and which seems to be getting little attention) is the governor’s rejection of Medicaid expansion. There are people who will be pushed off business-subsidized insurance (or denied access by cutting weekly work hours) and into the exchange who still will not be able to afford coverage. Rejecting the Medicaid expansion cuts off one avenue to coverage for these people.
How about medicare for all at a somewhat reduced benefit package for those under age 65. That gives everyone at least some kind of insurance. For the younger folks there would still be a substantial market for supplemental insurance that wouldn’t cost nearly so much. The feds would have a great deal of leverage to negotiate with pharma and hospitals to keep costs down. Insurance companies could still make a profit, albeit somewhat smaller. Hospitals would be guarenteed most of their payments so they would not have to aggressively pursue the uninsured for some type of payments. That should help keep costs down. Once this approach is fully implemented we could do away with medicaid and the VA alltogether. That would simplify things further (and make all the comments on this post irrelevant) and reduce costs. Patients could simply use their SS cards as insurance cards.
@bud – So you want welfare availability for everyone under age 65. Why have insurance, just give your employees money for a Medicare co-pay.
Now if you can convince doctors to accept Medicare and Medicaid. I know more and more that aren’t taking on any additional Medicare or Medicaid patients because they don’t get reimbursed enough to cover their overhead for procedures.
@Steven
Don’t you understand? The goal is to make all healthcare providers government employees. Every doctor is the same and will receive a government mandated payscale. Competence doesn’t matter. You can’t be paid what you are worth, only what the government determines you are worth.
What makes you think doctors are paid what they’re worth now? Who among us lay people can truly judge quality in doctors, and few doctors have much oversight. They charge what the market will bear, unrelated to quality.
For example, why do rich celebrities who can afford the best plastic surgery so often look so bad? I just saw a video of Marlo Thomas that was truly macabre, and Nicole Kidman has been looking fish-lipped off and on for years. Seems like a market failure to me.
Doug,
I have doubts about “the goal” as you describe it, but what you describe sounds a lot like the current pre-ACA reality – only with the words “government” replaced with “private insurance”.
@Doug, Silence, & SDII,
Why bother to debate the point? It is inevitable, we are going to have single pay within a few years, no matter who is in control of congress or the White House.
The way the system is set-up, too many will opt out, pay the fine and leave it up to the individual to secure their own health insurance. Or, they will use the escape mechanism by hiring part-time employees who do not meet the 30 hour requirement. Eventually, it will change to meet the Hawaiian requirement of 20 hours and then due to very low wages attributed to a reduction in hours, it leaves the uninsured in a dilemma. No health care coverage and no way to afford it without government assistance. When those who cannot afford it don’t obtain coverage, they will be fined or allowed to get coverage under medicaid and in the end, they will be able to either declare a deduction and end up not paying anything.
This will in turn, force the implementation of single pay as originally intended from day one. The employers will be off the hook and the government will be the ultimate authority on health care in the US. It may have a surface appearance of choice but in reality, choice will not be an option.
Quite frankly, I’ve quit worrying about it. Time to relax, enjoy life, and control what I can in my life the time I have left.
@Kathryn – This coming from a person in an industry where people charge $2000+/hr. for their services?
A friend of mine who is a specialist in the medical industry (and an MD) told me a few years ago that 5 years prior that for a procedure, Medicare/Medicaid paid X-dollars, 3 years ago it was about 70% of that and that year it was less than half of what it was 5 years ago and didn’t even cover his supplies and overhead for the surgical room.
Glad you’re basing the entire medical industry on facial plastic surgeons. I think I’ll base my entire legal opinion on drunken lawyers like Donnie Meyers.
@Doug – Do you know it’s harder to get into veterinary school than it is to get into medical school. A friend of mine who’s an MD had people in his graduating class that were there because they couldn’t get into veterinary school. I wonder why that is? Also why more and more doctors in this country appear to be foreign born and trained.
Here’s a guess Steven. Same job except times 10 or so different species. Kind of ups the complexity.
Steven, you realize that medicaid reimbursement rates are set by the State, right? Does it surprise you that Haley has lowered them?
