Sullivan dismisses public healthcare.
One reason I’m a conservative is the British National Health Service. Until you have lived under socialism, it sounds like a great idea. It isn’t misery – although watching my parents go through the system lately has been nerve-wracking – but there is a basic assumption. The government collective decides everything. You, the individual patient, and you, the individual doctor, are the least of their concerns. I prefer freedom and the market to rationalism and the collective. That’s why I live here.
When Ezra points out that the British love their system, Sullivan creates an elaborate mental construct to avoid the obvious.
Satisfaction is a subjective function of subjective expectations. If you have the kind of expectations that many Brits have for their healthcare system, it is not hard to feel satisfied. The Brits are very happy with their dentists as well. And there is a cultural aspect here – Brits simply believe suffering is an important part of life, especially through ill health. Going to the doctor is often viewed as a moral failure, a sign of weakness. This is a cultural function of decades of conditioning that success is morally problematic and that translating that success into better health is morally inexcusable.
Yes, clearly the masochistic British spirit explains why they prefer a system that costs less, covers every citizen and outperforms America in important metrics such as infant mortality.
Now for some aimless noodling.
But if most Americans with insurance had to live under the NHS for a day, there would be a revolution. It was one of my first epiphanies about most Americans: they believe in demanding and expecting the best from healthcare, not enduring and surviving the worst, because it is their collective obligation. Ah, I thought. This is how free people think and act. Which, for much of the left, is, of course, the problem.
Accuse me of shooting barrel fish all you want, this argument deserves to be deconstructed. Sullivan, for example, does not demand the best from his healthcare. The Atlantic Monthly does that. It is not unfair to point out that Sullivan would not be nearly so sanguine about American healthcare if he had to compete on the individual market like the other half of America does. It is also not unfair to point out that with a pre-existing condition, Sullivan would not get individual insurance at any price if he did not live in a liberal nanny state like Massachussetts. There is no particular stigma in that; I have a preexisting condition. Given the term’s ever-expanding definition (and the ulcer-causing specter of medical bankruptcy) half of America has one by now.
That is not to say that Sullivan does not have a point. Palin-like, we could define America as people who live in Massachussetts and/or pay into generous employer-provided group plans. In that case American healthcare is indeed stellar. True ‘muricans demand the best and Adam Smith’s benevolent hand graciously delivers it to them. Awesome! Naturally non-American Americans can also ‘demand’ great healthcare if that makes them happy. Those kind of people also enjoy ‘demanding’ a tasty zero-calorie beer and intelligent programing on FOX News. Whatever noise comes out of the wind hole, Adam Smith will bitch-slap not-quite-as-real Americans with denials, spiteful rationing and murder by spreadsheet.
On the other hand, if you consider all legal US residents equally American then Sullivan’s argument is just fucking stupid.
Firefly is so in the past, Tim. The wave of the future is going to be in demanding a second season of Dollhouse.
Well, they’re doing something right, seeing as how the pound buys twice as much as the dollar in this country.
We shouldn’t have a national helthcare plan because Britain has a ‘crappy’ one? Couldn’t we do better than them? We’re America right?
I thought the beauty of single payer was you and your doctor decided treatment not the payer. Am I wrong?
I’m thinking Sully doesn’t understand the complex interaction of insurance and hospitals. By the time it’s all said and done, the patient only gets to demand….nothing.
It’s strange how so many work so hard to defend companies whose business model is literally to defraud their customers out of the services for which they’ve paid. Personally, after my private insurer declared my seasonal allergies to be a pre-existing condition, we parted ways. I’m waiting to see what the federal offering will be, because at least if I have a problem with that, I have a congressman and two senators I can complain to. That’s a huge step up from the corporate bureaucracy.
Didn’t you know that the "American exceptionalism" the conservatives love to talk about is null and void when it involves something like universal health care? Then it becomes too hard to do. I mean, just look at Canada and the UK. We could never figure out a better system…
Shorter Andy Sullivan:
"Yanks are more unhappy than Brits with their shitty healthcare cuz Yanks are spoiled brats that don’t know what’s good for them"
It is hard to gauge Sullivan — when he makes sense he is so right-on, but when he doesn’t he is so far off it makes you question the things he once made sense about!
He still needs to somehow grasp the basic fact that American conservatives are not Tories — the Dems are much, much closer.
Someone needs to tell Sully the Pooh that until you have lived without health insurance, you don’t know how good the ‘crappy’ British system looks.
Damned at Random
I don’t see any reason that being denied a procedure by a government bureaucrat is a greater harm than being denied the same procedure by an insurance bureaucrat.
Would "socialized" medicine possibly address the shortage of family practitioners and internists in rural areas? That would be a major improvement over the existing system IMHO
The bottom line being that Brits haven’t been exposed to the healthcare nightmares of the US, so human nature being what it is, they bitch about how ‘bad’ they’ve got it without truly understanding how bad it can really be. Sullivan is an asshat I sometimes agree with though he’s remarkably out of touch on this one. Lacking comments on his site makes it less desirable as a destination as well.
Sullivan gets credit for opposing torture and turning on Bush before many other conservatives, but his views on health care just illustrate the basic problem with the Right in America.
NONE of Sullivan’s views on health care have a thing to do with an objective analysis of which approach actually works better. I don’t believe Utilitarianism should always rule the day but when it comes to health care, the system that produces the best results for the most people should get some credit for that. But Sullivan, like so many righties, prefers a fantasy that he thinks should work to a reality that does work.
Well, they’re doing something right, seeing as how the pound buys twice as much as the dollar in this country.
That, in itself, is a meaningless comparison. What if stuff in the U.K. costs 75% as many pounds as it cost in dollars in the U.S.? Or if prices are mostly the same after in exchange rates but Britains only get paid a third of the pounds the Americans get in dollars? You also would want to include stuff that they get that they don’t have to pay for (e.g. healthcare) in their wages. I just made up those figures for argument’s sake, btw. I have no idea what actual costs and earnings are like for the British.
The point was that just looking at the nominal exchange rate between two countries doesn’t tell you very much. Looking at them how those rates change over time, on the other hand…
Caidence (fmr. Chris)
Yeah, I’m a big Sully-groupie but even I thought that post was a pretty over-wrought.
I’m willing to take the "The British see going to the doctor as a moral weakness" argument at face value — I’ve seen a similar thing in Japanese culture — and it informs my view of what he’s trying to get at.
But discounting his entire country’s healthcare system because of some intra-cultural prejudices? Nope.
The reason I like Sully is that he seems to notice when he wrote something retarded, and he’ll probably work on this thread some more.
I’m an American who has been living in the UK for 2.5 years now. I have a variety of medical conditions and have been extensively treated under both systems. I’ve found rationing issues under both systems but both to my benefit and to my detriment.
One thing I do not at all miss is any aspect of dealing with insurance. I was uninsured for a while; paid my own way on COBRA for a while (same issues for my beloved); I hate copayments; I hate having to decide which flavor of insurance my employer will give me; etc. etc.
It’s actually pretty fabulous that you can just go and get care without having to think hard about it. You do need to book things appropriately (and often there are waits longer than I personally like) and the booking systems is superstupid (e.g., you almost *never* book an appointment at the desk; you say you need an appointment and they send you a letter; if it’s no good, rinse and repeat).
Overall, I think I prefer it. I’ve got a crappy GP and sometimes the bedside manner is awful :) They don’t seem to be that great at sanitation as well (washing hands is a bit hit or miss). But I don’t think that’s a function of the *structure* of the care. The *system* is quite ok, in general.
Sullivan hates the idea of the "collective" being involved in health decisions. He wants them to be made by insurance company stockholder’s meetings.
The emerging US health care plan is effectively "Everyone gets a health care policy" rather than "Everyone gets medical treatment". The government will have a public policy and the private companies can continue doing business in competition.
This is about as far away from "socialized" medicine as you can get without living under the current system. And Sullivan’s complaint is extra-special-super-bonus inane because he has employee coverage which is effectively "socialized" medicine (by his definition) except it extends to his company rather than the entire country. If The Atlantic were to hire on an extra 100 million people such that everyone had coverage under its company insurance plan, you’d effectively be living under Obama’s vision of universal health care.
But it’s better to live in the world of "haves" and "have nots", because that way you won’t need to worry about waiting more than a week for hip replacement surgery.
I agree with Sully on many many things, and he has a flair for picking out the interesting tidbits, and for that, he will remain at the top of my RSS list. On Healthcare, however, we part ways. My guess is that he’s simply never seen how vicious the insurance companies in America can and will be. Government run healthcare will have it’s share of failures and idiotic bylaws, but private healthcare concerns have potential for even greater levels of evil, because there’s no oversight whatsoever.
Oh, the US system is great if you don’t have to deal with its rationing mechanisms — being part of the elite is a wonderful thing. If you don’t have to worry about service denial, if you don’t have to worry about bankruptcy to figure out if a problem is just an annoyance or an oh-my-god, thank god you got tested today as we can treat it now and save your life, but if you waited another three months, you should have written your will sooner. If you don’t have to worry about the tradeoff between paying your health insurance premium OR the heating bill OR the grocery bill, then the US system is pretty damn good. If you don’t have to worry about paying for COBRA if you lose a job or are locked into a dead-end job with decent coverage but no prospects in a dying industry, then the US system is pretty damn good. If anyone of those caveats are in your life, there are massive issues with the US healthcare system.
Now the year and a half I walked on a torn meniscus because my deductible was more than my after tax take-home pay for that time period was a blast as I got to value the entire freedom that painfree walking denied me.
Sullivan doesn’t demand squat. He gets what his employer and the insurance company choose to give him. lol Then they may choose to not cover his procedure.
If I were fighting a government bureaucrat over my health care, at least I could take some solace in believing that I could theoretically (I know, only theoretically) put some pressure on my elected officials to do something about it by threatening to bounce them out of office in the next election. I don’t have even that puny, measely, pathetic amount of leverage over the insurance company bureaucrats I’m currently battling.
And at least the government bureaucrat wouldn’t be fucking me over just to make a buck.
The day Andrew Sullivan has to go to battle with his revered private health insurer is the day he’ll wake up and start railing about the horrors of the US private health care system. As long as it’s only happening to millions of others, but not him personally, he’s perfectly happy with our current system. Douchebag.
The pound spends there like the dollar spends here and salaries are equivalent – if not higher. For .50 you have a Brit has $1. Not too hard to figure out.
He has a lot in common with Hitchens in that respect–they’re both often so wrong, and so fucking obnoxious about it, that on the rare occasions when I find myself on the same side of an issue with them, I feel dirty about it.
Caidence (fmr. Chris)
That’s how it will start out, but not how it will end up.
The payer will always argue for, and win, the right to determine what it’s paying for.
Therefore one gigantic reason to avoid having the government pay for any healthcare is that they’ll write laws to restrict your freedoms so their risk of future payment is lessened.
Sullivan is back drinking the RNC Kool aid.
My wife gave birth to 2 children in the USA and 2 in the UK and the health care she received in the UK was much better. The only thing the medical profession in the USA seemed to care about was avoiding getting sued, so every step they took was to limit liability. They could not care about the patient. Certainly for maternity, the UK system is strangely enough geared about the wants and needs of the mother and child. It may help explain the lower incidences of c-sections in the UK as well as infant mortality.
When I went to a US doctor for a minor problem (ear infection) the fastest I could see one was 2 days. I had the same problem in the UK and it too 3 hours from initial call to my doctors to me taking the antibiotics after having seen one.
My subjective opinion counts for nothing but statistics seem to back me up.
Of course all good conservatives know that facts have a liberal bias.
Comrade Sock Puppet of the Great Satan
As a HIV+ guy, you’d have thought Sully would be familiar with the term "pre-existing condition".
I have elected to not have surgery on my herniated C7 disc because the pain I can live with, but the cost is to much to bear. I am on a student health plan, and I hope that in a year I will have a job (here’s hoping) with better coverage.
The thing that sucks, is that my health care providers rock. I go to a state school and the Health center is the only part of the school where people actually care about there jobs. But paying for it, forget about it.
Except that already exists in the form of Medicare and Medicaid. If the government – the single biggest health care provider in the US – decides not to cover something (or to cover something it previously didn’t, see: Viagra) this makes a massive impact in the medical marketplace.
