Socialized Health Care in the USA

[kandrathe]

Maybe it needs to be a redistribution of food thing

You do realize that the cheapest food in the US is the junk food? Poor people suffer the worst from being overweight, because good food (e.g. fruits, vegetables. salads) are more expensive, so they tend to eat the cheap foods. Wealthier people can afford to eat leaner meats, higher in protein, and are more likely to eat healthier whether that be cooking in their homes or eating out. Wealthier people can afford to have hobbies and a lifestyle that accommodates exercise as well.

So again, more wealth means more choices.

[kandrathe]

It appears that Obama is signaling that he is willing to move away from a health insurance program option run by the Federal Government.

White House appears ready to drop 'public option'

Having squandered his high approval rating, and witnessing a genuine "grass roots" (as well as other political) organization mounting against his Health Care (as well as other policies), the administration is going to attempt to do what politicians usually do, which is move in a third direction which will be marginally palatable to some, but will outrage the extremes on all sides.

[Jester]

Having squandered his high approval rating, and witnessing a genuine "grass roots" (as well as other political) organization mounting against his Health Care (as well as other policies), the administration is going to attempt to do what politicians usually do, which is move in a third direction which will be marginally palatable to some, but will outrage the extremes on all sides.

Genuine grass roots movement... sure.

This is astroturf. The one time they tried to get a real turnout (the "tea parties"), it was underwhelming at best, eclipsed by even the average one-issue rally from the left. Subsequent "tea parties" have been no larger than backyard barbecues.

So, having failed at that, they decide to put the "mob" back in "flash mob" and show up in small, but very angry crowds to overwhelm town hall meetings, turning democratic discussion into bizarre, nonsensical rants and rank intimidation. Rush, Beck, and their ilk whip up the enthusiasm, Fox lists the locations, and pharmaceutical and insurance corporations provide the organization and cash. It doesn't take much more than a few lunatics and a lot of disruption to give the impression of a popular movement, but neither the polls nor the rallies show that any such movement exists.

If you can't tell the difference between that and a genuinely popular grassroots movement, then I think you need new glasses.

-Jester

[kandrathe]

If you can't tell the difference between that and a genuinely popular grassroots movement, then I think you need new glasses

I can only tell you that the one I went to had my *real* neighbors of all political persuasions, and not a whole bunch of yelling. There were no Washington politicians there either, just citizens and people from the energy and health care industries to talk about Cap & Trade, and the Health care bills. I was invited by my neighbor.

How do you define grass roots?

[Jester]

How do you define grass roots?

Well, just look at the metaphor: it grows from the ground up. If Fox News is shilling your movement from day one, and Dick Armey is backing it, you can be pretty sure that it isn't grassroots. That's top down designed to look like grassroots; that is to say, astroturf.

People discussing the issue in a sane way and expressing their concerns is not astroturf. But, then, in such a discussion, you'd probably hear all sorts of views, right and left, for and against.

What's astroturf is when beltway lobby groups and partisan front organizations get together with their media mouthpieces to channel fringe outrage in such a way that it overwhelms rational citizen participation in favour of nonsensical ranting and intimidation. Rich, powerful people need health care reform to die a death in the senate, and so they make it seem like people don't want it. But the polls don't show that at all. It's all just a low blow, a PR stunt channelling a small minority of very angry, mostly confused people.

-Jester

[kandrathe]

Well, just look at the metaphor: it grows from the ground up.

Ok, so like the NRA (founded in 1871)? Millions of registered gun owning hunters, who collectively fight to retain their 2nd amendment rights?

People discussing the issue in a sane way and expressing their concerns is not astroturf. But, then, in such a discussion, you'd probably hear all sorts of views, right and left, for and against.

Sanity is what I prefer anyway. If I want to watch people scream at each other I can flip to FOX, or MSNBC for whichever flavor I'm in the mood (neither usually). I don't understand why Congress is so loathe to attempt a free market solution, such as make health care portable across all 50 states. That would force the conglomerates to compete and would drive down the prices. Why not allow people to self insure, and defer taxation on the amount they socked away in a HCSA? The objective is to enable people to afford health care right? So, two things need to happen. Remove the rigid lock on an employer style health insurance plan to enable people to find low cost non-employer alternatives. And, increase the competition to help drive down prices. There is no reason the government needs to grab a trillion (or five) of our dollars to set up another inefficient administrative bureaucracy to sit between patients and health care.

