Going without insurance isn’t just for the poor anymore:
About a third of California’s uninsured had family incomes of more than $50,000 a year in 2009, according to the California HealthCare Foundation.
Indeed, the percentage of uninsured among families earning between $50,000 and $75,000 annually has nearly doubled over the past decade.
It costs about $13,000/year to buy good quality (not “Cadillac” quality) insurance for a family in Western New York, so I assume that it’s that expensive or more in California. That’s a big bite even if you’re making between $50K and $75K.
Brian S (formerly Incertus)
Meanwhile, banksters are grousing because they might not get bonuses this year, even though many of them saw their base salaries nearly double. Tell me again why the middle class hasn’t set fire to the upper middle class and the wealthy?
MikeJ
@Brian S (formerly Incertus):
Brian S (formerly Incertus)
@MikeJ: Yeah, that one stung particularly given that I don’t make much more than that in a year, and that my raise this year was 1) the first in 3 years and 2) was 2%. And my bonus is that I get to keep my job for at least six months.
mai name
USA Number One! USA Number One! USA Number One!
BTW that’s people who don’t have insurance. I have a friend who’s got a $5000 deductible and makes $30K a yr and she is avoiding taking care of a major issue right now because she can’t afford the deductible. Also have another friend with the same deal who just had surgery, had to come up with a $1,200 downpayment and she’s doing the restof the deductible in payments. Remember these people have insurance.
The Real American Democrat
We’re only a few short months from the greatest American economic recovery in history. You’ll get your raise in time. The banks are the leading edge of the economy and are the prime indicator of health. The left wing loons will soon realize that Obama is, once again, ahead of the curve and saved the economy from disastrous ruin.
Woodrow "asim" Jarvis Hill
Contrast with the Ezra Klein-reported good news on the MA exchanges:
guster
That’s me. Make $50-70k (usually), can’t afford reasonable health insurance for my family. We’ve got a $15,000 deductible plan that costs about $8,000/year and I’m pretty sure won’t actually help if anything catastrophic occurs. So why am I spending $8,000/year for nothing?
I do not know,
Brian S (formerly Incertus)
@guster: Because you’re hoping that if something truly catastrophic happens–something that will cost six figures, for example–that the insurance company will limit your part to the $15K they promised. That’s the only reason to do it, and it’s indicative of how fucked up our system is that it makes a sort of sense to do that, even though insurance companies have a history of making sure you’ll be on the hook for well more than that $15K.
guster
@Brian S (formerly Incertus): Yeah, I guess ‘hoping’ is the word. I don’t believe they actually would do anything if we had a catastrophic problem, but I’ve send them $8,000/year for seven years now just in case.
Mostly I guess it’s guilt management. If something terrible happens, I can prove to myself I wasn’t a bad father/husband. See? I had insurance.
MattF
Well, surgery and hospitalization is on the order of $10K/day, and then you’ve got medication and rehab– not to mention lost income– so, costs can get catastrophic pretty quickly.
What you don’t get with $15K deductible medicine is ‘wellness’, e.g., treatment for chronic things like high blood pressure and high cholesterol. So, stay healthy, exercise, and eat that fiber.
satby
A lot of people in IT make $50k but are temp or contract workers who get no employer paid benefits, which is where the majority of health care coverage comes from. I was one, and as a single mom was able to keep food on the table, a roof over our heads and my car on the road and that was about it. Health insurance was not in the picture, and neither was any health care except when the kids were really sick. $50k is a lot of money, but that kind of money is also paid in areas like cities where the cost of living is lots higher too.
guster
@MattF: Yeah, but I don’t believe that Anthem would actually pay any of those costs. Maybe it’s too-cynical, but my assumption is that if anything terrible happened, they’d find a way to drop us.
Comrade Javamanphil
@Brian S (formerly Incertus): I liked this:
I’m thinking of starting a paypal account to collect donations so we can turn those bankster frowns upside down.
tBoy
Need non-emergent care? Consider a trip to a civilized country. My wife (French national) just spent three weeks at her home. Went to a GP for over all exam & lab work etc … – $30.00. Went to a cardiologist for an exam & went back the next Monday for a stress stress test – $130.00 & $100.00 respectively.
For all 3 appointments there no technicians, no nurses, no assistants – the doctors did everything alone. Including the cardiologist who not only put the ECG leads on my wife but interpreted the test strip in real time.
My wife is no longer under the French health care system so the above amounts were the actual prices. No insurance. No subsidies.
BTW – the GP required no appointment. Simply walk in the office and ask for an exam. The cardiologists normally have a two week wait but when they found out she was returning to the US they decided it was an emergency and he saw her the next day. They are fully aware of how absolutely shitty the US system is & did what they could to help her avoid it.
SP
@1
I can understand why they’re confused about these difficult number problems- it’s not like they’re in the finance industry or anything.
David
This is a good organization and helps get freelancers with insurance:
“Freelancers Union is a national membership organization that’s free to join. We offer benefits like insurance and retirement to our members and provide political advocacy for all independent workers.”
freelancersunion.org/
Pancake
@tBoy:
Sounds great if the French taxpayers can afford (and don’t mind) the subsidization involved. It’s examples such as this one that help explain, in part, why much of Europe is on the brink of financial collapse. Generous government paid for healthcare is just one of the factors, of course, along with too generous retirement benefits, lax tax payment enforcement practices, etc.
Chyron HR
@Pancake:
Why do you hate Israel so much?
shortstop
But this can never happen to me. The people who don’t have insurance are the ones who don’t work hard or refuse to look for a job and demand a free ride at my expense.
cathyx
@Pancake: Maybe they have just shifted their financial priorities to put free health care for all on top. Unlike here, where we put the defense department on top, and bailing out too big too fail banks second.
daryljfontaine
@Comrade Javamanphil:
Surgically? I may be game, if that’s the case.
D
Comrade Javamanphil
@daryljfontaine: A shovel would be faster.
vtr
@guster: Last April, our 17-year-old son needed an appendectomy. Our employer- subsidized insurance paid all but about $6G. Had we purchased the $8G insurance with a $15G deductible you passed up, the plan would have paid $7G of the $30G bill. What a racket. But at least it isn’t socialism.
El Cid
They can always go to emergency rooms. Also, sometimes charities can help.
John S.
@guster:
I do the same thing. Though here in Florida, my HDHP insurance plan costs about $6000 a year with a $10k deductible.
It’s there for the ‘catastrophe’ part. Two of my wife’s cousins got cancer this year, and I can’t even fathom going through that without insurance. The only thing that sucked was that until Obamacare kicks in, our policy didn’t cover maternity. So last year we had to pony up an extra $15k for her to be born.
El Cid
A bit of actual journalism and suddenly the AP can momentarily put in perspective our GOP budget hawks.
I’m not suggesting that there’s something wrong with expanding staff and pay as necessary and decent. It is, however, nasty to always be decrying any other federal employees simultaneously.
PurpleGirl
When I became unemployed I was able pay for a COBRA because the Feds subsidized it. The payment would have been $54X a moth, if which I would have paid 35%, the Feds picked up the rest. In one of the extensions last year, they left out the COBRA subsidy and I had to give up the insurance. Then I heard in July that insurance cost was going up — to $643 a month. If I couldn’t afford $54X without the subsidy, no way would I have been able to afford it after the premium increase. I should have done it sooner but last week I started the process to get Medicaid so I could get my medications. At least NYC will extend Medicaid to single, childless adults.
burnspbesq
@Brian S (formerly Incertus):
“Tell me again why the middle class hasn’t set fire to the upper middle class and the wealthy?”
Because they are still bought into the idea of upward mobility.
It’s very similar to the politics of estate tax repeal. The most vociferous support for estate tax repeal has for many years come from the NFIB, nearly all of whose members run businesses so small that there is no way that an estate tax will ever be imposed. But they all believe that if they continue to work hard, they will someday be rich.
Once people grab hold of an illusion, it’s hard to let go.
Dennis SGMM
@Pancake:
This is another area where America is way ahead of Europe: we’re on the brink of financial collapse without providing UHC or generous retirement benefits.
Were #1! We’re #1!
PurpleGirl
@Dennis SGMM: Brilliant comment. Would you like an Internet?
guster
@John S.: I’m in Maine, and the maternity/prenatal stuff is _great_, actually. (Before then, we didn’t have any insurance at all–but even with the crappiest possible insurance, you get well-baby checkups and all.)
I’ve spent a whole lotta time looking for an organization to join that offers health benefits (Freelancer’s Union is, I think, good in some states but in many others–such as Maine–only offers a dental plan), and even ran the numbers on enrolling in community college for the health benefits.
daveNYC
Eh, that’s just basic human nature though. If someone gives you a five thousand dollar raise, that works out to about two hundred bucks (pre-tax) every paycheck, assuming you get paid every couple of weeks. For a lot of people, that isn’t as visible as a fat lump sum deposit.
That doesn’t mean that they aren’t being whiny-ass-titty-babies about it.
Dennis SGMM
@SP:
Silly Massachusetts: who wants an MIT health economist to work on health care legislation when you can have Max Baucus, Big Pharma and the HMO’s to work on it?
El Cid
Funny, in Europe they (including the conservative politicians) actually blame the housing bubble and the gambling of banks in fictitional investments.
Germany still has its generous social welfare, and have even expanded job subsidies to allow companies to give current workers fewer hours so to permit them to hire more workers.
And they’re the ones lauded for doing much better than the rest of Europe.
El Cid
@Dennis SGMM: You may not be able to count on an MIT ivory tower elite to keep any health care reforms bottled up for an entire summer while opponents scream ‘Stalin’ at townhalls and come out the other end with no changes.
Xboxershorts
We may be approaching the end game of 40+ years of a coordinated strategy between corporate leaders and government (mostly GoP) to make the nation secure from the social uprisings that were the hallmark of the 60’s. Media consolidation and removal of the “fariness doctrine” ensured a unified message. An endless stream of boogiemen and enemies of the state kept our collective attention focused elsewhere along with the demonization of “liberal” social safety net programs like welfare, health care and education which were all systematically and incrementally defunded.