This reality isn’t going away until you get rid of existing government coverage. Furthermore, insurance companies typically balance their numbers off of medicare figures. Costs and payments on procedures in the medical billing field actually reference prices in term of a percent of medicare. I think the general expected cost of a procedure is 135% of whatever medicare is willing to pay. This is SOP in the current system. You’re not sparing us any grief by expanding it.
Caidence (fmr. Chris)
They’re made by a contract you sign at the beginning of the term. The insurance has to adhere to the contract. Yes, they’ll dodge if they can, but you still have the judicial system as arbitrator, and you have no guarantee that the "collective" won’t enact policies to dodge the contract.
You want to knock the private companies for being dickheads, you can enact "pay-first-litigate-later" laws. But don’t knock the idea of two parties coming to a written agreement before doing business.
Those numbers are not too far out of line. As a rule of thumb dollar and pound numbers are about the same for the same item, althought the pound number includes sales tax, and the dollar number typically doesn’t.
Salary wise, one number I can remember is that about 3 years ago, 11% of the British taxpayers were in the top tax bracket, which starts at about £ 32,000 (and is taxed at 40%). The average American household income is slightly over $ 50,000.
And the pound isn’t worth 2 dollars anymore, or even 2.20 as it was at one point last year, when British GDP per capita was higher than that of the US for the first time in more than a century, it’s now about 1.45.
Public healthcare is like public education, it always sucks, but no one in its sane mind would go without it.
I always find it funny that according to conservative commentators the UK is the only country in the world with universal healthcare (Canada sometimes, part-time, when it can be made to look bad). Yeah, its system sucks more than others according to all studies and my very limited personal experience with it. Not the least because it’s chronically underfunded. But apparently no one ever sees about complaining about, say, Germany. Or France (le gasp!). Or even my humble motherland Spain where we do indeed spend the day bitching and moaning about how sucky our national healthcare service is, but try to replace it with something else and you’ll start the old folks revolution in half a minute, which everyone else would join a minute later.
I have a friend with a case of bronchitis which is lingering and the Urgent Care office where she has been twice told her she should see a real doctor. The earliest appointment she can get with a real doctor is the end of January, over a month and a half away and she does not live in a rural area.
She is married to a tenured private law school professor so I assume her health insurance is at least average.
I don’t know if she shopped around for a different doctor yet or how much choice she really has. I suppose the hospital emergency room will be open if she gets sick enough….
Of course I would like to have this problem. My problem is I have no employer health insurance through my job and there is that little precondition problem thing too. I can get insurance but it costs a mind boggling amount and it still has such a high deductible that I will be very sick before it will pay anything at all. Any uncovered procedure or doctor visit won’t count toward toward the deductible and the wellness benefits are a joke. I assume their business model counts on the fact that customers won’t stay long enough to make it worthwhile financially for them to prevent any cancers other than the state mandate that they pay for breast and uterine screenings. Since I am a guy I’m not even sure they would pay for a breast screening.
The problem is when one side has all of the structural advantages. I mean, if health were something I could live without, I could game the system for better services. Problem is…
I’ll knock it all I want, because the image of contract law is too often used as a fig leaf for asymmetrical relationships.
I need a service that only a large corporation can provide (e.g. insurance, credit, airline travel). Sure, there’s competition, but all the competing offers come down to the same thing: we make the rules, we hold the cards, you take it or leave it.
I don’t get to negotiate with Farmers or Citibank or United in any meaningful way. They make an offer and I’m free to walk away, but there’s no better option for me to walk to. I’m not an equal bargainer at this table.
John from Concord
Okay, this — and I mean your inane and completely uninformed dismissal of Sullivan’s argument — is the stupidest thing I’ve seen on the internet today.
You and Ezra should go spend six months in the UK trying to get anything useful from the NHS. For bonus points, contract some interesting chronic condition first. If you survive, come tell us about it afterwards.
Don’t bother flaming me, Cole isn’t worth my time. I won’t be back.
Caidence (fmr. Chris)
Man, I keep looking through these comments, and people seem to have lost focus/hope on the presence of market pressure.
I mean, yeah, the system is waaaaaaaay over-designed, and there’s too many places where sunlight doesn’t reach, but why aren’t people calling for insurance-policy reform, instead of various modes of upending the system and having the government litigate?
If the people who designed the first system fucked it up, don’t erase the whiteboard and hand it back to them. Pick it the hell up and change what’s in front of you.
Off topic, but I thought this would amuse everyone. It’s the Bush plan for dealing with the housing crisis, as explained in early 2008.
You might want to forward this to Radley Balko, Hit and Run, and a few others in your blog roll.
There will be rationing in any system of health care, because resources are scarce and insurance companies can no more afford to meet the demand of ‘free’ health care than the government could.
Whether it is an elaborate bureaucracy of the HMO denying a claim or a government functionary, some people are going to be left out, denied needed operations for specious reasons, or otherwise screwed over.
So we’re left with a choice of which would be better?
A ‘free-market’ system that is simultaneously over-regulated in some aspects and severely under-regulated in others?
This works fine for a lot of people now, but as mentioned, there is the problem that the chronically ill and the destitute not having insurance, as well as the problem of critical unexpected (and expensive) life saving care wiping out savings.
So a government run single-payer solution? Everyone would be covered, but rationing would take place in other ways, and you could easily have a situation with arguably even less accountability. (Because really, what government official actually pays for their mistakes, or pays for being a callous ass these days?) And, of course, there’s always the possibility that the ‘evil’ Republicans will get control of government again and start their own form of rationing (cutting off funding for abortion, contraceptives, etc.)
Or a combination of the two with a safety net provided for the sick, the destitute, and critical, unexpected needs combined with better laws letting individuals purchase health insurance across state lines and allowing individuals recourse to sue in court or get a review by an independent agency for procedures denied by their HMO?
I, personally, have little love for HMOs, but I have even less for Government, and after the last seven years, I don’t trust it to handle health care.
While the third option doesn’t really appeal to me either, it seems like the best solution.
Caidence (fmr. Chris)
Italicized statement is where the argument goes bad. A small-ish company with backing capital can cover you just fine, if they follow reasonably-kept actuarial tables.
What your failing to insert into your argument is that there’s rarely an opportunity for an individual to buy insurance, because it’s usually a bulk purchase from your employer to you. And you get two awesome bonuses:
1.) A decreased rate
2.) Which the employer pays for you.
If that shit’s not good enough for you, go negotiate on your own!
Really, I support your "this system is fucked" argument, but everybody is shooting right past the simple stuff and asking for a full fucking mulligan.
Watching from Australia, it’s dumbfounding to try and understand how your medical system works (or apparently doesn’t work for many people).
We complain about our system as well. There are shortages of doctors in rural areas. The public health of our aboriginal population is (in some areas) at third world level.
However, I can front up to a "bulk billing" medical centre without an appointment, and see a doctor within a few hours at most, and not get charged for it. Alternatively, because I can afford it, I can pay to see my GP. I also know that if something goes wrong, I will get good free emergency care – my father had two heart bypasses and didn’t pay a cent in medical bills.
Yes, I pay extra taxes to subsidise the socialised system. Yes, our Liberal (read: conservative) party tinkers around the edges of the Medicare system when we let them get their grubby hands on it, but political parties of all stripes pretty much accept our semi socialised system as a given. (I’m not meaning to sound boastful, I promise)
I think that’s what dumbfounds me the most – that in the richest, smartest country in the world, healthcare issues are still a political football (unlike the quiet croquet game we have over here).
I’m sure I’m missing something, but isn’t that essentially what Obama’s version of "national health care" is? I definitely haven’t looked at it in any detail, but my impression during the campaign was that he was proposing mandated universal coverage, not an actual governmental health system.
You mean heath insurance problems? Britain has it’s own problems with health care, see for example MSRA, a.k.a. the Superbug.
You’re just ranting off about something you have no clue about really, just like most of the other septics on this thread. Sullivan’s description of the British attitude towards their health care system is pretty accurate, their expectations are not high and they don’t go to see the doctor for every little pain and ache. (I have lived in the UK for six years and are married to a Brit, so I make a decent claim to knowing their attitude.)
The conclusions he draws from it are dead wrong though, but then again, he is a British conservative, so what do you expect. In any case, universal or private health insurance, someone has to deny people care and let people suffer or die, because society simply doesn’t want to pay every last penny they have on healthcare. And with universal health insurance, you can at least vote for a party you think will do a better job for you. With employer enforced private insurance, you don’t have that choice.
as soon as i read that, i started hearing Pink Floyd’s "Time":
great line. classic line. the Floyd transcends. but then when i went to look up the lyrics to the rest of that song i ran into this, from noted non-Brit, Henry David Thoreau:
doesn’t sound like the America Sullivan imagines.
Fair enough, though I suspect the smaller company is going to protect its end of the contract in much the same way the larger company is. But taking the example of airline travel, if you live in a big enough market, the small carriers do offer a genuinely competitive market. Maybe part of my problem is that I live in a rural area where the choices are more limited.
This is true for people who are employed by a company (like I am). But my line of work is full of freelancers, and I imagine those folks get all too many opportunities to buy insurance.
Caidence (fmr. Chris)
Wait, I blew that statement, lemme try again.
What I was trying to say is: You don’t experience buying your own insurance that often because you’re company usually makes it a simple issue and you just sign-here and that’s it.
You don’t have to do that. There are companies out there that can cover you, and all you have to do is say "no-thanks" to the company insurance. Yes, it will cost a bit more, but you’ll have the right to demand things from the insurance company, and the company has incentive because they’re taking more money from you than they would from your employer.
The Moar You Know
@David Hunt: An interesting idea but it really doesn’t work that way – I remember being astonished when I went to China a few years back and found that, just like in the US, a Coke was a buck. A pack of smokes was three bucks.
I figured that, hell, these people make a buck a day, everything’s gonna be cheaper, right? No so – the difference is that most of the Chinese live month-to-month in cinderblock homes, with no health care, or cars, or books, or any of our manifold modern luxuries – in what we would consider abject poverty. Costs of the necessities are pretty much the same round the world.
So yeah, if the British pound is worth twice the American dollar, they’re richer than we are.
Caidence — please look up the phrase adverse selection and informational asymetry in regards to your comments in #45 regarding market power in the individual insurance market.
I agree in principle, but the company’s incentive is an aggregate one. They have incentive to maximize the number of high-paying customers they satisfy, but they don’t have strong incentive to satisfy my particular demands per se.
I’ll still have better negotiating power if I can do it collectively, the way my corporate employer does. But then I’ll be giving up control over what demands I can make. It’s something of a dilemma for the individual.
Because reforms can be rolled back, but an entitlement is permanent.
@The Moar You Know:
Shit man, you have never been to Britain have you? A Coke is about £ 1.50 there and a pack of fags probably now somewhere between 5 and 6 quid. Stuff is a shitload more expensive there.
A Coke is about £ 1.50 there and a pack of fags probably now somewhere between 5 and 6 quid. Stuff is a shitload more expensive there.
Quid, fags, what is this, a Guy Ritchie movie?
In addition to my role as a student and a patient (and before my injury) worker, I am also supposed to become an insurance agent for myself. Bullshit!
Edit: Stop telling me the little guy can fix the system if he just works a little damn harder.
Check it out, Sully is back in Trig Truther mode, having posted a 40,000-word entry about Sarah Palin’s pregnancy, hilariously complete with enlarged photo of her pregnant (or is she????) gut.
Caidence, try to grok the fact that you are simply wrong about this. I have a pre-existing condition. It is not a big deal, but I would lead a less happy life if it went untreated. So here is the part that you seem to miss: if I had to compete in the individual market, in many states I could not get any insurance at all. In other states I could only get unrealistically expensive plans that specifically exclude the care I need.
Do you think that people like me do not exist? Someone else on the thread pointed out that seasonal allergies qualify now. We are a huge fraction of the country at this point. If you think that those of us who don’t have the good luck to work for a generous large corporation (many are trimming or eliminating their group plans, by the way) should shut up and die then you might as well say it directly.
Two things. When HealthNet recently enjoyed a lot of publicity for cancelling a patient’s insurance in the middle of her cancer chemotherapy: Health Net had defended its actions, saying it never would have issued Bates a policy in the first place if she had disclosed her true weight and a preexisting heart condition on her application.
See. They only insure healthy people. And that’s their public defense for cancelling her insurance and endangering her life.
