Me, discussing what I think will come from a future health care plan:
Again, the only real question is will we be able to summon up our American ingenuity and in our Solomonic wisdom make a single-payer system that tries to adopt the best of both worlds, does neither, yet still manages to make the members of the gilded class even richer and leaves us with the worst health care system in the industrial and post-industrial world.
Megan McCardle (via Sullivan):
All of the problems with the Medicare reimbursement structure–and the problems are large–are a result of a historical legacy that has hardened into a nearly immovable system. You can add to it, but no one has so far had much success with the substantial changes that would be necessary to make the system function better. It’s like trying to maneuver an aircraft carrier in your bathtub.
If we get national healthcare, we will not get anything like the neat little systems proposed by academics who can assume away many of the political problems. I am aware that proponents would rejoinder, that yes, they know it won’t be perfect, but . . . But I’m not making the perfect the enemy of the good. A national healthcare system in the United States will not merely be something sadly less than ideal–it will be nothing like most of the internally coherent proposals. It will be something jury rigged out of Medicare, S-Chip and insurance mandates, ugly and very expensive.
I just don’t see how anything will come out of Congress with enough votes that won’t be a disaster. Most of our elected representatives are entirely too beholden to the special interests that they represent. And I do mean most all of them. You can probably count on one hand the number of people in the House and Senate who genuinely have the best interests of the American people at heart (anyone here think Chuck Schumer and Chris Dodd and Maxine Waters and John Murtha and Diane Feinstein have covered themselves with glory lately?). Joe Biden voted for the bankruptcy bill in 2005, and probably has his hands as deep as anyone in the protection of credit card company abuses, and we just elected him Vice President (in fairness, there was no choice between Biden and Palin. Palin simply was not an option). Granted, admitting they are all awful plays into the Republicans hand, but the simple fact of the matter is I have very little confidence in Congress. The Democrats are only marginally better, and I never found “The Democrats are worse” to be a very persuasive message the last eight years anyway.
It is sad, but I am that cynical.
If this is true, maybe you could blackmail a few of them into voting the right way.
Yes, many (perhaps most) Congresscritters are pretty pathetic, but the biggest obstacle to reform isn’t Congress.
It’s (in no particular order) the health insurance companies, the AMA, and PHARMA.
Congress’ position/crazy contortions is merely an effect; these are the cause.
This is why I was arguing in a prior post that the collapse of the Republican Party is BAD for a multiparty system. The Republican Party may have long ago stopped being loyal to the United States of America, but so has the Democratic Party. It’s all about a bunch of self-interested procedural tricks and sophistic propaganda.
The last thing we need is a one party state in the United States. The GOP may suck, but at least they’re some kind of an opposition party. I don’t know what else to suggest, other than supporting third and fourth parties, and Kang and Kodos tells us what happens there.
"Go ahead, throw your vote away! HAHAHAHAHA!!!!"
Cynical is the only way to be on this issue. Maybe the reason Social Security was able to be implemented is because it filled a void. Health care isn’t like that–the system that’s in place is uber-shitty, but it’s in place, and the people who benefit from having that shitty system in place have gotten really fat on it, so they’re going to fight to keep it there. I know–obvious. Sorry, it’s all I’ve got–still on the first cup of coffee.
Oh, come now.
The Dems are both awful AND far, far better than the Republicans (not just marginally so).
Gotta increase the dynamic range of your evil-meter, JC.
It takes a special type of person to run for a federal office as a "representative" of "the people."
A semi-serious question: Is there a form of government that actually works? And "dictatorship or monarchy with a truly benevolent leader" is not an acceptable answer. Is the answer term limits? Public financing for all elections? We need to get rid of disproportionate representation in the Senate and allow the people of DC to, you know, count, but what else can we actually do?
Maybe I’m a closet Commie and just don’t realize it yet.
If an f—ed up program comes out of Congress it is going to be because of the system for passing laws in this country. There are too many choke points which is made all the worse by the extra constitutional choke point of the filibuster (or closure). In most or all western European countries the systems they have in place were the systems that the leadership of the parties that implemented wanted, not some jacked up Rube Goldberg version.
Personally I think for that reason Obama should go for broke on an intellectually coherent system, and if he doesn’t get it don’t pass anything and simply campaign around the country until congress gives you an up or down vote on the plan.