I know this will never convince anyone who worships at the alter of free enterprise but it needs to be said yet again. The USA pays BY FAR the highest percentage of its GDP for healthcare. And until recently it had as many as 40 million people uninsured. And it has a relatively low life expectancy. Given that this reprehensible situation developed under a system largely controlled by the free market how can anyone defend it? Thankfully Obama won and Obamacare will proceed. We won’t really know the result for at least 5 years, probably more. Can’t we at least give it that much time? If by 2020 we are still number 1 in healthcare costs and rank behind the other major countries of the world in life expectancy then we can revisit this issue.
@Kathryn
A person’s labor is worth whatever someone else is willing to pay for it. Steven’s comments about lawyers is correct – they charge what they believe they are worth.
I have a very good friend who is a local ortho surgeon. He does not normally take Medicare patients for hip replacements because the reimbursement is too low for him to even cover his own costs. Part of this is because he provides extensive face-to-face consultations with his patients both pre- and post-op. He is considered one of the best in the country at what he does and people come from around the country to take advantage of his skills. And many pay thousands of dollars out of pocket because they consider his ability to help them walk again without pain worth the cost. Repeat “WORTH THE COST”.
He has made it clear to me that if the government attempts to limit the way he wants to treat patients or what he expects to be paid, he will just stop doing it. And he would have every right to refuse to work under government rule.
“I know this will never convince anyone who worships at the alter of free enterprise”
So bud admits it, he’s against free enterprise. Government controlled business is what he wants. Make too much money, your supplies get cut, don’t make enough, we’ll ship more and cut your costs. Gotta make everyone equal regardless of effort.
@Doug – Why did Marcus Lattimore having his knee surgery done in Alabama and not his home state of SC? Because the best knee reconstruction surgeon lives and operates in Alabama. I bet he just a tad bit more expensive than a run of the mill orthopedic surgeon who operates on every joint in the body at Richland Memorial who could have put that knee back together to the best of his ability… Marcus might have ended up with one leg a half-inch shorter and would walk with a cane, but that shouldn’t matter to the likes of Kathryn. Maybe we should just request the Mayo Clinics be shut down… those doctors make just too darn much money.
@Scout – Most mammals internal structures look and function the same. My point is your doctor might be someone who wasn’t qualified to work on your dog.
Earlier, Steven Davis II wondered why it’s harder to get into veterinary school than medical school.
I suppose it’s because there are fewer veterinary schools. Think about it; look around the community — there are way fewer vets than there are human docs.
So when there are fewer slots, you get more intense competition.
Brad – There are less people applying for veterinary school as medical school.
Veterinary School – Fewer schools, fewer applicants.
Medical School – More schools, more applicants.
Shouldn’t that acceptance rates be somewhat similar? Like I said earlier, if you can’t work on dogs, you go work on people where it’s easier to get accepted into school.
@Steven
Regarding your Lattimore comment, you are absolutely correct. Skill matters and skill should be rewarded.
In Lattimore’s case, even USC’s doctors agreed that there was someone else better at doing the surgery than they were.
I frequently run into people in my profession who I know are better than me at what they do. And they probably are compensated for that expertise. And that doesn’t bother me a bit because I know I am better than many others at what I do.
The market decides what you are worth unless the government intervenes.
Or unless the market intervenes.
If I had a time machine, Doug, I’d lend it to you so you could go back and explain that to the hard-working Okies, many of them no doubt very good farmers (some of whom were doing very well before circumstances beyond their control kicked their legs out from under them), whose lives were ruined by the Dust Bowl.
Oh, and then the government intervened, got the farmers to take measures to prevent erosion, provided incentives for growing the right crops in the right amounts, and the land healed, and that part of the country again became a significant part of the world’s breadbasket.
Before that, when the market was in charge, these farmers had (while they still had soil, before it all blew away) responded to depressed wheat prices at the beginning of the Depression (which didn’t hit them until a couple of years after it did other parts of the country) by growing MORE wheat. Which had the entirely predictable effect of driving prices down further.