Not to mention:
At the arbitration hearing, internal company documents were disclosed showing that Health Net had paid employee bonuses for meeting a cancellation quota and for the amount of money saved.
Now, how on earth could any sane person consider this an ideal system for health?
Secondly, it remains breathtaking that all those stupid, stupid, stupid people in Spain, Italy, Ghana, France, Cuba, Macedonia, Great Britain, Quebec, Czech Republic, Liechtenstein, Sweden, Ireland, Iceland , England, Chile, United Kingdom, Switzerland, Pakistan, Poland, Wales , Belgian , Canada, Hungary, Finland, Denmark, Croatia, Scotland, Slovenia, Japan, Israel, Korea, Turkey, Germany, Morocco, Northern Ireland, Norway, Thailand, Russia, Costa Rica, Australia, Netherlands, Estonia, South Africa, New Zealand, Luxembourg, and every other industrialized country just haven’t grasped the superiority of our ideal for-profit system.
Yes, that’s it, they must just be very stupid people.
Caidence (fmr. Chris)
I’m sure his plan means lots of things. But as the people who voted for him know, the man is Prudence incarnate, and his staff probably isn’t. So whatever plan he’s got now is the most right-ward it’s ever going to be.
But I’m really responding to this rainbow of arguments, from people lamenting against not being Canada, to not being Britain, to not being France. There are a lot of calls for "This isn’t good enough, scrap it". Except nobody is identifying the actual points of failure, and people are discounting the working parts of the system, too. (No I don’t know what they are, but some people are getting healthcare, so something works somewhere)
I really wish this energy was put into making people eat healthier, start exercising, shit like that. MUCH simpler.
any discussion of health care and its costs must include the issue of medical bankruptcy. basically only americans suffer from this "disease".
TR Reid’s recent comparison of five national systems on PBS is required viewing. it drew my attention to the brit’s NHS aggressive approach to changing lifestyle choices. docs get money from then gov when their patients stop smoking/lower serum cholesterol, etc.
oh, and Sully is an asshole. i’ll never forgive him for "left = fifth column" and his personal ad ISO "bare-backing partner". shun him.
Before I went back to college and got covered under that plan, I was on individual coverage that cost more than twice as much as the school plan.
The coverage was a little better at the time, but since it was from the same parent company, I think the advantage would have eroded by now.
Is it Sully or his partner that has the sleep-apnea problem? Under my plan he wouldn’t be covered, so…
It’s not just the chronically ill and the destitute who have problems with paying for their health insurance.
We have private health insurance, but in order for it to be "affordable" (about $9K a year for the 3 of us) we have a huge deductible. This year my husband had surgery and with the deductibles and co-pays, we ended up on the hook for about $25K. We are fortunate in having two incomes and generally good health, and some savings, so that didn’t wipe us out. I have a medical issue right now, but because we can’t afford another $25K, I am waiting to see a doctor, trying to treat myself with diet and herbs and hoping it gets better.
A friend in Oregon had insurance, but after 2 weeks in the hospital, she now owes about $30K for her deductible and co-pays. She’s single and her surgery has made her unable to work more than a few hours a day, recovery will take months. What’s she going to do? Her friends and family have taken up a collection to help her pay her rent until she’s back on her feet, but no one has any idea how she’ll pay the hospital bills. She wasn’t "destitute" before, but she’s sure approaching that now.
So Andrew, with his nice fat employer health insurance, and his two homes, singing the praises of the American health system, can just bite me.
Cigarettes are 5.60 UKP a pack of 20.
Beer and Wine is also more expensive than the USA in general. The health care in the UK is not free, it is paid for in taxes and ‘sin’ taxes are an effective method raising the funds to pay for health care.
Coke 1.50 a can really? You must have been in London.
Tesco is selling 2 ltr bottle of coke for 1.25UKP.
@Caidence (fmr. Chris):
Have you ever actually done this? I suspect not. Because you seem to be describing something that does not exist. I’ve had to deal with the individual market, and the result isn’t a cheerful individual sitting down and negotiating the perfect plan for him or herself, but generally finding that wanting to do something as simple as finding health care coverage for a healthy woman that covers pregnancy is next to impossible, let alone a typical 55-year-old man who hopes that maybe his insurance will cover doctor’s visits. (It won’t. Being 56 with catastrophic only coverage means your financial security is dependent on not getting sick.)
Employers have an advantage in bargaining because they represent many individuals, and so mean more money for the company. It’s absolutely not true that you get more coverage for your dollar on the individual market.
@Damned at Random:
Verily. It’s not an either-or proposition, though. Personally, I’d like to see our health insurance system itself give more emphasis to preventive measures, not only routine "wellness" checkups but also incentivising the "shit-like-that" you mention. (And I’ll add that my corporate employer does provide such incentives, in addition to and apart from the insurance package.)
But that’s pretty pie-in-sky; there are bigger fish to fry. In the pie.
that really is one of the strangest things i’ve seen on the web. besides being completely irrelevant to everything, it’s ugly.
I did. Tell it to my neck and genes.
Ghana has universal healthcare?
I’m sure that’s why they are dirt poor. Better avoid that deathtrap and keep the current system.
Given the specific topic of conversation, I find it laughable to claim that someone with a pre-existing condition that requires very expensive medications and eventually more and more expensive hospitalizations would be able to buy insurance on the private market. That’s clearly false. Anyone with a pre-existing condition, which is basically anyone over age 30ish, is not going to get that condition covered in the individual private market.
In America 84% of people have access to healthcare; in Britain 100% of people have access to healthcare. I somehow doubt that those Americans who die because they can’t afford treatment take much comfort from the fact that, by the standards of the Right, they’re "free".
What is it going to take for people to get their heads around the idea that, in a democracy, the people are the government?
And what is it with people like Sully and Michael D. (who wrote basically the same thing as Sully earlier this week) that they’re perfectly fine with an insurance company violating its contract to cover expenses six ways from Sunday, denying its customers coverage and medical treatment, but they’re absolutely outraged if that insurance program is run by an entity without a profit motive. Oh, if it’s all in the name of making a buck, then that’s just the way the cookie crumbles, but if it’s the much more straightforward "this is how much the country is willing to pay in taxes for health care, this is how to get the most good for that money" that’s an insufferable soul-crunching bureaucracy at work.
The US health care rationing system where health care is only accessible to cubicle dwellers and above is not freedom; it’s Freidman, and there’s a big fucking difference between the two.
Caidence (fmr. Chris)
No, I’m not including that into the issue because nobody has a requirement to treat your condition. Good health is not a right. Repeat that 100 times. I do not have a duty to fend off bad health and death. Those unhappy things were present before I got here, and I’ll be dead before they leave.
I’m sorry you’re sick, it’s part of life, but the moment you demand that misery stop being bad, up becomes down, left becomes right, and people become stupid.
If you want to figure out how you and your money and your sickness go together, remove the insurance portion, and ask what all this shit is paying for. How much does this treatment cost? Why does it cost that much? What does it get you?
It may turn out that you should’ve been dead 5 years ago, but you’ve got 10 years left because of an exorbitant new technology. You had insurance, they paid two houses and one Mercedes for it as per the contract. You didn’t know you were slated for a dirt nap, so you go on assuming that your good health is the norm.
It might not be.
And insurance isn’t the God of Life. Your pre-existing condition might fuck you, and it’s not the insurance companies’ fault, and not their duty to make your life peaches-and-cream.
Actually, you’ve got a point (as often).
In France (as you might know it), there’s a complain about Brits.
Why? Because the waiting time in their system is so long, and they have no real choices about their doctors that the richest ones go to France. With E111, it’s free for them.
You just have to pay the tickets to Calais, and that’s it!
Which is quite a problem…. French people (there’s a lot to say about social security there) don’t have to pay for the richest Brits (by this term, I mean Brits, who can afford going to France).
And it says something about the British health system….
This is where we disagree.
Caidence, I honestly want to meet you halfway, but it sounds like you just told sick people to fuck off and die. If you meant to say something else, try it again with more logic and fewer glib one-liners.
Caidence (fmr. Chris)
If you haven’t noticed, I’m always way too happy to get even more idealistic than I am now, so I’ll address this.
You’re right that if there’s a statute on the books that’s abusive, popular will should be able to reverse it, but that’s not the problem.
The problem is case law and precedent. If you put a government-health-insurance case in front of a federal bench, they’re going to have to give the government some relief sometimes. And that relief is going to set precedents that that Constitution couldn’t even have imagined. And that precedent is going to have some serious momentum, and will influence judicial thinking for the next 100 years or so.
And that "relief"? Keeping your from eating the occasional ice cream cone. Keeping you from taking homeopathic medication. Keeping you from picking up your kids because it might throw out your back.
It’ll often be more abstract rulings, but eventually they add up and then you have limited options to live your life.
Hm. It occurs to me that stupid isn’t where you think it is.
A bit more? You’re fucking joking, right? Most people not making 6 figures couldn’t even consider buying stand-alone insurance of any value, they simply don’t have that kind of money. They’d be better off just saving and hoping nothing bad happens; it’s all those services will cover anyway, and it’s a lot cheaper.
And Caidence: hope you never get sick. That’s all I can say without turning into a complete jackass.
@Caidence (fmr. Chris):
Jesus fucking Christ, that’s the most rancid pile of fatalism and nihilistic bullshit I’ve ever seen.
@Caidence (fmr. Chris):
Even if nobody has a requirement, they probably have a vested interest. I am a 37 year old, father of two that has Parkinson’s Disease. Without insurance, I could not work and I’d be on SSDI as well as many other government programs because I would not get the care I need to be a productive employee. Yeah, people used to die from diseases now treated with new technology, they also used to go to debtor’s prison if they could not pay their bills.
Its also worth asking what this personal liberty to buy insurance rather than have the government provide it gets us. At the very least, it costs us a lot extra, that’s clear. It doesn’t seem to get us better access to most care (though you can cherry pick individual diseases that have better expected outcomes for any particular area). Measured across all levels, the US has a relatively high level of morbidity and mortality that could be prevented relative to most other first world countries. So we get at best subaverage care but pay the absolute most. Not a great tradeoff.
Caidence (fmr. Chris)
I can’t keep you alive forever. Therefore you can’t demand it of me. Therefore you can’t make it a right. You’re demanding everyone be penalized when someone dies.
Rights are more than privileges.
Close, I told sick people that they’re sick and they’re going to die. Until this becomes utterable, this healthcare debate will run aground again and again until the Dems throw something hackeneyed together and were still just as confused as we were before.
I dunno how. I was being pretty cold to begin with, and now you want me to wonk it out?
Really, all I have on this is that these insurance constructs are just financial companies, and they owe you nothing, unless you’ve signed a contract with them. It’s nothing new that there’s a group of people that demand some new right that makes their life better, but this one is especially frightening to me because people are demanding for something that has an asymptotically infinite cost. You think these fuckers with CDSs and CDOs are bad, wait until all cancer treatments are legislatively made free and these billion-dollar pharmas are $10000 shells overnight, and most future research is obliterated. Holy shit.
Look at what Ahab said. Assuming he wasn’t being pedantic about the meaning of a right, he might have thought I was saying he doesn’t deserve good health, and he shot back quickly that he did to some degree. This was never written down for us. I didn’t hear this lecture in 2nd grade. Where did it come from?
Again, people also need to get it through their head that it’s not just the poor winkielessweenieless sickest-of-the-sick that are ill-served by the individual market. The average middle-aged clown, generally healthy, somewhat overweight (+25%), doesn’t smoke, maybe one or two meds is probably uninsurable at anything thing like a reasonable price. If one has any kind of pre-existing condition, forget it.
You’re right. You and your friend do not fall into the destitute category, which is why I included a category for unexpected catastrophic conditions.
And why I would support some sort of subsidized government safety net that people who wanted it could opt to pay into, which would provide some relief to those in that situation.
Depending on how expensive this would be, there would still have to be some rationing, but even covering some of those huge bills for people would be an improvement over the current situation.
But I pray you will excuse me, especially after the recent crapfest of the last eight years, if I’m not particularly gung-ho about turning over all health care to the Federal Government.
@Caidence (fmr. Chris): so in other words people should die now because your imaginary strawmen might go oogity-bogity a hundred years from now. oooooohkayyyyyy.
