This is how one sad story begins:
May the justices please meet my sister-in-law. On Feb. 8, she was a healthy 32-year-old, who was seven and a half months pregnant with her first baby. On Feb. 9, she was a quadriplegic, paralyzed from the chest down by a car accident that damaged her spine. Miraculously, the baby, born by emergency C-section, is healthy.
This is what follows that terrible moment:
My brother’s small employer — he is the manager of a metal-fabrication shop — does not offer health insurance, which was too expensive for them to buy on their own. Fortunately, my sister-in-law had enrolled in the Access for Infants and Mothers program, California’s insurance plan for middle-income pregnant women. AIM coverage extends 60 days postpartum and paid for her stay in intensive care and early rehabilitation. But when the 60 days is up next week, the family will fall through the welfare medicine rabbit hole.
And here is what those people will have to deal with for the rest of their lives:
When the AIM coverage expires, my sister-in-law will be covered by Medi-Cal, California’s version of Medicaid, because she is disabled and has limited income. But because my brother works, they are subject to cost-sharing: they pay the first $1,100 of her health costs each month. Paying $1,100 leaves them with a monthly income of just 133 percent of the federal poverty level. If my brother makes more money, their share of the cost increases.
They must also meet the Medi-Cal asset test: beyond their house and one vehicle, they can hold $3,150 in total assets, a limit last adjusted in 1989. They cannot save for retirement (retirement plans are not exempt from the asset test in California, as they are in some states). They cannot save for college (California is not among the states that have exempted 529 college savings plans from their asset tests). They cannot establish an emergency fund. Family members like me cannot give them financial help, at least not officially. If either of them receives an inheritance, it will go to Medi-Cal. Medi-Cal services that my sister-in-law uses after age 55 will be added to a tab that she will rack up over the rest of her life. When she and my brother die, the state will put a lien on their estate; their child may inherit nothing. Even my brother’s hobby runs afoul of the asset test: he enjoys working on old cars, which he can no longer keep.
This is what this story reminds us: for too many of our fellow citizens, our health care system, when it delivers care at all, turns families permanently poor.
This is what “Repeal” means. Welcome to the Republican vision for health care.*
Oh — and, yes, of course, this is what the case before the Supreme Court is alll about. Which is why the willed and faux-naive ignorance of Scalia, Alito and others earns the name of evil.
Go read the whole piece. Get angry, then angrier. If you live with GOP representatives, send this column to them. If you have friends or family or acquaintances who might be able to make the same leap John managed, pass it on to them too. Pressure is a daily accumulation of little taps and nudges, and there is no time the present.
*I won’t insult you by adding the reflexive “and Replace,” as there is no replacement on offer; vouchers are not a health care system, and would, as now proposed, do for this family that quantity of good that asymptotically approaches zero.
Image: Gustave Doré, A Couple and Two Children Sleeping Under the London Bridge, 1871.
The Moar You Know
“No, Mr. Patient, I expect you to DIE!!!”
Please someone tell the Republicans to quit yanking policy from fictional villains.
elmo
My partner is disabled, and because she’s my partner instead of my husband, hasn’t been on my medical insurance. We’ve lived in California (Medi-Cal) and Tennessee (TennCare), and are now in Virginia. Because she’s a veteran, she’s been using the VA system since we left Tennessee; she hasn’t had the emotional wherewithal to deal with yet another state’s Byzantine rules and shaming rituals.
But this May, for the first time, my (new) employer will be offering insurance to same-sex domestic partners. I am still in teary-eyed disbelief at my incredible good fortune. Our VP of HR cautioned me not to be too excited – the benefit change will also mean that they no longer cover 100% of my premium, as they have done in the past. I don’t care. But wait, she said, we will also only cover 65% of spouse/partner premiums. I told her I had fully expected that I would have to cover the whole thing. So instead of paying nothing for my own health insurance, and having my partner subject to the whims of the state and the VA, I will now be paying $400 a month for us both.
And I am over the fucking moon with relief and joy.
Satanicpanic
That piece is heartbreaking. And as sad as the system that’s helping them is, Republicans would do away with even that. Remember, they “care about life”, but all they would do for this new mother would be roll her out onto skid row and let her die.
Ben Cisco
In a lot of households in my childhood, there were plates, portraits, etc. of Martin, John, and Jack.