America hates Americans for their freedoms. So America conspired with American business to take their freedoms away.
Bohemian Grove is much more than just a weekend getaway.
Dennis SGMM
@El Cid:
As someone observed on another thread, when Republicans pull that kind of counter-productive crap they get punished. When Democrats do it they get (And keep) committee chairmanships.
Mark
One of many problems in California is often that no one will sell you insurance. If you have been to the doctor for any reason over the last year other than a routine checkup, you will be denied. It doesn’t matter if you’re 35 years old, they will still refuse to sell to you.
agrippa
@Xboxershorts:
Not all americans believe in freedom. There is a strong authoritarian strain and a real paranoid style [ Richard Hofstadter] in America.
mclaren
Wait a while. The bite will get a lot bigger.
Health insurance premiums keep skyrocketing not primarily because of any alleged greed by the insurance companies, but mainly because of the endless stratospheric increase of underlying medical costs in America.
This graph of health care spending as a percentage of GDP in inflation-adjusted dollars over the last 40 years by a variety of differen countries tells the whole story.
This is why Obama’s HCR is ultimately doomed to failure. Without cost controls, you get perhaps 15 to 20 years (more likely significantly less) at the very outside before health insurance becomes too expensive for anyone but the rich to afford in America. At that point, America’s medical-industrial system collapses.
mclaren
@Pancake:
Obviously horseshit, and easily proven. Germany has the most generous government paid healthcare and some of the most generous retirement benefits and the longest employee vacations of any of the European countries, yet Germany is doing just great, having entirely avoided the speculative subprime financial meltdown.
Canada, which also provides extravagantly generous government healthcare by American standards, is also doing just fine. The Scandanavian countries by and large avoided the subprime meltdown and they provide fabulous government healthcare.
Turns out the real reason some European governments are in trouble is the same reason America’s financial system went into the toilet: excessive speculation by greedy financial criminals running the big banks.
Next you time you tell a lie, Pancake, try to make sure it’s not an obvious and stupid lie. It reveals you as not only dishonest, but dumb as a box of rocks. You really need a refresher course in remedial lying from your Koch brothers paymasters.
Dennis SGMM
@mclaren:
A worrisome aspect of the bill for me is that the subsidies for lower income folks aren’t indexed to anything. Adjustments to the amounts of the subsidies are reliant on the good will and attentiveness of Congress. To me that can only mean that they are in jeopardy of falling behind increases in the cost of health insurance.
El Cid
@Xboxershorts: Bigger than that — rolling back the gains of the New Deal, particularly the gains in the power of labor and the increased equality in earnings of the middle and working classes to the super-rich.
The most prominent scholar of ruling power in the U.S.
Also, Domhoff’s updated brief on more recent research on wealth concentration and income inequality here.
And a contextual background of the role played by the Bohemian grove in upper-class sociaIization and interconnection here. (It’s one of many important venues and organizations.)
Erik Vanderhoff
Here in California, I pay about $10,000 per year out-of-pocket to add my wife and child to my health care plan, which I get through CalPERS (the California Public Employee Retirement System), which I pay in to instead of Social Security and Medicare (so no payroll tax holiday for me, fuck you very much Tax Cut Bill), and that’s for a decent PPO plan. Fortunately, my employer pays up to the cost of just the employee enrolling, so the first $450 of the per-month cost is covered.
So, yeah, prices are similar, and if I didn’t have an employer contribution or had a second kid, it’d be a fair amount more.
jcricket
So everyone who’s uninsured has totally stopped getting sick, right? And when the states cut all the basic healthcare services that were offered for the poor and lower-middle class, those people stop getting sick too, right? And everyone with insurance they can’t afford (like the people mentioned in the comments above), they’ve stopped needing healthcare, right?
Even with ACA people large numbers of people will only have insurance in name only (part of why I support reforms like banning “mini-med” plans). And with wages stagnant, unemployment high – the ERs are just going to get more and more crowded. My dad, who’s been a physician for 40 years and now supports single-payer (after long opposing any kind of federal intervention) says the only way the country will wake up is when the hospitals start going bankrupt, and turning people away in droves.
That’s why I always want to punch libertarian-ish friends in the face when they say, “healthcare is too cheap. People should feel the cost of it more”. People can’t afford the fucking premiums and deductibles, let alone if they were subject to the paying for their regular full-price healthcare costs. Yeah, yeah, insert hand-waving bullshit about how more “educated healthcare consumers” would magically bring down costs of medical care, despite the fact none of us are doctors and when you are sick or injured you are not capable of comparison shopping and many treatments are only available at limited facilities (and treatments for conditions like cancer or transplants are astronomically expensive)
It’s all just bullshit, and I say without hyperbole, it’s literally killing people.
We can either decide it’s ok for your access to healthcare to be decided based on your wealth (poor = die in the street sucker; rich = sure, here’s a payment plan) or take the pragmatic approach and design a national healthcare system like one of those offered by everyone else. Yes, the other countries face rising costs too, but nothing like ours, because their larger risk pools and better regulation have dramatically altered the landscape. Plus everyone is covered and their outcomes are as good or better.
Shorter me: we are idiots and we are doomed.
daveNYC
Bullshit. Who do you think the banks were that bought up the craptastic debt coming out of Ireland, Iceland, Spain and the rest. All the ECB bailouts are doing is covering up the bad debts owned by German and French banks.
And that’s not even getting into the overly tight monetary policy that is designed to benefit Germany’s export market, and the rest of the EU be damned.
El Cid
@jcricket:
Maybe the point is not just that you could afford if you really worked at it, but that you need to just live with or accept the consequences of not having care.
Joey Maloney
@David: Unless that org has changed a lot in the last 10 years, good luck getting coverage if you’re not 26 and healthy, or have any history of serious illness in your family.
Josh Reiter
@cathyx: Umm, actually defense spending is dwarfed by Social Security and Medicare. But nice try with recycling that old and tired anti-military meme. Plus, our military provides a great deal of security to the whole of Europe so that they can sit around and enjoy that “civilized” and “free” healthcare.
mclaren
@Dennis SGMM:
That’s not a bug, that’s a feature. It was an intentional part of the HCR bill that the “cadillac coverage tax” and the refusal to index the subsidies of the low income people were deliberately designed to discourage consumption of health care. The masterminds who designed the Obamacare plan decided that the way to reduce the overall cost of American helathcare was to reduce consumption of health care — and the way to do that was to gradually price it out of reach.
The problem with that “solution” is that it isn’t really controlling costs. If you buy less of something expensive, that doesn’t lower its cost. So what Obama’s HCR really means is that low-income people will defer getting treatment for serious medical problems. But those medical problems will gradually get worse over time, to the point where the low-income poeple will eventually have to seek treatment at the ER. That will mean very expensive health care and a dead loss for the hospital, since those poor people typically can’t pay when they get the $200,000 bill from the hospital, so the hospital must simply write it off.
The big irony here is that these medical conditions would often cost a lot less to treat if they were treated up front, instead of allowing them to progress to the point where they become critical. But the foolish scheme behind Obamacare insures that poor people — and, increasingly middle-class people who can’t afford the sky-high deductibles, which now range from $5000 to $10,000 to in some case $15,000 and $20,000 and $30,000 and more — let serious medical conditions go untreated and worsen until they become life-threatening and require massive medical intervention, major surgery, and so on.
This is completely bass-ackwards from the way medical care logically ought to be delivered. The medical-industrial complex should seek to aggressively identify and preventively treat conditions as early as possible, the better to reduce costs. Instead, Obama’s HCR forces people to avoid seeing a doctor until they collapse and the ambulance rushes them to the hospital and what would have been a treatable condition turns into a gigantic major critical-care problem requiring massive medical resources.
The really evil part of the Obama HCR bill is that the “cadillac coverage” tax is specifically designed to discourage employers from offering high quality health insurance.
From “Cadillac tax pros and cons.”
But what is actually going on here is that Obama’s HCR bill will force employers to gradually restrict the kind of health insurance they offer as premiums inexorably rise over time. This is actually a stealth privatization scheme, since it insures that over a period of some years, employers must shift more and more of the burden of paying for health insurance to employees.
Insurers are already doing this by constantly raising the deductibles. As times passes, the deductibles go up and up and up, from $2000 to $5000 to $20,000 to $100,000. When the deductible gets high enough, you might as well not have insurance, since you can’t pay for the deductible. Hospitals typically demand a cash or cash-equivalent down payment based on the deductible, so you can’t even get admitted to the hospital if the deductible is too high.
This is fundamentally evil. And it’s deliberate. Obama’s White House signed off on this evil shite. Of course after the compromises and alterations, the “cadillac tax” won’t kick in until 2018, but insurers and employers are taking pre-emptive action now by reducing the health insurance plan offered and raising deductibles. Meanwhile, the cost curve isn’t getting bent as Obama claimed it would be.
And now it’s all starting to crash and burn.
See the article Obama punts on containing health care costs.
This is the result of refusing to use government regulation to control medical costs, and instead trying to let the “magic of the market” do it.
This is completely false. In fact there are three ways to control health care costs: the first two described above, but the third is to nationalize the system and force the medical devicemakers and the doctors and the hospitals to come in at a maximum cost or get frozen out and get paid nothing because the government (which provides all healthcare) won’t do business with them. This third method is the method used by every other country in the industrialized world — and it works.
Trying to use the free market to control health care costs will never work because the free market is the basic reason for high health care costs. Obama’s approaches to controlling health care costs are like trying to put out a fire in your propane stove by dousing it with kerosene. You’re trying to solve the problem by using more of what created the problem in the first place. That’s never going to work.
Wiesman
Break out the foam fingers!
USA!
mclaren
@daveNYC:
You’re lying. Germany’s banks had much lower exposure to the subprime meltdown because their banks had much lower leverage than banks in the U.S., Spain, Britain, Greece and Iceland.
