Now that the Global War Against Public Health Care is in full swing, let’s consider the main objection to it (the Times via Jon Taplin)
But critics argue that with low administrative costs and no need to produce profits, a public plan will start with an unfair pricing advantage. They say that if a public plan is allowed to pay doctors and hospitals at levels comparable to Medicare’s, which are substantially below commercial insurance rates, it could set premiums so low it would quickly consume the market.
Taplin makes the obvious point:
So let me get this straight. It’s not fair to have a public option because they don’t have to make obscene profits for their shareholders and they can use the leverage of the combined group of medicare and public option customers to negotiate better fees with doctors, hospitals and drug companies.
Isn’t that the point?
I support a public option for one reason and one reason only: I think it would save money. But then again, I’m one of those hard-line dirty hippies who believes in pinko things like cost-benefit analysis.
Sometimes, I think it would be easier to be one of those wooly-headed conservatives who dreams of a private solution or a Villager seeing visions of bipartisan peace and love:
Bennett, who is not on the committee, underlined that determination, telling me “we will fight almost to the last man and woman against a government-run plan, and not a few Democrats will join us.”
Wyden, careful to preserve his credentials within his own party, said he saw this fight as more of a broad philosophical debate about the role and scope of government, but he reminded me that his bill last year did not include a government-sponsored plan.
The time may come — either before or after the House votes on its bill — when Obama may have to demonstrate his flexibility on the issue of a government-run option. Wyden and Bennett are potential allies if he removes what Bennett calls “the rock” blocking a bipartisan bill. And the president couldn’t wish for better partners.
But maybe all this talk about health care is a mistake. Maybe getting love studies into our universities would cure all of our problems (from a particularly disturbing Brooks musing):
The most important decision any of us make is who we marry. Yet there are no courses on how to choose a spouse. There’s no graduate department in spouse selection studies. Institutions of higher learning devote more resources to semiotics than love.
The most important talent any person can possess is the ability to make and keep friends. And yet here too there is no curriculum for this.
When did conservatives become such hopeless daydream believers? I thought they were all tough-minded realists who saw through all the hippie utopianism. I thought they’d been mugged by reality.
Maybe they have been mugged by reality, and their response was to retreat from it.
Davis X. Machina
I can’t get my brain into a space where no plan, or a plan that didn’t work, in conformity to certain abstract principles — or ‘principles’, because they are widely flouted elsewhere — is preferable to a plan based on heretical ones.
At the margin I might care whether my brake shoes were made in a union shop or not. But first and foremost I want them to make my car stop.
arguingwithsignposts
I’m waiting for them to abandon their own “government-run” health care plan because of teh socia – lism. But I’m not holding my breath.
Mike G
…he saw this fight as more of a broad philosophical debate about
the role and scope of governmentdoing the bidding of insurance companies whocontribute to his campaignbribe him like a cheap whore.Kyle
The quickest way to get a decent public health care option in the country would be to throw congress off their gold-plated government health coverage.
Let these “magic marketplace” jerkwads go shopping for private health insurance (Pre-existing conditions? You’re shit out of luck!).
Northern Observer
Very perceptive.
What conservative leaders don’t understand is that there are no free lunches. You have to make choices and measure the outcomes. If the outcome is unacceptable then you are always free to change your mind. Back in the 50s public health care was passed over in the US and the employer insurance system was established. Looking back that was a bad choice that has saddled American businesses and American workers with ruinous costs. A public plan is the other choice. Yes, it involves sacrificing for profit medical companies and insurers; but the net benefit of that sacrifice for the economy and the general public health far outweighs the cost. Those that deny it, when you scratch the surface of the arguments, turn out to be free market utopians who are terrified of having their illusions burst by a concrete example of a non-market method providing a superior outcome. It’s all about political theology for the opponents of public health care. Does America need to hobble itself like this, for the sake of an intellectual illusion?
You’ll be amazed in the months that follow how many place the illusion over reality in their preferences.
dmsilev
Sheesh. That’s almost the Platonic Ideal of The Broderian Bipartisan Column. It’s got everything, the pursuit of bipartisanship as a desirable goal in and of itself, the idea that bipartisanship means Democrats cave to Republican demands but not the reverse, the insistence that the (Democratic) administration *must* be bipartisan. Etc.
Sometimes I think that Broder is just a slightly more sophisticated version of the old ELIZA program.
-dms
bago
Seriously, Liberty Prime is a more succint speaker.
North Dallas Thirty
It is amusing to watch people who for some reason aren’t aware that the only thing that keeps Medicare afloat is a tax levied on virtually every legally-working individual in the United States — the vast majority of which are legally barred from accessing the system in the first place.
Since the “public plan” can supposedly compete with private plans, then remove the government subsidy. Let the Obama Party run their “public plan” without any taxes and live off premiums and cost control, just like private plans must do.
Third Eye Open
In my own anecdotal experience with those opposed to public options, I find that emotional arguments fall on deaf ears, but arguing on the basis that private health care is a de-facto tax on small business and the self-employed cuts the legs from under most conversations. Where do they go when you tell them that corporate bottom-lines can only be helped by taking these payments off their books and spreading the risk across a much broader base.
The usual rejoinder is that this is shifting tax from one pocket of business to another, at which point I ask them to tell me which side of the Laffer Curve we are on, and why.
DougJ
That’s the idea, actually.
North Dallas Thirty
Or, more precisely, it’s the people who actually have jobs and businesses who know that, in the countries with the utopian leftist free healthcare systems, employers STILL have to pay for private insurance coverage for their employees — because the employees there demand it.
Comrade Dread
My main concern with government run health care will be waste and bureaucratic growth.
I’m not entirely convinced that it will be cheaper in the long run, given how government organizations have a propensity to grow, how spineless most legislators are when it comes to entitlements, and how few of them actually believe in oversight, accountability, and checks and balances anymore.
Martin
More embrace of the money shifters.
They aren’t arguing for doctors and nurses to make money, but the folks that pool dollars and dispense them at their own reward. Now, conservatives used to oppose government programs for doing that kind of reallocation of wealth, but here they are embracing and defending it for a group that doesn’t reallocate based on any principle at all other than what improves their personal bottom line. Why private entitlement programs are more noble than public ones, that have an actual responsibility to the taxpayer, is beyond me.
anonevent
@North Dallas Thirty: But I want to be able to choose to pay the money I currently spend on my employer chosen insurance on the medicare system so that can use it as my health insurance. If it then gets called a tax, I’m all for it.
DougJ
Medicare is administered much more cheaply than private insurance. And opponents of the public option admit it will be cheaper, that’s their criticism of it, in fact.
I do agree with you in principle about government organizations, but in this case, they can hardly do worse than private ones. (I don’t think this is true very often at all — health care is a special case.)
Michael
One of my officemates is a retired GOP state legislator who has had a great state paid policy his entire career as a result of his position.
He was whining just the other day, going on about “choice of doctors”.
I pointed out that at least with a public option, you had some electoral recourse on plan failures. he retorted with a “freedom, best care in the world”. We pointed out that no other advanced nation was signing on for American style care.
He also had no idea what the rest of us pay for care. I pay a bunch of money for insurance with deductibles so high that I wind up paying for 100% of my family’s treatment.
he was asking me about my $10 copay – I laughed and told him that I ay about $200 jsut to walk in to a doctor’s office, all over and above my insurance.
Another guy here pays $2000 a month. Yet another pays $1400 a month.
Bob was surprised and doing his patented Republican shrug over the rates we pay (as well as the annual increases). To top it off, he still can’t say what the GOP has to offer which improves the current status quo.
bago
@anonevent: He’ll have to find a way of putting it more succintly than Liberty Prime.
Martin
Shh, ND30 is busy fighting a crusade against legions of idol-worshipping Marxists deep in his imagination. Don’t disturb him or he might wake up and get lockjaw.
John T
I realize that you’re ideologically opposed to anything vaguely “public”, but do you even understand what “public” means?
North Dallas Thirty
No, it is not, for a very simple reason; you are not required by law to have health insurance, or to provide health insurance to your employees. Furthermore, providing health insurance to your employees or paying your own healthcare premiums and expenses when you are self-employed is deductible from your taxes.
What Obama is fully intending to do is to eliminate the tax deduction for both individuals and businesses and raise taxes to subsidize the government plan.
Michael
My local rant girl was talking to my idiot congressman, the chinless Geoff Davis. He was quite upset about the notion of having people in the mix who don’t deliver health care.
I was punching the headliner in my car about zillion dollar CEOs who’ve never applied the first bandaid, and wondering what ferretface thinks they’ve done in the healthcare field that entitles them to big bucks.
Roger Moore
@Comrade Dread:
This would be a more legitimate concern if the public plan were being compared to something less wasteful and bureaucratic than the private insurance industry. As it is, the private plans are much, much more wasteful than the existing publicly administered plans. Private insurers have had their chance, and they’ve done a terrible job. It’s time to give the government a shot.
scav
Oversight, accountability, checks and balances being the hallmarks of such large, reputable private enterprises such as AIG, Bear Stearns, GM, Enron and, most likely, the very company you work for. The longer I work, the less I believe in upper management and the more I believe in emergent control.
North Dallas Thirty
But I want to be able to choose to pay the money I currently spend on my employer chosen insurance on the medicare system so that can use it as my health insurance.