If they had been able to think of themselves outside of the libertarian model of the isolated individual (“Maybe everybody else is going broke growing wheat, but I’m going to work harder and grow so much of it that I’ll be all right”), they would have seen the aggregate effect of this. But it was years of suffering later before they came to understand the interdependence of people and economic forces…
Anybody else watching that Ken Burns series? It’s pretty remarkable. The most remarkable thing about it was that while vast numbers migrated to California, three-fourths of these people stayed put, which defies belief.
I have practiced law with top lawyers and less expensive lawyers, and there are idiots at the top and excellent lawyers at the street level. A lot goes into what a lawyer charges, including the market, the lawyer’s marketing skills, the schools the lawyer went to, the lawyer’s connections. Rich lawyers’s kids do better in law school for example, since they have a lot more experience going in. S much depends on your first year, and if you are baffled, you are at a disadvantage. You may, however, end up a vastly better lawyer, but you won’t have a shot at the top law firms without top grades from a top school.
The most meritocratic law areas are the maligned “trial lawyers.” If you get paid on contingency, and you are wealthy, you must be good.
Or bad, if you pursue paying clients regardless of whether their cause is just…
Oh, but you meant in terms of effectiveness, not moral worth… 🙂
@Brad
You make the mistake of thinking that because the government did X, there was result Y.
Anyway, doctors are not wheat farmers. There is no oversupply of doctors. They don’t call it a “Waiting room” for nothing… How would YOU pay doctors? How would you determine what a brain surgeon should be paid versus a podiatrist? What would you do to differentiate between the best doctors and the worst (or would you?)? What would you do to make sure doctors have incentives to do research to make treatments more effective, safer?
Would you allow a cancer drug that is 95% effective to be administered if it cost 10 times as much to produce as one that was 80% effective? Even if that meant there would be less money available to treat other patients?
There are unintended consequences to every attempt to control the market. We are starting to see the impact of Obamacare in how some companies are responding to the requirements. Medical suppliers will be cutting jobs due to the tax increase. Small businesses will make hiring decisions based on the arbitrary 50 employee limits where different rules/taxes apply.
These don’t seem like meaningful questions to me, Doug.
Medical care doesn’t take place in a free market the way selling laundry detergent does. Most of us have private (or public) insurance, which pays a certain amount for a certain visit or procedure, regardless of how good or bad at his job the doc may be.
People who don’t want a government program go on and on about how they don’t want the government making decisions that they think should be left to some sort of free-market relationship between a doctor and a patient — which only exists among people who are so wealthy that they don’t need health insurance. Which is almost no one.
Somehow, it doesn’t bother them for a for-profit entity to be rationing their health care and making those decisions. It doesn’t bother them that the insurance company has every motive for denying you care.
That baffles me.
@Brad
It doesn’t bother us as much because there are many insurance companies. You know there’s a Blue Cross and Aetna and others, right? Why is that? Because competition forces them to provide a service that people and corporations will pay for. And that competition, while far from perfect, offers things that the government does not: #1 would be far less fraud. When you are motivated by profit, you tend to pay more attention to providers and other scammers stealing your money. This is an area where Medicare fails miserably. #2 is innovation in the information technology. The government certainly doesn’t offer the same level of self-service that I have experienced with private insurers. We’ve had this discussion before but you continue to disregard the fact that the large majority of people with private insurance are satisfied with their coverage. If they didn’t, those companies wouldn’t exist. Companies like Blue Cross provide a service and make a profit doing so.. that’s the way it’s supposed to work. The more we can do to make those markets competitive versus controlled, the better it will be for consumers overall.
What you fail to accept is that there is a finite pool of resources and a finite pool of money to spend on those resources. Any attempts to control one pool or the other has consequences.
Are you okay with a surgeon saying “I believe my talents are worth $X” or do you believe society has the right to decide that for him? That’s the fundamental question.
“which pays a certain amount for a certain visit or procedure, regardless of how good or bad at his job the doc may be.”
So when you’ve had a bad experience with a doctor, you continue to go back to him? Do you use laundry detergent that doesn’t clean your clothes just because it’s cheaper?
There are unintended consequences to every attempt to control the market.