Germany’s financial system was hit by the global financial crisis primarily through its exposure to financial instruments issued by U.S. banks, which were thought to be AAA rated and turned out to be junk. This was a result of U.S. banks lying and scamming everyone.
See, for example, this report about German reinsurer Munich Re from 30 June 2008 and compare with the total meltdown of AIG in America.
Contrary to your provably false claim, Germany made out very well and has escaped with minimal financial damage compared to the heavy hits taken by British and American and Spanish and Greek banks.
Fang
What’s also forgotten here is other costs. $50K a year may sound great until someone looks as the cost for renting an apartment in these areas. In California, a state I do love, rents are over twice what I’ve seen in the midwest.
And yes out here in the Land of Opportunity we’ve got plenty of people without insurance. I know some smack in Silicon Valley.
El Cruzado
@tBoy: Well, for anything that won’t kill me in less than two days, my deductible equals the price of a plane ticket to Spain. As a national I have the right to get free healthcare there, never mind it’s been years since I paid any taxes to the Spanish government.
Triassic Sands
@Brian S (formerly Incertus):
Because in the good old US of A members of the middle class (and even the poor) will inevitably become rich in the not-too-distant future. If one is making $15,000 a year, it makes no sense to “punish” the rich when one will also be rich in a few years.
Apparently, somewhere there is an American Enterprise Institute study proving this to be true. How else can one explain the poor and middle class routinely voting contrary to their own best interests? Well, I suppose stupidity would be an alternative explanation, but what are the chances of that being the case?
Martin
@Erik Vanderhoff: Gosh, California is so irresponsible with all those free services it hands out.
mclaren
@Fang:
To follow up on what you’re saying, Fang, let’s run some real numbers. An apartment in Los Angeles or San Diego typically costs around $2500 to $3000 a month for a 2 bdrm in a decent area (meaning: not Compton, not South Central HelL.A. where the gangbangers will bust a cap in your ass when you try to start your car to drive to work in the morning). If this sounds ridiculous, bear in mind that in HelL.A. or Scam Diego a studio apartment typically costs $1500 a month.
On top of that you’re looking at probably at least a half-hour commute, so figure at least $200 a month for gasoline for commuting. Your car insurance will cost another $200 a month times two for two people, your car payments come to $200 a month times two for two people.
So now you’re looking at burning through $4000 a month before you pay for food. Figure another $300 a month for food, now you’re burning through around $4300 a month. And that’s without exotic luxuries like…phone service. Or broadband internet. Figure $4600 a month for things like clothes, car repairs (which do add up), phone + internet + cable TV.
Women typically make 70% of what men make so if you’re married, you’ve got a combined pretax income of $50K + $35K and after state and federal taxes and FICA and the other stuff you’re looking at a combined two-income takehome of 53K per year. That works out to $4500 per months. But we’re already up to $4600 a month in expenses without paying for health insurance. Whoops.
How the hell do people make ends meet?
Good question, amigo. I don’t know. Even if the wife makes 50K, that’s only $5000 a month takehome for both of you after taxes and FICA etc., which leaves a bare $400 a month to pay for health care. Here’s a news flash: $400 a month won’t cut it, not for family health care coverage.
Triassic Sands
@PurpleGirl:
If you can get Medicaid as a single, childless adult, you’re fortunate (though not fortunate to be in a position where you have to rely on Medicaid). In Washington State (a blue state, ha, ha) you have to be disabled to qualify. Of course, we have the Basic Health plan for low income people — except that enrollment to that was closed a couple of years ago, and the governor (pretending to be all torn up by her decision) has just called on the legislature to eliminate the Basic Health program altogether, at the same time there are something like 122,000 people on the waiting list.
Simultaneously, cuts in Medicaid have begun. It’s becoming harder and harder to understand what the point in having Democrats is, since the Republican agenda seems to be moving forward nearly everywhere.
I nearly choked when the new health care reform bill claimed it was going to extend coverage by expanding Medicaid. There is no way states are going to stand by and accept that (and, indeed, some of the court cases trying to get HCR canceled are based on objections to Medicaid). Also, since states are now cutting the current Medicaid benefits, what are the chances of expanding the program to cover millions of uninsured? I think the answer to that is pretty obvious.
Svensker
@Pancake:
So explain the Canadian system, then. You know, the one with sound banks and a non-collapsing financial system? And government health care.
Our son recently had to see a Canadian doctor and had to pay cash for services (long story regarding kid-world vs reality, not relevant). His doctor was upset for him because it was going to be “expensive”. Doctor visit was $25 and the MRI scan was $150.
The American system is a huge scam and a national disgrace.
drkrick
@Triassic Sands:
Never underestimate the carefully cultivated fear that somewhere a brown person might get a dollar or a benefit they don’t “deserve.” An astonishing number of people are willing to let their children die in the streets before they let that happen. An element of the elite in this country has been using that fear to keep poor whites from defending their own interests for centuries, why would they walk away from a winning strategy now?
Schad
This is what I find hard to fathom, as a Canadian…$13,000 for a family of four isn’t simply more than the portion of our taxes which would go to pay for universal health care. It’s probably more than what that family would pay in taxes, period. I just ran the federal and provincial numbers for an individual making $50k, using Nova Scotia’s income tax rates and no deductions whatsoever, and got $13,904. Throw in the piles of tax credits that would come with being a family of four rather than a single person and it should be a fair sight below $13k.
mclaren
@Triassic Sands:
This is the other drum I was beating over and over again during the HCR debate, and no one paid attention. Now that the chickens are coming home to roost, everyone’s starting to wake up and realize what’s going on.
Google “states slash Medicaid” and you’ll find links to literally hundreds of stories. Every state in the union is cutting Medicaid because these costs are bleeding them white, and Great Depression Part Two has continued to roll on, sending out a tidal wave of red ink as every state sinks deeper and deeper into budget deficits. The tax base keeps eroding because employers are using this recession to ship high-wage high-skill jobs overseas (as well as low-skill high-wage manufacting jobs), so now states are really hurting. Every year their deficits keep rising.
The great boast of the Obamacare boosters was “Obama has shifted fifteen million previously uninsured people to Medicaid,” to which the response of anyone who knew what Obama’s HCR program really involves was “No he hasn’t, he’s simply dumped 15 million uninsured poor people with chronic medical conditions on the state medicaid system, but the state Medicaid system is already bankrupt in almost every state in the union, so those 15 million poor people will wind up on the streets dying without medical care real fast.”
Dumping this many uninsured sick people on Medicaid is the biggest unfunded mandate in American history. And when you shout “But Obama has budgeted for Medicaid payments to the states!” the answer is: not enough, not nearly enough.
The whole U.S. medical-industrial complex is starting to crash and burn in slow motion. It’s sickeing to watch this debacle unfold. Obama and the Democrats kicked the can down the road, refusing to control costs and refusing to make the systemic changes necessary to fix America’s broken medical-industrial complex. Why? Because they thought it “would cause too much disruption.”
Wait till you see the disruption when America’s medical-industrial complex comes apart at the seams because the costs keep rising and the states’ tax base keeps eroding as automation + offshoring keeps destroying jobs.
This is why people like Chris Hedges are saying “U.S. Empire Could Collapse Any Day Now.”
America is running an unsustainability marathon in half a dozen different areas. Health care is just part of it. It’s unbelievable. And nobody wants to talk about this stuff. Nobody wants to admit it’s happening.
BDeevDad
We are also paying more for less. I live in CA and I have great insurance through my company. However, the copays have gone up 125% and hospital stays have gone from a flat rate to 10% of the bill (up to the out-of-pocket max). For a family with a chronically ill child or adult, this would result in an additional 7-10k a year.
Martin
@mclaren:
As usual, you don’t know what the fuck you’re talking about. ACA expands access to the expensive treatments – that’s what all the pre-existing and recision language is there for. What it does is try to reduce consumption of the mid-cost items that are largely discretionary and have become ‘important new markets’ like CiaIis (I have nothing against CiaIis, etc. as a covered medication, but it’s pretty clear that the market for these are much larger than the medical need.)
As usual, like with most of the attacks against ACA from the left, you fail to distinguish between critical care and discretionary care. Any health care system needs to make such a distinction and so expanding access to critical care items for such little things as cancer treatment over access to the range of other treatments that employers pad their health care plans as a means to attract employees is perfectly reasonable and responsible. Every time the argument is trotted out about how awesome France or Canada’s health care system is, these folks point out how they take care of cancer patients. But as soon as the US wants to tax coverage for jimmy legs and short eyelashes, the ACA attackers point and scream ‘See! Obamacare is trying to kill poor people!’
The solution is absolutely going to control costs, just not the costs you want controlled. Will it drive up the cost of medication for ugly toenails? Yep. But Medicare and Medicaid don’t cover that, so who gives a shit? Will it drive down the cost of cancer treatments, heart medication, and so on? Yes, and those are the kinds of things that Medicare and Medicaid do pay for, and they’re the kinds of things that people who are uninsured are desperate to get covered and to afford.
What the fuck do you think we’re doing!? Insurers will now be required to pay out for everything. They’ll be required to keep costs under a certain limit. They’ll be constrained on how much they can raise premiums. The only uncontrolled variable in the equation is how much they pay care and equipment providers. Have you talked to any C-level health care executives about what they expect the outcome of this is going to be? I do, all the time.
Is it going to be as efficient as a nationalized system? No, but then Obama isn’t dictator either – something you seem to think he is. This is the most workable system possible in the US right now. Deal.
Triassic Sands
@drkrick:
I agree. There is a powerful element in American thinking that letting one person get something he or she doesn’t deserve is far worse than forcing thousands to go without something they need.
The same reasoning afflicts thinking about the death penalty. Many wingers are willing to trade the occasional innocent person being executed for the chance of killing more guilty people. Similar thinking enters into the discussion about rights for the accused (not just of capital crimes). If we protect the rights of the accused, then a guilty person might walk. That is seen as much worse than wrongfully convicting any number of innocent people.