Then opt out of your employer’s plan and demand that Obama open Medicare to everyone, not just people over the age of 65 — but that he then removes the Medicare tax levied on all paychecks and requires Medicare to work solely on the basis of premiums.
You are not going to like the end result, I promise you, but far be it for me to stop you.
anonevent
@Comrade Dread: You mean as compared to the 37% increase in the cost of private health care over the last 5 years? How about the fact that Medicare is about 93% efficient at converting money sent in the program to paying for actual health care, as compared to the 60% that private insurance converts? Or how about the fact that Canadians live an average of two years longer, with both of those years being healthy years, on a significantly cheaper health care system, than here in the US?
Michael
OK. In the absence of siphoning off huge money to pay for solid gold toilets on annually replaced private jets (along with massive executive class bonuses, crony-based consulting contracts, grotesque marketing costs and some pretense of dividends to shareholders), I think it would do just fine.
Martin
Administrative costs for Social Security is 0.6%, which is lower than the industry average for investment funds and comparable to the lowest expense funds.
The government is actually very efficient with their entitlement program administration. Medicare administration should probably be a bit *less* efficient, because one downside of that efficiency is more fraud, due to less people investigating medicare fraud. There’s a break-even point, beyond which its cheaper to accept the fraud than to combat it, but Medicare has a ways to go to reach that.
tripletee (formerly tBone)
@dmsilev:
Slightly more sophisticated?
Still, I guess it’s more convincing that the North Dallas Thirty bot, which seems to have an incredibly limited database:
“It is amusing to watch (abortionists/leftists/Trig truthers) argue for (insert sensible proposal here) when in reality the Obama Party (insert tired wingnut talking point here).”
Comrade Dread
I have no particular love for private insurance companies. I’m reasonably healthy (thank God) so I’ve had little issue with them either, but I can empathize with the hell of losing your insurance (due to job loss) and being stuck with a pre-existing condition (as recently happened to my wife).
So I am in agreement that reforms are needed to get us off of employer based insurance and deal with ‘pre-existing’ and chronic conditions.
Probably true. (Though, I remain skeptical given how often the budgets for proposed programs is based on Enron accounting.)
But I would worry about the future. In the event that private insurers leave the market because they can’t compete, it seems more than likely that lobbyists for the medical industry would just start sinking their claws into Congress in order to get a bigger piece of the pie and the pressure for unchecked growth and handouts would skyrocket, unless Congress puts in some significant checks and balances on such a national program which seems unlikely.
North Dallas Thirty
“Cheaply” is the right word to use, true.
A private company could never survive with over 10% annual loss to fraud. But Medicare can, because Obama and the Obama Party just cook the books to cover up all the money they’re losing.
Of course it will be “cheaper”; it’s being subsidized by people who can’t participate in it. Let Aetna or BCBS charge people who don’t participate in their plans a 1% premium every month and see what they can do with their rates.
scav
Well, the gold standard of access is, of star-spangled course, being provided by private companies that charge you to pay for the paper pushers and land sharks needed to find reasons to deny you coverage.
North Dallas Thirty
Oh, and Obama Party leftists; how do you reconcile the proven, cited fact that Medicare annually loses 10% of its budget to fraud with your unproven, unlinked, uncited statement that it provides “93% efficiency”?
Answer: In the Obama Party, fraud is counted as providing medical care, even if it’s completely wasteful.
Martin
But they’ve controlled costs by denying legitimate claims and by canceling policies of people as soon as they get sick. They’ve got spreadsheets with lots and lots of numbers to show you how much they’ve controlled costs, and they have charts with trendlines showing how they’ll reduce costs to zero by continually improving their methods! They’re solving the problem!
gopher2b
The only benefit you are considering is the quantity of people covered. You are ignoring the fact that the quality of care available already available to many people will get worse under a plan like this.
Punchy
If you limit profits, you’ll limit salaries, which’ll limit how many Escalades each doc can buy, which’ll hurt GM to the point that they may go bankru……wait, nevermind.
DougJ
The same way infant mortality is so much higher in Canada, right?
scav
Hey, somewhat O/T. How much does the military lose to fraud? Can we get rid of it? /snark
ppcli
The Anti – Public – Health care argument in two easy theses:
.
a) Government run everything is an inefficient, costly, clumsy, bureaucratic abomination compared to what the private sector offers. (You want hospitals to be like the DMV? Haw, Haw.)
.
b) Government run health care will be so attractive to customers that it will unfairly drive private insurers out of business, since they won’t be able to successfully compete.
.
How many times have I read or heard both these arguments used in the course of one paragraph…?
anonevent
@North Dallas Thirty:
I know you are, but what am I?
Try saying something without sounding more childish than my four year old.
Martin
We reconcile it by noting that the GOP has continually cut the ability of Medicare to investigate fraud claims as part of their strategy to drown it. If you continually cut their administrative staff, who will stop the fraud? Like I said, Medicare should allow it’s overhead to creep up specifically to address fraud. It’d save the taxpayers a lot of money, but don’t blame Obama – he hasn’t had a single budget passed yet.
jayackroyd
Broder doesn’t seem to get that 85% of what Obama wants may include a public option. And that the republicans have no interest in even offering 50% of what he wants.
What this comes down to is what the Democrats are actually willing to stand up for?
schrodinger's cat
David Brooks is extremely disingenuous, he sounds reasonable but is not. He is always making excuses for the Republicans, he is just as bad as all the Fox blowhards, but with better manners. He is particularly hilarious when he writes about economics or science, this is from one of his recent columns:
After reading this gibberish I wonder how many classes in economics or quantum mechanics has he taken?
DanSmoot'sGhost
Yes, he has it exactly straight. And those obscene profits are driving the intense campaign underway to defeat reforms this year.
It’s going to come down to organization and money, just like the presidential campaign did. If you aren’t signed up for some action contacts, it’s time to do so.
Visit this website, and find a path to participation.
Watch the video too.
Last but not least, I urge the gods of BJ (if they support these reforms) to make action and organization an integral part of the presentation here until the issue is settled for this year. It’s going to be a long, hot summer!
Michael
I’m amused at the insurance industry. It charges a lot of money for a product that reminds me of smoke, and has somehow captured our legislative and executive bodies with an argument that it is somehow indispensible.
scav
Well, the general health stats seems to hold up fairly well under the more people getting at least some care rather than the wealthy getting their third bypass system. And what about all the orthodontists and plastic surgeons? Who will speak for those that whiten teeth?!
PeakVT
When did conservatives become such hopeless daydream believers?
When the facts became inconvenient.
Public insurance system = better results at lower cost. There can be no rational argument against this. Thus the endless supply of FUD from the conservatards.
TenguPhule
Like just about everything ND30 spouts off, this is a lie.
You are required BY LAW in several states to cover your full time employees with health insurance.
Zach
The insurers and drug makers are already leaning – hard – on vulnerable Congressmen. Frank Kratovil won by a couple hundred votes in MD-1, a very conservative district. I’ve seen several ads here in Baltimore (on broadcast TV) paid for by pharma and praising him for his work on healthcare (vote on schip, etc). You know what that really means now, though – they’ll pull their support if he’s on board with Obama and throw their weight behind the other guy. It’s a clear message.
So, Obama needs to grit his teeth and make a serious political sacrifice to get people in line on this issue (and on cap-and-trade as well, which has similarly intense industry pressure and is similarly vital to get right). He needs to promise to withhold the OFA and DNC voter files and any other party assistance from any vulnerable Dem that doesn’t play along without a really good reason (in a big-coal district in the case of cap-and-trade, the home district of Kaiser Permanente, etc). The advantage of building the best 50-state voter database by a mile is that access to it is more important than practically any assistance a candidate can get from industry; leverage that.
tripletee (formerly tBone)
@North Dallas Thirty:
So ND30 says this:
and then links to a report from December 2007. Presumably, among the many other Dark Arts available to him as King of the Abortoislamocommiefascists, Obama can time-travel at will to advance his insidious agenda of an affordable, sustainable healthcare system.
TenguPhule
Impossible.
For the simple fact that more doctors and hospitals would be paid because claims wouldn’t be denied at anywhere near the rate of private insurance.
gex
@Comrade Dread: You know this has already been studied. We spend about 5 cents of every dollar in public programs on administrative costs, while we spend 20 cents on every dollar in private programs on administrative costs. “Let’s study this” is just a way to kick the can down the road.
Remember in the early 2000’s where United Health care kept posting all those record profits, while employers were complaining about rising health care costs and employees were complaining about rising copays and less coverage? All we have right now is a severely distorted market where obscene profits aren’t being driven down by real competition. There’s no free market defense of the current system, but God forbid we try to have a public plan. There could be waste!
Comrade Dread
I make no claims with regard to the private sector, since the most inefficient companies are usually the largest and the most likely to be absolved of their bad management when the s*** hits the fan.
But I think it is a bit Polyannish to assume that government will be much better in the long run.
If the government becomes the chief insurer to the nation, (and assuming the initial projections are correct, there is no reason to assume they won’t) then the lobbying pressure will probably ramp up exponentially and we’ll have every medically related interest group lining Congress’ pockets and simultaneously sticking out their hand for a return favor.
It is entirely possible that I am overly cynical with regard to government, but we have been repeatedly burned by this in the pas, and I don’t see our ‘leaders’ having the fortitude or incentive to be any different this time.
SpotWeld
Wouldn’t the existance of a publlic plan allow the private insurers a release valuve to carefully suffle off all thier “low profit” clients?