Yeah, this is key. People are making a boatload of money on this system.
Real reform in either the insurance realm or the medical realm would cost some very powerful people a lot of money.
No president who nominated Daschle for head of HHS is going to try to implement reform that will hurt those with a moneyed interest in the issue.
Best we can hope for from Obama is extending health insurance to the uninsured. As for making the system less jury-rigged and more rational, that ain’t gonna come from Obama.
The Moar You Know
I routinely vote for the Republican running against Feinstein. It’s the only time I vote Republican. She’s a disgrace to my state.
I can’t wait for her to either go for the governorship, die, or get primaried.
Its going to take a massive populist movement to adopt a coherent single system. I think if one is proposed that can rally people behind it AND if business sees that it is to their benefit (which most will since paying for insurance is killing them), then and only then will it happen. If left to the legislators we’re all fucked.
This means that Democrats had better start acting like the "Democrats" we rubes thought they were all along or be punished by voters. Part of the point of being a Democrat is not being Republican. Let’s try being non-Republicans with a dash of morals and see how that works out.
One thing that should be done is dramatically increase the pay of Congressmen (and concomittantly stiffen the rules against payback, to draconian levels). The system as constructed now filters for the independently wealthy and those who are willing to take a "second job" as handmaidens to moneyed interests.
Cf obligatory Churchill quote.
Absolutely not. Astute commentators point out that that just decreases institutional knowledge in a legislature, and it’s typically provided by the folks we don’t want to provide it.
That can help.
The Senate thing sucks, unless one bizarrely thinks that reactionary rural constituencies are most in need of protection from mob-like majority rule, but I don’t see how it can be fixed given the requirements for passing Constitutional amendments.
It’s just going to get suckier as the urbanization of the US continues.
Obama spokes people have said he is not going to radically change the system so we can dispense with single-payer notion altogether. That is unless, as bootlegger suggests, a massive wave of plebes just overwhelms him and Congress and I just don’t see that happening with our downtrodden masses at this time, since most of them are not starving, not yet. They typically take their places last in line since they are used to that, all the while thinking they are still better than the other guy b/c they still support the "free" market system and think populism is a disease. Not enough people have been educated enough, e.g., again, they are not yet starving.
Ted Kennedy wants this done. Hopefully he’s got pictures of all of them.
I agree that the dems are bad enough on giving aid and comfort to the "moneyed Interest" but that is like comparing the Chinese Flu to Ebola. Right now, dems have the numbers and public sentiment in their favor to pass something hybrid for health care reform. But a single payer system is the brass ring for making the system fundamentally different in favor of something sustainable and covering those without insurance.
It will be hard fought and a close call to get that right now. If the economy improves enough, the 2010 elections should increase dems numbers in the senate to over 60, since the slate of races once again favors them, at least in theory. If they pull it off now they will need to placate the repubs and significant number of dems and throw some big bones to the plutocrats to get it done. If things get better and they pick up seats, there will a better chance at real and focused reform IMO.
Much as it pains me to agree with McMegan, she’s probably right. A huge part of the expense of our health system is the insurance industry–bloated, inefficient (often purposely so), expensive and with profits predicated on denial of service. No one in any power position is even hinting at removing this costly and counterproductive administrative overhead; despite the fact that Medicare, whatever its problems, runs at a tiny fraction of the admin cost of the private sector. I think John’s faith in the system will turn out to be wholly justified.
John, you can be as cynical as you want, but the big question is whether in doing something we’ll make things worse. Certainly, that’s a possibility and imho it’s really the only decent reason to oppose reform. Personally, I think things are currently so bad, that even the nightmare scenario outlined by you seems like it has a good chance of offering a material improvement to our current health care "system." In my view, that means we go forward, recognizing in advance that whatever we come up with will be bad, maybe even horrible—just as long as we understand that the alternative of doing nothing is worse.
I have to agree — I think the new "system" will leave the existing insurance and provider structures in place.
I expect the plan will be that the taxpayers send gobs and gobs of money to insurance companies to subsidize the provision of insurance to the uninsured.
Small business and strapped corporations will dump insurance as a benefit and rely on government-subsidized health-care for their workers.