We allow this kind of thing to go on because historically the injustices tend to be hidden. The Innocence Project has made a small number of such cases visible, but the true problem is far greater than DNA evidence can reveal, since the vast majority of criminal cases don’t have any DNA evidence.
Now that significant cuts are coming in health care programs for the poor and low income people, there are going to be deaths — directly attributable to specific cuts (see Arizona). It remains to be seen whether such deaths will be highly publicized or largely hidden. In the case of transplants, the cases are relatively few and highly visible, but people will be dying for much more mundane reasons, like inability to pay for prescription medications. Those deaths will be more numerous, but less visible, so they will be easier to ignore and it will be easier for people to pretend they don’t exist.
mclaren
@Schad:
Yes, but Canada isn’t spending 1.35 trillion dollars a year to fight two pointless unwinnable wars on the far side of the earth while simultaneously sending black ops assassination teams into 200 countries and maintaining a network of 700 military bases around the world, plus building 11 aircraft carrier battle groups and hundreds of supersonic jet fighters and billion-dollar Polaris nuclear submarines and M1A1 Abrams tanks and Blackhawk attack choppers and B2 stealth bombers, along with funding the CIA and NSA (to intercept and record every phone call on earth) and the NRO (sending hundreds of boxcar-sized imaging satellites in orbit to photograph and track thousands of sites on earth) plus the VA hospital system that now has to provide care for hundreds of thousands of brain-damaged vets who’ve been permanently disabled by IEDs.
All that stuff costs money, buckaroo. It adds up.
Of course America still can’t win any wars, but whaddaya expect for a mere 1.3 trillion bucks?
Martin
@mclaren:
So because we have a lot of tanks, an MRI needs to cost $2000 instead of $150 out-of-pocket? Read the comment 2 above Schad’s.
Quit the handwaving and bullshitting.
change
Defense spending is 5% of US GDP, Healthcare is already much, much higher.
Karmakin
A significant part of the increased cost of the American health care system is the primary reliance on the insurance industry. Each insurance company has their own procedures and rules that MUST be followed, and as such it drastically increases the workload in getting medical business done.
The sad part? These jobs are solidly middle class jobs and it’s politically non-viable to do anything that might threaten them. That’s why single payer and even a public option never stood a chance.
mclaren
@Martin:
We start by stating the documented fact that whenever Martin opens his mouth, a lie comes out. Based on this essential reality, everything else follows.
Here’s Martin’s first lie:
Health insurers are simply refusing to write coverage for families with children who have pre-existing conditions.
See “Heath inusrers to skirt new law, refuse policies for children with pre-existing conditions.”
Obama was, as usual, incredulous when the health insurers betrayed him. Just as Obama couldn’t believe it when the Wall Street criminals he’d bailed out turned around and used taxpayers’ money to give themselves lavish bonuses, just as Obama couldn’t believe it when Republicans still voted against him even after he pre-emptively gave them everything they asked for. Obama is hopelessly naive and far out of his league, a gullible dupe who keeps getting scammed and taken to the cleaners by far smarter and more ruthless pols.
Moving on to Martin’s second lie, he doesn’t explain how the cost of cancer treatments and heart medication will be reduced. That’s because he can’t. In fact, the primary mode of reducing cost for all medications in America, which would have been drug-reimportation, was explictily bargained away before Obama even began HCR negotiations with the republicans. Drug reimportation was “off the table,” like the public option, and thus there was absolutely no incentive for big pharma to reduce its drug prices. Medicare Part D, that giant giveaway to big pharma, was also never under threat from Obama — a savvy president might have used the threat of cutting back on Part D to force big pharma to agree to radical cost cuts.
Obama’s duplicity on these points is truly nauseating. See “Two months after he negotiated it away, Obama argued for public option in joint address to congress.
And now we come to Martin’s third lie.
No, insurers will only be able to raise their premiums by X amount more than the underlying medical costs increase. That’s the problem. If insurers can document that medical costs double, they can double their premiums. And that’s what is actually going on here in America — our health insurers actually operate on fairly slim profit margins. The big money is begin made by medical devicemakers and doctors (who earn on average twice what doctors in France or Germany or Britain make) and for-profit hospitals and imaging clinics (which charge $950 for a CAT scan with the exact same machine that a French hospital charges $150 for).
Exactly. Health insurers will have to raise their premiums infinitely because the underlying costs are rising without limit. Why? Greed, collusion, corruption, sweetheart contracts, non-disclosure agreements between devicemakers and hospitals, between doctors and hospitals, between big pharma companies and doctors, lock-in contracts forcing a hospital to buy services and equipment only from certain suppliers, who jack up their prices without limit, 700% of costs, 1000% of costs, 5000% of costs, 10,000% of costs. Medical devicemakers manufacture disposable plastic surgical instrumetns for $40 and sell ’em to hospitals for $1200 and the hopsitals just pass the costs along to the insurer. Hospitals charge $5 per aspirin and the insurer just passes the cost along to the person who has to pay the premiums.
On their yachts, I bet. On a Cancun fishing trip. With five hookers.
Gee, I wonder why. Could it be because…a for-profit health care system fundamentally cannot work in a laissez faire free enterprise system like America? Hm. Maybe.
I’m always impressed when people like Martin tell sick people who are dying “Deal.” That really gives us an insight into the mindset of those people like Martin. I’m surprised you didn’t sneer at those sick Americans who are dying from lack of medical care, “You need to grow up.” Or better yet: “Shut up and stop whining, you grade IV astrocytoma cancer patient. What a punk. Just because that grapefruit -sized brain tumor is causing you unbearable agony and you can’t get insurance, you think you can disturb us all by yelling and screaming. Pussy. Man up, you little bitch.”
Thanks for telling us who you really are, Martin. It’s an eye-opener, that’s for sure.
mclaren
@change:
You’re lying. U.S. military expenditures are far above 5% of GDP per year. You’ve been fed a pack of lies by the military-industrial complex and you’ve swallowed them whole, and now you’re regurgitating them.
Here’s the short breakdown:
“Official” military budget 650 billion FY 2011
NSA budget 50 billion
NRO budget 50 billion
CIA budget 50 billion
VA budget 73 billion
military retirement annual costs 70 billion
DHS budget 50 billion
Pentagon black ops budget 50 billion
Department of Energy budget 20 billion (death ray lasers, etc. almost all for the military)
DEA budget 20 billion
Miltiary law enforcement to militarize local police forces with SWAT tanks, military sniper rifles, etc. 1 billion
Xe (AKA Blackwater, which has been revealed as a front for the CIA) 60 billion
That’s well over 1.1 trillion just using back-of-the-envelope quick ‘n dirty numbers.
You’re lying. With a 13 trillion dollar GDP, 1.1 trillion is around 9% of GDP. There are a bunch of smaller military costs I haven’t included that raise it to 1.35 trillion, which comes American military spending to more than 10% of GDP.
When you tell these kinds of obvious lies, you just look stupid.
mclaren
@Martin:
Either you’re drunk, or you need to retake you Test of English as Foreign Language.
America’s sky-high military expenditures explain why Americans spend so much more in taxes than Canadians do.
These kind of foolish hand-waving scams aren’t fooling anyone, Martin. If you want to distract us by lying about what I said, you need to do a better job.
kay
@Martin:
This comment is a thing of beauty, Martin.
change
@mclaren:
I find it rather droll when Marxists reply with such arrogant, childish lies, but I will attempt to engage you. Do try to follow along:
The Pentagon budget is 4.7% of GDP in FY 2010. Healthcare spending is 16% of GDP.
Even after, (in your apparent ignorance) you tried to fluff the number by adding on costs from other departments outside the Pentagon, you still couldn’t quite get it up to the amount of our GDP we spend on healthcare. Sad, isn’t it?
As to the percentage of our budget, perhaps this will come as a shock to a stunningly ignorant child as yourself, mandatory entitlement spending is nearly twice the percentage of our budget that the DoD is.
I do hope you can continue to discuss this with me in a mature, adult manner, and refrain from screaming about “lies”.
mclaren
@Karmakin:
Actually, it’s complicated. The reasons for America’s stratospherically high health care costs are systemic and result from many different contributing factors.
First, the AMA artificially restricts the supply of doctors to make certain that American doctors earn more than $230,000 per year (general MDs, that’s an average). Compare with general MDs in Germany or France or the Netherlands who typically make between $80,000 and $100,000 per year.
Second, cost of CAT scans, a simple routine doctor’s visit, blood wokrup, etc, in America runs between 7x and 15x what the exact same procedure costs in Germany or France or the Netherlands. For example, a routine doctor’s visit in America costs $10, whereas a routine doctor’s visit in France costs $35, in Germany it costs $25, and so on.
Third, medical devicemakers operate by bribery in America. They bribe doctors and hospitals to use a particular brand of hyperexpensive medical gear. Google “medical device makers caught in bribery scandal” and you’ll find literally thousands of these per year. It’s absolutely routine in America, medical devicemakers regard giving bribes to doctors and hospitals as a basic cost of business.
Fourth, doctors take bribes from big pharma companies to prescribe overpriced medications. The doctors often don’t even know the cost of the medication and don’t care because they bill the insurers, who pays for it.
Fifth, doctors and hospitals and medical devicemakers use lock-in contractors to contactually require that a hospital uses a particular mabulance compnay, a particular imaigng suite, a particular doctors’ group, a particular medical devicemaker — usually the most expensive one. Competing imaging services or blood labs or ambulance services can’t even negotiate with the hospitals because the hospitals are contractually prohibited from telling these competing organizations how much they already pay for existing services.
Sixth, insurers have cartel power and geographic monopolies, forcing anyone who lives in that geographic area to pay whatever the insurer demands or go without health insurance.