Caidence (fmr. Chris)
Holy shit, dude, they’re only facts, and I only had to bring them out because we’re dealing with serious fact-based enterprises. Are you really thinking this insurance crap lives in the Land of Milk and Honey?
There’s some really dark shit behind that door. Don’t go saying you’re going to bust it down before you’re ready to get real sad.
I make $70K and can afford it easily. It would hurt, sure. But I’d rather my wallet hurt than me.
I wouldn’t be surprised if you don’t see all the options out there, there’s barely any real "market" to speak of, and that’s one thing Obama’s idea would really help. It would force all of the options to float to the surface. I just hope that’s the only serious change that comes to the system.
And of course, I hope I never get sick, as well. But when I do (I will), I’m going to ask for the cheaper treatments if instead of asking for a $10000 that was invented Last Wednesday.
You are arguing from a false perspective. What I want is some sanity in the bills we do get. Why can a hospital charge 3-5 times more to a patient without insurance than the insurance companies are charged. And basic economics does not cut it, because the hospital system is basically a bunch of mini-monopolies since the hospital is usually not chosen by the patient due to emergencies or lack of choice due to your location. When there is a monopoly, the government has every right to come in and set rates because the monopoly cannot be trusted.
I think Caidance is Objective Scrutator having a depressive episode. Take your god damned Lamictal, will you?
It’s called major depression. You exhibit all the symptoms: we’re all gonna die anyway, why bother, people who say they care are liars and hypocrites. You need help, and you need to face whatever shit it is you’ve got locked behind your door. And since you’ve got your $70K/yr salary and can afford it, you have no reason not to.
Funny how the rich can not maintain a national economy by themselves. It requires millions and millions of other people participating in the economy for the United States to survive and thrive.
I would have to say that having a 340 million population where the majority were healthy and able to see doctors when sick without going bankrupt, since you know healthy people are more productive than sick and dead people, is better for the longevity of the United States. That’s just me of course. I haven’t evaluated the economic impact of dead people working and shopping. I have heard that it’s good for profits. Dead is better, Alive is the worst. is a really bad business and national motto.
Caidence (fmr. Chris)
Are you saying we should start writing off future freedoms just to delay death for people alive today?
If so, this thread of thought frightens me. I’ve accepted that my life is limited, and I don’t want anyone younger (or older – could happen) being forced to change their habits just so I can live past 50. I don’t live to hurt others.
Caidence, you need to explain why your arguments appeal to some imaginary universe when the world is full of real examples. Many other countries already have scary oogedy boogedy universal health plans. These plans generally cost less, get better overall health results and people love them.
This strategy of appealing to theory rather than reality makes as much sense as arguing that seatbelt laws could cause spontaneous apendix bursting. Sure, in some imaginary land where people write the world’s stupidest seatbelt laws, appendixes might be in some danger. Here in America they seem fine.
Ground your argument in reality and the boogeyman under your bed might stop to seem quite so terrifying.
@Caidence (fmr. Chris): I think you are confusing facts with opinions. For example
is not a fact. Please don’t try to claim the high ground of "i’m just being the responsible factual person" if you’re just spewing the most baseless of opinions in the thread.
Caidence (fmr. Chris)
Because the treatments are ridiculously expensive, and nobody cares because the majority of the paid money comes through insurance.
Some of these treatments have to be this expensive, like antibiotics. Medicines that are trying to beat out evolution are going to hurt the wallet hard.
But if a hospital says "we have to x-ray your leg, we’ll get you a CAT scan appointment", don’t say "OK", ask for a regular x-ray.
And for that matter, why the hell do simple x-rays cost $80? An 8"x11" size of x-ray sensitive film is really $50? This shit was invented in the 19th century. If film really has to be that expensive, can we make this shit digital?
You see where I’m going with this line of thought…?
There is a certain degree of truth to this. Likewise, "Free Speech" and "Trial By Jury" are not rights. At least not when your government can toss you in Gitmo indefinitely and without cause a la Jose Padilla.
The rights of the people are ultimately upheld or cast down by the people. So the question you ask doesn’t need to be "Is good health a right?" so much as "should good health be a right?"
I would argue that a healthy society is a productive society and that we gain as much or more from folks not dying in the emergency room from easily treated conditions like diabetes or influenza as from the freedom to pray or blog about it. Certainly, health care is more valuable than the freedom to own a gun.
@Caidence (fmr. Chris): You just showed your ignorance of healthcare costs. Ask anyone you know who has been to a hospital what an aspirin costs. And insurance companies do not pay for
I know because it took two years for my insurance to cover an FDA approved medication that has stopped the progression of my PD symptoms (the drug company gave me free samples because I participated in their drug study). Ask anyone trying to get experimental treatment if insurance pays and what the definition of experimental treatment is.
If you read enough Sullivan (and there is plenty to read, the guy is
prolific) you start to see the he is always making the argument that
his form of conservatism is righteous and good.
I would love to see a majority of conservatives adopt his form of conservatism because that would be an excellent counter to the
liberalism I have adopted, thank you bushies.
Unfortunately, most conservatives have even more blind spots than
Sullivan (religion) and the Conservative Soul (bible) is not the answer
no matter had bad they want it to be.
@Caidence (fmr. Chris):
Private health insurance doesn’t add any value: the extra paper pushing and cost of marketing overwhelms any efficiencies you get by not relying on a government-funded insurance system. (That’s not a claim, but an empirical fact.)
Another advantage of nationalized health insurance is that adverse selection goes away, because there’s a single risk pool—the entire nation.
@Caidence (fmr. Chris): Well, they probably aren’t using film anyway, its probably digital, as digital is typically more sensitive. But there’s the cost of the tech to run the machine, the amortization cost of the machine, the amortization cost of the building, the radiologist to read the film, etc.
@Caidence (fmr. Chris): nope. frankly i think Tim has been the essence of trying to work with your arguments in good faith. me? i think you are seriously misrepresenting what me and the other people like me are talking about here. when pushed you just fall back on anecdotes and stories about new novel treatments. nobody’s arguing about that stuff.
i don’t have health insurance. know why? cuz the last time i checked it ran about 20k/year for me. that’s right, just me. IF i’m approved and IF they decide that nothing that’s ever happened to me disqualifies me. we’re not talking about the latest treatments, dude, we’re talking about what happens if i get appendicitis or a stroke or, hell, fall down the stairs. NOBODY is saying that we should all live for ever or that we are all entitled to spend a trillion dollars on ourselves. what we are saying is that the profit motive should not be the main driver behind care decisions. (incidentally, just to forestall more strawmen, removal of the profit motive doesn’t mean costs spiral–if anything, the return would be better because the profit motive distorts the practice of medicine in countless ways.) your shibboleths are just that–imaginary concerns ginned up by people who have a stake in the current system.
The way I read this statement is that "Good health is not a right" it’s a (personal) responsibility.
We may scorn Sully’s observation about British stiff-upper-lipness, but it speaks to attitudes, mores and, therefore, expectations that we Americans have regarding health care. It’s part of our cultural identity to expect the best out of life.
How many of us seek care when we have the common cold? How many of us seek care when we get achy, or feverish or have the slightest pain in the neck? How many of us are morbidly obese? what have we been eating and what exercise do we get?
What role has the pharmaceutical industry played in convincing us that there is a pill for everything and, of course, we’re required to see (pay) a doctor to obtain that pill? and then pay for the pill itself?
I’m hoping a new system will include incentives to stay well. Meantime, while it’s fair to expect adequate care, paid in advance as insurance premiums, we must also do what we can to ameliorate the health problems that we brought on ourselves through poor habits.
Genetic predisposition and trauma caused by accidents should be viewed as one’s lot in life and should be treated to the extent they can be. If you feel the need to blame someone for lingering maladies, blame god but, stop expecting that you may whole through medicine.
Caidence’s remarks may feel like a slap, but, don’t throw the baby out with the bath water. I think he brings up something at the root of the problem. Something which will have to change if we are to successfully construct the new paradigm for delivering medicine.
incidentally, i should have made clear that if i had the 20k i would pay it, even though i think it’s insane that i should have to pay that much. but like millions of other people i don’t have the money. so all of this talk about the poor insurance companies is just drivel from my perspective.
Caidence (fmr. Chris)
Ok, this isn’t going to be a complete argument, because we’re both dealing with a lack of the relevant evidence. But I’ll make my case. And, this is going to be a shitty abstract argument.
First, a rejection: Just because Britain has a plan rolling doesn’t mean it’s not going to fall apart later. You say I can’t prove it will suck. I say you can’t prove it will be eternally awesome.
Second, a lamentation: we’re having serious trouble keeping the group subject in focus. I’m wringing my hands over Everyone Is Healthy Everyday arguments, and you’re trying to implement some other country’s health care system. Practice is harder to argue than theory, so I stick to theory. People like Ezra get paid to argue practice, so I’ll defer to him.
My argument: What imaginary universe? Unless the Second Coming is on its way, we have some pretty solid constants. People get sick. People die. It’s not always fair how that happens. And most importantly: systems break down. Entropy. It’s a proven physical law. It means the more you build, the more shit there is to break. And you don’t even have to break it. Nature will do it for you.
So I go back to what I really want to see: don’t build, fix. It costs less time, less money, less labor, and gives less shit for entropy to destroy.
More exercise programs, better nutrition/food supply, price caps, patient options to choose cheaper technologies,
government plans to reduce costs, and insurance transparency. All of those things fix what we have now. It costs less, and is easier to break down and argue individually. That’s what I want.
I grant you this entropy thing is unwieldy, and will cause people unlike me to go "WTF?", but people that deal with large systems of small components get very cozy with the fact that shit WILL fall apart, and most of your job is fixing shit that you didn’t think could break in the first place.
I grant you, no evidence, but that’s my argument.
@Caidence (fmr. Chris):
This is true, but it’s a problem in the present system as well: some new treatment comes along, insurance companies don’t want to cover it (which IMHO is a good thing if there’s no evidence the treatment works), and eventually the insurers give into pressure directly and cover it, or regulators force them to.
But I agree that it needs to be recognized that we can’t pay for everything. In addition, it needs to be recognized that a lot of expensive treatments out there are either extremely expensive (per extra year of added life, say), or at best marginally effective (and thus essentially useless), or actually have costs (not just financial, but possible complications (either direct, or from additional care)) that outweigh benefits on average.
A rational health insurance system would be designed around utilitarian principles: costs and benefits would be weighed based on the statistics of the outcomes.
One thing to note is that not only should insurance not be private, because it cannot compete with a government insurance program (that’s empirical fact), health care itself (doctors, nurses, hospitals, etc—not merely the financial side (insurance)) cannot work efficiently as a private industry. That’s because it’s impossible to design a market system to provide health care with the correct incentives. Aside from providers being paid for treatment, not for outcome, it’s not possible to create incentives for the truly desired outcome: optimal _long term_ health (at a reasonable price). Why? Because the term is too long, and by the time a provider will have seen his "investment" pay off (fewer future visits, etc), the patient will long ago have left his care.
A good article describing such market failures is The Best Care Anywhere.
@passerby: i’m sorry but i think your perspective is way off. if i read you correctly, we should just let auto accident victims die in the streets if they are uninsured.
we could not have had this discussion a hundred years ago because, frankly, there wasn’t much that medicine could do for people, rich or poor. but there is now, and there is no reason to say that people get to live or die based on how much money they have. because at the end of the day, that’s what you are advocating. this isn’t some Mad Max game; it’s a society.
i should say that i agree with liberal’s comment just above. another way to put it is that you are arguing about a facet of human nature. but since that’s an aspect of human nature no matter what, your argument is irrelevant to what kind of health care we should have.
i do think we need to understand that we will be entering a more explicitly utilitarian world WRT health care, and that’s probably a good thing. if anything, i suspect the current fetishization of health care in this country leads to the notion that we should spend unlimited sums in futile cases. and yes that does need to change.
karma’s a bitch
Caidence (fmr. Chris)
Maybe I did, but you didn’t show how. I said things are expensive, and then you said things are expensive. Take another shot? Oh and,
was referring to medicines that are trying to beat bacteria, which evolves to the drug that’s killing it. Sorry if I was being confusing.
I’m going to trust you were getting somewhere with "doesn’t add any value". But a government-funded system isn’t going to add paperwork? Expand, please?