How easy would it be for a private company to write up a small clause in a plan that pretty much states “if you get sick enough that you’ll cost more than you pay you’ll agree to switch over to a goverment plan, to takes-backsies”
The goverment plan will be a risk for losing money because of this, but in the end people will be getting care instead of stuck in an endless “review and derferral” cycle from a private insurance company
THis may be why medicare has the (yet unverified) 10% fraud cost. Medicare’s default is to provide care at the risk of a loss, whereas most private plans seem to default to denial of care when there is a risk of fraud?
Of course I really suspect the conservatives will balk and complain until some sort of “voucher” plan is set up where a client can take money and apply it to a private plan if they qualify.
Martin
Sure it could. It just perpetrates the fraud on the consumer.
Look, I’ve got C-level heath insurance execs in my immediate family. They’re married to people that fight health carriers on behalf of policy holders. I know this problem from both sides.
You blame government for allowing Medicare fraud without acknowledging that the fraud is coming exclusively from the private sector. Private insurers have high levels of fraud as well – lower, but that’s because they put more money from premiums into fraud detection (which is a good thing up to a point) but they ALSO perpetrate FAR more fraud on policy holders (and doctors, etc.) by illegally denying claims, canceling policies, and so on.
It’s not uniform, and you can find good outfits (my HMO is excellent) and bad ones (some of the Blue Cross orgs are horrifically bad), but Medicare fraud isn’t substantially worse than fraud across the industry – it’s just more visible, which is actually a benefit in that we can see it to raise a stink about it. How much of your premiums did your local insurer lose to fraud? You have no idea.
schrodinger's cat
@schrodinger’s cat
Sorry the block quotes are all messed, I tried to edit but the time to edit has lapsed. Everything, except the last line is from Brook’s column.
Chuck Butcher
What the soshulizm ass wipes can’t wrap their heads around is that we already have soshilized medicine. It is a bastardized particularly stupid greedy version of soshilizm where private health insurance and government run ones cover the costs of services provided to the uninsured and under-insured who can’t pay. The solution naturally was to increase the load imposed by bankruptcy.
kay
Republicans are abandoning Medicare?
I think they have to, if they have principled ideological objections to government-run health care. Old people love Medicare. My father’s old-man friends call it “the medicare”, as in, “I have the medicare, thank God…”
I had no idea. Do they run on that? My House member never mentioned it. I think that’s deceptive and dishonest of him.
Zach
It’s worth noting that progressives also display a bit of irrational fantasy when it comes to judging the virtue of greater socialization of healthcare. Comparisons are often drawn between the cost of care in America and in developed Western nations with nationalized systems of care; progressives deride critiques that focus on the NHS because it’s one example out of many. However, America has a higher poverty rate than those countries (roughly the same as the UK’s) and this correlates extremely well with health costs.
I’m not saying that I don’t support nationalizing healthcare to the greatest extent that politically possible – it does save money – but some of the comparisons drawn are pretty Utopian. On the flip side, the Swiss system that the GOP loves to pimp is the most expensive in Europe and provides subsidy at levels that are simply impossible in the States given our poverty level and revenue.
North Dallas Thirty
@Martin:
LOL….so you just quoted how low Medicare’s overhead is as proof of how efficient it is, but now are trying to argue that it’s TOO low and should be allowed to get larger because Medicare is wasting money on fraud.
By the way, do you know how private insurance stops fraud? By denying claims. Since the Obama Party insists that denying claims is wrong and it will never do it, how, exactly, do you intend to cut down on fraud?
Name them.
What liberals don’t realize is that the “requirement” for health insurance in the vast majority of cases — Massachusetts being a notable exception and a basket case all its own — is made as a requirement for getting government contracts.
Comrade Mary, Would-Be Minion Of Bad Horse
Disingenuous at best, bullshit at worse.
Here in Canada, we get our medical care paid through a taxes paid by employees, taxes paid by employers and/or individual paid fees — the exact combo varies by province. In Ontario, our provincial OHIP plan covers all things medical except for drugs, dental, optical and physio/paramedical. I had major surgery as a teen COMPLETELY covered by OHIP and had some (prompt, no waiting list) elective surgery a few years ago also COMPLETELY covered by OHIP. I’ve had ongoing care by a GP, gynecologist, and a few other specialists over the years, with every single doctor chosen by me, not assigned to me by an HMO, also covered by OHIP.
Employers offer extra insurance for the stuff OHIP doesn’t cover. As a small business owner, I now buy my own extra insurance. For about $90 a month, a decent rate for someone in her forties, I get 90% of my first $2000 in drug prescriptions and 100% of the next $6000 over the year, $750 each year for paramedical treatment (ask me about the last year of physio, completely covered by my premiums), up to $8500 a year for durable medical goods, home nursing and prosthetics (ask me about my walking cast), $225 toward orthotics every year, and a few other items. (I skipped on dental coverage because I have good teeth and I floss between dental cleanings, but if I had opted for that, that would have raised my monthly premium to about $150. I save the $70 every month instead.)
My insurance premiums and extra health costs, like dental checkups and cleaning, are completely deductible, dropping my taxes noticeably each year. And the core medical care I receive is excellent.
Laura W
“Daydream Believers”? Do not think that your ability to squeeze a Beatles and Monkees reference into a post went unappreciated, DougJ. You are a white knight on a steed.
chuck
Since when have conservatives been against the notion of “love study” classes? They’ve long been working toward a mandatory curriculum of classes that tell you that the right choice is always a member of the opposite sex, and for goodness sake, no hanky-panky til you tie the knot.
Martin
Not to mention that hospitals that are required to provide care (even when the party can’t pay) have to get funded from somewhere. Go get to know some hospital administrators VERY well and they’ll finally come clean that they significantly overcharge insured patients when they can negotiate it (usually on things that the insurer knows they don’t usually cover), and MASSIVELY overcharge non-insured patients – up to 10x the cost of treatment to offset the expenses of covering the uninsured/underinsured.
Comrade Dread
And I have no problem with ramming a bunch of regulations down the throat of insurance companies.
Though, to be honest, I must admit I would find myself engaging in a bit of schadenfreude if Obama took the insurance company we already owned and opened up the AIG Health Insurance division.
DougJ
I just added that category, along with another one I haven’t used yet “Hoot-Smalley”. I felt I was overusing “Burkean Bells” and needed more gradation for types of conservative stupidity.
tripletee (formerly tBone)
ND30: given that the link you cited above is from December 2007, can we assume that Bush and the Bush Party “just cook(ed) the books to cover up all the money they’re losing”? Just curious.
KG
I have to admit, “health care” is one of those issues where I tend toward the libertarian fringe. I think the problem, really, is the existence of insurance (which, really, is illogical, you’re essentially betting that something bad is going to happen to you, despite the fact that statistically, nothing bad will happen). Insurance actually distorts the market because from the perspective of the patient (the consumer) and the doctor (the service provider) someone else is paying for it. If the patient actually had to pay for the services provided, I am willing to bet prices/costs would drop dramatically because the prices that insurance companies tend to pay are much more than a free market would bear. Which is why I tend to like the idea of health savings accounts, because the money you’d otherwise be paying for a service you’re not using would be in an interest bearing account (this of course assumes you have something that resembles disposable income, I know). As for a government run program, so long as it remains optional, and it’s the government acting as a market participant rather than a market regulator (regulation should come from a separate agency and the state run insurance should be subject to the regulation like other businesses), I don’t have much problem with it.
North Dallas Thirty
Speaking of Massachusetts, how ARE they doing these days?
I seem to remember “Lower costs, lower costs” being the mantra there too.
tripletee (formerly tBone)
@DougJ:
“Little Starbursts” seems like another good one.
slag
Wondering if N Dallas 30 et al would be better off checking out Obama’s townhall on this very subject in order to learn a little something rather than coming here and illustrating their ignorance: http://www.whitehouse.gov/live/.
CalD
It’s actually worse than that. I’ve read that something close to 80 cents of every dollar spent on Medicare goes to actual patient care, compared to maybe 65 cents on average for private industry. This is to say that administrative costs in the private sector (you know, the sector that’s supposed to be able to provide services so much more efficiently than the government) are almost double what it costs you when the government does the same job.
That of course means a government plan potentially needs no unfair advantage in terms of the rates it pays providers to significantly undercut private insurers. Lacking a bloated, overpaid and typically incompetent senior management layer (along with any imperative to do better than break even of course), they could pay the same rates as everyone else and still charge consumers less for exactly the same level of services.
Martin
Comment #27, asshole:
Administrative costs don’t cover what is lost to fraud. While medicare costs are very low, too much is being lost to fraud and more staff should be hired to combat fraud. We’d save more from fraud reduction then we’d pay in salaries to get the fraud reduction – up to a point.
I ask again – what percentage of your (or your employers) private insurance premiums are lost to fraud? Please look that number up and tell me.
SpotWeld
Um KG.. there is a flaw in your assumtion when you say.
“…you’re essentially betting that something bad is going to happen to you, despite the fact that statistically, nothing bad will happen”
Statistically something bad will happen to you eventually.
You just don’t when, and to what magnitide.
It’s just statitically unlikely that it’ll happen in such a way that you’ll get more money from the insurance company than you end up paying to them.
It’s just that “bad things” usually are very very(!) expensive in the short term. Insureance (ideally) is a way of spreading that out over a much longer timeline (with the insurance company adding another thing layer ontop of things that cover thier costs and profit margins)… well, ideally anyway.