Seventh, hospitals jack up costs cover the hit they take from treating uninsured patients — and also to make sure the doctors who run the hospital drive Bugatti Veyrons and wear Patek Phillipe watches and have a second vacation home in Maui as well as one in St. Moritz. If you’re uninsured but hav a decent joba nd own a home and have some net worth, the cost of a treatment may be 5x or 10x what it is if you’re insured.
Eighth, hospitals and doctors in America practice a “heroic extreme measures” style of medicine where teams of specialists will labor for 15 hours straight to do spectacular life-saving operations — that cost millions of dollars. Other countries forgo such wildly elaborate procedures on terminal cancer patients and conjoined twins with a poor chance of surviving the operation. But in America, doctors love this cowboy stuff, especially with dying patients in their last 6 weeks of life. Other countries ration care for end-of-life patients, but in America, if you’ve got the insurance, the moon’s the limit. Spending two or three million dollars for pointless experimental last-ditch treatments on patients who have 6 weeks left to live but have great insurance…why, that’s the American way.
Ninth, doctors set the prices of medical procedures according to how complex it is, so hospitals have a strong incentive to use the most complex and expensive treatments. After all, the insurance company will pay for it, so why not?
Tenth, American physicians neglect preventive care in favor of heroic spectacular expensive procedures.
Eleventh, American fast food and a sedentary lifestyle contributes to poor health. The French have a much lower level of heart disease in large part because you don’t see a McDonalds or Wendys or Carls Jr. sludgeburder fast food restaurant every two blocks in Paris. It took America to invent the KFC Double Down, which is basically an intravenous lard injection.
So there are a lot of reasons why American health care costs so damn much. It’s not just one thing, it’s the entire structure of the U.S. medical industrial complex.
To get you started, take a look at the articles
“Soaring costs laid to growing power of medical cartels,” San Francisco Chronicle, 21 February 2010.
“The hidden public-private cartel that sets health care prices,” Slate magazine online.
For more, see the excellent New Yorker article “McAllen Texas and the High Cost of Health Care.” Health costs skyrocket because doctors set up their own imaging clinics and blood test labs and charge hospitals 40x what those tests actually cost, raking in vast profits. The hospitals sign sweetheart contracts with the doctor-owned labs that lock them in as suppliers and prevent disclosure of prices. The health insurers lock in customers as regional monopolies, prevented people with insurance from getting insurance anywhere else. All along the line you have bribery, collusion, sweetheart contracts, non-disclosure agreements, price-fixing, massive monopolies that collude corruptly to raise prices and prevent competition.
For a discussion of the massive bribery that goes on when medical devicemakers pay off hospitals to use their brand rather than someone else’s (massively raising prices in the process), google “Medical device maker kickback allegations keep coming” at fiercehealthcare dot com, July 16 2009.
Also see the Rolling Stone article “Take two kickbacks” from December 2009.
For details on doctor monopolies, google the article “The Medical Cartel: Why are MD Salaries so High?” Because the AMA artificially restricts the number of doctors to keep doctors’ income sky-high.
For details on the grossly corrupt cartelization of the health insurance industry, google the article “Insurers set to raise prices, walk away from consumers” in the huffington post, March 5, 2010.
For more on the gross failure of Obama’s HCR bill to tackle these cartelization issues, google “Obama Points to the Lack of Insurance Competition, a Problem His Plan No Longer Solves” at commondreams dot org, March 8 2010.
For a general overview on the insanely high cost of American health care, where costs are typically 10x to 40x what they run in Germany or France or Spain for the exact same procedure or test or image using the exact same equipment, see the article “An insurance industry CEO explains why American health care is so expensive,” in Ezra Klein’s blog at The Washington Post, December 2009.
mclaren
@change:
Continuing to tell the lie that U.S. military spending is 4.6% of GDP when I’ve just demonstrated that it’s at least 9% of GDP, and when a little bit more research on your part would clearly demonstrate that it’s actually above 10% of U.S. GDP, is altogether pointless.
I’ve documented the numbers clearly.
You can continue to claim that a circle is square and 2 + 2 = 9 and that U.S. spending is 4.6% or 2% or 0.5% of GDP, or whatever you want to claim, but your claims are provably false and have been clearly demonstrated to be false. Look at the budget numbers I provided. Add them up. Check my numbers. It’s all there. It’s perfectly straightforward.
I honestly don’t know why people persist in telling these kinds of remarkably baldfaced lies in the face of clear evidence to the contrary. It’s like global warming deniers or evolution deniers. Why do they bother? What’s the point? Do they actually think they’re going to convince anyone that palpably untrue claims are accurate merely by repeating them?
mclaren
@kay:
Spoken with the usual ignorance. I have a comment in that systematically disproves all of Martin’s false claims, but of course it’s in moderation — for no discernible reason.
Standard stuff.
Kenneth
@mclaren:
The only way you get that number is by including things that are not the Department of Defense. It seems the only ones repeating falsehoods is you, rather ironic isn’t it?
Still, even if we use your “special” math and start including things in the DoD budget that aren’t really in the DoD budget, it still doesn’t reach the percentage of GDP we already spend on healthcare.
Perhaps you should refer to your Marxist talking points and find new ways to fluff up the number.
Martin
@mclaren: Maybe FYWP has finally figured out that you’re full of shit as well. Sentience, this blog has attained it.
mclaren
@Martin:
So this is a repeat comment and will doubtless also wind up in moderation…for no reason. Typical.
We start by stating the documented fact that whenever Martin opens his mouth, a lie comes out. Based on this essential reality, everything else follows.
Here’s Martin’s first lie:
That’s provably false, Martin, and I have to believe you realize it’s false, since the news coverage on this has been extensive. Health insurers are simply refusing to write coverage for families with children who have pre-existing conditions.
See Heath insurers to skirt new law, refuse policies for children with pre-existing conditions.
Obama was, as usual, incredulous when the health insurers betrayed him. Just as Obama couldn’t believe it when the Wall Street criminals he’d bailed out turned around and used taxpayers’ money to give themselves lavish bonuses, just as Obama couldn’t believe it when Republicans still voted against him even after he pre-emptively gave them everything they asked for. Obama is hopelessly naive and far out of his league, a gullible dupe who keeps getting scammed and taken to the cleaners by far smarter and more ruthless pols.
kay
@mclaren:
You’re claiming rationing, mclaren, and Martin called you on it.
Because that fear-based scarcity argument resonates, I guess.
You’re different than the death panels people…how, again?
mclaren
@Kenneth:
Thanks for telling that particularly stupid lie. So military satellites aren’t part of the military. Riiiiiight. And the Veterans Administration hospital that treats vets wounded in Ameircan wars isn’t part of the military. Riiiiiiiiiiiiiiiight. And all that money being paid out every year for retired military personnel isn’t actually part of the military budget. Riiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiight.
You just dropped your credibility so low that whenever anyone reads something you write, they’ll burst into uncontrollable laughter.
mclaren
So it’s a game of whack-a-mole. The goal of the trolls here is to scream lies faster than I can type. Too bad, you lose.
Moving on to Martin’s second lie, he doesn’t explain how the cost of cancer treatments and heart medication will be reduced. That’s because he can’t. In fact, the primary mode of reducing cost for all medications in America, which would have been drug-reimportation, was explictily bargained away before Obama even began HCR negotiations with the republicans. Drug reimportation was “off the table,” like the public option, and thus there was absolutely no incentive for big pharma to reduce its drug prices. Medicare Part D, that giant giveaway to big pharma, was also never under threat from Obama—a savvy president might have used the threat of cutting back on Part D to force big pharma to agree to radical cost cuts.
Obama’s duplicity on these points is truly nauseating. See “Two months after he negotiated it away, Obama argued for public option in joint address to congress.”
This comment will doubtless also get dumped into moderation for no reason. Standard operating procedure, typical, usual and quotidian.
change
milexdata.sipri.org/result.php4
Go look up “USA”. No further comment needed, unless McClaren knows more than the SIPRI (I guess they’re just CIA puppets, no?)
mclaren
And now we come to Martin’s third lie.
Foul-mouthed as well as dishonest, Martin. No, insurers will only be able to raise their premiums by X amount more than the underlying medical costs increase. That’s the problem. If insurers can document that medical costs double, they can double their premiums. And that’s what is actually going on here in America—our health insurers actually operate on fairly slim profit margins. The big money in the U.S. medical-industrial complex is being made by medical devicemakers and doctors (who earn on average twice what doctors in France or Germany or Britain make) and for-profit hospitals and imaging clinics (which charge $950 for a CAT scan with the exact same machine that a French hospital charges $150 for).
Your second sentence is the key. Health insurers will have to raise their premiums infinitely because the underlying costs of care and medical equipment are rising without limit. Why? Greed, collusion, corruption, sweetheart contracts, non-disclosure agreements between devicemakers and hospitals, between doctors and hospitals, between big pharma companies and doctors, lock-in contracts forcing a hospital to buy services and equipment only from certain suppliers, who jack up their prices without limit, 700% of costs, 1000% of costs, 5000% of costs, 10,000% of costs. Medical devicemakers manufacture disposable plastic surgical instruments for $40 and sell ‘em to hospitals for $1200 and the hopsitals just pass the costs along to the insurer. Hospitals charge $5 per aspirin and the insurer just passes the cost along to the person who has to pay the premiums.
See Soaring costs laid to growing power of medical cartels, San Francisco Chronicle, 21 February 2010.
On their yachts, I bet. On a Cancun fishing trip. With five hookers.
Gee, I wonder why. Could it be because…a for-profit health care system fundamentally cannot work in a laissez faire free enterprise wild west casino capitalism system like America? Hm. Maybe. (And don’t even try to tell me the Swiss system is a free market system — it’s not, and everyone knows it’s not, because the government rigidly regulates prices and costs. the Swiss health care system has no more actual resemblance to a laissez faire free enterprise for-profit health care system like America’s than Singapore’s weird central-government-regulated economy does.)