In NeoConfederate land, I imagine those images were replaced with those of Blofeld, Karl Stromberg, and Hugo Drax.
JPL
@elmo: Congratulations to you. What occurred to me was the situation the NYTimes article discusses, the couple should divorce. The state would then provide medical care for her. There might be rules against it but they’d be better off.
edit.. I’m not suggesting they split, just legally divorce if that helps maintain her state care.
kindness
Won’t this poor woman qualify for Medi-Cal?
merrinc
@elmo:
Elmo, I’m so happy for you and your partner.
I wish everyone would understand that these kind of catastrophic tragedies can happen to anyone, anytime. My husband was in a motorcycle accident three years ago this June. We’d been skating by without insurance for several years as he’d been a contractor (I’m a SAHM) and we couldn’t afford insurance on our own due to each of us having pre-existing conditions. Fortunately for us, the company for which he’d been contracting hired him less than 2 months before the accident. He was in the hospital for two weeks; his left leg was so badly damaged that it was amputated above the knee. Total hospital bill was right around 100K. His prosthetic was 27K. Insurance covered all but a few thou. Had the accident occurred prior to him being hired, we’d probably be living in a cardboard box right now, with me pushing him around in a wheelchair bought at Goodwill.
Say it again: IT COULD HAPPEN TO ANYONE.
katie5
I engaged in self-abuse of watching Morning Joe this morning and wondering, with the coming assault of Super PAC billions paired with the morons of punditry, whether we’ll ever again hear a discussion of the substance of issues like these.
Tom Levenson
@kindness: Read the piece. The point is that even with Medi-cal, the rules under which that system operates mandates life long poverty.
SP
I daresay that even if there were some kind of Federal vouchers, the state portion and/or asset limit would be decreased accordingly, because we can’t let these welfare queens keep buying T-bone steaks.
Schlemizel
those glib bastards would simply say she should have gotten a better job so she could have afforded better insurance. It must be nice to live in their world were nothing bad ever happens beyond your control.
@merrinc: Say it again: IT COULD HAPPEN TO ANYONE.
Stories like this make me think that single payer is the only way to go – how are they going to afford the mandate when you know they are going to be very expensive to cover? But it also makes me know that the USSC can’t kill ACA as much as I hope it would. The result would be too much pain for too many people. Gawd this is depressing
dp
I e-mailed the story to my block-headed Republican congressman. Even though he’s a doctor, he won’t care; he’s the one who famously said there’s no proof that Medicaid improves poor people’s health.
Amir Khalid
@JPL:
i understand the financial calculation behind such a divorce. But it’s an abhorrent solution: legally dissolving a perfectly good marriage so that one spouse can qualify for sorely needed benefits. Where are the right-wing defenders of marriage and the family on this?
SP
Schiemizel- they would be within the 300% of poverty level that gets subsidies to comply with the mandate.
ruemara
I feel odd that I’m scared of ACA being repealed, but the $15 for pressure meds is sometimes the last $15 for a week. I don’t understand what is the problem in America, why we’re so damned eager to turn into Calcutta.
Davis X. Machina
@dp: Dead people have health that neither deteriorates nor improves, which is how his math comes out the way it does.
ant
this women can get all the care she needs from the emergency room. We need to end this, so the takers in society do their fair share.
————————————————————
Tom, I heard a blurb on the radio the other day that made me think of you. It was about the Google Art Project.
But seeing as how you’re a pretentious art douche, you prolly already know about it.
rikyrah
this simply shouldn’t happen.
period.
I absolutely loathe Republicans, because when faced with the obviousness of this case, they’ll pull some bullshyt like have bake sales, ask the church.
fuck all those evil mofos.
Mnemosyne
@kindness:
Medi-Cal sucks. My co-worker’s sister has epilepsy and broke several of her front teeth when she fell during a serious seizure. Medi-Cal initially refused to pay because they don’t cover ordinary dentistry, and it took several weeks to convince them that since it had happened because of a medical condition that they were already covering, she should be allowed to see a dentist and get them repaired.
There are so many rules in place to make sure that people don’t “cheat” and get medical coverage that you really do have to be impoverished in order to get it.
comrade scott's agenda of rage
@The Moar You Know:
In Greater Wingnutistan, that’s a feature not a bug.
They’re never going to change. This is the party that wants to kill Social Security so that the elderly can all die in poverty. We shouldn’t expect them to give a shit about any other segment of the population.