What's astroturf is when beltway lobby groups and partisan front organizations get together with their media mouthpieces to channel fringe outrage in such a way that it overwhelms rational citizen participation in favour of nonsensical ranting and intimidation. Rich, powerful people need health care reform to die a death in the senate, and so they make it seem like people don't want it. But the polls don't show that at all. It's all just a low blow, a PR stunt channelling a small minority of very angry, mostly confused people.

Ok, so replace it with Acorn, HCAN, Families USA, AFSCME, SEIU, AARP, George Soros/Moveon.org, Organizing For America aka "http://healthcare.barackobama.com" which hauls in the buses of professional protesters. The fine print for OFA is "Paid for by the Democratic National Committee..."

What I don't understand is why some rich powerful people are funding an effort to implement socialist programs, or maybe its the grab for power. Why do some people think the way to solve poverty is to reach into another persons pocket for cash? Maybe if you are the one authorized to grab the cash, not all of it ends up helping the poor, eh? In our society there are dependents(those who can't work), workers, owners (who are often also workers, who take risks for a chance at the profits), and leeches (those who earn by taking from others). Every time I see that stupid Matthew Lesko commercial about free money just waiting for you to go claim it, I burn out another hundred brain cells. The leeches in our society pander to our sympathies by pointing to the suffering dependents. I'm close to needing to buy a new car, but am loathe to do so while this whole "cash for clunkers" nonsense is around. It will cost our society the same, but where possible I refuse to feed at the public trough.

In my world view, what we need to do is elevate more workers to be owners, and eliminate the leeches. In that world, everyone can take care of their own dependents whether that be father, mother, sister, brother, son or daughter.

[Jester]

Ok, so like the NRA (founded in 1871)? Millions of registered gun owning hunters, who collectively fight to retain their 2nd amendment rights?

Yes, that's right.

I don't understand why Congress is so loathe to attempt a free market solution, such as make health care portable across all 50 states.

Nobody wants it, or at least, nobody in power, nor most Americans. The Republicans didn't even try when they were in power, and instead pushed through the most bloated, painful "reform" imaginable, driving up costs while providing scarcely any benefit. The Democrats won the last election, and ideologically prefer egalitarian programs to market ones.

I think a market solution would serve you better than what you have, but substantially worse than even a mediocre single-payer system. But as is obvious from the current wrangling, the politics of this decision are tied in knots. "Courageous" folk like Max Baucus, who speak their own minds, and also happen to take more money than anyone else from Insurance and HMOs are making sure that reform dies on the floor, and the rents from the current system still flow into corporate coffers.

There is no reason the government needs to grab a trillion (or five) of our dollars to set up another inefficient administrative bureaucracy to sit between patients and health care.

The evidence of international health care costs is out there to look at. Nobody in the OECD enjoys less health care for more money than the US currently does, but pretty much every other country has either some kind of single payer or socialized medicine. Unless you think that Americans are just fundamentally less efficient than every other developed country, I think it's safe to say it's your system at fault. Maybe moving in completely the opposite direction from more successful models will work, but it certainly doesn't sound like the safe way to go.

Ok, so replace it with Acorn, HCAN, Families USA, AFSCME, SEIU, AARP, George Soros/Moveon.org, Organizing For America aka "http://healthcare.barackobama.com" which hauls in the buses of professional protesters. The fine print for OFA is "Paid for by the Democratic National Committee..."

ACORN is grassroots, although I suppose that doesn't include their reputed "shadow wing" that controls the Kremlin, the Black Helicopters, the Faked Moon Landings, and whatever else the right blogosphere is laying at their doorstep today. AARP sounds like it was grassroots, at least at its inception, but I don't know enough about it to really say.

AFSCME and SEIU are unions. Different kettle of fish, really. But certainly much closer to a grassroots organization than, say, an HMO lobbyist.

HCAN and Families USA are pro lobbyists. So you're right there.

Moveon.org is just a website. It's netroots, rather than grassroots per se.

And George Soros is just a guy with a lot of money and some opinions that don't wash well with the right. So he gets to be the shadowy puppetmaster.

What I don't understand is why some rich powerful people are funding an effort to implement socialist programs, or maybe its the grab for power.

This may shock you, but some people actually think some form of single-payer or socialized medicine is a good idea. They aren't making money off of it. I don't stand to see a single dime, nor any change in my life whatsoever from health care reform in the US, but it looks to me to be the pretty obvious choice for bringing down costs while improving coverage.