I mean, at least with a budgeted company, they might move from paper to digital documents and lower premiums by a penny. Not great, no, but…
@Caidence (fmr. Chris):
Sorry to be disrespectful, but that’s a nearly vacuous line of argument. It’s essentially unfalsifiable.
Given that the US pays 2–3 times as much (as a fraction of GDP) for the same (or even worse) results, you’re wrong IMHO. We’re not talking about differences in inefficiency on the margin; we’re talking relative inefficiency of an entire order of magnitude.
I agree with all that, but I don’t see what useful role private insurance companies can play; they just end up costing more.
If you want to argue that, in terms of practical politics, it might be better in near and medium run to do it your way (because the political cost will make more radical solutions essentially unavailable), that’s fine. Arguing that actual systemic changes themselves would be too expensive doesn’t mesh with the facts, as far as health care economics is concerned.
Care to elaborate on these? Because it sounds a lot like your saying we can fix the free-market system by having the government bail out the insurance industry when the going gets rough.
Parenthetically, a number of your suggestions are targeted toward keeping people healthier and decreasing utilization, which of course are good things. However, they have nothing to do with the cost of health care per se once you’re sick.
Caidence (fmr. Chris)
No, those are rights that aren’t being upheld.
I have a duty to not punch anyone here in the mouth for what they say about me being an asshole. My government has a duty not to torture Gitmo-held Arabs. I can and will uphold the former. My government is too retarded to uphold the latter.
@Caidence (fmr. Chris):
Instead of relying on theory, like you do, I rely on fact. It’s an empirical fact of international health care economics that nationalized health care systems are smaller in terms of administrative overhead.
There’s really no point in arguing with you if you’re not willing to leave the realm of ethereal theory and look at actual facts on the ground.
The US private systems have the greatest administrative costs, by far. Heck, IIRC, for every dollar you spend, about a penny of it goes to either doctors fighting insurance companies or insurance companies fighting doctors. Note, that’s not health care dollars, that just general money spent. Insurance companies has every incentive to increase administrative costs as that ends up saving them money by better denying care. The fact that you aren’t aware of this dynamic in the public vs private health care debate shows how little you actually understand about what’s happening.
Caidence (fmr. Chris)
Noooooo, no bail out insurance…. bail out baaaad. And I glare at you for suggesting that I was suggesting.
I’m saying you bring down the risks when you bring down the causes. It might turn out I’m way off and that’s not the right solution to bring costs down, but I’m only trying to demonstrate how I think and where I’d be happy to spend taxpayer money.
Just so all of you know: I’m saying keep the current structure, but fuck the current corporations all you want. They’ve been horrible the entire way. I just don’t think you should change the market layout.
@dr. bloor: Actually, preventive care, especially for long term issues are a good reason to have some form of universal coverage. If you are sure that you’ll have to pay for the disease eventually, its likely going to be better to prevent it. But with private insurance, its a collective action problem. They can spend lots on prevention, but likely as not, its some other insurance company that sees the savings. Or they plan on passing the cost to medicare, etc.
@Caidence (fmr. Chris):
That’s because the current health care system (read: health care system, the provision of health care itself, NOT health insurance) is some bizarre medieval-guild like system with grotesque inefficiencies (lack of infotech), barriers to entry (MDs protecting their turf), etc.
One thing that drives me crazy is that in these debates, folks I agree with on the insurance question (namely, advocate single payor) think everything is going to be wonderful if we go to single payor and leave all other decision making to the "patient and their doctor", when in fact AFAICT neither patients nor doctors are capable of making rational health care decisions.
Caidence (fmr. Chris)
That was my fucking point; the whole post was shit, but our gracious host asked a question, and I answered it as best I can. I know I’m writing a lot, but it was right there for you.
I’m taking a lot of pile-on here, and writing a lot, so:
a.) I was asking for you to tell me more. Don’t want to, then don’t respond.
b.) No, I can’t leave the "ethereal", or theoretical. I deal in system design. I don’t know where the good data is. I can tell you which endeavors are likely to fail and which aren’t. If you don’t want to argue that/it bores you, don’t respond.
Sorry dude, but a search of your web posting history shows your knowledge of a PRE-EXISTING condition concerning your vertebrate problems. Consider this a ‘free’ tutorial in the School of Hard Knocks.
Insurance Company of America
To those who continue to support and argue that US health care is better than the socialized versions:
Where are your facts? Life expectancy numbers, infant mortality rates, etc. You’d bring something to the table besides sophistry if you had it.
Dennis - SGMM
Seems like every time one company sucks up another one, or two companies merge, the first thing they do is trim jobs because of redundancies. The companies are then patted on the back for cutting costs. Odd, then, that no one complains about the cost of redundancies inherent in having multiple health insurance providers.
@Caidence (fmr. Chris): If all the corporations involved in the medical insurance market are horrible and need to be replaced, that indicates that its the market that’s the problem not the individual companies. And hell, if you want to completely restructure the companies from the ground up anyway, I don’t really see how that’s less of a major change than just extending Medicare to all.
Yeah, funny how Sullivan gets rehabilitated because he admits GW Bush is a loser when his wingnut rhetoric is as uniformed and stupid as ever. Sullivan is a disgrace–no facts, only impressions, and it doesn’t matter. That’s the conservative way.
He is HIV positive with an admitted history of bareback. He thinks his healthcare is guaranteed. No buddy, if he had to compete on the open market as an individual, he might just have the smarts to appreciate the British system.
I have news for Sullivan–preexisting conditions as cause for denial are no joke. Individuals with celiacs–which is simply the inability to tolerate gluten in the diet–is enough to make an individual uninsurable. So is skin cancer, even in its mildest form.
Sullivan is a nutjob AND a boob. Why anyone takes him seriously is beyond comprehension.
@Caidence: Others have pretty well addressed your arguments’ shortcomings as to health insurance. Now I’ll whack your "liberty" arguments. To put it plainly, government already has all the "power" it needs to take essential Liberties, and it does so routinely. From the War on Drugs, to creeping criminalization (see, e.g., the Lori Drew "cyberstalking" case; Feinstein’s effort to criminalize selling inauguration tickets), to continual efforts to rape the 1st Amendment, to the virtual end of the 4th Amendment, to torture, to rendition, to arbitrarily declaring us "enemy combatants", government is stomping on our Liberty everywhere.
If you think government needs to pay for healthcare in order to "justify" enacting a statute criminalizing say, ice cream, you haven’t understood the precedents long-established in the War on Drugs. We already live in the Nanny State, except today’s Nanny takes our Liberty without providing much in the way of security.
In sum, your apparent fears already have been realized. Single-payer healthcare is unlikely to make government much less respectful of Liberty, and will at least benefit millions who have no, or substandard, care.
Such points are well illustrated in that article I linked to, "The Best Care Anywhere."
Caidence (fmr. Chris)
To expand: you’re not looking at what I’m looking at. Intertwined with what we have now, there are still structures in place that both hospitals and insurance companies exist in. This environment will be at least part-way useful to any new endeavor. I’m talking about boring shit like computer networks, and associations, and non-profit information-sharing databases.
When I say "fix", I mean keep those stupid boring things, because that will be 40% of the system that wasn’t fucking you in the first place. You don’t notice it because it hasn’t been helping or hurting you, but it’s still there.
And if you ask the government to "build" they’ll build a new framework all over again. Why? It creates jobs.
You’re way off. A number of somewhat effective cost savings were introduced during the first wave of managed care in the 80’s and 90’s, and guess what? It’s not inefficiency that makes health care expensive, it’s not greedy doctors, and it’s not overutilization of the system by people who don’t need care. It’s the fact that the technologies involved are very expensive, the salaries of the professionals in the system can only be driven so low before you get a brain drain, and it costs a fucking lot of money to keep a hospital well-lit, warm, and clean 24/7. Perversely, many advances in our understanding of how to keep people healthy (through meds, clean living, etc) can actually drive up the costs, because they keep people alive and utilizing the system a lot longer than used to be the case.
One thing I noted in one of your responses above seemed to be an assumption that everything would be covered for everyone in a government run system (something about chemo for everyone). This is a fallacious assumption, if you’re maintaining it. A single-payor system will simply implement a more valid, consensually-agreed upon system of utilization (or "rationing," if you prefer) than the perverse system that’s in place right now.
Caidence (fmr. Chris)
No kidding. So think I’m going to give up making the argument that we shouldn’t shoot ourselves in the foot anymore?
The war on drugs is 40 some years old. I assure you healthcare will last forever.
@Caidence (fmr. Chris):
You’ve got it exactly backwards. The only plausible argument for keeping the market layout is that the private insurers will fight to survive, making the move to single payer untenable.
If you actually knew anything about health care economics (instead of mouthing empty platitudes on the subject), you’d know the market layout for private insurance (a) cannot compete on efficiency terms with a system of universal, government funded insurance, and (b) is always going to be beset by adverse selection.
Then you aren’t qualified to debate.
You can’t tell which endeavors are likely to fail and which aren’t IF YOU DON’T WORK WITH THE EMPIRICAL DATA FIRST.
Looks like you’re skipping three or four steps here.
And @Caidence once more:
If all entrants in a market are "horrible", that indicates that the market is badly-regulated. It’s rather like patent medicines before the FDA. It’s not the players that need "fuck[ing]" — if the market was fair, competition would already have fixed that; it’s that the market is fundamentally unfair.
I actually like Sullivan, but he can be such an ass sometimes (e.g. "People who want a different system because they can’t afford shitty overpriced American health care hate freedom"). Don’t know if he’s just being provocative to get page hits or if he’s just a typical Gen Jones prick who’s got his so to hell with everyone else. Probably both. You’d think that being a despised minority would have made him a little more gracious and empathetic. I guess not.
Caidence (fmr. Chris)
giving credit where credit is due
This the first time I’ve seen this argument made. I’m not sure I can accept it, but I’ll read into it.
Caidence (fmr. Chris)
Yes. I’m fighting against people that are advocating for a new market. I’d rather use transparency regulations first before I call time-of-death on what we have now.
Reread. I said trauma should be treated to the extent that it can be. You have inserted melodrama where there was none.
I don’t get what your saying here. At no point in my editorial did I suggest that ability to pay should have any bearing on outcome. I’m arguing for a universal system, a level playing field.
Yes. I tried to put emphasis on the word expectation without using the word expectation in every other sentence. Our perceptions of what health care is and what it should/could be are very much reliant on moving away from currently held expectations toward more self-reliance and personal responsibility. A point you help me make when you say:
If you really want to reduce foot trauma, I urge you to focus on the things I listed earlier, especially the "there ought’a be a law" syndrome among our citizenry, the War on Drugs, and the repeated, brutal rape of the 4th Amendment. Medicare-for-all is far down on the list of potential, let alone actual, Liberty problems.
Caidence (fmr. Chris)
You say that because you don’t see what I see: That most of the people advocating the hard-left argument are foremost saying that they would like to run right off the cliff into a tarpit. They don’t see it because they’re drowning in non-structural data, I do see it (because I deal with structural design by profession), and I suck at explaining what I see.
The idea is to work together, but there’s more fight here because we all have different wishes for different things.
Caidence- wow. It amazes me that with all your darwinistic claptrap, you don’t get it that for the United States to be able to compete in the global economy we have to have healthy workers.
At least, reasonably healthy.
I don’t know about keeping people alive past 95, but a country where lots of workers of all types- not just grunt labor but entreprenurial types- cannot survive a simple medical disaster is a country destined to burn out and fail.
New business and innovation requires a lot of effort and so often is running on a shoestring. Maybe it’s just because I’m running an American small business that competes globally for a particular market (audio DSP plugins for musicians) that I notice this. Where do you think businesses come from, the Reagan fairy? Most new businesses fail. Further undermining them by blowing away the possibility of health care is economic suicide.
If you are running a small entreprenurial business of the type that so many of our corporations grew from, and you can afford $10K a year for health insurance, you are FEATHERBEDDING and you’re not going to be able to price things competitively to deal with rivals in places like, geez- about everywhere else in the world you’d find rivals.