Except zygotes. And the rich, also too.
elmo
@merrinc:
Oh god, that is terrifying. Is it strange that I’m happy for your good fortune in the timing? The accident itself is horrifying enough – how much worse to be unable to pay for necessary treatment!
jrg
@Satanicpanic: They only “care about life” when someone else has to sacrifice. That’s why they’ll try to force a husband to keep his brain-dead wife alive, but then have a shit-flinging fit over medical coverage for the poor (or even for the husband’s brain-dead wife).
In the first case, they don’t have to do a thing except engage in a holier-than-thou wank fest. In the second case they have to make a sacrifice, so they turn into howler monkeys.
Ronzoni Rigatoni
My cousin is currently living with me in beautiful sunny Florida, enjoying the weather (if he dares to go outside). His wife is living in NY and they must live apart if she is to qualify for needed surgery and related medical care. Mary suffers from recurring intestinal ulcers and has undergone numerous surgeries for this. If they hadn’t separated she would be dead. Yup. I send a paltry and barely affordable monthly amount of sheckels to Allan Grayson each month. Great system we have here folx.
batgirl
I’ve used very little health care until very recently when I passed out, fell face forward, and when I came to had brief paralysis in my limbs. Hurt my neck and spine. Spent 10 days in the hospital. Had to have surgery.
But I’m damn lucky. No lasting paralysis or weakness, just some continuing nerve pain in my arms. Great insurance which means for the hundreds of thousands of dollars of medical care I have received I’ll owe $3000 out of pocket. And that pesky regulation FMLA protected my job and health insurance while I had to take time off of work.
What it does mean is that if I should lose my job or become unemployed at some point in the future and Obamacare is overturned by the SC, I will be unable to buy insurance on the open market.
Fuck the GOP.
Yutsano
But Rush told me health care is not a right.
Paul (@princejvstin)
I believe the answer in some circles is “Charity”
Problem is, Charity is not a Healthcare program.
JPL
@Yutsano: It’s a right for a fetus though.
Michele C
I read this yesterday and couldn’t sleep well all night, partly because I was feeling like the “block-headed Republicans,” as @dp calls them, just won’t change their minds. This feeling especially came from reading that a relative of mine read some crap article in Slate about how liberals want “post-birth abortion.” It just made me feel like I was screaming into a wind tunnel.
I am thinking that legal divorce may work.
Yutsano
@JPL: Fetuses are people. Just like corporations. Slutty birth-control using women and poor folks? Not so much. Back to the kitchen/salt mines. Our Galtian overlords need another yacht for their spawn’s tenth birthday after all.
JPL
Tom, You are never to old to cry.
Quiddity
The Medi-Cal claim on 401K is an outrage. If you have a defined pension, that’s not takeable (at least not as a lump sum equivalent). More people should know that the 401K program has many trapdoors for the unlucky.
ThatLeftTurnInABQ
@JPL:
__
The other words, in addition to its other merits, once it is fully implemented the PPACA will be an actual, for reals Defense of Marriage Act.
__
No wonder the GOP hates it.
Judas Escargot, Your Postmodern Neighbor
Her human capital must be of insufficient quality.
Kevin
Damn…you’re country really needs single payer…this is awful. As a Canadian with an expensive disease (Crohn’s), reading this, I realize how lucky I am to not have to worry about something like this. Not being able to save, having a limit on the assets you own…it’s like government mandated poverty. These people are being shamed for not being healthy or rich, and it is awful.
calliope jane
Heart-breaking. I’m convinced that the people who think the current, pre-ACA system is fantastic and ‘dont want to cover for people who dont have insurance’ are those lucky few who have never had something catastrophic happen to them or their loved ones. The callousness with which some of these people talk about it– completely forgetting that these are human beings and there but for the grace of the FSM…
Also, fuck Scalia. “people will buy insurance when they need to, like us.”. What “us,” jackass. We’ve been paying for your government healthcare for decades.
Yutsano
@Kevin:
Our country was founded by an extreme Calvinist tradition that still dominates our national discourse to this day. We didn’t get as lucky as Canada (bunch of rogue French priests and English exiles) or Australia (prison colony) so until we shake off the Puritan moral ethic we’ll keep floundering along making haves and have-nots.
EDIT: But it’s already starting to change, it will be a state at a time fight though. Just like you guys did it. GO VERMONT!!