North Dallas Thirty
And also, it’s interesting; I haven’t heard one word from the liberal left about what they’re doing in terms of tort law for those who will be on the “public plan”.
Indeed, let’s try this; implement the tort laws similar to Canada and the UK, where “loser pays” applies to virtually all cases, contingency fees are significantly limited or eliminated completely, and there is a cap on damages that can be awarded.
Or is the other part of the Obama Plan to enrich his trial-lawyer buddies by allowing them to sue Uncle Sam and collect massive payouts at taxpayer expense? We already have the UAW being paid by the taxpayer, with suitable kickbacks being given to the Obama campaign funds; are trial lawyers next?
Gordon, The Big Express Engine
@slag: I used to detest going to the whitehouse.gov site and seeing W’s smarmy visage. Much better now!
Zach
I’m really curious what the savings would be if the artificial barriers between state health systems were removed. Get rid of state regulators for care, state regulators for insurance. Stop artificially limiting insured pools within state lines. I suppose there’s a virtue in this, but health providers are already double-checked by state and federal inspectors, and the federal inspectors basically think the state inspectors are incompetent (that’s not totally accurate, but close enough). It seems that differences between states impose additional cost and erect artificial market barriers. Not to mention complicating transferring medical records and managing care between multiple health systems.
I have no clue if this is actually the case, but it seems like there’s some substantial possible savings there and no one’s talking about it.
slag
The second sentence of N Dallas 30’s link: “Costs are soaring and Massachusetts lawmakers are weighing a dollar-a-pack hike in the state’s cigarette tax to help pay for a larger-than-expected enrollment in the law’s subsidized insurance plans.” Yes, nobody wants government-run healthcare. Nobody.
SpotWeld
Wouldn’t current legal rulings regarding medicare/medicade also address this? (Or the VA system)
North Dallas Thirty
With pleasure.
So let’s see; they do 3%, Medicare manages 10%.
Then again, why would Medicare need to be responsible? They can just raise taxes. Besides, they would actually have to deny claims, which is always evil and awful in the eyes of the Obama Party.
tripletee (formerly tBone)
@North Dallas Thirty:
Spoof fail. Trial lawyers are a 2004 conservative boogieman, and have been retired in favor of earmarks and social-ists. If you can’t be bothered to do the bare minimum to keep your spoof fresh, why should we bother to read it?
slag
@Gordon, The Big Express Engine: Sooo much better! Beyond the significant smarm shrinkage. A lot of change we can believe in is happening on teh interwebs.
North Dallas Thirty
@slag:
Oh, I’m sure people are more than happy to take something for free; after all, look at Obama’s illegal-alien Aunt Zeituni.
Do you think the taxpayers of Massachusetts should be forced to pay for her health insurance?
Oh, what’s that? You mean Medicare and Medicaid and the VA system get some sort of price break in terms of for what they can be held legally liable?
Why not extend that to private insurance? After all, if it’s good enough for the government to not have to pay for its mistakes, certainly it’s good enough for private insurance.
Comrade Dread
I’d be okay with this.
But this? After seeing the bang-up job Federal regulators did with regard to Wall St., I’m definitely not convinced that getting rid of state regulators would be a wise move to take with regard to insurance companies.
Nor am I convinced that they would altruistically pass on those proposed savings to policy holders. Or use that revenue to actually pay off and fund serious ailment care.
Zach
@North Dallas Thirty:
That’s rich. Literally the entire public push against the reform bill is going to be about big government telling you that you can’t have X, Y, or Z expensive procedures. Then there’s the additional irony of this coming from the party that spent 8 years writing cost/benefit analysis into any and every program that they wanted to slow down. GOP logic on this stuff is so twisted.
SpotWeld
Um.. ND30.
That 3% number…I think it might include Medicare/Medicade.
PeakVT
I think the problem, really, is the existence of insurance (which, really, is illogical, you’re essentially betting that something bad is going to happen to you, despite the fact that statistically, nothing bad will happen).
Whu-huh? That’s the exact purpose of insurance – to mitigate low probability high cost events at the price of forgoing some current consumption. If insurance is so stupid why has it been around since the birth of capitalism?
I should have stopped at “libertarian.” My head would hurt less now.
SpotWeld
ND30… do you know what tort law is?
slag
@North Dallas Thirty:
Strange. I just now heard Obama address this very issue in his townhall speech: http://www.whitehouse.gov/live/, which apparently you would rather not listen to.
TenguPhule
Cropped Quote Fail!
Tell us lies, Nd30, tell us sweet little lies!
TenguPhule
I happen to live in one of them, moran.
Zach
@Comrade Dread: On state regulators, I’m not saying that that’s a solution in absence of the sorts of reform Obama’s pushing. I’m just curious how much savings could actually be there. A solution you’d be happier with is uniform regulations for insurance and care with regulators employed by the individual states but following Federal guidelines.
Now, facilities are routinely inspected at the state level and the feds perform random inspections to double check things. It’s good to have two sets of eyes; I’m talking less about redundancy in the actual inspections than inefficiencies in having different standards to meet.
Lastly, health regulation within states is notoriously corrupt because of the political influence of owners of health care providers. This influence is diluted if you have purely Federal regulation. Sanctions against providers are often delayed or reversed once someone calls up their favorite legislator.
Bootlegger
@schrodinger’s cat: Damned good point. In my field, criminology, we’re facing the same damned thing as all of our old theories and policy recommendations were based on the rationalist black box model for human nature. Now that evidence is overwhelmingly finding the flaws in the classical assumptions criminology will have to either rethink the assumptions about human nature (my paper at this year’s American Society of Criminology annual meetings) or dig in its heels, put its fingers in its ears and say la-la-la-la-la loud enough to drown other voices out (like modern conservatives). My money is on the latter.
TenguPhule
Corrected for proper person.
The GOP wanted to eliminate the tax deduction on health insurance premiums.
This has been another edition of ND30 is a shitty liar.
geg6
@North Dallas Thirty:
Yup, that leukemia that killed my cousin’s daughter because she went untreated for months and months while they fought with their insurance company was nothing but a scheme to make money off the poor insurance company.
You fucking asshole.
r€nato
Call me crazy, but I thought the primary purpose of health care is to provide health care, not to allow investors to profit from sickness.
If a privately-run, for-profit health care system can deliver better health care in a more efficient manner, fine with me. But it is pretty obvious that it does not do so.
TenguPhule
Slighty O/T: Flu Pandemic Declared by WTO.
$10 says the WATB on the right start running for the hospitals demanding immediate treatment ahead of everyone else.
TenguPhule
When your business model makes money by not paying out claims, guess what happens.
Church Lady
@TenguPhule: Ah, but you forget that McCain would have given a tax credit that would have, in almost all cases, more than offset the tax that would have accrued against the value of the employer paid plan. Nothing that either Obama or his surrogates have said so far has included any mention of an offsetting tax credit. Under that scenario, anyone that has an employer paid health insurance plan will be paying more in taxes.
TenguPhule
Except that it’s the private companies commiting most of the fraud to line their board members’ pockets.
Oops!
r€nato
Actually, all it sacrifices is obscene insurance company profits, onerous insurance company shenanigans, and obscene drug company profits.
Nobody’s going to be forced to work for free for the Obammunist health care system.
TenguPhule
Linkie please, because I never saw that in any of the coverage.
gwangung
Wait a minute, I don’t think that’s the case. In the majority of cases I was looking at, it entailed an increase in payments or decrease in coverage because the credit did not come anywhere near the value of the employer plan.
TenguPhule
And spending less on coverage and overall.
At least, that’s the idea.
r€nato
pretty much all GOP policies with regard to health care boil down to, ‘fuck you, I got mine.’
DanSmoot'sGhost
I have AIG on the line, shall I ask them to hold?
Bootlegger
Here’s the bottom line why so-called free market principles don’t work when treating health care as a commodity–demand is not elastic. With any other commodity, apples lets say, if the price gets too high I can choose not to buy. If apples are scarce I can eat something else. Neither is true with health care. When you’re sick you need health care, period. There are no alternatives except to get sicker and die.
As for the cost, check out these data from Hans Rosling demonstrating that “health comes before wealth”. Coupled with the fact that we pay far more than our economic competitors for lesser health and it is an obvious conclusion that we can’t afford *not to* invest in public health care.
Not only is health care a public good, but its an investment in our economic success.
Geeno
ND30 – are you proposing that the indigent should just be dumped on the curb to die?
geg6
@Church Lady:
Yup, that big $5000 tax credit would have totally covered the $12,000 annual average it costs a family for health insurance. Totally.
Ohio Mom
Perhaps somewhat ot by this point in the thread, but —
Re: “Making Friends curriculum”: there acutally are such things. Good elementary ed teachers weave social skills building into their classroom activities, and learning how to make & keep friends is a big focus in special ed programs. Lots and lots of professional literature on this stuff.
But things like how well a kid does relating to his/her peers, or in show-and-tell (which is, after all, beginning public speaking), or in group projects, can’t be tested via multiple choice, fill-in-the-bubble tests. So in this day and age of No Child Left Behind, those kinds of classroom activities get left behind.
Worth noting too, the NYT absolutely LOVES NCLB.