I get business from Scandinavia. Those guys have government MUSIC programs as well as government health care. They’re making customers for me with the support for the arts, but if there’s a plugin developer there who gets sick, his business doesn’t have to die. I’m an American, which puts me at a severe disadvantage on that front. I basically just hope nothing ever will happen to me because I can’t afford to pay for it. If I adjusted my prices to cover private health insurance they wouldn’t be competitive anymore…
I guess just fuck you, Caidence: go play John Galt somewhere else. I hope you lose this societal argument: I’ll sleep easier. Your attitude puts me at a serious, serious disadvantage as an American small businessman and I’m offended that you consider it for my own good.
Dude, you don’t create brave plucky competitive people by pwning them with inaccessible health care. People will be competitive or not depending on their nature. Some will be the fighters and winners you want, and some will just be customers- for instance MY customers. I’m sure I’d sell better in the US if people weren’t so hosed. Every private insurance premium going to a claim that will just be denied anyway is money that I could have earned if those people had their society there to keep them alive and working.
That’s empirically false. The guys at Dartmouth have shown that there are tremendous regional variations in Medicare billing that are not explained by patient/case mix, and which have zero relationship to outcomes.
You can argue whether "greed" per se is at work. But the fact is that the current system is incentivized to treat, not to generate good outcomes. In the latter case, there’s no a priori reason (given no information about a case) why treatment should be favored over a decision not to treat.
Even if we grant for the sake of argument that health care is not as adequate under the British system, is that because there is something inherent in nationalized health care that makes it impossible to be as good as privatized care? If you’re willing to spend more, you should get more.
It sounds like the typical conservative strategy: call for fiscal responsibility slash government or at least resist its expansion every step of the way, then look at the result and say hey, these services aren’t as good as what you get in the private sector (where you spend a hell of a lot more, of course).
@Caidence (fmr. Chris):
Thanks for the positive response and the civil tone.
Like I said, an excellent starting point is that article "The Best Care Anywhere."
Now, when I say that there’s no market system (of price signals and incentives) that can result in a quasi-efficient system of health care (meaning, that such a system must involve top-down decisions and rationing), that doesn’t mean I’ve proven that no one will ever be able to devise such a system. I just don’t see how, and I don’t see anyone making any reasonable progress on it. I’d be happy to be proven wrong.
What sort of tarpit do you mean? And why do you assume that the "hard-left" will be successful in hypnotizing the government into uncritically legislating their ideas?
You have to be careful discussing the British system, because both insurance and medicine are socialized there.
Most people in the US discussing single payer seem to be referring to socializing insurance only, kind of like in Canada. (IMHO they should both be socialized, but that seems to be a minority view.)
Caidence (fmr. Chris)
You know, I was so prepared with a "Tell me more" statement, until you shot off
Standard rule of human fallibility: We all have no fucking idea what we’re doing/asking for/getting into.
You know what’s on all four sides of us, and a 100 yards away. That’s good. I appreciate that.
I’m telling you what’s 20 miles away. Less relevant now, more relevant later, will be just as important as what you’ve got in front of you.
Until you learn to recognize who’s got what to offer the issue, you’re going to fuck up just as bad as I would on my own. That’s why I’m here, I’m trying to find people and facts that inform me.
But everyone makes this shit tiring. I just spent 2 hours fighting and got 20 minutes of reading. Damnit. Learn that I’m fallible, you’re fallible, your data is fallible, and then maybe we can work together.
Well, you certainly do suck at explaining it, because what some people are pointing to are actual, real world experiences that are not tarpits or cliffs.
And no amount of structural design jargon is going to cover that up–maybe you CAN’T get there from here, but maybe you CAN. We can’t tell since you aren’t able to point out the factors that prevent it in the US, but allowed it in places like Taiwan.
Caidence (fmr. Chris)
I was being entirely civil until 5 minutes ago. Nihilists are civil, until they say your mom is something less than motherly. Not that I am one. Yet…
Caidence (fmr. Chris)
I wouldn’t blame you if didn’t read all 100 posts I made here, but really, I’m not trying to make it hard. I’m trying to keep from having people up-end the system, which will make it a different kind of hard.
You recognized the problem, now fix it.
Congratulations for saying the most moronic fucking thing that I have read so far this week. The world is literally full of systems that have run for multiple decades. If you want to know which systems are ‘likely’ to work, look at the dozens of systems that already do work. You are one infantile statement away from flunking the Turing test.
Caidence (fmr. Chris)
As for up-ending WordPress and pushing Cole over to a Blogger server… wow I’d do that in a heartbeat.
I’m done. I got barely anything, and you just got all pissed off, and now I realize why I don’t have my own groupies.
I need food and to finish my work.
And care is still very expensive even in the most utlization-sensitive regions.
The devil’s in the details, isn’t it? The decision to "not treat" would be much easier and much more prevalent if everyone was required to show up at their doctor’s each morning, whether they felt they needed to go or not.
But base rates dictate that the majority of folks who go to the doctor do indeed have something wrong with them. In some cases, the "treatment" consists of nothing more than "take two aspirin and call next week if you’re not better"–this happens a lot more than economists seem to think–but in many other cases further testing or a higher level of care is warranted.
That is destined to become a classic quote.
I dunno, but either my reading is reasonable or this sentence is bereft of meaning. What does "treated to the extent they can be" mean? You give people a bandaid if they are crippled? Should we stop all genetic testing and research? Who decides?
And what exactly is the baseline for your level playing field? The healthy stay healthy, no treatment for anyone else? (I can ask a lot of rhetorical questions just like you did).
I’m sorry but you just handed us a bunch of platitudes with nothing behind them. We can argue about the standard of care at the margin, at least if we are talking about a utilitarian measure. But "we’re all going to die" isn’t a sufficient justification on any ground for denying standard medical care.
Oh and one other thing for those of you "defending" this system. You really really need to make some powerful arguments to defend a system that provides such a poor return on investment. The only principled basis I can see for arguing in favor of this system–if you are aware of how ass-backwards it really is–is that you are a current stakeholder in it. otherwise, you’re just inventing hypothetical objections that wouldn’t even hold up in a philosophy classroom.
Caidence (fmr. Chris)
I wouldn’t be able to get it right, and trust that you do. I’m worried that your overall solutions will fail. Your smaller ideas have some good color to them, though.
Goddamn it dude, I’m just trying to advocate prudence. Nothing in here is designed to rape dogs or kill babies, I’m just taking different input and making different output, and only "liberal" here is reading me right and then coloring my input. I’m sorry I came back. Toss the thread.
OK, that was hilarious.
@liberal: I really don’t think people are even talking about socializing insurance to the extent of the CA system, because I don’t see America ever adopting a system wherein its difficult for the rich to either get supplemental insurance or get fancy care. Really I just see the french system as being the most likely to work here.
@Caidence (fmr. Chris): I don’t see how you can possibly see what’s 20 miles away when you don’t even know which state the stadium is in. Yes that might be insulting, but note that you’re coming in here claiming that you know better than everyone else, even though you’re far less knowledgeable about any of the relevant facts.
@Caidence (fmr. Chris):
Unless you are advocating a system that does actually, you know, kill babies.
I agree, but something is definitely wrong with our health care system. When I went out on my own in the early 1990s, private insurance was affordable with reasonable deductibles, and getting a job so that you could get insurance just wasn’t something most people thought of. We paid about $1K/year with a $500 deductible. Now, private insurance is an absolute killer. Our $9K annual premium with a $15K deductible PER person PER year, is grandfathered in and not available to any other lucky folks– if we went on the market now for a new policy for our family it would be somewhere around $14K/year for the least coverage.
What has happened in those 20 years to make health care so unaffordable?
I don’t know if universal coverage is the ideal answer, but something is wrong. If you talk to doctors, many of the older guys absolutely hate their work now — they spend most of their time wrassling with HMOs and don’t feel like they’re able to be doctors anymore. Every judgment call of theirs is second-guessed by an insurance bureaucrat.
It’s all scood up.
I really don’t see how anyone who has actually experienced a major dose of our health care system through a chronic / catastrophic diagnosis would defend it.
My daughter had lung cancer when she was 3 years old. We underwent years and years of surgery, chemo, more surgery, more chemo, radiation and stem cell transplant.
Through it all, and based on the rarity of her disease, we were aware of others in a similar situation. You’d think that the US system, for all its warts, would tower over other nations in dealing with this crisis, as we specialize in high tech / high end treatment. I had the best possible insurance.
I don’t quibble over my out of pocket expenses, because based on my coverages, they were minimal (and because my daughter qualified for a supplemental medicaid benefit based on her catastrophic diagnosis and treatment).
But what was striking to me was that kids in other nations, presumably 2nd world I guess, clearly got the same treatment, and better systemic support.
And while my coverage was the best possible, it was not based on my ability to negotiate it – because if you’ve actually tried that as a single purchaser, then you’d know that it is NOT possible.
Caidence is clearly just a bullshit artist. I have no idea why anyone even takes him seriously in this thread.
Anyway, I now think our system is a pathetic joke, and that it is criminal that people suffer. We already ration healthcare, and we do a really bad job of it.
Insurance actually works best in principle with the largest pool, where everyone pays. Insurers makes the most money when they can only insure the heathly, but risk assess against a wider pool. So the incentive is the "insure" a wider pool, but to then figure out incentives / limitations to weed out the sick. As Liberal says, there aren’t actually any incentives for an optimal system.
Insure everyone, and make everyone pay. Bring on single payer. I’m ready for it.
BTW, I know exactly when this country will get national, single payer healthcare.
It will be that moment when American businesses get tired of the morons at the Chamber of Commerce and realize that healthcare costs are killing their ability to compete in a global market.
Once they get this understanding, and they will, then at that moment we will get a different health care system.
What’s really mind-boggling about supposed capitalism proponents arguing to keep the current deal is that it’s hard to imagine anything LESS competitive. Caidence, above, suggests at one point that a health care consumer should push for cheaper options, but anyone who has ever actually tried to do that discovers just how hard it is to do.
You might be able to guide a doctor to less expensive options when it comes to notably different technologies like MRI vs X-ray, but it is simply impossible to discover what any given procedure costs in a hospital or even most doctor’s offices: prices are different based on who is paying, even between two insurance companies.
Prescriptions are marginally better, since doctors have been forced to become more aware as (some) patients – faced with rising co-pays and limited plans – have started asking them for generics. However that market is similarly plagued by varying prices. Some studies have found price disparities in common drugs that range by a factor of 5 within a geographic area, both generic and name brand.
That is, of course, ‘civilian’ price – each insurance company has negotiated a different price with the pharmacy chain, so you not only will need to call and ask, but provide your insurance company’s name as well. And possibly your plan number.
You also have the issue that when you undergo these procedures you’re paying the price your insurance company has negotiated, but often you’re expected to cover a percentage of the cost. So the price being paid has been pre-negotiated, and you’re going to pay it, but you didn’t have a say in it.
I’d be delighted with a health care system benefiting from an open market. Unfortunately we don’t have anything like a real open market, and to suggest that it can be simply "fixed" with minor alterations reflects a lack of understanding of how it really works.
Who do you think decides now and who do you want to decide going forward?
If you would, please, quote me where I Justify denying standard medical care to anyone and I will formulate a response that would help clarify my point.
Platitudes are ideas that are commonly understood. Don’t look now but we’re interacting on a blog. Space and time allow for essay at most, but, not full blown dissertation complete with footnotes, definitions, and other details.
And arguing the Standards of Care of any health system is where the rubber meets the road. No, we cannot go through the entire MCD IX medical code in our discussion of standards, we agree on that.
I don’t pretend to be an expert in this field, but I imagine that some of it extends beyond the general health care industry to the larger economy as a whole.
Inflation combined with wage stagnation would seem to play at least some role.
Inefficiencies and greed in the oligopoly of health care providers and insurers seem to be another factor.
And yes, not to sound like a Republican, but some government regulations make the situation worse by favoring the oligopoly and making entry by smaller and cheaper alternatives into the field of health care more difficult and expensive.
So, it would seem to me more prudent and useful to have a discussion identifying these various pressures on the market for health care and addressing them first, along with implementing a basic safety net, before we opt to dive into the pool of government health care.
Perhaps not solely, but it’s a hell of a contributor. When a small, multi-doctor office needs as many staff people managing insurance payments as delivering services; when insurance companies refuse to process more than one claim per phone call from a provider; when the portion of our (bloated) health care bill taken up by admin is more than double European standards; then inefficiency is absolutely making health care expensive.
No, you come on.
It’s your sentence. Explain it.