Jay S
@JPL: I’m sorry, I must have missed that pre-natal care plan. Here I thought they were all about stopping abortion, not creating healthy babies.
Satanicpanic
@jrg: Yep. Back when the whole healtcare debate started I was talking to a friend and his take on the Republican opposition was “no one wants to be on the hook for anything.” Which I thought was pretty cynical, but now I realize was 100% correct. Plus shaming people is easy and feel good, building a fundamentally decent society is hard.
katie5
Been reading Chris Mooney’s discussion of his new book on the Republican Brain (here and here). The mind of these guys will not be changed with evidence because the animal brain immediately engages in confirmation bias. I suppose, unfortunately, it’ll only change when they or a family member experiences the downside of the health care system.
Tom, this would be a good Virtually Speaking session: the neuroscience of the conservative.
Gex
@Amir Khalid: Protecting them from gays. They haven’t cared one whit about adultery or divorce or spousal abuse, etc.
Conservatives don’t care about the quality of the result just that the right ideology was followed to get there.
MikeJ
Marginally related, here’s a chart I stumbled on last night having to do with health care and the war on women.
kay
Great post, Tom.
I find these individual stories very grounding, compared to the the blathering moronic hypotheticals we heard at hearing.
Oh, too, has she considered burial insurance?
Justice Alito thinks the two things are comparable.
JPL
@ThatLeftTurnInABQ: What a horrible situation to be in. I’m not a lawyer but can you imagine having to divorce in order to insure health care.
Republicans suck.
Gex
@Paul (@princejvstin): Indeed the main problem with doing this through government is that conservatives don’t get to sit in judgment and decide who is worthy and who isn’t.
Let me rephrase. They do that. They just are sad they can’t deny coverage to people they hate.
JPL
@Jay S: For those that qualify medicaid normally covers pre-natal care.
SectarianSofa
But if we let them have health insurance, the slackers will go back to painting, making movies, being in bands, doing “art” — what’s to keep the creative types in the legitimate work force? We’d be just like the French, or the French-Canadians!
cckids
As appalling as this story is, the scary part is that there are worse states than California if this happens to you. At least there is a program, however cruel and insufficient it is. Her initial 60 day coverage under the maternity care program was covered. The baby was/is covered. Here in NV there is a (last I checked) 2-year waiting period to get on the Children’s Health Insurance Program. There just isn’t any program like Medi-Cal. If you have this type of accident here, or if you are unlucky enough to have been born with any kind of disabling condition, you are SOL. You get Medicaid, if you qualify, and that is it.
And, since 5 years ago, they turned Medicaid over to a private company to run (into the ground), it is as soulless and inefficient as any crappy insurance company.
The whole situation is so depressing and soul-deadening. My spouse & I are just trying to hold on & hope that the ACA survives & that we will maybe be able to get insurance, after 8+ years without it. Broccoli? Scalia can kiss my Pomeranians furry arse.
28 Percent
@Kevin: If we don’t shame people for being sick and poor they’d just keep on being sick and poor as long as they liked, and where would that get us? It’s our duty to the sick and the poor to chastise them into being healthy and rich. Sure, Dickens among others made a career out of mocking exactly that attitude a full century and a half ago, but doing pretty much exactly what the British already did, but bigger and much later pretty much sums up the “American Way”. Superman would beat you up for trying to put a stop to it.
Tom, you missed the real gut-wrencher quote in that article:
Tom Levenson
@katie5: Good thought. I’ll see if/when I can get Chris Mooney on the show.
Tom Levenson
@28 Percent: Didn’t miss it. Alomst stole the last line. But that story and that last word belong to Andrea Campbell, and I thought it right to leave it there for the click-throughs to find.
Jay S
@JPL: Ah yes I forgot for a moment that we had a pre-natal program in place.
I suppose the usual suspects will point to that in the same way they point to free birth control while they try to eliminate it or restrict its availability.
It’s not exactly a right is it? But I quibble.
eemom
You know what would be awesome? If Scalia’s fat, smug, utterly unbearable ass would just drop dead tomorrow amidst all of his gold-plated taxpayer-funded lifetime-guaranteed Cadillac coverage. kthxbai.
DFH no.6
It’s simple.
“I got mine, fuck you” is the foundation of conservatism. Everything else the fascists build is based on that bedrock principle.