In my world view, what we need to do is elevate more workers to be owners, and eliminate the leeches. In that world, everyone can take care of their own dependents whether that be father, mother, sister, brother, son or daughter.

Who is John Galt?

-Jester

[Hammerskjold]

Who is John Galt?

-Jester

Nailed it for 300$, nicely done contestant Jester.

You get the next pick of the board. Would you like:

-Hocus POTUS

-Troops Good "Gov" Bad

-A. Rand American Hero

-Potent Potables

-Astro Serf N Turf

[kandrathe]

I think a market solution would serve you better than what you have, but substantially worse than even a mediocre single-payer system. But as is obvious from the current wrangling, the politics of this decision are tied in knots. "Courageous" folk like Max Baucus, who speak their own minds, and also happen to take more money than anyone else from Insurance and HMOs are making sure that reform dies on the floor, and the rents from the current system still flow into corporate coffers.

I'm not sure what makes a "single payer government run system" better. It just means that there are price controls making providing health care uniformly less lucrative for providers, and prioritized waiting lists for services which result in rationed care where the oldest and sickest die rather than get care. Right?

The burden of administering plans remains the same. Yes, you do cut out that whole actuarial science of managing risk, but will cost more in that people will not self ration the amount of health care they consume. Everyone uses more when the apparent cost is free. I don't hear of hordes of people heading north or south of the USA border to get "better" health care. The fact is that the USA probably has the best health care on the planet, in fact, the best health care that money can buy.

The evidence of international health care costs is out there to look at. Nobody in the OECD enjoys less health care for more money than the US currently does, but pretty much every other country has either some kind of single payer or socialized medicine. Unless you think that Americans are just fundamentally less efficient than every other developed country, I think it's safe to say it's your system at fault. Maybe moving in completely the opposite direction from more successful models will work, but it certainly doesn't sound like the safe way to go.

Ok, the cost of HEALTH INSURANCE is high, when you compare it per capita to what is paid by government run systems. Our system is upside down in expectations. The prices are set artificially high, because the other government programs, Medicare, and Medicaid have set limits on the price they will pay for almost every charge. In order to balance the losses, clinics, hospitals, and other care givers charge rates at the 200% to 400% of cost level across the board. Medicare, and Medicaid automatically refuse to pay, and then enter into arbitration with the provider to negotiate a compromise, while the insurance company will either outright pay, or also choose to barter for a fair price. The uninsured are billed for the jacked up amount, and if they are rich are soaked for the higher price, or when they are unable to pay will be nagged by collection agents for months until it is eventually written off.

The problem is clear. If beer was free, we'd drink all the time.

As with any other commodity, the individual must somehow pay an amount that is proportional to what they use. The problem started when prices were lower, and employers were convinced by unions, or calculated that they could attract better employees by offering health insurance as a part of the benefits package. This is especially attractive for employers, since the government allows companies to write off the costs on their taxes. Even this level of insulation of costs from the consumer, results in an artificially high use of the service, and thus artificially driving up the demand, and thereby the costs. So, 60/40 plans and copays are an attempt to reintroduce the consumer to the realities of paying for their own consumption.

And, if you want to factor in insurance, which is the aggregation of risk, then the cost of insurance should relate to your health history. Like, with your car insurance. If you get into many accidents, your rates go up. This provides the incentive to use only what you need, and to keep yourself healthy to prevent disease. The people in the USA are very unhealthy, and perhaps a part of the reason for this is that they no longer bear the financial burden of their illness.

Next, the government is interfering in employer offered plans. The plans are not portable across state boundaries, which limits the competition. And, each state regulates by force of law what must be offered in the employer plans. These mandates are political hot potatoes that legislatures use to gain constituency brownie points. If employers were allowed to offer a slim plan that covered catastrophic illness (heart attack, strokes, cancer, car accidents, etc), along with some general wellness coverage (yearly doctor exams), then the costs of those plans would be extremely affordable. Yes, some people might opt to for a plan that includes AIDs/STD testing coverage, birth control, alcohol/substance abuse treatment, psychiatric, etc. But, then, they should expect to pay higher rates for that level of insurance.

Who is John Galt?

More importantly, where is he hiding? Galt's Gulch, perhaps, to escape from this dystopian nightmare. Me too, once the USA achieves the equal distribution of poverty being crafted by the "everyone gets a free lunch (... and then we'll get some future generation to pay for it)" crowd in power for the past few decades. We, in the USA, should be ashamed of our deficit spending and national debt. The concept of national borrowing was as a short term measure to adjust for extraordinary circumstances (e.g. war (not world policing), depression), but for us its become the status quo. Tarp money, cash for clunkers, psudo-stimulus, are just ways of transferring the mistakes of the present onto the backs of future workers.