The provided insurance will be lousy and degrade the quality of care for many people, but fewer people will get no care.
All-in-all, I expect it to be hugely expensive and to provide worse care on the whole than exists in the US now.
If anyone doubts this is a likely scenario, consider that the Obama administration is considering making veterans purchase subsidized private insurance.
Obama addressed this yesterday, when he said we can’t just add 45 million people to the existing system, because the system is unsustainable.
I agree with Mr. Cole on this. The current leaders in the Senate, if I’m reading McCain’s ranting right, are John McCain and Harry Reid. McCain takes more money from the health care industry than any other Senator, and Reid is (in my opinion) not so much a bad tactical leader as he is a completely compromised pol. I think Reid and McCain essentially were in cahoots on Abramoff. They conspired to protect Congress from any accountability on Abramoff. I watched the hearings. That may well have been the point of the Abramoff hearings: to protect Congress.
Congress is broken. I don’t know how to fix it.
The massive overhead is what is dragging the current insurance / health care system through the mud.
A handful of specialist doctors absolutely clean up in their trade. A handful of medical equipment vendors and pharmaceutical companies monopolize sales and clean up in the free market. A handful of massive insurance companies dominate the landscape with crappy policies that people can’t afford to not have.
If you reduce the cost of overhead in any of these areas, you are going to hurt someone’s pocket book. At the end of the day, the people who are going to have to sacrifice are the ones with the fewest Washington connections and lowest paid insider lobbyists.
Fortunately, we’re in an epically shitty economy. If companies start cutting health care to save a buck and insurance companies start eating themselves with their overwhelming overhead costs, you might start seeing cracks that a universal health care policy can punch through. Alternately, non-insurance corporations can unify against the private insurance industry. There is a great deal of money to be made for businesses that wouldn’t have to fork over millions a year to keep their staffs insured.
But that hasn’t happened yet. And until it does, you’re right. We’ll be left with an insurance system that costs a fortune and serves absolutely no one.
If they want a soluion that doesn’t involve nationalized healthcare, the only viable option isn’t a pretty one.
1. Remutualize health insurance via tax incentive.
2. Restore the non-profit model to the creation of hospitals via tax incentive.
3. Make medicine a five year degree, and quadruple the number of doctors in training.
4. Prohibit consumer advertisement of controlled substances.
5. Ration third party payment for end-of-life care.
We’re not getting single payer any time soon, if ever. I think the best we can hope for is:
1) Some Medicare-like pool for the uninsured and those that can’t afford their current insurance. It will have the same problems (and benefits) that Medicare/S-CHIP do.
2) Maybe we also get a few useful regulations on the private insurance companies (no more pre-existing clauses)
3) Price negotiations with Big Pharma for Medicare Plan B.
But that’s about it. And unless we address costs (which we likely won’t), more an more people will be thrown into the new public pool (which is 1/2 desired by private insurance and 1/2 feared by them).
Then, down the road, we’ll have to reform the Medicare/public pool with cost controls, electronic medical records, blah blah blah. We’ll eventually end up with the vast majority of people in some kind of public pool, and we can only hope the public would actually support fixing whatever problems that pool has.
It’s like the stimulus bill. Democrats are so "cautious" and there’s so much opposition from the dishonest Republicans, that you can’t get anything resembling the "right bill" passed the first time around. Something which Republicans then later use (shocking) to oppose the second bill "righting" the situation (read: you couldn’t get things right the first time, so how can you be trusted now).
Wow, think about it, tho. If Dems could push through a single-payer system (just dreaming here, of course) they would be set for years to come. They should put all their energies behind this but, eh, as we all know, there are other interests involved besides ours.
"It’s like the stimulus bill. Democrats are so "cautious" and there’s so much opposition from the dishonest Republicans, "
I agree with this but I think they are being stupid and short-sighted about their electorate. Erhm, that is if the electorate has stopped being stupid and short-sighted itself. I guess I don’t have much faith in either – Congress or the peeps. Ugh, depressing. We need a sea change.
Oh please. Of course it is, and always will be, as far as any particular constituency getting every thing it wants. And that is precisely why the Senate was created in the first place. When it begins to look unbroken with a rubber stamp on House majority rule, then we will really need to worry.