Scalia, with his smug and flippant “well, then, don’t obligate yourself to that” in regards to emergency room care for the uninsured, showed that as obviously as if he had gleefully quoted Scrooge’s “if they would rather die, they had better do it, and decrease the surplus population” as words of wisdom to live by.
And roughly half my countrymen, and a preponderance of the power structure in my country, hold to that position.
Which is why progress on this is all so fucking hard.
cella
I am visiting Ireland and while there health care system could definitely stand some improvement it is ranked higher than ours and they think we are barbarians because we allow people’s lives to be ruined because of health crisis….and they think rightly!
Yutsano
@eemom: The FSM does not love us enough for that to happen. Although if it did to Thomas would anyone notice the difference?
ThatLeftTurnInABQ
@28 Percent:
__
Our nation is held back by an ideology of suffering which I think of as the hell-spawned offspring produced by the mating of Calvinism with Social Darwinism. We combined two different sets of ideas, originally distinct from one another but now merged: that people are inherently sinful and bad and deserve to suffer for their wickedness, and the idea of progress achieved thru social struggle and survival of the most fit, and came up with the perverted notion that what really makes America great is that our economy should be a collective Thunderdome for sorting out the Wicked and the Weak, from which the Strong and the Morally Upright will ultimately emerge victorious. It goes without saying that the losers in this struggle are nothing but chaff which needed to be winnowed from the grain. It is an ideology which demands human sacrifice, and to the extent that we treat it like an actual religion, it receives the sacrifices which it demands.
pseudonymous in nc
@28 Percent:
It makes the point that “charity”, even when heartfelt and well-meaning, is inadequate to the task. At worst, it’s invoked as a way to avoid confronting this reality.
JPL
Didn’t Christ already die on the cross for our sins?
cckids
@eemom: No, justice would be for him to have an incapacitating stroke, leaving him mostly paralyzed, unable to speak or communicate clearly, incontinent, able to only eat mush. But with his thought processes still clear, so he can understand everything that happens to him. Then, he needs to be kicked off his nice government-issued health care & have to rely on Medicaid + the lowest of the low state programs available. And, just to round it off, have to stoop to asking his family and friends to feed him, change his diapers, do daily range of motion exercises, make endless calls to doctors begging them to take one more Medicaid patient, just so he can get the bare minimum of care his condition requires.
Then I want him to live like that for at least 10-15 years, while he and his family go broke; economically, physically and mentally.
That would maybe, just a little, come close to justice.
Not that I’ve given it any thought.
quannlace
Good God. Welcome to the 21st century version of debtor’s prison.
Schlemizel
@SP:
subsidies yes but I have no faith that those will go far enough to make things right for families like this one.
Anoniminous
GOP Health Care Policy:
It is better for ten thousand to suffer rather than one ni-CLANG welfare cheat eat a t-bone.
Schlemizel
@rikyrah:
Yeah, ask the church – “Oh, you have a gay cousin – no help for you!”
TK421
Maybe the Democrats should have used their control of the federal government to enact a program that would pass Supreme Court scrutiny. Medicare for everyone, for instance.
Forum Transmitted Disease
@TK421: Which wouldn’t have passed, and you already knew that.
Davis X. Machina
If you’ve got nothing, then the little I’ve managed to get doesn’t look like shit coverage any more… and I’ll fight like a wolverine to keep it.
My increasingly less valuable insurance gets relatively more valuable even as it’s getting absolutely worth less.
In the free Market, blessed be It, my making sure you lose what you once had, making sure you continue to have nothing, is a rational move. It’s an attempt to see that my inadequate coverage maintains at least some value.
Zero-sum — it’s not just for casinos any more.
Belafon (formerly anonevent)
@Forum Transmitted Disease: Someone had posted the other day a link showing how, when Ted Kennedy tried to get that bill passed in the 90s, he couldn’t find a single sponsor.
Also, what makes anyone think that if the ACA is struck down that Single Payer or Medicare for all would pass.
Schlemizel
@eemom:
No, better he have a severe stroke that took his ability to hear speak and write. Then a nice long, slow decline in a nursing home. Sure it will be 10x better than what you or I could afford but then he could be alone with his evil for a long long time.
Yes, I suppose wish this makes me a bad person & proof both sides do it blah blah blah
ETA – just saw @cckids: got here before me. Great minds & all that.