-Doug
That’s a good point if you’re arguing that we should be very careful when government implements a regulation or a change. It is a decidedly weak point to the argument that government should do NOTHING. Doug, you are really not addressing the vital issues involved with healthcare by continuing to harp on the virtues of the market and the vices of government. I get that. What you seem not to get is simply the state of healthcare as it existed prior to Obamacare. How could you defend that situation? Yes there are unintended consequences to Obamacare. But I for one am more than willing to take that chance in order to pursue a more fair, equitable and less costly healthcare system. Given that we were arguably the worst in the world at it seems to argue more for risky change rather than predictable failure.
The jury/judge is in charge of morality. A lawyer’s moral duty, under this system, is to pursue his client’s best interests.
Here’s a story Doug will enjoy. It’s about Dabo Swinney. Apparently Dabo grew up in abject poverty and now he’s a very wealthy and successful College football coach. From USA Today:
http://www.usatoday.com/story/sports/ncaaf/2012/11/19/college-football-coaches-contracts-analysis-pay-increase/1715435/
Laundry detergent is a heck of a lot easier to evaluate, and the cost of a mistake is small. A lot of medical care is a one off for the patient. I believe my surgeon did a good job, but how do I really know? Was it reasonable to miss a diagnosis or not?
All I can really judge by is whether I thought I was given appropriate attention. If a doctor listens to me, I figure we have better shot at arriving at the truth of a diagnosis and effective treatment. I do trust independent certifiers like boards and practice privileges at hospitals, but that’s a weak basis.
Physicians Atul Gawande and Jerome Groopman have written in The New Yorker about how to improve medical outcomes and accountability. It isn’t through lay persons’ market decisions!
You have review panels.check lists, things like that.
” How could you defend that situation?”
Because the vast majority of Americans were happy with the system they had?
Seems pretty simple to defend.
It shouldn’t take two thousand pages of regulations and taxes to address covering all Americans. The government can only do things in the most complex and least efficient way.
Here’s a graphic showing all the hoops companies with around 50 employees have to navigate with Obamacare. You think this is going to make things easier?
http://www.nationalreview.com/corner/333745/curse-50th-employee-jillian-kay-melchior
@bud
But Swinney doesn’t deserve to be paid that much, right? And he shouldn’t have that extra money to pass on to his assistants because they aren’t worth it either. Nevermind that a BCS bowl bid is worth millions to the ACC and millions in revenue to the university. You think the coach at Tennessee is ever going to see a multi-million dollar contract again in his lifetime? Doubtful. Why? He didn’t perform.
the vast majority of Americans were happy with the system they had?
Seems pretty simple to defend.
-Doug
Seriously? If true (which I seriously doubt) it’s only because the vast majority of Americans have not had to deal the system. It was simply failing. And the metric is simple: Highest Cost coupled with among the Poorest of Outcomes in the developed World. Simply indefensible.
@Kathryn
Have you ever used a reference from a person to determine which doctor to use? When we moved to Columbia in 1990 and needed a GP and a pediatrician, my wife did what most people do – she asked other wives/mothers (i.e. the market) and used that information to decide. When I had a bad experience with a dentist, the first time, I never went back.
Back up to Doug’s comment: “It doesn’t bother us as much because there are many insurance companies.”
What good does that do most of us? I’ve never once in my life had a choice in where my coverage was. When I was a kid, the Navy took care of my medical needs. As an adult, my coverage was wherever my employer said it was.
Choice doesn’t enter into it, for the vast majority of “lucky” ones who have coverage.
There’s also a big cognitive disconnect on this point — Doug and other libertarians imagine that they have more control in the private sector. I’ve never seen any reason to believe that. I have a lot more confidence in my and my fellow citizens’ ability to influence government policy than I do with a private company.
If the government is screwing us all over on health care, there will be an outcry that won’t cease until something is done. If a private company is screwing us over, a likely outcome is that shareholders will get a dividend.
I would speak from personal experience, but actually it has always been my long-suffering wife who spends hours and hours on the phone getting the insurance company to provide the coverage it’s supposed to provide. It has been so very obvious that anyone a trifle less insistent and patient than my wife would simply have to eat the cost. (People who are less well-educated, or lacking in self-confidence, might quit after the first or second or third refusal, before finally getting to the person who says, “Well of COURSE the policy covers that.”) And that gives me an insight into the business model…
As for shopping around for docs — I remember doing that overtly only once — when my wife was diagnosed with stage 4 cancer in 2001.