Church Lady
@TengPhule: Just google “McCain tax credit for health care” and over a half million hits will come up. I can’t believe you don’t remember this – the $5,000 tax credit was an integral part of McCain’s campaign platform. And Obama was adamantly against taxing employer paid plans and was very vocal about it.
DanSmoot'sGhost
5 Dec 2005 // Senate Majority Leader Bill Frist is pushing a “healthy America” plan that includes tax breaks to help the poor buy insurance and legal limits on excessive jury awards that Frist says hurt access to care.
“America’s health care system is failing the American people,” the lawmaker said in a speech this summer in San Francisco.
But Frist’s plan would do something else besides help cover the poor and reduce what he says are frivolous lawsuits.
It would help Hospital Corporation of America Inc. make money. The Nashville-based hospital company is the foundation of the Frist family’s wealth.
Uninsured patients hurt HCA, which loses billions of dollars when they don’t pay their bills. The company set aside $2.7 billion in 2004 for such doubtful accounts.
And it owns an insurance company that would benefit from limits on hefty jury awards. Health Care Indemnity Inc. is one of the country’s largest providers of medical malpractice insurance, with gross premiums of $382.3 million a year.
Frist has denied that his connections to HCA, which his father and brother co-founded, influence his actions in the Senate.
–// Citizens For Ethics dot org
In case you wondered who is paying for ND30 to do his harangues here.
boomshanka
@North Dallas Thirty:
Huh? You lost me on the tort issue. Personal health insurance doesn’t cover injuries to third parties, even if the insured is at fault. The third party’s insurance carrier can seek to recover it’s costs from the individual who is at fault, but that reimbursement would come either from that person’s pocket or other form of insurance (vehicle, homeowner’s, etc.)
That may be why you don’t hear liberals address it – it’s not an issue.
TenguPhule
Because you said:
McCain was trying to sell the $5,000 credit as a way for employees to pay their own medical insurance. Except it was so laughable as to be ridiculous.
liberal
Damn straight.
liberal
@Comrade Dread:
But it’s cheaper in all the other countries which have it, for roughly comparable or even better outcomes.
Of course, just extending Medicare itself isn’t such a good idea, because there’s too little rationing. By “rationing,” I mean a system where cost/benefit analysis is conducted, and treatments which are either too expensive per benefit, or just not effective, are not provided.
TenguPhule
They actually meant they’re the *muggers* of reality.
DanSmoot'sGhost
Psh. If $5k would cover my healthcare costs for a year, I could retire today. I could retire an hour ago.
I would wager that John McCain’s family healthcare costs (which are borne entirely by the US Government, I expect) are more than $5k per month.
liberal
@Bootlegger:
That’s indeed one of the most important reasons for market failure in health care markets.
But it’s not the only reason. IMHO the most important reason is perverse incentives. The right thing to optimize, given a budget constraint, is long-term health outcomes. But doctors/hospitals/etc aren’t paid for that—they’re paid for treatments.
The article The Best Care Anywhere has evidence for the claim that it’s not possible to design market incentives for providing good long term outcomes, as opposed to providing treatments.
Kirk Spencer
@TenguPhule: And more cropped quote fail, this time the bit about spending money to save money (paying more in admin costs…)
ND30, you keep sidestepping a simple fact. We pay significantly more per capita for worse health care than in any other nation. You tried to wave that away by saying we had higher poverty levels than UK, conveniently not noting that the UK has better health care and pays (per capita) significantly less than we do. Now I could continue by arguing cost, but I’m going to note a different reason. Public good.
An argument as to the reason we all pay for and/or require stuff some people get is that it benefits us all indirectly. To take one example, school age vaccinations. BECAUSE of these vaccinations pox is dead. Polio is practically non-existent. Measels, mumps, and rubella are almost non-existent as opposed to infecting millions and killing thousands (source).
National health care is another public good. We the people, as a whole, are the least healthy people of the industrial nations. We don’t live as long. We spend more days per year sick – this last for multiple causes, but a significant one being so many of us put off going to the doctor unless and until what we have is severe. “Pay now or pay more later” is a truism. Another significant public good effect is bankruptcies. The number one proximate cause of bankruptcy in the US is major medical expense. Bankruptcies have a negative impact on communities – not just on morale but on the local economy as well.
The classic argument of the libertarian is that private is more efficient and effective than public. The private will cost less and do more because of the competition. I’ve long argued that when theory and fact differ, fact should win. And it is fact that we pay more for less than those places providing health care as a public good. Trying to scare me with “if we do this, we’ll…” and the nonsense of how medicare is eeeevil or how we should make those lazy bastidges on the public tit pay for their own pales (if not fails) in that light.
Comrade Dread
I have to admit being more ignorant of other country’s politics than I should be, but do other nations have their own equivalent of K street to the degree that we do?
Maybe one of our friends from outside the US can fill me in on whether their MPs are as bought and paid for by special interests as our Congressmen.
Gregory
@Northern Observer:
This.
And I would add, again, as their illusions are already burst by the success and popularity of Social Security.
TenguPhule
And the UK has the shittiest healthcare in the EU to boot.
So US healthcare is WORSE then the dregs of the EU.
DougJ
I think the rough answer is “no”, but there may be some isolated counterexamples.
Jennifer
This Frontline program, Sick Around the World, looks at how 5 other capitalist democracies provide universal health coverage. Highly recommended viewing – it shows a number of public and private solutions. They all, however, have a few things in common: no one is allowed to profit on basic coverage/care, prices are controlled, and there’s government mandates (at the minimum) all the way around on providers, insurers (where they have private ones) and the citizens, who are required to have coverage.
Free markets that allow unfettered profits simply don’t work for things that are universal human needs without producing very bad consequences. Examples are health care and water. If the health insurers were in charge of our water, we’d currently have 47 million people dead of thirst rather than just uninsured. Universal needs simply can’t be handled this way – and we’ve had example after example after example to prove it. Remember how the magical free market was going to lower utiltiy costs? Remember Enron?
One of two things will happen with this: either we’ll get the public insurance option, or we’ll get some kind of bullshit regulation forcing insurers to provide coverage for all applicants which we’ll end up subsidizing through taxes, all the better to preserve their 30% profit margins. Guess which one is most likely? Remember the prescription drug plan?
It’s time to hit the streets if they come out with anything at all that simply continues to leave us at the mercy of private insurers, only at higher cost. Which is where it looks to be headed.
liberal
@TenguPhule:
Maybe, but it’s also extremely cheap compared to some of the other countries.
IIRC Germany is more along the lines of “we’ll let physicians waste as many resources as they want” model.
Anne Laurie
At last, David Brooks says something I can wholeheartedly agree with.
Please, guys… stop feeding the troll. If you keep responding to its stream of lies, bullshit, cherry-picked statistics & general fvckwittery, it’s NEVER going to go away!
liberal
@Kirk Spencer:
I don’t think that’s really true except for public health stuff.
OTOH I’ll be the first to argue that markets in health care are doomed to fail.
R-Jud
@Comrade Dread:
I’ve seen no evidence of a lobbying industry in the UK the way there is in the USA. People are routinely shocked when I explain how lobbying in the USA works. You do get individual MPs being found to have connections to a company that gets a cushy private contract, or to a donor who ends up being elevated to the peerage, but it’s seen as really horrible and underhanded when it happens. Google “cash for honours scandal” to read about the worst recent example of this.
Xenos
Let’s get back to first principles. Private, for-profit medical insurance is immoral, contrary to the public interest, and should be illegal under the corporate governance laws that banned this sort of toxic enterprise for the first 150 years of this country’s history.
Once we force the corporate plans to close we can go after profiteering ‘charities’ that pay their executives million dollar salaries and the pharmaceutical companies that develop treatments with federal grant money and then sit on patents.
This will involve breaking and wrecking something like 10% of the economy, but if we don’t do it they will grow to 30% of the economy, and we will work all our days to feed these parasites.
Bootlegger
@liberal: The reason you cite is why the system we have is a colossal failure as opposed to just a toddler’s thud. You certainly won’t get any argument from me.
Bootlegger
@Comrade Dread: K-street dates back to the courtesans of yore. The rulers always had people pulling him or her this way and that, offering favors for favors.
DarrenG
While I’m not opposed to a public plan and like much of what Obama has proposed, there are a few misstatements above about the wonders of Medicare that any larger-scale public plan will still need to address.
First is the myth that Medicare administrative costs are a fraction of private plans. Federal administrative costs are low, but that’s because a lot of the administrative burden is shifted to states and health care providers, which buries a lot of the existing costs of the system in places that won’t scale well for a much larger population.
Second is the idea that Medicare negotiates better rates with providers. Medicare doesn’t negotiate anything. Providers submit a claim listing diagnosis and treatment codes and a check eventually appears in the mail with what Medicare thinks they should pay.
N.B.: Most private insurers reimburse in a similar manner. One of the biggest, and least understood, problems with our existing payments system is that it operates *nothing* like a free and efficient market. Spend a day with someone who does health care billing for a living and you’ll see that it resembles the movie Brazil more than anything else.
Comrade Dread
So, the comparison between a British or European national health system and an American one would not necessarily hold true, as the American system would be at the mercy and whims of a Congress that is far more prone to corruption and far less likely to rein in costs if it means hurting their benefactors.
Which is also the problem with the current health care debate now.
Zuzu's Petals
@DarrenG:
I’m interested to hear how states bear and administrative burden under Medicare. Could you please explain? Thanks.
North Dallas Thirty
@liberal:
Of course, that’s followed with what “public” healthcare is going to do.