In just a few months, there has been a steady stream of progressive bills passed this year, that is unprecedented since the 70’s. IE Ledbetter, CHIPS, Stimulus, omnibus, etc…. The money that will begin to flow into progressive programs is nothing short of jaw dropping when compared to the last 30 years. But there are always some who insist on making perfect the enemy of the good.
I agree with that, except that I think #2 won’t happen. The votes won’t be there in a thoroughly bought-out congress. What could happen is that the insurance companies agree to offer insurance for those with pre-existing conditions if the government sends them loads of money. This of course will be more inefficient than the government directly insuring those people, but we’re constrained by "the possible".
The reason that we’re going to get the screwed up system that McCardle predicts is because of corporate shills like Megan McCardle who fight reform.
Add this to the long list of problems with McCardle:
She’s completely unqualified to offer any sort of economic opinion but she says the right things so she’s promoted by her corporate masters. Like most libertarians, she has no actual ideas; she is only good at complaining. Glibertarian describes her perfectly. To top it off, she is incredibly thin skinned.
How does the Atlantic manage to have two types of writers that are so far apart? They have qualified, interesting writers like Fallows, and then they have the goof squad of McCardle, Goldberg, and Douthat (well, not anymore), and very few people in the middle.
Does anyone know of a good study that breaks down health-care costs in the US? What makes up the majority of the costs, if anything? I’d like to know what part of the cost goes to medical equipment, doctor’s fees, nurses, drugs, etc.
While I’m willing to offer opinions on things I know nothing about, it did occur to me that when suggesting ways to contain health-care costs it would help if I knew exactly what was driving those costs.
The best comment on government I’ve ever heard comes from a Canuck funnyman Rick Mercer (kind of the Canadian version of Jon Stewart)
"Democracy is the process in which the people determine the government we deserve"
In order to get single-payer through, you need the people prepared to accept the following:
Massive job losses as the health care bureaucracy (which is a huge portion of health care costs) is reduced to a natural sustainable level. I’m not just talking insurance companies, I’m talking about service-side personnel as well. For what it’s worth, Obama dismisses single-payer for this sole reason.
For a large portion of the public to accept that just because they’re a bit luckier that they are no longer at the "front of the line". They probably never were at the front of the line, but you’re fighting the perception. Which is breaking down slowly, to be honest, but it’s still there.
And you have to fight the S-word tag. Which again, is breaking down but it’s still there.
Oh. And if the financial crash didn’t already do it, it would probably result in a gutting of the financial markets. (A lot of insurance funds go into the markets)
Blaming Congress-critters and special interests solely is missing the point. If there was enough pressure by the public to do it, they would do it. But the pressure isn’t strong enough that the public would ignore the massive potential down-sides of the process of the changeover. Selfishness and greed still trump the greater good. And thus you get what you get.
You can imagine how the bankruptcy reform bill sailed through when you look at the people who agree with the point that "irresponsible" people deserve to be punished. In their eyes, the reform bill did this.
Yes, and she’s been complaining quite a lot lately, and it’s really brought out the wingnuttery in her comment section.
Yet the only political position that does not seem to get a voice in this country is that of the DFHs. The Dems would be better on this issue if they’d listen to the left.
And I think to be fair, the Republicans have poisoned the well. For whatever reason, the most efficient health care solutions can’t even be discussed in this country. Even now the politics don’t allow it.
Ideally what I think should happen is some sort of universal / mandate components with a complementary government program to pick up the slack. Do what’s feasible now in terms of getting some sort of public option that isn’t the VA or Medicare. It won’t fix the cost problem because we won’t get rid of the current system.
What it means is that we have some place to fail over when the insurance industry becomes unstable. Like FDIC helped during this crash, when unsustainable health care really hits we will have the public program to fall back on. At which point it will probably be made universal single payer.
Obama’s an incrementalist and views things in the long term. This is certainly the strategy I think is the best bet in this environment.
Edit: must stop posting for a bit. Must be extra chatty today.
Newflash to you and Megan…..Medicare is a very successful program. The reason it is so expensive is because it covers the most sickly group of people in country. If these people didn’t have insurance or used a private insurance plan then your insurance premiums would be much much higher. Another side effect would be that many more elderly people would be dead right now.