We didn’t have a lot of time, but we still interviewed several oncologists before settling on Bill Butler. Nothing against those other docs, but we thought, and still think, he’s the best.
When I had a bad experience with a dentist, the first time, I never went back.
-Doug
If you have a bad experience with a dentist you may lose a tooth. The first bad experience with a physician who fails to detect cancer or a heart problem could be a death sentence. And no, I’m not suggesting Obamacare will solve those problems but it does underscore how ridiculous it is to rely on the free market to ensure quality healthcare.
Interesting, my grandfather was one of those Okies who farmed through the Dust Bowl. I’m sure he’d have been greatful to know that the reason he recovered was because the government stepped in and told him how to farm and ranch.
@Kathryn – Your scenario works out until you look at the friend of mine who I’ve mentioned several times in the past. First member of her family to ever go to college, came from a broken family with a drunk for a father and a single mother who raised 5 children in a small rural town. She had good enough grades to get into Yale Law School, graduated near the top of class and is now the office managing attorney for a top 10 worldwide law firm located in Los Angeles. Yep she can credit her dad the town drunk for where she is today.
“I’ve never once in my life had a choice in where my coverage was. ”
BS, there is no written law stating that you have to use your employers insurance provider. You have every right to go out and choose whatever company you wish to use. You CHOOSE to use your employers company because it pays a large percentage of the premium that you CHOOSE not to pay yourself.
@bud – How do you insure that Obamacare is going to provide an equal diagnosis or treatment? Are the same doctors in practice today not going to be the same doctors under Obamacare? Is your doctor going to get smarter the day Obamacare switches on?
Steven, you don’t have a choice when you can’t afford anything but what your employer provides.
Which most of us with families cannot.
But crowd sourcing only helps if the information’s somewhat reliable. Garbage in, garbage out.
Most everybody thinks his/her divorce lawyer was the best and the Ed’s was terrible, unless the client didn’t get enough of what s/he wanted, regardless of how realistic the outcome could be. I have heard people diss their divorce lawyer when the divorce lawyer could not legally have done any better, for example, adultery is an absolute bar to receiving alimony.
Ex’s
Curse you, autocorrect
“If the government is screwing us all over on health care, there will be an outcry that won’t cease until something is done.”
Replace “health care” with “Richland County Election” and tell me how much outcry it will take to fix that situation.
You’ve complained for years about how screwed up our government is.. you wrote a whole series of articles on it… and yet you somehow think that if we put those same yahoos in charge of healthcare, it will be better. We already have an example of how that works (or doesn’t): Medicare. Contantly being tweaked, many providers will not accept Medicare patients, going broke all the time… you want MORE of that?
Any company I’ve ever worked for offered multiple insurance options. My son started work in February and had the choice of four different plans from two different providers. He chose the one that fit his budget and his willingness to accept risk… State employees have four options as well (Employees may choose one of the four health insurance options: the State Health Plan Savings Plan, the State Health Plan Standard Plan, BlueChoice Health Plan or CIGNA HMO.).
Other companies I have worked for allowed you to opt out and receive a couple hundred dollars a month in extra pay.
Rather than going thru the expense and overhead of setting up healthcare exchanges, there is a much simpler solution: let anyone who wants to purchase from the same vendors federal employees like the President and Congress have access to at the same rates. The poor get Medicaid, the old get Medicare, and everyone else can buy into the same plan or any other competing plan. The profit motive of the private insurers holds down fraud and abuse costs. The option to switch vendors each year drives companies to provide the best service. That doesn’t take 2000 pages to implement.
And how do we pay for those who can’t afford it? By cutting military spending accordingly. Make a choice. Healthy citizens or world police.
But you can choose your employer, which in turn allows you to choose your insurance provider.
First of all, Doug, it’s been well discussed here and elsewhere why the Richland County election situation is an anomaly. That’s what makes it news. That’s what keeps in the headlines, day after day, and which may actually eventually lead to some politically acceptable outcome.