I’m always impressed when people like Martin tell sick people who are dying “Deal.” That really gives us an insight into the mindset of those people like Martin. I’m surprised you didn’t sneer at those sick Americans who are dying from lack of medical care, “You need to grow up.” Or better yet: “Shut up and stop whining, you grade IV astrocytoma cancer patient. What a punk. Just because that grapefruit -sized brain tumor is causing you unbearable agony and you can’t get insurance, you think you can disturb us all by yelling and screaming. Pussy. Man up, you little bitch.”
Thanks for telling us who you really are, Martin. It’s an eye-opener.
kay
@mclaren:
Your link on health insurance for children with preexisting conditions is from March.
Here’s the current status.
If you’re in fact interested.
I suspect this is more about Arglebargle! Weak! OBAMA! RATIONING!, though, than children.
mclaren
@change:
Pointing to a source that regurgitates garbage numbers doesn’t make those garbage numbers accurate.
The Pentagon and the military contractors have worked very hard to conceal and distort the true extent of America’s annual military expenditures. Fortunately for you, I’ve clearly and specifically laid out the basic costs, and as you can see, the total comes to well over 1.1 trillion dollars per year.
“Official” military budget 650 billion FY 2011
NSA budget 50 billion
NRO budget 50 billion
CIA budget 50 billion
VA budget 73 billion
military retirement annual costs 70 billion
DHS budget 50 billion
Pentagon black ops budget 50 billion
Department of Energy budget 20 billion (death ray lasers, etc. almost all for the military)
DEA budget 20 billion
Miltiary law enforcement to militarize local police forces with SWAT tanks, military sniper rifles, etc. 1 billion
Xe (AKA Blackwater, which has been revealed as a front for the CIA) 60 billion
That’s well over 1.1 trillion just using back-of-the-envelope quick ‘n dirty numbers.
By all means, keep pointing to websites that falsely claim that America spends only 4.7% of its GDP on its military. I’ll point you to websites that falsely claim that global warming isn’t real. Here, go to http://www.wattsupwiththat.com That’s a classic global warming denial site. I can point you to plenty of these. Doesn’t make the claims true, and you can verify for yourself that these global warming denial claims are false by reading the IPCC report.
Just as you can verify for yourself that the claim about America spending only 4.7% of its GDP on its military is false merely by adding up the numbers I’ve listed above.
This must be a behavior that has rubbed off from the GOP. People have started to think they can make plainly false claims become true merely by repeating them over and over again in the face of contradictory evidence.
kay
@mclaren:
Except they can’t, mclaren, under the ACA, because if they do, the mandate drops out.
The premiums have to be at or less than 8% of gross, or the mandate is inoperable. “Affordable” is a term of art. It means something specific. Here, it means “8%”.
Ruckus
@Brian S (formerly Incertus):
Tell me again why the middle class hasn’t set fire to the upper middle class and the wealthy?
Can’t afford the matches?
mclaren
@kay:
More whack-a-mole. Aren’t there more of you to tag-team these lies? I’m disappointed that only two of you are working this scam. I can type fast enough to debunk both of you. You really need to call in more trolls, get 5 or 6 of you working at once. The goal should be overwhelm me but you’re not even close.
That qualifies as a lie by implication, Kay. Cleverer than Martin’s outright lies, but not much.
Let’s start with the basics: all health care delivery systems require rationing.
This is a simple fact of today’s world. There are not enough doctors and there is not enough money in the world to try every possible treatment and to deal with every ailment of every potential patient. That’s simply the reality of the situation on the ground. And not just in America — it’s true in Canada, in Britain, everywhere.
So every health care delivery system in the developed world must use some form of rationing. In Britain, for example, one form of rationing occurs when a chronic drinker who has destroyed his liver gets a liver transplant and then goes back to drinking and wrecks his new liver. That patient will not get a second liver from the NHS. That’s a form of rationing, and it’s necessary — in fact, unavoidable.
Another form of rationing occurs in Canada when an expensive operation on a torn rotator cuff or a shoulder injury like the one John Cole had comes into question. If the operation is to be done solely to relieve pain, then in Canada there’s a long waiting list. Once again, this is unavoidable given the structure of the Canadian health care system, because the Canadian health care system prioritizes life-saving surgeries over surgeries that merely reduce pain or increase mobility of a limb. It’s a downside of Canada’s health care system, and it is a form of rationing, but most people agree that this form of rationing, like the rationing practiced by Britain’s NHS, are superior to the form of rationing used in America.
In America, we have a strange form of rationing. It’s rationing by the ability to pay. If you have enough money, you can get just about any medical procedure you want done in America. You can even find doctors to do procedures that other doctors have warned you against doing — the doctors will make you sign consent form that waives your ability to sue them if something goes wrong, but if you really want a medical procedure that another doctors has advised against, like lasik eye surgery if your eyes aren’t suited for, if you’re wealthy enough in America, you can very often find a doctor who will do that medical procedure on you.
That’s a weird system. People who can’t pay get sick and die in the street, while people with lots of cash and/or great insurance get fabulous care. People in the middle class often get good care but then have to declare bankrupcty.
So America has a very strange system with a weird form of rationing. In Britain, a medical panel made up of doctors and health bureaucrats decides whether that alcoholic who goes back to drinking will get a third liver. The decision is usually pretty sensible: no, he had his chance, sorry, that’s it.
But in America, health insurers do the rationing. It’s weird. The death panels are called “health insurance companies” in America. A health insurance bureaucrat decides whether you’ll live or die, and unlike britain or Canda thaqt decision to ration health care isn’t based on your welfare or the chances that the operation will work or on social justice or anything like that. In America, the rationing (done by health insurers) is based solely on one thing: how much cash has this guy got?
I guarant-fricking-tee you that when Steve Jobs needed a new liver, his health insurance company did not turn him down. They knew old Steve had a pile of money as high as the moon. Steve Jobs did not get his health care rationed because he’s a billionaire.
So let’s put your dishonest claim about “rationing” being a ‘fear based argument’ to rest. All health care systems must use some form of rationing. The question is: how do we ration care? According to social justice? According to the most efficient use of available health care resources? Or according to the amount of hard cash the patient has?
America chooses the last version — hard cash. The problem with that solution to the health care rationing dilemma is that when your life is on the line, you’re willing to pay anything. So costs for medical care in America are bound to rise to infinity.
Your lie by implication has fallen apart, Kay. You now know clearly how I’m different from the Palin death panel people. Unlike them, I recognize that all health care systems must limit the delivery of services. You can’t give a chronic alcoholic 5 or 10 or 20 liver transplants if he keeps drinking and blowing through each of them. That’s just common sense.
The real question, to cut through your bullshit and lies, Kay, is: How do we choose to whom to give medical care?
In America the choice is made according to how much cash you have. That’s a bad solution and it produces a lot of pathologies in American society. (Not least of which being that it makes American businesses as a whole uncompetitive with the rest of the world because so much of their profits get sucked up into providing overpriced ineffective health care to their workers.) The health care professionals who’ve studied the American system and other systems like Canada’s or the French health care system agree with me — other methods are better.
You need to speed up your whack-a-mole posts, Kay. I’m debunking your distortions and misrepresentations a lot faster than you can type them.
trollhattan
this year, my California middle-of-the-road healthcare premium for myself and family is $16,706.04
With this plan there are significant copayments for every service used, a “donut hole” deductable for large claims and we’re limited to generic drugs unless none is available (then, the copay jumps considerably).
Best Healthcare in the Planet(tm), bitchez.
mclaren
@kay:
Then health insurers will simply drop insurance, since it won’t be profitable. You can’t get around this, Kay. If Obama’s HCR bill limits the total based on gross costs, than it will inevitably cover less and less as costs rise (or the deductibles will rise to the point where with, say, a $500,000 deductible, the patient might as well not have insurance. This is not as ridiculous as it might sound, since some health insurers are now offering “bargain” health insurance with $40,000 annual deductibles.)
Alternatively, if Obama HCR bill limits the profit based on net costs, then the cost of health insurance premiums will rise infinitely without limit.
Either way, Obama’s HCR bill does not control costs. And the reason is obvious: America has a fragmented balkanized health care delivery system with a zillion different components. If one health insurer can no longer stay in business and stops offering insurance, that does nothing to induce medical devicemakers and doctors and hospitals to reduce the amount they charge insurers because the devicemakers and doctors and hospitals simply say “Oh, well, we’ll just charge another insurer.”
You’re squirming and wriggling like a worm on a hook, Kay, but you can’t get away from the basic reality that the only real way to control costs is to clear out the fragmented balkanized health care delivery system we have in America and use a single-payer system. When there’s only one payer, the devicemakers and doctors and hospitals can no longer shrug and say, “Oh, well, we’ll just charge some other payer. They’ll pay.”
In a single-payer system, there is no other payer.
Got it?
Are we clear yet?
Crystal?
mclaren
@kay:
I notice your ‘source’ of info about the alleged ‘current status’ of health insurers refusing outright to provide coverage for the entire family if the kid has a pre-existing condition is (wait for it) the Kaiser Permanente website.
Why, thank you, Kay! It’s ever so helpful for you to point me to a corporate website containing pabulum written by highly-paid health care PR flacks.
When you have some hard cold objective evidence to back up your claims, please provide it. Until then, I’m not interested in being pointed to PR fluff vomited out by health insurance PR hacks.
The author of that craptacular article was listed as “KHN [Kaiser Health News] staff writer,” which qualifies as just about as impressive as those tobacco lobbyists who used to write up pamphlets explaining how there was absolutely no scientific evidence that smoking caused cancer.
I dunno, Kay, maybe you actually believe the horseshit these corporate health care PR flacks spew at you. Maybe that’s why you’re so confused.
kay
@mclaren:
Well, what’s the problem, then, mclaren? Then you’ll get single payer, and your troubles will be over.
Except they won’t be, because we’ll still be paying too much for health care.
What you want is government-run health care, like the VA, but you’re too chicken to admit it.