For some reason, liberals are always opposed to denial of treatment and insistence that a cheaper alternative be used — except, of course, when the government does it.
anonevent
@Comrade Dread: I’m curious, how many things have really burnt us in the past that have been run by the government. Here’s my list of good things:
1. The Postal System, until it started trying to fight the future.
2. The Military.
3. Social Security.
4. Medicare
5. The VA hospital system, a taxpayer paid – which means that soldiers also pay for it – socialist medical system.
6. NASA
The first thing on top of my list of bad things is the CIA. But the CIA suffers from the same problem as the Postal System, in that it’s fighting to stay alive when it should have gone away. That’s the exact same kind of fight we’re going to see with the healthcare companies, even though their the wrong solution to the problem.
gopher2b
@DougJ:
You know where the highest incident of infant deaths in this country occur: the poor. You know who is eligible for Medicaid: poor pregnant women. You know what program the current “global health” program is going to expand: Medicaid and Medicare.
No thanks. You want to make a system more expensive, add 40 million people too it. Because nothing decreases cost like increasing demand. That logic makes utterly no sense. Of course, you can artificially make things cheaper by colluding on price (which is what the Obama administration is essentially proposing). The result will be less services, and worse overall quality services for most people.
WereBear
I see three main areas, right off the bat, that a government-run health care plan would save money:
a) Overhead.
My aunt used to run insurance for a one-dentist practice. She had a 40 hour a week job for one dentist just to handle all the paperwork and make sure the office got paid. That’s ridiculous. Multiply it greatly with other medical situations, since not that many people have dental insurance, and you see how an office can have one doctor, one nurse, and three insurance assistants.
b) Obscene profits.
Look at this number.
$10,318,000,000.00
That’s ten billion, three hundred and eighteen million, dollars.
That’s how much profit health care insurance companies made in one year, as of the April 17th, 2006 issue of Fortune.
c) Catch it early.
Right now, on the front page of GOS, someone has a Recc’d diary describing how, unable to afford to treat her diabetes and high blood pressure (both dirt cheap to treat,) a woman now has to do dialysis and is waiting for a kidney transplant.
But that she can get help with!
People don’t go to the doctor until it’s life-threatening… and expensive.
Zuzu's Petals
Edit: never mind. Do not feed the trolls and all that.
LD50
Tell you what, ND30 can not pay his taxes and feel virtuous by refusing ‘socialized medicine’, provided he agrees to simply die if he gets sick when he’s uninsured. Deal?
SadOldVet
And they will fight to the death to preserve corporate profits…
And their ability to buy politicians
Naturally, dumbocrap senators will resist the corporate interests…
Except for maybe the ones who have received millions in campaign donations from the health insurance industry…
And, of course, Evan Bayh will be a champion of no public option to show that the $337,000 a year his wife is paid to be on the board of directors of Wellpoint is corporate money well spent!
gopher2b
@Zuzu’s Petals:
How the hell would I know. The point is that they have socialized medicine available to them yet they still have high infant mortality rates – which was the statistic Doug chose to refute my statement that socialized medicine will result is lower quality of care for most people. Thus, the people Doug uses to demonstrate his point either (1) don’t use the care that is available to them, or (2) that care does not work. Either way, it doesn’t refute what I originally said. It was his non-sequiter, not mine.
DZ
I don’t want a ‘public option’. I want total elimination of any ‘private option’. Insurance companies aren’t just part of the problem, they are the problem.
DarrenG
@Zuzu’s Petals:
Here’s some details on how states pay for Medicare Part D administration: http://www.kff.org/medicaid/upload/7438.pdf
There’s similar issues elsewhere in the system, not to mention Medicare doesn’t count things like OIG audits or revenue collection and management as administrative costs in their official figures, since those come from Treasury or GAO budgets.
The best estimates I’ve seen for fully-burdened admin costs of Medicare range from 5 to 8%, rather than the oft-quoted 2%, so they’re still much better than private insurance, just not by the huge margin claimed by posters above.
DougJ
I’m not a first principles person in general, but I agree with you here.
geg6
@North Dallas Thirty:
First, the top quote wasn’t from liberal, it was from me. But way to distort the premise anyway. My hat is off to you.
But even if the complete misattribution in your post had been true, I don’t see what your point is. Using the most cost effective treatments isn’t rationing or denial of treatment. And refusal to pay for treatments that don’t work isn’t rationing or denial of treatment.
But then, logic isn’t your strong point as you make more obvious with every post.
Anne Laurie
Werebear brings up an excellent point — one reason individual doctors are getting aboard the Public Plan train is that the average American doctor spends 30%-35% of his or her time on paperwork, mostly trying to pick the right billing codes to get the insurance companies to pony up. “Medical billing assistant” is a growth occupation because it takes special training to learn how to stave off the insurance weasels whose whole reason for existence is to NOT pay out the money they’ve taken in. We could pay for a big chunk of the cost of covering “the uninsured” if we weren’t wasting all this time, education & money keeping Bill Frist’s family’s HMO obscenely profitable.
Gordon, The Big Express Engine
@liberal: Check out the recent article in the New Yorker about the differences in costs around the US for healthcare and what can be done about it. .
Phoebe
“Maybe they have been mugged by reality, and their response was to retreat from it.”
Yeeeeessss! Yes! Yes! Yes! Yes. Bingo. The end.
North Dallas Thirty
That’s mainly due to two factors:
1) Our care is not rationed to nearly the extent that it is in other countries
2) Our tort system allows lawsuits at a level and payout amount that is either outright banned or significantly limited in other countries.
In the United States, you can demand to see a specialist, get antibiotics (which will be utterly ineffective) or a pricey antiviral, and have a follow-up visit for a three-day virus.
From a purely medical standpoint, that makes no sense; a nurse or a PA can diagnose it, assess your condition, and send you home with instructions to rest and drink plenty of clear fluids. Your body’s immune system will do the work without the need for drugs.
But it’s what people demand.
Of course, when health insurance companies start imposing some sanity on the process by requiring you to see a nurse or PA first, limiting the number and type of drugs they will pay for, making it clear that you should go home and rest instead of providing instant hospitalization, and having the temerity to actually ask you to pay a portion of your doctor’s visits or accept higher premiums, liberals:
1) Scream about “denial of care”
2) Scream about “hurting the poor”
3) Find John Edwards and file a lawsuit for millions in “pain and suffering” claims.
So the health insurance companies do the obvious; raise premiums and pass the increased costs for covering unnecessary procedures onto other people.
Now, what we have here is Barack Obama and his Obama Party, who insist that “the government” can provide the same level of healthcare at no cost and with no restrictions.
Just a massive hike in taxes — which of course, won’t affect most Obama Party voters, since they don’t pay taxes or own businesses anyway.
Gordon, The Big Express Engine
@Anne Laurie: This kind of troll feeding is good overall. Martin’s (and others’) rational cogent arguments help the less erudite among us (read: me!) hone our off-line discourse. Many fantastic links are often provided as ammo. Links that I don’t always have the time to seek out.
I readily acknowledge the diminishing returns aspect of this – last week’s thread is a break the mold example of that.
Plus – who here does not love BOB, even just a little bit? C’mon, show of hands people!
Gordon, The Big Express Engine
@Gordon, The Big Express Engine: Damn link did not embed.
New Yorker piece is here: http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande
Leelee for Obama
@Comrade Dread: Who would they be lobbying for? We the people wouldn’t be paying them, we’d just try to vote out anyone who didn’t listen. THIS is what they’re really afraid of. The big Companies out of the game and unemployed lobbyists! AND Legislators who weren’t getting any ducats to screw us!
THE HORROR!
THE HORROR!
North Dallas Thirty
@Geeno:
No; I am proposing that you spend your own money to buy them healthcare instead of taxing others to pay for it.
The funny part about this is that the Obama Party is full of multi-millionaires like Kerry, Pelosi, Kennedy, Soros, and Buffett. Yet not a single one of them has opened up their own nonprofit healthcare company; instead, they’ve demanded that other people be taxed.
Barack Obama rails about overpaid healthcare executives. What was he saying to his own wife? Why don’t all of you liberals here who scream about that browbeat Michelle Obama for her greed?
Leelee for Obama
What percentage of premiums are spent by the glorious private companies you champion to deny coverage that they should cover? And how is that not fraud as well?
Just askin’
Northern Observer
@North Dallas Thirty:
1) there ain’t nothing utopian about health care, period, be it commie athiest or objectivist libertarian.
2) funny how even with the additional private insurance coverage for dental and glasses , those crazy stalinist dystopias like France and Canada still manage to spend 50% less per capita than the amazing manly virtuous current American system.
Funny how that works out, eh?
LD50
So ND30 wants to leave health care for the poor to private charities. If said charities don’t materialize, and people die for lack of health care, that’s still MUCH better than TAXES paying to keep those people from dying.
Bravo. Selfishness rebranded as morality. You couldn’t sum up conservatism better.
North Dallas Thirty
Not a surprise. Both of them ration care, just as I outlined above, and both of them have laws severely limiting your ability to file massive malpractice lawsuits.
The problem here is that you simply can’t comprehend a system in which your “right” to go see a specialist for a two-day-cold and then file a $10 million dollar lawsuit against them at no cost to you doesn’t exist. Furthermore, Barack Obama hasn’t exactly educated you to the facts, either.