Megan preempted a ‘perfect is the enemy of good’ rebuttal but it is still valid. Medicare works. If we do end up with a national health care plan it will work too.
The market can’t fix this problem. Anyone who thinks otherwise is fooling himself.
Well reasoned. I agree.
One issue not being accounted for is all the corporations that are pushing for a total reset of the system. It is affecting their worldwide competitiveness as well as their ability to keep costs under control while retaining talented employees. One of the reasons real wages have not gone up is employers are spending a higher percentage of total employee costs on health care. This is not just the auto industry, but everyone, including high tech. Their is a lot of money represented there.
This is one of my favorite blogs for a reason. It displays high wisdom from musings like this one.
Our medical system is obviously broken but it’s slowly and surely being fixed. But not in the way anyone expected.
What’s happening is that people in ever larger numbers are taking plane flights to India and other third world countries with high-quality but dirt cheap medical care and they’re reducing the cost of their medical procedures by 90%. This is happening right now only with the upper middle class, but as time passes it’ll become more and more common for middle class people to do. The lowest-income quintile is screwed, but they’ve always been screwed. They’ll be stuck using medicare forever. I don’t see any solution for medical care for the underclass, ever. But the underclass has always been an intractable problem, and that’s a different issue.
The essential problem remains that medical care and dental care are hideously, wildly, insanely overpriced in America. ICU nurses make salaries starting at $150,000, RN’s start at $70,000, any doctor with a specialty in demand like orthopedic surgery makes millions per years, and hospital administrators are just as wildly overpaid, typically making well over $300K per year. Independent clinics and private medical labs make absurd amounts of money, overcharging insanely for simple tests. Most of the labs and clinics are owned by doctors, who rake in vast amounts of money in addition to their regular pay. Dentists are so insanely overpaid it’s demented — a typical dentists makes anywhere from $250K to $500K. That’s crazy. It’s completely out of touch with the skills that are involved.
Insurance companies, private labs, American companies that build and operate MRI machines, doctors, hospital staff, nurses, all grotesquely overpaid. This is a river of gold flowing into these peoples’ pockets and I don’t see how anyone is ever going to be able to stop it. There are just too many people making too much money off sick people.
So instead what will happen is that all the sick people who can scrape together $5K or $10K will buy tickets to India and get that $150,000 operation for $7500. Instead of paying $5000 to get their teeth fixed in America, they’ll fly to India and get it done for $500. Medical tourism is a large and growing industry, and it hasn’t even gotten organized yet. Wait till companies start organizing charter flights to cut down air travel costs and start lining up doctors and dentists in India who are willing to cut their prices in return for a steady stream of first world patients who pay in cash. That’s when you’ll really start to see the U.S, medical system crumble.
Our broken medical system will never reform itself and can’t be reformed. Instead, it’ll just collapse as everyone in America who can even remotely afford it (think: companies set up in the U.S. to provide low-interest loans for sick people to fly to India for medical tourism — that hasn’t started yet, but it will) abandons U.S. doctors and U.S. hospitals and U.S. dentists.
Me too. I would vote for a calico cat running against Feinsein. Look how much good it’s done us.
Fixing Congress? Well, the problem is that there isn’t any one thing wrong with our political system, everything is broken. Absolutely everyhting that can go wrong has gone wrong. Everything is so badly broken that there is not even any place to start. It is not a string with no end, it is a string with nothing but ends.
Our founding fathers are not spinning in their graves, they have left their graves and departed the planet in despair.
Don’t lose hope people, the only reason the brits have UHC is because of WWII. The public sector basically filled a need and then the plebs liked it and continued to support it. Maybe if there is enough global unrest and we find our selves drawn into a conflict (not a one-sided hit job on some small middle eastern shithole) we can ask the feds to step in. This is probably an easier course than running anything through our congressional offices these days
I hope you’re wrong too. Sounds spot on though. As much as we like to rail against Republicans, and as much as they deserve it, the Democratic party is also deeply wedded to corporate interests. It was Clinton’s administration that brought us such wonders as the repeal of Glass-Steagall and the commodities exchange modernization act.