Screw the “Obama’s health care bill”, mclaren. Either you want to talk about health care or you want to do the Obama! ArgleBargle! thing.
No one wanted to talk about controlling costs, because that brings up a whole host of difficult and scary questions, about who gets what, and who makes what, and how health care is 1/6 of our economy. No one wanted to talk about controlling costs because 94% of white college educated people are 1. INSURED and 2. HAPPY with our ridiculous system.
Baby steps, for babies. That’s what he did, and is it any wonder he did? We can’t even talk about this without people going berserk.
Jesus Christ. You’re the perfect example of the hysteria attendant to these discussions. Calm down and drop the hyperbole and fear-based spinning everything out 50 years with these worst-case scenarios. If the health insurance market fails, it fails. Am I supposed to run screaming and hide under my bed? OBAMACARE!
kay
@mclaren:
Oh, admit you were wrong. You leaped in joy in March when you read the screeching, fear-based headlines on children’s health insurance being canceled, and you simply didn’t follow it past that. You’re not alone.
You didn’t follow it. Probably because you don’t really care about this issue, you’re simply looking for something to scream “OBAMA” about.
Pancake
Here’s an item that relates to comments I made here earlier today. As contrasted with the rubbish several lefty commenters posted, the problems of countries such as France, Greece, and Spain, among many others, are their huge public expenditures on healthcare, pensions, bloated bureaucracies, etc. Their problems are not traceable to “over investment” in US mortgages and other assets, as some nimrod suggested above.
mclaren
@kay:
You need to snap it up. Type faster, Kay. You want to overwhelm my ability to respond. But you’re not even remotely there yet. Call in some more trolls, you’re falling behind.
I notice you don’t have any substantive points to counter the arguments I made.
As for you claim that “You want government-run health care, but you won’t admit it” this is presumably a way of implying that I’m an evil filthy commie pinko so-shul-ist. I guess that’s supposed to scare me, or discredit me, or something. Only in America, huh?
The plain fact of the matter, Kay, is that what I want and what I have repeatedly advocated is a health care delivery system that works.
America’s health care delivery system manifestly does not work, unless you’re rich. In case you hadn’t noticed, let me point to the excerpt mistermix used at the top of this article. Mistermix is pointing out that health insurance (which in America means health care) unavailable is slowly but steadily creeping up the income scale. It used to be only poor people who couldn’t afford health care (insurance, same thing). Now, increasingly, middle class people making 50K a year can’t afford it.
Look at the trend lines. You can see where this is going. This tells us the American health care system is broken, Kay.
What I want is a health care system is NOT broken.
Now, it so happens that we have existing models for health care systems that are NOT broken. Where are those models? Well, to the north there’s one in Canada. In Europe there are a whole bunch of ’em. In Japan, they’re got one. And so on.
The plain fact of the matter is that this is not rocket science, Kay. We can look at other societies and clearly see health care systems that DO work. Therefore it is not mysterious how to set up a health care system that works. We can see the systems in other countries, we can reverse-engineer them, it’s not exotic, it’s not superstring theory.
Kay, the only people who are actually happy with “our ridiculous [American health care] system” are people who are either (A) rich, or (B) have never gotten sick or had to use their health insurance. Otherwise, if you have ever gotten sick, even if you have excellent health insurance, you know that you have to spend more time and energy fighting the goddamn insurance company and the hospital over billing and eligibility and copays and blah blah blah than you do recovering from the surgery.
So as for the claim that Americans are HAPPY with their health care…that’s just another lie, Kay. Shame on you. Only billionaires are happy with America’s health care system.
Forcing the American people to buy rotten overpriced health insurance for wildly overpriced health care with no cost controls is not “baby steps,” Kay. That’s trying to find your way around a gasoline-flooded basement by lighting a match.
As for the use of the language “baby steps, for babies,” yes, Obama’s supporters doubtless find it wonderfully convenient to portray those of us who cite inconvenient facts and use inappropriate logic as “babies.” Out here in the real world, the fact that sick people in America are now shooting themselves so they can get taken to the ER can get health care for their chronic conditions is not the action of “babies.” It’s the last desperate frantic resort of terrified people who are sick and in horrible pain. You may find it satisfying to call these kinds of people “babies,:” Kay. I don’t.
Really? Who has been using the F-words — me, or Martin?
Who has been using exclamations like “Jesus Christ” — me, or you, Kay?
I have calmly and implacably linked to source after source after source.
Isn’t it interesting how you don’t seem to link to any sources other than a health insurance PR website?
I’ve linked to the San Francisco Chronicle, the Washington Post, source after objective source, fact after fact, graph after graph. You link to..some paid Kaiser Permanent flack.
Which is us shows evidence of hysteria here, Kay?
Who said anything about “50 years” from now? Can you quote any claim where I said that? No? Then who is guilty of hyperbole, Kay? Me? Or you?
That’s calm, I suppose. Most of us would find it strange. If the health insurance market fails it fails, if people can’t get insurance, they can’t get insurance, if there’s chaos, there’s chaos, if sick people die en masse, they die en masse.
Hm. I guess you’re calm about all that. Should you be?
Now who’s exhibiting hyperbole, Kay?
You really don’t have anything other than this stuff, do you?
A PR website by Kaiser Permanente and some inflammatory hyperbole, and that’s about it.
For my part, I shall simply link to this New York Review of Books article by a medical doctor. It explains why we ought to be concerned about America’s broken health care system:
Source: Health care: the disquieting truth, Dr. Arnold relman, New York Review of Books, 30 September 2010.
Mnemosyne
Allow me to giggle at the fact that mclaren doesn’t know that the Kaiser Family Foundation is not associated with the healthcare corporation that has a similar name.
mclaren
@kay:
I haven’t seen any hard evidence aside from (1) the health insurers waffling and claim that, oh, sure we’ll cover families who have kids with pre-existing conditions when Obama’s people hammered them on it, and then (2) the health insurers quietly retracting that statement and changing to “No, we’re refusing to cover the entire family if the kid has a pre-existing illness.”
If you can point me to some hard evidence from a reputable source, like, say the Washington Post or the New York Times to show that health insurers are actually not betraying Obama and gaming the system to deny sick kids health care…by all means. Link away. Show us.
Do you have any hard evidence from a reputable source like the New York Times?
kay
@mclaren:
Baby steps for babies wasn’t directed at you, mclaren.
It was a simple observation of the fact that this country is on no way ready to have an honest discussion about health care, or we would have done that. I think we will do that, at some point, but we’re not ready, apparently.
We’re still on “health insurance” and that was SO scary, Democrats lost 60 seats in the House for cutting 500 billion from ONE PORTION of privatized Medicare. I can’t imagine what will happen when we get to the down and dirty. They’ll impeach.
Of course, you took it as a personal insult, because this is about you, isn’t it?
mclaren
@Mnemosyne:
Allow me to quietly giggle at the fact that Mnemosyne doesn’t realize that a PR flack is a PR flack.
Why don’t you explain to us how the Cato Foundation’s press releases are reliable, Kay? Of course, the Cato Foundation was co-founded by the Koch brothers and receives its funding from them, but, hey! It’s a foundation! So apparently we ought to gullibly believe whatever its PR flack churn out, just as we ought to foolishly believe whatever the Kaiser Family Foundation’s PR flacks vomit out as a press release.
From the Wikipedia article on the Kaiser Family Foundation:
Sounds like the Kaiser Family Foundations bribes reporters with awards then hires ’em to work for the foundation full-time. Somewhat like, oh, say, Fox News? Subvert the press, then use reputable reporters you’ve lured into cozy well-paid positions to spout your corporate party line.
By the way, Mnemosyne, until 1985 the Kaiser Family Foundation had a huge ownership stake in the Kaiser Permanent health care group. Whoops! Looks like your lie is showing! Better luck next time. If at first you don’t succeed in getting us to believe there is absolutely no connection twixt KFF and Kaiser Permanente, lie and lie again, Mnemosyne.
Show us the New York Times or Washington Post that confirms Kay’s claim that health insurers are not doing what they are in fact doing — going back on their word and denying coverage to kids with pre-existing conditions by simply refusing to write health insurance for the entire family.
Once again, Mnemosyne finds the prospect of sick kids dying in agony with no insurance something to “giggle” at. Leave it to her to snicker and giggle whenever someone is suffering. The classic hallmark of the sociopath.
mclaren
@kay:
Aside from your ad hominem rhetoric, Kay, do you actually have anything of substance to add to this discussion?
I’m still waiting for your objective evidence that health insurers are not doing what they are in fact doing — namely, refusing to write coverage for entire families merely in order to avoid having to insure kids with pre-existing conditions. A link to a recent article in a major newspaper? Anything?
Tax Analyst
If the sky is indeed falling is there any chance it will hit mclaren on the head and shut him up?
burnspbesq
Man, we DESPERATELY need a pie filter for mobile devices.
If we forced detainees to read mclaren’s comments, that would be a war crime, even if John Yoo opined to the contrary.
mclaren
Here’s a report from September 2010, about 2 and a half months ago:
Health insurers drop coverage for children ahead of new rules.
And here’s a report from Kentucky:
Kentucky health insureres drop child-only policies. This report is from 14 October 2010.
I keep linking to source after source, providing more and more evidence. Kay responds that I’m “hysterical.”
Which argument is more convincing — newspaper reports, or rhetoric about “hyperbole”?
mclaren
@burnspbesq:
Shorter burnspbesq: “I have no facts and no arguments, so I’m going to fall back on vacuous insults.”
agrippa
There is not going to be an honest discussion about medical care in the USA. It is a cumbustible issue owing to several factors:
Medical care is a business run for a profit. Doctors, hospitals, pharmaceutical compnies, health insurance companies, etc, are all seeking a profit.
They are in a one up position.
Patients are in a different place altogether. They are sick, and medical care, for them, is a life and death matter. This is a one down position.