ThatLeftTurnInABQ
@Forum Transmitted Disease:
__
It also assumes that the SCOTUS majority aren’t partisan hacks eager to strike down whatever solutions Dems came up with. If you grant this assumption, then the PPACA should be upheld, in which case the original premise of the hypothetical is nullified.
Loneoak
A sad story, to be sure. But isn’t it all it worth it to have Freedom(TM)?
Davis X. Machina
@Forum Transmitted Disease: Medicare for all, ca. 2008, from someone who was there.
By 2009, that zero had, I am sure, doubled, and doubled again.
RosiesDad
The “American Way” is, in some ways, so fucking selfish it leaves me speechless.
Schlemizel
Not think, just hope. With the alternative taken off the table something will need to be done. The fear would be that Medicare would be given to anyone who could not get or afford private insurance. The insurers would dump every high-risk customer they could & make Medicare unaffordable. So the only alternative is to force everyone into a national plan of some kind. When faced with no other options this would at least be considered. Hell, in another 40 or 50 years it might even pass.
Dee Loralei
@ThatLeftTurnInABQ: Damn. That was fucking depressing. But true. That’s the American philosophy now. Brought to you by Saint Ronnie and 30 years of trickle down economics.
Davis X. Machina
@Belafon (formerly anonevent):
@Schlemizel:
You’re using the wrong unit of measure. In another 20 or 25 election cycles, it might even pass.
The problem we have is we didn’t elect Nelson Mandela president, apparently
hitchhiker
Three days after my husband broke his neck, a very nice financial counselor at the trauma center told me gently that the hospital expenses alone would run about $70,000 more than our insurance would cover.
Did we have any other resources? There would be Medicaid if not . . .
I said, joking — “Hopefully you’ll let us keep our house.”
“Oh, yes,” she said, not joking. “And one car.”
We’d have to spend all the money we were saving for retirement & our kids’ college, in other words, before we were poor enough to meet that total assets limit. And, as anyone who’s lived into life with paralysis knows, the expenses are impossible to describe. What does it cost to retrofit your house so that a wheelchair can get through the doors and into the bathrooms? How do you pay for that? The last time he had a medical issue (vicious skin infection that went from nothing to icu in 24 hours) it was a few thousand out of pocket for us, and that’s with good insurance.
I smile at people who tell me that their catastrophe coverage will protect them. They have no idea. We’ve come to know people from all over Europe who have spinal cord injuries; they always think we’re lying when we tell them how it is here, where it’s not bad enough to lose control of your bowel and bladder or be unable to have sex or be dependent on other people to brush your teeth for you . . . you have to go bankrupt as well.
kay
@ThatLeftTurnInABQ:
They happily took up the challenge to Medicaid, and no one has any idea what they’re going to do with that.
Congress can not expand Medicaid without a legal challenge that goes all the way to the Supreme Court. It’s absolutely incredible.
Medicaid at 72% fed subsidy for children is “constitutional” but Medicaid at 90% fed subsidy when we add more adults may be “unconstitutional”.
Davis X. Machina
@hitchhiker:
Moral hazard, don’t you know? Even skin that is riddled with Staphylococcus aureus is still skin in the game
Emerald
@Schlemizel: Joe Lieberman proposed, during the ACA debate, that the bill include a buy-in to Medicare for folks 55+. The proposal got a major favorable response, so Lieberman stated that if his proposal were included in the ACA, he would vote NO on the whole bill.
And that was just expanding Medicare by 10 years. With a buy-in.
ThatLeftTurnInABQ
@Dee Loralei:
__
Fixt. This only becomes the American philosophy if we surrender to it. I’m not giving up, and I suspect that nobody else who reads this blog on a regular basis is giving up either.
Jennifer
We should be preparing to riot in the streets the day the ACA ruling is handed down, just in case.
I’m serious. We need to start organizing right now to be sure we can turn out millions in case the court decides to fuck us all back into the horrendous system we’ve suffered under all these years. Give the motherfuckers something to think about.
Mnemosyne
@Schlemizel:
Counties that can’t afford road maintenance due to budget cuts are turning paved roads back into gravel roads.
The “something” that will need to be done will almost certainly not be single-payer, and it will almost certainly be worse than the problems the ACA was supposed to fix.
gene108
If it’s not explicitly stated in the Constitution it isn’t something you should expect.
For right-wingers, the whole “public welfare” part of the Preamble stretches the scope of government too much.