This is a bizarre effect of the idiosyncratic governing arrangements we still have in South Carolina, which are noteworthy in part because in this country, government doesn’t usually work this way.
This is sort of like when you cite a case of someone defrauding Medicaid or Medicare(a case of a private actor defrauding the government, not the other way around), and use it as evidence that the system doesn’t work. No, the fact that someone gets caught and punished for it (which is how you hear about it) is an example of the system working.
We have a system that is particularly and unusually insensitive to public opinion in this election commission. Yet there is sufficient heat on the delegation that I’m thinking they’ll find some way to get around that structural defect. We’ll see.
Well, YOU can choose your employer, but few others can, these days.
@Brad
“According to the According to the Office of Management and Budget, Medicare “improper payments” were $47.9 billion in 2010… The Congressional Budget Office estimates that total Medicare spending was $528 billion in 2010.”
Do you think insurance companies would accept a 9% fraud rate?
Why do you think that catching someone committing a crime (usually months or years after it occurs) is a sign the system is working? Wouldn’t it be better to have a system in place that made it more difficult to steal in the first place? It’s like leaving your front door wide open but praising the police for catching the guy who stole your TV.
@Kathryn – How many people do you know who are unhappy with their medical insurance provider? How many people are even concerned about who their employer uses for medical insurance? I have friends in the medical field, the only insurance plan I’ve heard them complain about is Medicare/Medicaid. The rest are all about the same when it comes to coverage.
@Kathryn
By “few” I assume you mean everyone who has a job where healthcare is offered as a benefit? That’s probably only tens of millions of people… just a few.
Your husband (as well as my wife) has four different choices as do all state employees. 2012 rates for the SHP plan is only $250 a month for worker and spouse and only $77 for the savings plan with high deductibles. Seems like a good deal… and one that any South Carolina resident should be able to buy into (by paying the combined employer/employee total). Why can’t that be allowed?
@Kathryn – Your husband works for USC. How many different medical insurance plans to they have?
Don’t know, here you are:
http://hr.sc.edu/benefits/hlthproviders.html
A little something for everybody.
I know I am not, but I feel like an enigma with the health care situatiuon I am facing. I work for a company that employees under 50 people and does not provide health coverage. I am currently covered under my husband’s insurance, which is great. He is retiring in 9 months. I am assuming I will be able to go with COBRA for 18 months…but I don’t know if COBRA is in the mix for changing.
I checked private insurance rates when Obamacare was being decide in reviewed in the Supreme Court — after the decision in favor – I checked rates again on 2 policies which interested me — $166 to $200 higher/month from 1.5 months earlier.
I am thinking about MD-VIP — 1500/year and 30.00 office visits, 1 physical and complete labs every years — but I still would not have catastrophic or prescription insurance.
Or….changing to a job with health insurance.
Sorry about the typos — I am typing with my toes
State employees have four options as well (Employees may choose one of the four health insurance options: the State Health Plan Savings Plan, the State Health Plan Standard Plan, BlueChoice Health Plan or CIGNA HMO.).
-Doug
Not really much choice here. The BlueChoice and CIGNA plans are extremely expensive and rarely used. The Savings Plan has huge deductables and is only useful for folks who have a huge amount of savings and hence are largely self-insured. So most people opt for the Standard Plan. It’s Ok but getting more expensive all the time and really requires you to jump through a lot of hoops to get proper treatment. Obviously that is way better than no insurance but this environment is not what I would consider competitive.
Do you think insurance companies would accept a 9% fraud rate?
-Doug
A 9% fraud rate is far lower than a 25% profit margin. Call it what you will but 9% beats 25% any day.
Of course my husband has choices, but when I worked at major law firms, I might have had two choices, an HMO and an indemnity plan. At a smaller firm, only one.
The choice of employers is something enjoyed by IT professionals. Not so much for most other people, and few would make their choice based on the content of the health plan, even if they had a choice of employers. Few even think about more than the fact that there is a plan.
@Beth : catastrophic coverage is cheaper and more necessary than wellness coverage. You really HAVE to have that.