Various insurers decide right now, based on their p/l projections. I’ll take career civil service MDs, thank you (if we’re positing possible scenarios).
As for the other point, I could quote you again but you’d just say come on. So I’ll just paraphrase: everyone should just learn to live with whatever hand they are dealt.
I repeat: that’s fine as a statement of the human condition. As a decision principle for who should get what health care, unless you articulate some kind of principle that flows from it it’s certainly plausible to infer what I did from it because it’s devoid of content. In other words, a platitude.
You’re quite right, it’s only a blog. But you chose to post something that I read one way, and rather than explain yourself you just put up more bogus dichotomies. Example: if you are telling me that you have a dissertation-sized theory of health care, fine. Is it posted anywhere else? Got an executive summary? Thesis? Anything?
There’s a lot of bullshit artistry flying around when we try to address something about which we know little. Teh Blogs are slap full of it.
Caidence is looking at the problem with a macro view, others are drawn to more a more micro view (sometimes egocentrically in an anecdotal form) which allows for more triviality. Both macro and micro views serve to illuminate the problem.
Misunderstandings arise from trying to argue a macro viewpoint with a microview. There’s agreement on some level but, the real argument is simply macro vs. micro.
I give my view as an allied health professional who has worked in the system for 22 years. The need for the system to change is something we can all agree on. What and how to change will vary according to viewpoint. I make my points based on what I’ve experienced as a cog in the machinery.
I am not qualified to orchestrate nor dictate the changes we need, nor is Caidence nor is anyone who’s currently involved on this thread.
We’re all what-iffing and how-abouting and if that’s bullshitting well, so be it. If we learn something in the process, even if just to clarify our own views, good.
The Washington Post recently ran a story called 5 Myths About Our Ailing Health-Care System. Many of the arguments discussed here are addressed in that article.
I found this interesting:
A very large proportion of our health care bill in this country goes to providing "treatment" that is at best experimental (and at worst, formerly experimental but now pretty well proven to be worthless) for ailments that they can do nothing about but won’t admit it; primarily cancer. These "treatments" have nothing going for them other than that they are extremely expensive.
If the government would pass a law making it illegal to charge people or their insurance companies for experimental treatments, the cost of health care would plummet. Then they need to hand the insurance companies a dictionary, because their cherry-picking people who can prove they’ll never need to pay them anything demonstrates that they don’t know the meaning of the word insurance!!!
Oh, and Caidence, as far as antibiotics trying to "beat evolution": All those "new" antibiotics that cost so much are very minor chemical variations whose only purpose is to allow the drug companies to give them new names and charge an arm and a leg for something that’s in the public domain. Not counting the sulfa drugs, there are exactly seven different antibiotics, and the last one was discovered in 1964. Evolution is winning.
Part of it too is another kind of inefficiency, that of excess equipment that sits around unused most of the time (but costs money to get). I remember reading an explanation of this: everybody wants to boast that they have, for instance, the latest in MRI technology, so one small city might have three different hospitals which each get the new MRI machine at oodles of monies apiece. Even if potential patients don’t actually need to use that MRI, the impression they get of hospitals that have it is that they are better and more cutting edge than hospitals that don’t. However, the actual need of all the small city’s residents combined for MRI’s would only keep one of those machines busy, and if the healthcare was managed, only one of the hospitals would have gotten that particular machine (the upside here is there’s always a machine available to do a scan with no waiting. The downside is that it’s expensive to have the damn things sitting around not being used so either the cost is repackaged as operational costs and added to the cost of a "visit" or "stay", or else that the hospital tries to recover the costs more directly from the insurance company by overusing the MRI. No such thing as a free lunch, donchaknow.)
So that’s a bloated cost because the hospital’s individual interest is to have the machine that goes ping and the most expensive machine in the hospital because it looks good to potential patients. The insurance company’s individual interest is to offer discounts and incentives to their real customers – corporate HR execs – and then cut expenses by not paying anything they don’t have to (and the worse their reputations for denying claims, the easier this gets for them, because when people avoid going to the doctor altogether out of fear that their claims will be denied, the better for the insurance company). The patient’s interest doesn’t figure into it, but hey – if he ever needs an MRI, there are lots of machines and no waiting.
I’m a Brit and I worked for the NHS and I lived in France and I live in the US and I’d just like to say:
I’ve been in emergency rooms in all 3 countries and the level of care is pretty much identical. The only difference in the US is that there is carpet in the waiting room instead of linoleum, and you get a $500 copay at the end.
Forget the NHS as a model for US healthcare – focus on France, which is much more freemarket orientated, and the quality of care is superb. Even with a top-quality PPO plan in the US, you still don’t get the same level of care as you do in France.
For all the bitching about the NHS, Neither I nor any of my family have ever not received any necessary care, ever. If you want to talk about costs, my father received 4 years terminal care at a state-of-the art Hospice, and it cost NOTHING, NADA, ZILCH. Here in the USA, my mother would have had to sell everything she owned to pay for it.
No, you come on.
It’s your sentence. Explain it.
Various insurers decide right now, based on their p/l projections. I’ll take career civil service MDs, thank you (if we’re positing possible scenarios)[email protected]:
No, you come on.
It’s your sentence. Explain it.
Various insurers decide right now, based on their p/l projections. I’ll take career civil service MDs, thank you (if we’re positing possible scenarios)."
Ok. Ok. I’ll try to explain what I mean when I say that disease and trauma should be treated to the extent that that can be treated.
Any type of acute trauma ( vehicular, industrial, gunshot wounds, basically anything where there’s blood or broken bones) should be treated in a fashion where the goal is to preserve life with the view of optimizing quality of life going forward.
Where chronic disease and cancer is concerned, these conditions should be treated with effective surgical techniques when warranted by a doctor who will also prescribe appropriate use of drugs (including chemotherapy) to be employed for healing and recovery toward optimizing quality of life.
Please note that "Quality of Life" is a subjective condition around which standards may be agreed to.
re: "Bogus dichotomies".
Not everything is black and white. Sometimes, discussion of that which does not yet exist requires a philosophical (something unquantifyable) approach.
@passerby: thanks. as a blog commenter who is NOT in the health care industry (ie., the usual big mouth), i don’t see anything to quibble about with your propositions and i appreciate you taking the time to clarify.
i also agree that everything is not black and white. my objection is that often philosophical constructs are deployed as roadblocks to reform (their abstraction works either as a distraction or as an incomensurable [sp]). it may be that a philosophical objection can and should trump some action. but that objection should itself be subject to some scrutiny.
my objection in this thread was that use of the argument that because some people will object to any limit of their use of a health care system therefore we should not have some form of universal care. to my mind, that’s like saying we shouldn’t have banks because some of them will be robbed.
it seems Sullivans complaint comes down to Government being in charge of how to spend the money instead of a private insurer.
Still, if he thinks $2k a year in England doesn’t do enough, while we spend $6k here for less with private, well maybe we could find a middle ground like $4k a year here with the Gov dividing it up.
Still just by going to the Gov route we can get rid of a few stupid layers of bureaucracy and wasted spending.
1. Private Insurance
2. Malpractice Insurance
3. Initial MD training
4. Continuing education
Then increase funding to research, and preventive medicine. Doctors won’t have to make as much if they’re not drowning in college debt and insurance costs. I know many also would be very happy to do 8 years of "public service" after 8 years of school to pay off those 8 years.
@Damned at Random:
There is not that much chance in a universal health care system that you specifically will be denied a procedure by a government bureaucrat. You might be put on a waiting list (and die in the meantime) for expensive procedures for which there is a limited budget, but it’s the doctors who decide if a patient get the treatment, not the insurers.
Once the doctor has decided that the procedure is needed medically you can be more or less be assured that you will eventually get it (unlike having to wrestle you insurance company to approve it), and if the waiting time is significant, all parties involved are aware of it and any needed interim treatment can be worked out.
1. it costs too fucking much
2. it delivers too fucking little to sick people
3. EVERYONE MUST BE COVERED
Hey, hulu.com has a guy ritchie movie.. Lock, Stock, and two smoking hot women.. er.. maybe I got that title wrong..
BTW I know that the Brits seem to have only a passing acquaintance with oral hygiene thats for sure. I have never seen so much yellow teeth. It’s quite frightening. In Ireland, there was one guy who tried to glue his front tooth back… man.. hehe
Comrade The Other Steve
Naw, here in America only the honest people do that. The rest of them give their money to their children and then expect the state to pay for their hospice care.
So really it’s a similar system, we’re just less honest about it.
Wow, Andrew has really gone off his rocker this week.
He all but implied that African-Americans deserved AIDS because they see homosexuality as a sin, thinks he’s such a moral crusader by calling Mumbai by its former colonially-tinged name Bombay, and now this.
This is a complete, ignorant lie. I’ve been living in the UK for four years now. My co-workers were the ones who once told me the stigma works exactly in the opposite direction. People who don’t visit their GP are considered to be fearful children. Going to the NHS is as normal as queuing at a Royal Mail office (but then again, a nationalised postal service is another demonic construct of socialism).
First, having been through the US health care system some, I am surprised that there is not a bloody revolution starting in some Doctor’s office on a weekly basis, with the mob then going after the insurance companies.
Second, I have lived in France, and the French system is way better than the English. (The English system tends to involve long waits for anything that is not an emergency.)
An example of the basic coolness of the French medical system :
In France, my son needed something looked at. At 9:00 AM, we scheduled a Doctors appointment for 11. The Dr said he needed an ultrasound, that was scheduled immediately in a clinic down the street, and the results were looked at by 1:00 PM. The total cost was 20 Euros, and the total elapsed time from 9:00 AM was 4 hours. In the US, that same process would easily take a week, and cost a bundle (without insurance).
Sullivan’s argument is essentially that Americans are to much the spoiled whiny bitches who demand everything and want to pay nothing for them to ever accept a British style health system. And then he says that this is a good thing!
@Caidence (fmr. Chris):
To point out the obvious, most cancer treatments are already legislatively made "free." (Caidence implies single payer = free)
It’s called Medicare.
Whats more, more medical research, world-wide, is funded primarily by governments. Except for here, which is why we do such a good job with erectile dysfunction medicines.
Henry David Thoreau is hardly a good indicator of American attitudes. Especially today. If anything part of our present problems come from our failure to appreciate the "quiet desperation" that is always there. We’ve learned how to avoid thinking about it.
I’ve always assumed that Thoreau was lamenting that "quiet desperation", but now I begin to wonder if he was actually acknowledging its reality and, perhaps, its necessity.
Nationalized healthcare systems pay about 2%-3% in overhead costs.
The US healthcare system pays 30% in overhead costs.
Please explain where the extra government paperwork is going to come from, remembering that Medicare, Medicaid, and the parallel state programs have overhead costs of — that’s right — 2% -3%.
Must be some Japanese culture I am unaware of. Japanese are quite happy to go to the doctor and receive excellent service. Hell, people go spend a few days in hospital when they have the flu, just because there isn’t enough room in the house for someone to be laying around sick all day.
@Caidence (fmr. Chris):
Ever since the site redesign, the pie filter hasn’t worked for me. Help?
Dennis - SGMM
According to the US Census Bureau, as of 2006 47,000,000 Americans (15.8% of the population) had no health insurance. Considering that 2,000,000 more Americans lost their jobs this year the number is probably far higher.
So, there you go: 47,000,000 points of failure.
Here is the bottom line. My husband is a teacher, so he has relatively good health insurance coverage. He has been sick every year for the past three years, which means we have upwards of $2,500 per year of unpaid medical bills on his credit report, the hospital bills 15,000 for a three day hospital stay, his insurance pays whatever and they STILL bill him 1,500 co-pay, why cannot these health providers just accept what the insurance company pays them? Why do they have to go after the patient for the piddling amount left? It makes no sense. And speaking of the British health care system don’t knock it until you have tried it.
Is that whole original post of Sullivan not an admission that he can’t/doesn’t want to purchase some health care or health insurance for his parents on that glorious free health care market in the UK, that exsist besides the NHS, from his Atlantic salary and speaking engagement fees? At a stretch, they can go to France for treatment, there are numerous private doctors there. It’s not illegal to bypass the NHS.
So is the Atlantic a volunteer job or is this another example of conservative "family values" and "practising what you preach"?