Can we stop acting as though we had a two party system in which the Republican party played a necessary role? Even in a one party system there will be highly divergent interests between party members based on location, history, and ideology. If the Republican party disappeared off the face of the earth and we were left, technically, with nothing but Democrats *in every district* we would then see an ongoing debate between what is now seen as the center to the far left. What’s so bad about that? Right now we have had thirty years of polarizing debate between the far right and the center and anything slightly to the left of sheer lunacy has been labled "fringe." Its our host John C himself who asked what the "middle position" between "I want italian food" and "I’ want to eat tire rims" is in re trying to compromise with these lunatics.
I’d love, love, love to see a shift to a discussion of pragmatic and effective ways to achieve national health care in which the faked up hysteria of the pro-capitalist market crazies were simply excluded. I don’t think anyone who argues that
a) insurance companies are more effective
b) insurance companies are people too
c) healthcare is expensive so lets dump it
d) healthcare should be a for profit business
e) health care is not a right
f) people should die unless they are my relative
g) good people are always healthy and sick people are bad
should have anything to do with the debate at all. Period. megan McCardle is so fucking dumb that a cat could write her column *if it was on qualuudes* and her opinion of what will happen is utterly conditioned by her allegiance to a crappy economic philosophy which she herself poorly understands. I realize that politics is hard and it is going to be hard to get good votes on good bills but there is no way that Megan would like a good bill in the first place. Everything else she says is just boilerplate excuse making to cover the fact that she does, in fact, think that most americans are over insured rather than underinsured.
We could fix it if Mitch McConnell would man up and accept Reid’s challenge for a dual.
Or Boehner to stop crying long enough and pull Pelosi’s pigtails.
The Democrats have any number of issues, but they’d have to become about a thousand times worse before I’d even consider voting for the Republicans.
Now, as far as health care goes, I guess it’s too silly to hope that once a program is in place, we can improve it, as that would sort of prove McArdle’s point. Still, how bad would the sort of program that emerges from congress have to be before it was as bad as the system we have now?
Yeah, that’s where the problem is. /snark.
I remember late 90’s/early 2000’s when 1) everyone was complaining about rising health care costs and 2) companies like United Health were Exxon-like in their announcements of record quarterly profits. That no one could put two and two together puzzled me.
Whatever point you’re trying to make is rather diminished by this BS. RNs might start at 70k in NYC, but not in most of the rest of the country. ICU nurses do not start anywhere close to $150k. Orthopedic surgeons make bank, but very few earn millions.
@Andrew: Don’t get distracted by the numbers here. This is a workers not investors are getting paid complaint.
The insurance companies and and trial lawyers and administrators are the only folks making big bucks in the current system. They don’t even have the excuse that they add value. Even high proceedure specialists have had their income constrained over the last few years and at least actually touch the patient. The only real fat in play from the actual providers is the tests ordered defensively. If you thinks we can’t get decent health reform try tort reform.
I agree that the best we can hope for is a system where everyone is at least in basic coverage where a catastrophe doesn’t wipe you out. With some hope that more low tech and prevention is covered to help costs in the long run. But that costs up front money (that the critics will enjoy pointing out) as will the surge when long deferred care from the uninsured hits. We’ll get single payer when the system collapses enirely.
The next time someone screams socialized medicine just ask if they want to abolish medicare. They get the most astonished look when you suggest that a government run insurance company has lots of flaws but extending medicare to everybody beats what we got. Rich folks can pony up for extra special insurance and just like grandma everyone else can get a basic supplement policy. Too many gored oxes to get that through.
I can’t agree with this, but only because the Republicans are so frightfully shockingly bad. Pushing for a spending freeze in the middle of a possibly catastrophic recession? I’m not happy with Democrats in congress (though I feel sympathy because the challenges they are facing right now are huge), but I can’t agree their only marginally better than complete insanity.
Salaries aren’t the main problem, and if they were, you should be able to make a real argument instead of just making shit up.
Those are wrong numbers. The end.
I recall seeing a stat at one time on what percentage medical care was salaries, and it was surprisingly low.
@Andrew: Sorry. Conditioned by 30 years of right wing complaints about labor costs. I still don’t see a real problem with those numbers. I’m a programmer making around $60K. Do I think it is out of line for RNs to make $70? Not really.