None of the profit makers have an interest in reducing cost. And, medical care is different from other business as the field has difficulty controlling cost; there are real impediments to reducing the ‘cost per piece’ or the ‘seat mile’. Nor, are there economies of scale.
It looks to me that here will be a major cost crisis accompanied by a major healt delivery crisis. When that will come, I do not know. But, come it will.
I think that it will be ‘dealt with’ when that crisis appears. That seems to be the way matters are handled in the USA.
mclaren
@Tax Analyst:
TRANSLATION: When someone tells you something you don’t want to hear, find a way to shut him up.
There’s no evidence that the “sky is falling,” but when people are shooting themselves so they can get into an ER and get treatment for a chronic condition, it’s fair to say that there’s something badly wrong with America’s health care system.
Just my opinion, though.
mclaren
@agrippa:
Well said. An admirably succinct summary.
agrippa
@mclaren:
It is, I think, important to understand that ordinary cost controls that are used in other fields cannot be used in medical care.
There is, also, no effective competition in the field, as patients, who are sick, do not comparison shop on the basis of price.
The crisis will come – as surely as night follows day.
Mnemosyne
@mclaren:
And if it were 1986 right now, that would have some relevance. Unfortunately for you, it is currently 2010, so your “proof” that the Kaiser Family Foundation is currently flacking for Kaiser Permanente is that the Foundation split off from KP 25 years ago.
mclaren
@agrippa:
We do have a number of examples of health care systems in other countries that have managed to control health care costs, but as you say it’s complex. It’s both theoretically and practically possible to control health care costs, but the problem is do it in America in 2010.
Another society’s health care system can’t simply be transplanted to America — the cultural mores and the underlying social structures that support their health care systems, like the overall GINI coefficient or their national diet, can’t just be lifted out of another culture and dropped into ours.
I get that. It’s complex. It’s difficult. Some patients in America are starting to comparison shop on price, though, by getting medical care in India. Google “health tourism.” You’d be surprised. There’s even a service for people who need expensive dental procedures and want to get it in India.
But I’m afraid you’re right and we probably will have a crisis in our health delivery system at some point in the foreseeable future.
agrippa
@mclaren:
My concern: sick people getting medical care.
I, simply, do not think that medical care should be a profit making business.
That is what it comes to for me.
Triassic Sands
It’s worth reading TR Reid’s The Healing of America. First, it gives a first-hand look at the health care systems in other countries — instead of what’s available from the MSM, which is rarely helpful at all.
The book also shows why real, meaningful reform in this country is nearly impossible. I supported the health care reform legislation, not because I thought it would work, but because I figured we’re so stupid in this country we have to try things that obviously won’t work and have them fail, before we can move on to a real solution. However, I’m afraid that ideological blindness is so prevalent in this country that we’ll choose disaster over a solution.
In our current system, the major players all think making the absolute maximum profit possible is the most important goal. In other countries, that isn’t true, and until we accept that here, we have no chance of creating a workable, affordable health care system. Local public radio just had a discussion of CEO salaries for health care non-profits in Washington — all in the $1 to $2 million dollar range.
I’m not arguing that salaries are the key or only problem. But the attitude toward them is indicative of why progress is so difficult.
The first lesson of The Healing of America is that no country has ever managed to create an affordable health care system that relied on for-profit insurance companies. Yet, that was the starting point and basis for our current health care reform plan. Shouldn’t there at least have been a discussion of alternatives?
Mnemosyne
@Triassic Sands:
Do they discuss South Korea? Because the discussions I’ve seen seem to indicate that they were able to use private insurance as a springboard to universal coverage.
But as agrippa said, it’s not the “private” part that’s the problem, it’s the “for profit” part. I don’t think anyone has successfully come up with a universal health care plan that also provided a generous profit for the health care providers.
agrippa
@Mnemosyne:
We can’t seem to do anything in this country without a great deal of wailing and knashing of teeth, so I thought that the least painful way would have been to expand medicare to age 55.
It is an existing system and age 55 is where costs start to rise.
generous profit? egg in your beer and all that. Life is contingent, unfair and mortal. Not entitled to a generous profit. How about 2% ? I’ll give em 2% if they quit wailing.
Triassic Sands
@Mnemosyne:
The problem is the “for-profit” part. I don’t remember a discussion of the South Korean system, but one of the more impressive reforms was in Taiwan, where they apparently got a universal system up and running amazingly fast.
Sure, the US is a lot bigger and more diverse, but I think the real problem in this country is ideological. “Universal” is simply not as important as “private” in this country. For the time being neither is affordable, because most people are still able to get by.
It’s amazing how many people I’ve talked to who oppose a system that would help them immensely. But they’re all hung up on the “government” thing, even though, when they reach 65, they will virtually all happily sign up for Medicare. I think the big problem here is a kind of willful stupidity — not an innate lack of intelligence to understand the problems and recognize the solutions, but a voluntary refusal to accept reality.
The Reid book is well worth reading — it’s an easy read and I found it very interesting. The contrasts with the American system are striking. It’s hard to imagine American doctors ever accepting the pay-scale in. for example, Japan (or Great Britain, or…etc.). I don’t know what they’d do if somehow magically the pay scale in the US were changed. Would most current doctors just quit and go back to school to be lawyers? Would most college students switch majors and forget about going to medical school? With all the complaining I’ve heard in the last few years about the inability of some doctors to survive financially (funny, I don’t know a single doctor living in a trailer or driving a junker) and how they can’t make it on Medicare and Medicaid payments, any reform that significantly cut the pay of American doctors would cause a revolution.
On the other hand, I’ve been forced to see a lot of doctors in recent years and most of the specialists haven’t been native born Americans. So, as long as the pay in the US were higher than that in India or Thailand, maybe we could continue to import enough high quality doctors to keep going without missing a beat. That’s the flip side of moving jobs overseas. I’ve chosen, twice in the last four years, to switch from a Real American specialist to ones born in Asia, and the quality of care has improved significantly.
tBoy
@Pancake:
Poor Pancake. Lost in space.
I’ll go slow for you – that is the c.o.s.t. not the subsidized cost. The c.o.s.t. total – as in complete. The cost of healthcare in France is less than 1/2 the US. Understand?
And if you think France is in deep despair and on the brink of collapse you are even further in la-la land.
Triassic Sands
@agrippa:
The problem with this is that the Medicare system is much too expensive, because it clings to the fee-for-service payment model.
Two books worth reading for an understanding of cost problems in the US are Money Driven Medicine (Mahar) and Overtreated (Brownlee). However, telling an American to cut back generally doesn’t go over well. Recently, I’ve had to question the wisdom of certain tests and I’ve twice refused prescriptions for medications that were more far expensive than adequate substitutes (my cost was the same).
Personally, I’m very pessimistic about this country’s ability to deal with the problems we’re facing — not only health care, though health care may be the most difficult. Neither our political leadership, nor our citizenry is up to the task, as far as I can see. We lack both the wisdom and the will. One thing is certain, even if we eventually rise to the challenge, at a minimum, there will be a lot of unnecessary suffering and death before we get the job done. Of course, our political leaders will experience absolutely none of that, which helps explain why it will be difficult to impossible to do.
Triassic Sands
@Mnemosyne:
My response is languishing in Moderationland.
PurpleGirl
@change: I don’t have the numbers handy but we spend MORE on defense than the next 10 countries COMBINED.
Mnemosyne
@Triassic Sands:
I don’t see how you could drastically change the pay scale without drastically reducing the cost of medical school. As I understand it, medical school in Great Britain is essentially free. You don’t have people graduating who are $100,000 in debt.
Right now, it costs a LOT of money to go to medical school, so most of the people who go to medical school are people who come from rich families and want to stay rich, not people who are best suited to be doctors. If we could remove that financial disincentive, it would be a lot easier to cut doctors’ salaries because they won’t have massive, crippling debt when they graduate.
agrippa
@Triassic Sands:
I am pessimistic as well, for the same reasons.
Triassic Sands
@Mnemosyne: I think it would be great to
remove the burden of the cost of medical school, and I also think
you’re right about not being able to lower salaries without
removing that burden. But this is the US of A, so I’m assuming that
what prospective doctors would like most would be to remove the
financial burden without lowering salaries. And you’d have the
problem of a two-tiered system in which older doctors would get
paid at the old rates and younger doctors would get the new rates.
Down the road doctors would forget about the cost of their
education and focus more on the fact that they’re doing the same
work for lower pay. Of course, unions are now agreeing to two-tier
pay scales, so maybe that precedent would make the transition
easier. Medicine has become a profession with expectations of very
high salaries; that’s one reason why it’s so easy to find
specialists, while GP-types are harder to come by.
Triassic Sands
@PurpleGirl:
Damn, Purple, we spend more on defense than the other seven planets combined (and Pluto, too, if you’re sentimental).
Seriously, if you total all of our defense and defense-related expenditures, it’s not hard to believe that we spend more than all of the other countries on Earth combined. Some sources show exactly that, but I’m skeptical that the total used for the US accurately represents everything that can be legitimately considered “defense.” If that’s true, then sources that don’t show the US spending more than everyone else may be incorrect.
Whatever the exact numbers, the ratio is nauseating.
catdevotee
Here in *liberal* Oregon, the Oregon Health Plan, our version of Medicaid, was closed several years ago to non-disabled adults unless they have minor children. Even if you qualify, you have coverage only if you (literally) win the lottery – yes, there’s a lottery to determine who can have medical coverage. Dental treatment isn’t covered of course, unless in the most unusual of circumstances. At least kids are covered as soon as parents apply on their behalf.
catdevotee
@Triassic Sands:
I volunteer in a free clinic in my small town in idyllic southern Oregon. We have seen a number of people who probably would have died, had we not been here to provide such things as blood-pressure medication and diabetic supplies. Several diabetics had not been able to afford insulin, so just stopped even checking blood sugar levels for months or even years.
I have to wonder how many people have died because, before our clinic started this summer, they had no place to turn for medical help.