[Swiss Mercenary]

I don't hear of hordes of people heading north or south of the USA border to get "better" health care.

And you only 'hear' of people leaving Canada to get care in the US.


The myth of Canadian medical refugees is just that - a myth.

The problem is clear. If beer was free, we'd drink all the time.

Do you want to go to the doctor, when you don't need to? Do you want to get operated on? I sure don't. I'd rather avoid it, when not necessary.

[Jester]

I'm not sure what makes a "single payer government run system" better.

There's an old 1963 paper by Kenneth Arrow that Krugman mentioned awhile back that lists some of the reasons why the market in health care is particularly prone to market failure. But one of the big ones is right here:

The problem is clear. If beer was free, we'd drink all the time.

Not only is this not true in the case you cite (Alcohol has serious consequences which many people forego voluntarily, even in the case of free booze), it's not true of health care either. If someone offers me a free vacation next summer, I'll take it. If they offered me three, I'd take those as well. But if someone offers me a free heart transplant, I almost certainly wouldn't take it. And even if I needed one, I certainly wouldn't take three.

It just doesn't work the way other products do. You don't know what you need, but the amount of money you could spend finding out is limitless. You don't want the product, and you don't even know if you'll ever want the product, until you desperately need it, at which point, it's extremely expensive. There are huge information asymmetries and incentive issues among doctors, patients, insurers, hospitals, pharmaceutical companies, and everyone else in this crazy game. It's not like buying beer.

-Jester

Edit: My mother would chide me for using "between" when I meant "among".

[kandrathe]

It just doesn't work the way other products do.

I'd say... For catastrophic illness, you are probably correct. But that is not what has driven up the price of health insurance.

For example (one of many), why is birth control covered by health insurance? While it does involve a doctor, it is a voluntary procedure (for now). Probably because the consequences of birth control failure, pregnancy, is also then the responsibility of the health insurer to pay. Which, if fair, would also not be the kind of "catastrophic illness" that would be normally insured against. In our society, the government insists on treating people like they are irresponsible children, so the government passes laws that say that the medical costs of both pregnancy, and preventing pregnancy will be included.

It's that having sex and getting pregnant are indeed like drinking beer in one respect. Both are governed by people's behavior, and contrary to popular belief, getting pregnant is not accidental. It takes effort ( and sometimes beer). I could make the same argument for alcoholism. You don't just fall out of bed one day and suffer a bout of alcoholism ( but it might be the wake up call).

I would say that psychiatric conditions are a special case, like other chronic conditions (such as diabetes). While perhaps the initial discovery phase maybe should be covered, the ongoing cost of health maintenance should probably be considered as a separate non-insured cost for which the consumer would be responsible.

If the cost of treating a malady is a $1 a day, then people can afford to get themselves treated, but if the cost of keeping that chronically ill person is $1 M a day, then no one can afford to keep them well. Somewhere between the $1 and the $1M is the point where any group policy will go bust.

The beer analogy breaks when the person passes out, or begins to suffer cirrhosis and dies. But, when nearly everyone in the USA is getting "free" treatment for acne, birth control, over eating, feeling sad, etc., then the costs of insurance skyrocket. The answer is to move the responsibility of the consequences of consumption closer to the source of supply. Let doctors and patients negotiate together again. What a concept! Before getting Lasik surgery, maybe you'd ask the doctor how much the procedure will cost.

There is a real world example of what would happen. Cosmetic surgery has always been exempt from the insurance model, and thus, the costs of procedures are well known and competition has driven the quality up and the prices down. So, pretty much everyone knows that if you want big breasts, it costs between $4000 and $10000.

[Jester]

Medical issues that are directly traceable to individual actions (pregnancy, for instance) are overwhelmingly the exception, not the rule. There is no feasible direct accounting for individual contributions to costs, nor any way of predicting them in the future on anything resembling an individual basis. Someone who eats too much sugary food might contract serious diabetes and become a major burden on the health system, or they might die suddenly of a heart attack and cost it nothing. Someone who bikes to work and spends their free time camping might save the system thousands by their healthy lifestyle, or cost it tens of thousands when they're hit by a car and require a prosthetic limb.