Cole: ‘Most of our elected representatives are entirely too beholden to the special interests that they represent."
Damned Naderite is what you are. And ya’ know what we new-styled Dem progs do to them. Either stop this line of … ah, irrelevant egotistical insanity … or it gets the hose again.
@Napoleon: And salaries are even bigger than the malpractice lawsuits bogeyman – the only cost cutting solution the right has to offer.
I don’t like the idea of a private company participating in our receiving of so-called "health care" **. Millions of us pour money into a privately controlled pool. In return, we expect to draw out money when needed for medical care.
However these private companies have laced the system with co-pays and deductibles to the extent that we never realize a benefit from participating in the pool.
Further, these private companies have the power to deny coverage (same applies for home-owner, auto, etc policies) thereby delaying a payout and putting us in the position to dicker and fight for coverage when claim time comes. Many will not have the energy for the fight and will just give up.
Meanwhile, the private insurance company is gambling with this giant pool of money thereby enriching themselves and their preferred stock holders. They branch out into real estate developments, have stadiums named after them, and enjoy other high on the hog dealings while Aunt Flo has to decide whether to buy food or pay for Cousin Denny’s asthma medication.
Wrenching control from these companies, as noted above, will not be easy given that Congress serves them and not us. Beware of a plan that mandates coverage. It would mean a big win for private corporations making the system fascist at heart.
This is why I am for a nationalized coverage that aims to promote health and prevent disease, that prohibits the reckless trading and gambling of our money, and takes care of basic health maintenence.
Though I doubt we currently have the visionaries we need leading this charge, somethings gotta give and the insurance companies will not go down without a fight.
** Health care is the responsibility of each person.
It’s not cynicism is cold hard reality.
aimai, you are spot on — to borrow from the "broken Congress" comment, we need to wipe the "broken thinking" slate clean, the media debate must change which means they need to stop demonizing "the left" and automatically lumping people with common sense ideas and solutions into the big "left pile"
sickening, which is why I enjoyed the Jon Stewart interview so much — with a gazillion Cramers running around the teevee, and only one Jon Stewart to discredit him (& CNBC), that’s just not right
If you find yourself agreeing with McArdle, you may want to check yourself. She has a stunning track record of getting things wrong
I should be more specific: the main problem isn’t the salaries of medical workers. Administration and insurance salaries, that’s a different story.
Here’s a brief description of some causes of our high costs.
gex: I don’t think there is anything wrong with a nurse earning 70k. I hope my nurse girlfriend will earn that at some point. But it’s about $25k off of the actual average nursing wage.
@Andrew: Medical worker salaries are high, but its also worth noting that medical school is expensive as fuck. When you don’t even really start a job till you’re in your 30s, can anyone blame you for wanting to make six figures a year?
But yeah, I’ve got a friend training to be a pharm rep. He’s going to be pulling down doctor’s salaries for dispensing pills out of a bottle. Again, not that he doesn’t deserve it. The guy is acing grad school to get his degree. But perhaps we could reign in the cost of education if we don’t want to pay an arm and a leg for talented medical staff.
In fact, I’m much less cynical than many here, mostly because I think (a) the medical system is approaching the point of genuine, publicly obvious dysfunction, which enables more radical change than mere total suckiness, and, more important, (b) I have found as a so far unviolated rule that if you simply take the opposite position to anything Megan McArdle says, you’ll be right.
No. Again, this is not a major problem.
Now this, this is the problem.
Doctors are highly educated in a challenging profession where they make life and death decisions. Like airline pilots and other critical, difficult jobs, they basically deserve what they earn. In this way, they are the exact opposite of people in finance.
The administration, overhead, and over-delivery of medical care are the problems. Not doctors earning a good salary.
It still amazes me that anybody takes anything she says at all serious.
I frankly don’t know what is so wrong about the Medicare "reimbursement schedule". My wife has Medicare, and no physician has ever declined to see her, nor has any diagnostic test been refused.
That would not be the case if they were not making money treating her.
Extending Medicare to all citizens, with the government dictating lowered prices for services and tests, would in fact be a basis for perfectly good national healthcare. Private industry could play a role in providing Medigap back-up policies, or private policies for the very well to do.