So if Sullivan is so much for the free market in health care and health insurance, which don’t his parents buy some additional health insurance, or just go to a private doctor (in France if need be) and pay for it directly?
It’s not that getting medical treatment outside the NHS is actually illegal in the UK. There is a free market in health care there as well. And if Sullivan’s parents can’t afford it, surely the money he make from the Atlantic and his speaking engagements is enough to pay it for them? Or is this another episode of conservative "practice what you preach" and conservative "family values"?
I’ve been doing emergency medicine for three decades now. I’ve seen too many instances where patients and their families have been distracted from focusing on serious medical issues by the worry of how the bills would be paid. The US health care system is both inhumane and inefficient, an assertion supported by the fact that we manage to achieve results comparable to third world countries while spending nearly twice as much per capita as the next most expensive system in the world.
There are many villains in the story, including, but not only, health care executives and their 7,8, and 9 digit incomes, insurance companies and their 30% administrative overhead, pharmaceutical companies that spend more on marketing and advertising than they do on R&D (personally, I would advocate nationalizing the drug industry within the NIH and universities, where most of the basic research is done anyway), and physicians who make considerably more than their counterparts in other developed countries (I’ve read one estimate that we could save almost $100B/yr if doctors in this country were paid similarly to doctors in France or England).
One place to start is H.R. 676 (the United States National Health Insurance Act, aka "Medicare for All"), introduced by John Conyers in February and now with 95 co-sponsors. Call your rep and tell them to support it.
I was in India when that stupid decision to change the name from an internationally recognized name known around the world. It was a fucking brand. Callously thrown away in the name of local politics. Every indian paper in Bombay came out against the name change. Morever all the english names in the city was named. Most of the locals still call it by the old names cuz they are good names. Only the marathi people are happy by the name change. The rest believe it was a cynical move to garner votes. Another decision where they ignored the middle class in favor of dead beats that don’t pay taxes.
Mumbai sucks sorry. It sounds exactly like a fishing village it was originally. Fuck that. Unfortunately, the disease has spread to the rest of India. Imagine a country where every state speaks their own language, and then each state decides to name every major city after the local language unpronounceable by the other inhabitants. Does wonders for unity. Easy names like Trivandrum is now Thiruvananthapuram, how fun and touristy.
Whew! I didn’t think I’d rant like that. Some decisions really piss me off.
ps btw I can say Thiruvananthapuram, but I have to internally remember Trivandrum is now Thiruvananthapuram.
Yeah, you should see when they are tourists in other countries. Observing american tourists out of their habitats being whiny bitches who demand everything is simply embarassing.
This was probably already mentioned upthread, but I think the administration costs right now are like 23 or 24 cents on the dollar, whereas medicare is 2 or 3 percent.
The basic problem I see is trying to fit a square peg in a round hole. Meaning healthcare is not, or morally should not be left to the whim of free market only. In that arena, the number one rule is that there are going to be losers and winners, and that’s fine if your talking about stereos or cars or whatnot. But the losers for healthcare often die, and for a supposedly moral nation that shouldn’t be the case. And because it is a vital service, that is often fatal if denied, what happens is the normal supply and demand component of free market delivery get skewed and non functional because of the moral element. Most uninsured folks get some kind of care, usually the emergency kind with little follow up until the next crisis and the taxpayer ends up footing the bill for high cost deliver when if every one was covered there would be continuity of treatment and preventive care. I’m rambling, cause I don’t know a lot about this subject, but it seems to me a single payer system would keep the free market element and would by many ways reduce the cost to taxpayers in the end.
@Litlebritdifrnt: Slightly OT: I’d check what the insurance company actually paid, not what they were billed. If you have co-insurance, which is what it sounds like, the 10% co-insurance payment would probably be lower.
In Australia, the amount paid to a pharmaceutical company for a drug under patent, where the drug is a new breakthrough (as opposed to a ‘me-too’ patent) is almost identical to the US price. Drugs from ‘me-too’ patents get less, but still more than generics.
The French pharmaceutical industry does very well from domestic consumption, even before you figure in US income.
And as for research? There’s a dude in the University of Queensland who creates cancer vaccines. Cancer motherfucking VACCINES. He’s done one that covers the majority of cervical cancers; he’s got a skin cancer one in lab tests at the moment. Governments fund research plenty now; they’ll keep funding it, as will the Pharmaceutical companies, and research will keep happening even if the US stops paying Big Pharma whatever they ask for.
It does exist; just not in America.
If you don’t currently own a car, do you discuss what you would like in a car in a philosophical fashion, or do you look at the cars that are available and decide which one suits you best?
Dennis - SGMM
Have you listened to any of the ads for prescription drugs lately?
"Don’t suffer the misery and embarassment of sweaty palms! (Cut to attractive woman staring at her palms in dismay)
"Palmitol can relieve palminary hydrosis in a matter of days!
(Show full screen picture of Palmitol package and dissolve to same woman strolling along a beach at sunset with a man)
Then, no matter how trivial the condition these "wonder drugs" are supposed to treat, comes the disclaimer:
"In some subjects, Palmitol has caused projectile vomiting, full-blown aids, diarrhea, fainting, loss of bladder control, paralysis, and in rare cases, death by asphyxiation. Stop taking Palmitol immediately and call your doctor if you find yourself turning into a dugong."
pseudonymous in nc
Just to reiterate what I said at Ezra’s: Sullivan last lived in the UK in 1984. He left, at the age of 21, after completing a tuition-paid undergraduate degree at Oxford to begin a tuition-paid graduate degree at Harvard. Fair play to him, but had he been born in the US, there’s no guarantee that the Ivies would have been open to someone from his background, and to cast his British early life as some kind of Soviet-style raw-beetroot and bread-line existence is just disingenuous.
In the meantime, I can say that the NHS is a creature of the 1940s, but if it was a straight choice between that and the US "system" right now — and since it’s not, much of this discussion is daft — I’d take the NHS. (I’d guess that pretty much all of Sullivan’s peers at Magdalen who were studying medicine work for the NHS now.) Now, the country has the chance to build a system that keeps what Americans like about healthcare, and gets rid of what they don’t like. For everyone.
Uh-huh. I’ll just say that I’ve spent enough time sitting by the bed in NHS cancer wards to call bullshit on that one.
While there are good systems in other countries that serve their citizens well, converting the current American system from one that’s dominated by the private insurance industry and Big Pharma to one that uniformly serves 300 million people who live throughout 50 states (each with there own constitutions), will obviously be a massive challenge.
Present models from around the world will give us a view of what works well and what doesn’t.
How to accomplish this will involve discussion of many things such as: who loses their job, who gets a cut in pay, what constitutes abuse of the system, etc., etc., etc. What philosophy will be applied, and with what attitude will we approach this?
We have the chance to create something uniquely American (in scope alone), perhaps building some peripheral free market elements into it so that it does not become stale or heartless. Will there be rewards for efficiency at local levels? How will innovations that arise locally be successfully adopted into the main?
I’d like to see the creation of a system that breathes like the Constitution, allowing for growth and change as the times require. Basic goals and services would be "hardwired" into it" but it would not require an act of congress to make adjustments.
I’m dreaming of us having something better than what has been seen anywhere before.
@Dennis – SGMM: Think for a moment about what you’re saying. Drugs for trifles get advertisement because new life-saving drugs don’t need advertising. Even with a cut in basic biomed research for the last decade or so, we’re still cranking out life-saving drugs and treatments at a frightening rate. Not asking for a "thanks" because we get paid decent money (not MD money, but enough to live on), but unless you’re keeling over in the next two years or less, bad-mouthing medical research is shooting yourself in the foot.
The system is broken in so many ways it’s pathetic. I work on the inside of this system, and see how many dollars go not to patient care, but in trying to game the system. Pharmaceutical companies, insurance companies, medical groups – they all do it. And sometimes I don’t blame them, because the system as it is means some medical groups need to game the system to survive (large numbers went out of business in the past 10 years in California, can’t speak for other states), doctors often game the system to get what they feel their patients need. Administrative costs are high.
Patients with certain types of insurance will get their medicine for "sweaty palms" and those with poor or no insurance can’t afford their insulin or oral diabetes medicine.
From my perspective on the inside, Americans expect the wrong things from their health care. They want the drugs advertised on TV, whether they work any better or not, they want technology, whether it helps or not, and some turn up their noses at the basics which are measures of quality: long term aspirin for certain cardiac conditions, for instance. They may disdain generic old line meds which are proven to work as well or better for high blood pressure. I’m convinced advertising is the cause of some of the problems, and misunderstanding what medicine is about causes some of the others.
Most patients do not need a brilliant doctor, or "the best" doctor. Brilliant diagnosticians are jewels, but most people don’t need a brilliant diagnostician since most people have don’t have bizarre and unusual diseases. Most people need a competent doctor who has a good system. People were astonished a few years ago when one of the "report card" groups gave the VA such high marks; the VA has an excellent system. That system helps competent doctors deliver much better care that a brilliant doc with a poor system would deliver.
Why build something "uniquely American" if what other countries do works well?
The system I live under is "uniquely Australian" in certain ways. I couldn’t care less, and I’m not sure that it makes it any better than, say, France’s system. What I want is for it to work, which it does.
And all the other countries with universal healthcare did, at one point, transition from private healthcare to a public system. All of them have to deal with Big Pharma today – GlaxoSmithKline is a British company, and one of the other big pharmaceutical companies is French. The French and British are just as concerned about the viability of the Pharmaceutical industry as the US is.
Good luck with that, but the only way it’ll happen is to look at what is in the rest of the world now, and critique it. It’s not to philosophically discuss the viability of government-run healthcare, because that debate has already been won. It works. That’s why the rest of the world does it.
Dennis - SGMM
I’m not bad mouthing medical research, I’m bad mouthing Cures that seem to have worse consequences than the conditions they attempt to treat. Big Pharma does some estimable things, they also do some very bad things in the interest of protecting and enhancing their profits.
Advertising drugs (except over the counter stuff like painkillers and cough medicine) is illegal in quite a few countries. For good reasons.
Sully forgets that the UK also has private care. Totally private care, you have to pay for the lot. Not many people use it.
Because the only difference between the two is convenience, not quality.
For about the first 6 years of his life my son – who has a chronic and dangerous condition – was treated in the UK privately because the cost wasn’t very great (just a series of consultations really), and paying privately meant we could pick our consultation times.
Come the time for an operation (a serious one that cost real money) we were offered the option of going on the National Health.
Everything would be exactly the same, same surgeon, same hospital, same care. The downside: it would take about 6 months longer, not because of any real reason, but simply because we would have to repeat the entire consultative process with the same surgeon in a lengthy game of pretend
We would have to truck into London to see the same surgeon for a couple of consultations – where presumably he would just record the meeting, chat with us for 5 minutes "yep, still got it" and send us away – and then book the theatre.
It was going to be such a farce that I paid for the operation privately – which was carried out in a public hospital.
The only difference was the cost.
pseudonymous in nc
Sheer politics. The current debate is underwritten upon a few bullshit GOP tropes: "America has the best healthcare in the world" and "foreign healthcare is icky socialism". It doesn’t matter if what comes out is heavily influenced by Foreign: it has to be presented as a pure product of America. It needs to be fronted by Steve Carrell rather than Ricky Gervais.
On drug ads: during SNL, there was an ad for Abilify. This was, only a few years ago, an anti-psychotic prescribed to schizophrenics in managed mental health care. It was being prescribed off-label for bipolar disorder while the trials were still ongoing. It’s now being given to teenagers, and tonight I saw it advertised as a supplement for one’s existing anti-depressant. Taking Zoloft and still feel like shit? Take this drug! It’s tried and tested in the nation’s mental hospitals!
As it used to be in the US. For good reasons.
I got very tired of wasting time explaining to patients why the drug they saw advertised on TV wasn’t the only one for their condition, or even often the best one for their condition. I would much rather have used that time helping them understand their disease better. I held the line on drugs like Vioxx in people whom it wasn’t indicated, and was later damn glad I did. I’ve been around long enough to know not to prescribe brand new drugs unless they have clear benefits. I know plenty of colleagues who felt they didn’t have the time to explain why Mr. Jones shouldn’t have a prescription for the new wonderdrug, and just gave the prescription. Encouraged, I might add, by the new emphasis on patient satisfaction scores.
(I approve of patient satisfaction sampling, but some took it overboard.)