Medical costs swing wildly and are highly unpredictable. Dealing with them on an individual basis is very difficult, especially because comparison shopping is unfeasible. If I don't like a chocolate bar, I just don't buy that type again. But by the time you know that your health insurance wasn't adequate to your needs, it's already too late. The incentive for the insurance companies is always to give you the coverage you don't need, rather than the coverage you do. They're the ones who can hire the world's best actuaries to figure it out, whereas the consumer has little choice in the matter (none, if they are insured through their employer.)

-Jester

Afterthought: In Alberta, neither cosmetic surgery nor LAZIK eye surgery are covered by public plans. They are voluntary, one-off procedures that more closely resemble ordinary goods or services. Single-payer systems are neither necessary nor useful for such things. But they are the exception, not the rule. People do not have heart attacks, develop cancer, break bones, suffer strokes, or contract influenza at their own convenience.

[--Pete]

Hi,

But that is not what has driven up the price of health insurance.

How much has the cost of insurance really gone up in terms of constant dollars?

How much of what is paid to the medical profession goes to support a broken tort system?

How much of the medical expenses incurred by individuals are caused by unnecessary tests ordered so that doctors can cover themselves from liability?

How much does the competition to have all the cutting edge technology at *every* facility add to medical costs? And how many tests using this technology are ordered to cover the cost of buying and running these machines?

Those are just a few of the questions whose answers I really don't know.

What I do know is simpler -- the USA has an expensive and inefficient medical system. Our infant mortality rate is terrible, our life expectancy is poor. If we didn't spend more than anyone else on medical care, that might be understandable -- but we don't. The free market had its chance, and it failed. Instead of supplying coverage for all, it focused on profits for a few. Letting people 'take care of their own' is great in principle, but it fails in practice as more and more people lack 'their own' to care for them.

So, the real question is: does a compassionate society take care of its members, or does it let them suffer for some idealized concept of 'rugged independence'?

Perhaps, more fundamental still: are we a compassionate society?

--Pete

[Swiss Mercenary]

How much does the competition to have all the cutting edge technology at *every* facility add to medical costs? And how many tests using this technology are ordered to cover the cost of buying and running these machines?

We sometimes ship patients south to take advantage of excess capacity in the US, because it's cheaper for us to do, then to increase our own capacity to above-average levels, and have it sit idle some of the time.

So, come to think of it, we're better off as long as the US keeps on its current course.

[Skandranon]

I'm not sure what makes a "single payer government run system" better. It just means that there are price controls making providing health care uniformly less lucrative for providers, and prioritized waiting lists for services which result in rationed care where the oldest and sickest die rather than get care. Right?

I thought you were too smart to fall for this kind of propaganda, kandrathe. I'm disappointed.

Speaking from the Land of Socialized Medicine itself, my oldest and sickest relatives have always received prompt and excellent care. Ask any Canadian with an aged relative and they'll surely have a similar story to share.

By the way, I agree completely with Jester. Moral hazard does not apply to health care. Here, have an article by Malcolm Gladwell on the subject. It's old, but so is the problem.

[Swiss Mercenary]

Speaking from the Land of Socialized Medicine itself, my oldest and sickest relatives have always received prompt and excellent care. Ask any Canadian with an aged relative and they'll surely have a similar story to share.

According to certain American publications... "In a socialised healthcare system, someone like Stephen Hawkings wouldn't stand a chance."

Until that claim was retracted when it was noted that he lives in the UK.

[Kevin]

According to certain American publications... "In a socialised healthcare system, someone like Stephen Hawkings wouldn't stand a chance."

Until that claim was retracted when it was noted that he lives in the UK.

Do you know who said that? Which publication. I'm not doubting it at all, I just want some extra ammo for some of my co-workers when this topic comes up again. :)

That is priceless. :)

[Delc]

Do you know who said that? Which publication. I'm not doubting it at all, I just want some extra ammo for some of my co-workers when this topic comes up again. :)

That is priceless. :)

http://www.ibdeditorials.com/IBDArticles.a...333933006516877
http://blogs.ajc.com/jay-bookman-blog/2009...e-this-one-out/

[Kevin]

http://www.ibdeditorials.com/IBDArticles.a...333933006516877
http://blogs.ajc.com/jay-bookman-blog/2009...e-this-one-out/

Thank you, though I had done a bit of googlefu on my own earlier (which I should have done from the start I know).

Which also helped me get a laugh from finding the whole the French don't have a word for entrepreneur thing at the same time. Lovely. :)