Northern Observer
@Bootlegger:
Bingo.
Bootlegger hit the nail on the head.
The demand for health is completely inelastic.
Therefore it doesn’t respons to basic free market incentives like say, the grain market or the bond market.
When you want health, there is no limit.
This is why it needs to be treated like a public utility, like water, roads or sewers and not like the hotel business, the hard goods business or the fianacial services industry.
And here is the kicker for all you defenders of the capitalist way of life. By putting a public national health care system in place, you make the rest of your economy more competitive and efficient. You allow more people to take risks and become entrepreneurs. You improve labor mobility as people are no longer afraid not to make a new choice. All in all you reduce cost of entry and increase efficiency and velocity. It’s a big win overall at the cost of a very few. And that’s just it isn’t it. America has always been in the hands of the selfish very few when they had the chance. For shame.
North Dallas Thirty
@LD50:
Why wouldn’t they materialize? Don’t Obama Party members like yourself believe in actually helping the poor and unfortunate by reaching into your own pocket?
It’s amazing how willing liberals are to spend other peoples’ money. Obama Party members like Sebelius don’t pay their own taxes, but then insist on raising other peoples’ to pay for their leftist needs and accuse those people of being “uncompassionate” when they object.
LD50
Bravo. Your fumbling attempts to change the subject has basically reconfirmed my description. One such point you’re ignoring is that a charity of the kind you’re describing could never cover the costs of what America needs, but I doubt that bothers you.
And I can’t help but notice that you don’t want to pay taxes to keep people from dying, and that somehow this makes you a much better person than me.
See, this is why most Americans aren’t impressed with conservatives’ claims to superior ‘morality’.
Do you consider military spending to be another evil example of ‘spending other peoples’ money’?
Anonymouse
I do “spend my own my money” to buy them healthcare. I pay taxes. That is my money being spent on it. What you are complaining about is that you don’t get a choice whether to spend your money on it or not. Well, welcome to life in a democratic society where the majority of people support taxation for public services.
You might want to look into this thing called the “free rider problem”:
http://en.wikipedia.org/wiki/Free_rider_problem
It’s funny how conservatives understand the free rider problem when it comes to defense, or roads, but not when it comes to social insurance.
Medicare and Medicaid are open to all who qualify and need their help. If payment was voluntary, many selfish idiots with no empathy or ability to imagine a change in their circumstances would not pay. But many of them would still get old, disabled, or be reduced to poverty anyway, because shit happens, and then they’d come running to Medicare/Medicaid for help just like anyone else. So, because we can’t identify who is going to need the services in advance, we all get to pay for it. Again: welcome to life in a democracy. If you want to live somewhere they don’t have social insurance or taxes to support it, feel free to move there (and be sure to renounce your citizenship so that you can’t come back when you’re old or sick or poor and leech off the rest of us, thanks).
Alternatively, you could attempt to influence the direction of government by, oh I don’t know, voting in more Republicans or something. Uh, good luck with that.
gwangung
Idiot.
Talk to non-profit providers of health. Not enough capacity, not enough workers.
Idiot.
Look at the figures of percentages of wealth given cross tabbed by political parties. Democrats more generous.
Idiot. Idiot. Idiot.
North Dallas Thirty
Wrong. Again, to the example above, you can demand antibiotics for your cold, or you can go home and rest.
If the antibiotics are free, you don’t care. If the doctor knows you’ll sue if you don’t get them, she doesn’t care. If you are required to pay for them, though, you will think twice about whether or not you really need them.
Which is why, of course, the UK, France, and Germany all have lower GDP and higher unemployment than we do.
Why? When you’re paying over 50% in taxes on everything you earn, what is the incentive to earn more?
Again, why is it that the true entrepreneurs and visionaries always seem to be coming out of the awful old USA and its broken-down healthcare system?
Which is why they still demand private health coverage from their employers in the UK, France, and Germany.
Let’s be clear here. What the Obama Party is doing is trying to create a legal right for them to get their hands on $2 trillion of revenue every year which they can then pay back however they choose — or choose not.
If the Obama liberals here were so interested in creating health insurance plans, they don’t need to raise taxes; they could pay for it out of their own pockets. But they’re not.
Leelee for Obama
Like I have said to many who didn’t want “their” tax dollars used to pay for abortion: I will stipulate that mine can pay for abortion, and you can stipulate that yours pay for executions, which I don’t wish to pay for. Fair’s fair, amirite?
gwangung
Idiot. You don’t do antibiotics for colds. Details MATTER.
gwangung
Nonprofit executive. Of the type you were demanding.
Idiot.
North Dallas Thirty
Wrong. They have enough money to pay Obama’s wife and sixteen other vice-presidents over $300k per year.
Again, no link, no source. Likely because it counts donations to political parties as “charity”.
gwangung
Because they’re BIG, idiot.
And that money DOESN’T put a dent in health care costs.
What, are you innumerate as well as an idiot?
gwangung
Wrong, idiot.
GIving USA. Political donations are NEVER counted as charitable contributions.
Do some homework.
North Dallas Thirty
@gwangung:
A fact which I made abundantly clear above, thank you.
Perhaps if you actually noticed the details…..
Brachiator
I keep hearing that various health-care plans will save money, but I don’t see the proof of this. I would really like to see a health care plan that clearly laid out what it is expected to cost and how it will be paid for.
Some progressives even jump between proposals that are similar to the health systems of Canada, the UK and France, but never stop long enough to firmly declare which cost/pay model is preferable and why. And although I have seen some great things about the French system, I have seen little in the English language press that deals with the costs and funding of this system.
One thing that is not a good sign, England’s NHS is beginning to show some serious financial strains (NHS ‘faces huge budget shortfall’):
And keep in mind that this is just England, not Wales, Scotland and Northern Ireland, which have semi-autonomous NHS programs. The budget for the health care system appears to be in the $220 billion range (doing a quick currency conversion).
I am not convinced that a public plan would have a big advantage here. Low admin costs are promised, but as far as I can see, Medicare and VA programs, the closest thing to a comparison, are not models of administrative efficiency.
And I simply do not know, and have not seen anything documenting, how much is allocated to future R&D — which would be one place that “profits” could go even in a public system.
North Dallas Thirty
@gwangung:
Funny, all the liberals here have been whining about how “overpaid executives” are a major cost in the healthcare system and have no justification.
What changed? Why are the rules suddenly different when you’re required to criticize Michelle and Barack Obama?
dslak
I don’t know who this “they” is who demands private healthcare in the UK, but they don’t appear to be a majority. My wife and both receive NHS care despite the availability of private health insurance, and her company doesn’t offer any additional health insurance. Clearly the “they” at her company have not been demanding enough.
gwangung
No, you got it WRONG, idiot.
Not all, not the majority, not the most expensive health care follows your example. DETAILS matter and you focussed on the wrong ones.
Try again. Use a better model.
gwangung
Look them up, idiot. Compare. Order of magnitude.
INNUMERATE idiot.
North Dallas Thirty
@gwangung:
That’s a start Why don’t you show us where on their website?
North Dallas Thirty
Not all, not the majority, not the most expensive health care follows your example.
I am merely stating exactly what the Obama Party promises — that you will be able to see whatever doctor you want, whenever you want, get whatever drugs you want whenever you want, and all without paying anything out of your own pocket.
Now, are you going to start saying that the government will deny you the “right” to see whatever doctor you want, to get whatever drugs you want, and to do so without paying out of your own pocket? If so, you lied.
North Dallas Thirty
What about your company?
North Dallas Thirty
@gwangung:
Unfortunately for your argument, that very article I cited said that Michelle Obama’s salary was comparable to other healthcare executives.
Now why is it that you can’t condemn her for her salary when you’re condemning the other healthcare executives who make comparable amounts?
dslak
Mmm, that’s some good trolling.
Julia Grey
When you’re paying over 50% in taxes on everything you earn, what is the incentive to earn more?
The other 50 percent. Duh.
Are you actually saying that a guy who could make a million dollars would decide NOT to because he “only” got to keep $500,000 of it?
Somebody get this guy a cup of coffee or something.
TenguPhule
And?
This is well BELOW median.
$1 million is about average now.
TenguPhule
They ask for higher premiums and don’t pay out the claims.
Your arguments are pure industry bullshit.
What part did you miss the first time?
Wolfdaughter
ND30:
I don’t know what health insurance you have, but I have had an HMO or a PPO as insurance ever since 1973. Number of different ones over the years. I DON’T get to “demand” to see a specialist ever. If my PCP thinks it’s warranted, he refers me, and this is only for difficult situations. And NEVER for a “3-day virus” (for which I don’t go to the doctor anyway). You want to provide actual links about people getting such treatment? I don’t know anyone who does, but I know plenty of people, including myself, who have waited months for treatment, spent THREE DAYS in the ER, etc., etc., under our current system. I think you’re just repeating things you’ve heard somewhere.
Xenos
And what of Michelle O? She probably is overpaid. Since she works for a non-profit she should not get paid so much.
And since the business she works for is so closely regulated as a charity, all those VPs ought to get their salaries cut in half. I am totally down with that.
iluvsummr
@gopher2b: 60% of poor people are not covered by Medicaid (i.e., not every poor person in the US is eligible). From the pdf document I linked to, states must cover all pregnant women and children below age 6 with incomes up to 133 percent of the federal poverty level. For 2008, the federal poverty threshold for a family of two was $14,840. I’d like to know whether, in your opinion, a pregnant woman with one child who makes $19,950 a year is rich or poor (she’s above 133% of the federal poverty level and thus, ineligible for Medicaid).