This is a pretty interesting report. The part that shocked me were the rates of increase over the last couple of decades-see Category Breakdown
Insurers wouldn’t like it, but who cares. Big Pharma wouldn’t like it (Medicare could reduce the amount it pays for "me too" drugs, encourage generics, require more independent testing, etc) – but who cares.
I honestly think the hardest "nut" to crack, even with something like a good single-payer system, is getting rid of the perverse incentives that pay really low wages for internists & pediatricians and very high wages for acute-care specialists. General practitioners are forced to see people in 5 minutes or less to make any money (because they’re paid by procedure) – and they still make very little compared to other doctors. That "steers" medical students into the high-paying specialty fields, which (imho) leads to over-use of those specialists, with all their associated high costs, as well.
If someone can tell me how we can fix that, I’d love to hear it.
At my most cynical, I might ALMOST agree with Megan "2 by 4" (or maybe we should use her former pseudonym "Jane Galt"?) McArdle.
Except that Megan, being generally anti-government in her leanings, doesn’t have a good sense for how policy can evolve. As far as the health care plan goes, I think the most valuable parts of the plan are pretty likely to pass, and have a good chance of ameliorating our current healthcare debacle.
1) Any plan will involve some sort of a "public pool" for those who cannot afford health insurance. To the extent that there are cost controls on the public pool, this will put some pressure on insurance companies to control costs (if for no other reason than to avoid losing their customers)
2) Most importantly, the healthcare bill will probably create some kind of government entity/funding for efficacy testing. This is, honestly, where the real battle ought to be fought. Technological progress has been sort of a double-edged sword–while it’s produced a cornucopia of new drugs and surgical procedures, these are not necessarily effective. The whole angioplasty industry, for example, is a worthless crock (studies have shown similar success with drug treament, for a much lower cost), as is a lot of orthopedic surgery (spinal fusion, etc).
Most physicians, not having the resources, time, or empirical training to evaluate the effectiveness of medical procedures, have defaulted to a kind of fuzzy preference for the most expsensive, "hip" procedures and medications. These procedures and medications are continually produced, because the profit margin is high, and the medical research establishment is too underfunded and overworked to be able to evaluate their true effectiveness.
Of course, if medical efficacy research proliferates, and standards of effectiveness have to be adopted, it will kill entire medical industries. But it should initially appeal to the insurance industry–and to the extent that you can create a wedge between overcompensated physicians and teh bloated insurance industry, progress will be made.
@Andrew: Thanks for telling your ignorant lies. You’re doing a much better job of discrediting yourself than I could. Here are the facts: average starting salary for RNs with less than 1 year experience. But that’s average of small town hospital RNs and big city RNs. If we assume we’re talking only about a medium-sized or large American city, then my statement that a starting salary for an RN with less than 1 year experience is not only true, I actually understated the extremity to which RNs get overpaid.
@Zifnab: let’s not confuse doctors, who require a great deal of extremely expensive training, with nurses. A nurse needs only 2 years of college (which can be a community college, dirt cheap — you can even get your 2-year degree entirely online!) and then a 9-month nursing course, and you need to pass the nursing exam. That’s it. That’s all you need to become a nurse.
Moreover, these courses can be taken at a community college. Unlike a doctor, a nurse does not have to graduate from a fabulously expensive school in order to get a nursing license start work, nor to become an RN. The course requirements for becoming an RN are shockingly modest.
Want proof? Consider: here are the requirements for certification as a nurse in New York state. You need 2 years of college (not 4 years, two! It can even be a JuCo!) and you must complete a 9-month nursing course approved by the state of New York. Then you have to pass a nursing exam (which anyone with a pulse can do). That’s it.
That. Is. All.
That’s absolutely shockingly low educational requirements for the kind of money a nurse pulls in. 2 years of junior college and 9 months of rinky-dink courses at a community college? For a starting salary of $50,400? Holy crap, that’s absurd. That’s wildly overpaid.
"It will be something jury rigged out of Medicare, S-Chip and insurance mandates, ugly and very expensive."
If she doesn’t like jury-rigged, she should support sweeping away the entire crazy-quilt of insurance (non-)coverage we have now, in favor of a simple, universal single-payer program.
If nurses are so wildly overpaid, why is there always a shortage of them?