Thanks for calling our attention to this dismal statistic (infant mortality). The wiki link I visited tells me that based on UNDP data, Cuba, Slovenia, the Czech Republic, the UK, Canada, Germany, South Korea, Switzerland and Hong Kong have a lower infant mortality rate than the United States. Perhaps the poor in the US are poorer than their counterparts in all of these countries. I imagine that the pro-life movement will be exercised at this horrible outcome for US infants and do something to prevent poor children who are already born from dying an untimely death.
Kirk Spencer
@North Dallas Thirty:
I said:
and you replied:
That’s mainly due to two factors:
1) Our care is not rationed to nearly the extent that it is in other countries
2) Our tort system allows lawsuits at a level and payout amount that is either outright banned or significantly limited in other countries. (note, formatting done to get around the weird blockquote breaking on multiple paragraph problem)
I don’t think this word “rationed” means what you think it means. To me, “rationed” means it’s restricted. Since a greater proportion of people in these other places can get coverage that almost half the people in our nation cannot get, the word seems misapplied. The argument you present in your first paragraph is fallacious.
The second argument makes more sense at least in theory. However, like your other theoretical positions it runs against pesky contrary facts. Specifically, as this report from the CBO notes (footnote 3 for base source), “[M]alpractice costs account for less than 2 percent of that [health care] spending.” [in case you’re not familiar with the method, the brackets are my editorial changes for clarity.]
PaulB
Moron, are you aware of how much money the private insurance companies lose every year to fraud? Free clue: according to some estimates, it’s … wait for it … 10%. Did you have a point to make?
North Dallas Thirty
Cannot get, or simply choose not to buy? If you don’t want health insurance in this country, you don’t have to get it — and, more importantly, you don’t have to pay for it.
In so-called “universal coverage” countries, everyone and everything is taxed to pay for healthcare, whether they use it or not — and the healthcare they get is rationed out by the government, meaning that the bureaucracy gets a veto on the medicine, treatments, and doctors you use.
Liberals want everyone to be mandated to pay them for health insurance — and then not have to pay for it by “rationing” healthcare. As with Social Security, it gives leftists cash that they can spend now in exchange for IOUs that they can ignore or modify the terms of later without any recourse on the part of the people paying.
And once again, liberals try to minimize the problem by using just the premium cost. How about the extra tests, diagnostic procedures, and so forth that doctors must do in order to avoid being hauled into court for any result that isn’t what the patient wants?
Again, why don’t you tell us why you oppose putting in the simple restrictions on tort liability — such as loser-pays, a ban or strict limitation on contingency fees, and a cap on lawsuit damages — that the countries with nationalized healthcare systems have?
North Dallas Thirty
And under Obamacare, what do you think is going to happen?
That’s right; you claim you’ll never have to wait, be able to do whatever you want, and all that stuff, all without a single dime in payment.
North Dallas Thirty
Yup.
If you can work and make $400k a year for $700k of effort, it doesn’t make any sense to put in the additional $300k of effort for only $100k. High taxes depress economic activity on both a business and individual level.
Kirk Spencer
@North Dallas Thirty: “simply choose not to buy.” ?
Let’s ignore, for a moment, those people denied coverage because of pre-existing conditions. (More accurately, denied access to the group plan, but they can certainly buy a ‘short term’ [up to 18 month] plan that is significantly more expensive.)
Instead let’s crack a few numbers on the nominally healthy insured worker. First: source is the 2008 run of Kaiser’s annual survey of health benefits. (warning – large pdf file)
According to this survey the average cost of premiums for family (vs individual) employee provided health insurance in 2008 was $12,680. Of this, the average amount the employee paid was $3,354. Before I continue, let’s compare that fact with another fact – fewer than 50% of employee positions offer employer subsidized health care.
What that means is that if the employer cannot or will not pay for health insurance, the premiums alone are $12,680.
Same source says the average aggregate deductible (for the 68% not on other cost-sharing plans, such as most HMOs) is between $1040 and $1344. So we have an overall cost of insurance of between (approximate) $13,700 and $14,000 per year.
According to the Census, the median household income for 2007 was $50,233. (The report says, “real” as in adjusted for inflation. However, unlike other economic reports it’s adjusted in reverse – all previous year numbers are increased to be in 2007 dollars.) That same report says the increase in real median income for three years in a row was between half a percent and a full percent. I will therefore assume the appropriate household median income to match Kaiser’s report is $50,735.
If the employee is not receiving health benefits from the employer, the notional removal for taxes (income, FICA, etc) is 25%. This leaves a notional household median “take-home” of approximately $38,050.
We are now able to examine your phrase “choose not to buy” in a measured cost priority fashion. The number is 33% (33.4% if you want to be slightly more precise). For approximately 50% of households in the United States, if their employers do not offer health care benefits they have to spend 1/3 of their take-home income to have health insurance. I want to point out that this is approximately equal to median gross rent.
Bluntly stated, “choose not to buy” is a false choice – if you can’t afford it, it’s hobbe’s choice.
Kirk Spencer
@North Dallas Thirty: Beep, I detect another underlying assumption error.
Your point is theoretically correct. However the factual point is that doing another $300,000 of effort would earn $200,000.
You keep doing this, ND30. You keep making these theoretical arguments that would be true if your underlying assumptions were accurate. Unfortunately the underlying assumptions keep being wrong.
You make excellent points, and setting aside the constant patronizing tone (you liberals – sniff) they’re well argued. They’re also built on vapor.
For what it’s worth, I’ll probably not be back to this thread. First, it’s getting quite a ways down. Second, it’s an immaterial argument. We’re going to get a changed health care system. We’re going to get it not only because the party in power’s base wants it. We’re going to get it because Walmart and ATT and Lockheed (among others) want it. They want it because it will reduce their costs – direct (employer subsidization) and indirect (days lost from illness – illness exacerbated due to unwillingness to pay the lesser preventive cost for something that ‘might not be necessary’.) I’m generally seeing two groups of people resisting. The companies who will see the changes cut into their profits, and the people I’ve come know as IGOSUs. (I’ve got mine, screw you. Some people call them IGOFUs – you can figure out what the difference is on your own.)
North Dallas Thirty
Ah, the amusement value.
Let’s start with your healthcare hypothesis.
First off, you forgot something rather vital: the cost of health insurance premiums that you yourself pay, as well as your healthcare expenses, are deductible from your taxes.
Second off, you are using the calculated numbers for all employer-provided benefit plans, which would include such things as the gold-plated UAW plans that allow you to go wherever you want, whenever you want, with little to no deductible and virtually no copay or coinsurance (and which, not coincidentally, have dragged Government Motors into the financial slop).
A simple check of the Northern California Kaiser website found that I could provide a zero-deductible health insurance plan for a family of four for $899 per month, or a mere $9,600. Indeed, if I was willing to accept a higher deductible, I could get one with LOWER co-pays for $579 per month, or an annual total of just under $7,000.
If one chooses, as do the vast majority of the poor, to spend their money on cable TV, multiple vehicles, owning their own homes, and excess food, rather than on health insurance, that is their prerogative. I grew up in a conservative household where my parents went without fancy cars, new houses, large workshops, and whatnot to make sure we had health insurance, so I am admittedly not familiar with the liberal value system that puts all of those ahead of buying health insurance.
Excuse me, but weren’t liberals yelling at these places, Walmart in particular, with allegations about how they deliberately underpaid their employees so they would be eligible for government-provided healthcare?
Kirk Spencer
@North Dallas Thirty: Ah, the IGOFU amusement.
Yes, any medical expense (to include health care) that exceeds 7.5% of AGI is deductible against taxes. Gross: ~50,750. AGI assuming family of four and basic deductions only: ~36,150 . 7.5% of AGI = 2711. 13,000 – 2711 = 10289. So assuming no other deductibles or credits including the child tax credit) so as to allow this the MAXIMUM effect on income, we get:
Tax on 36,150 = $4624
Tax on 25,861 = $3079.
And I’m supposed to feel the tax break makes up for it? pfft.
I did use all benefits. But I didn’t cherry pick a “good” insurance as anecdotal rebuttal. Congratulations, you now remind me of high school debaters with whom I’ve had to deal in the past. Any fact is good enough, regardless of validity and sustainability.
Speaking of that, I’m going to ask you to provide what entries you used to find this Northern California plan. The link you gave was to the starting point for plan searches. I used 94101 (San Francisco), a 49 year old male, 45 year old female, 17 year old female, and 16 year old male. All the plans I got were a bit more expensive than you listed. I didn’t find a ‘no-deductible’, but did find a not-too-bad copay plan that “only” cost 913 per month. So I, too, can cherry pick. Of course, 913 a month is just under $11,000 – the copays for visits and drugs and such will probably push that upward.
By the way, check your math. 899 a month is not 9600 a year. 9 * 12 = 108. 899*12 = 10788.
Yaknow, this is getting tiresome. You want to argue by anecdote. You want to use theory and ignore fact. You insult and divert. And then when you finally do pull evidence, you mess that up as well.
insult and divert? I happen to shop at Walmart all the time. That also happens to be irrelevant. The basis of the argument was that some of the nations’ largest employees are in favor of the change and supporting it. Regardless of your political biases (or mine) that’s a weight that matters.