I think a lot of folks, who vote for right-wingers don’t realize the end result of the policies the people they are voting for want to enact or do away with. In 2004, for example, Florida overwhelming upped their minimum wage by state-wide referendum, even though they went heavily for Bush, Jr. Folks just don’t realize, if the right-wing gets their way the minimum wage will be deemed unconstitutional because it’s not explicitly mentioned in the constitution.
Healthcare is just another of the long list of powers government has taken on itself, that’s not explicitly enumerated in the Constitution and therefore government should be forced out of providing at any level.
There’s really nothing about practicality in this mindset. It’s just about adhering to an ideology, no matter how much damage you do.
EconWatcher
Sadly, I think we’d better brace for the prospect of the whole statute going down along with the mandate. If I were a betting man, I’d bet on it (5-4 split). The opinion polls disfavoring the mandate will give the wingnuts all the cover they need.
ThatLeftTurnInABQ
@gene108:
__
I think we are actually dealing with a two-headed monster. For the Federalist Society types, your quote above is applicable. But the other side of the right wing, and typically the more populist one, consist of folks who believe in “public welfare” as a legitimate exercise of the US Federal Govt. but who have very narrow, bigoted, self-centered and selfish definitions of who truly belongs to the public. Minorities, women, etc, do not belong and thus benefiting them is an illegitimate objective and a perversion of the Constitution. And it goes without saying that to them everything is a zero-sum game, so nobody who is defined as being outside of the charmed circle of the res publica can benefit in any way without they themselves on the inside suffering harm as a result.
TK421
“Also, what makes anyone think that if the ACA is struck down that Single Payer or Medicare for all would pass”
Well, if the people in charge of the Democratic Party really want to improve our nation’s health care system, they will work for that. If they just want to pass something quickly and easily that they can label “reform”, and that provides a big payoff for the insurance companies, they will keep doing what they’ve been doing these past few years.
TK421
“so Lieberman stated that if his proposal were included in the ACA, he would vote NO on the whole bill”
If only there had recently been a chance to destroy Lieberman’s political career. Like, say, if someone in Connecticut mounted a primary challenge against him, which other Democrats could have influenced with campaigning and endorsements.
Jim Pharo
Albert Brooks’s recent novel paints the picture of where this goes in about 20 years or so. It’s disheartening, to say the least.
Schlemizel
@Emerald:
I remember that but remember hes with us on everything but the war!
@Mnemosyne:
And that is exactly why I am ‘praying’ that the jackoffs on the court do not over turn ACA. I want to believe we can do better but the cost of getting there (assuming we could) is too high. “20-25 election cycles is a great (sadly) way to look at it. h/t@Davis X. Machina:
hope 3 links does not get me sent to the penalty box 8-{D
Mnemosyne
@TK421:
Yes, taking 8 months to pass a single piece of legislation is doing it “quickly and easily.” Good one. Next you’ll be telling us how nobody really knows what’s in the bill and that the Democrats “rammed it through Congress.”
Belafon (formerly anonevent)
@TK421: Democrats have been working on reform for 70 years. It’s not like this just came up in 2009.
It’s going to be hard to do reform if most of the voting public goes “meh, doesn’t affect me” when legislation like this passes. Democrats lost in 2010 in part because most people didn’t see any need for this, and they won’t until they or someone they know is affected.
But I will tell you that my goal is to put enough Democrats in Congress to continue with these reforms.
TK421
” The opinion polls disfavoring the mandate will give the wingnuts all the cover they need.”
Who could have foreseen that forcing people to buy health insurance from private corporations would be unpopular?
jl
The situation of US health care system is so disgusting, I am starting wonder if it can be made an official human rights issue.
I’ve posted similar numbers before here, so forgive me, but can’t help myself. Hope I can put in enough variation this time to make it worth people’s while
Let’s look at life expectancy at age 40.
Among high income developed economies, for women at age 40 the US was tenth out of 19 in 1960, and in 1980 the US was tenth out of 21, and in 2009 was 23 out of 23. Talk about a war on women.
US life expectancy for men at age 40 has been horrible for as long as data has been available. In 1960 US was 19 out of 19, and in 2009 was tied for 23 out of 23 (with Portugal). For men life expectancy at all ages looked better in terms of growth rates because at least the US was able to retain its relative position. But recent years show a stall out in gain for life expectancy for men, similar to what happened to women for 20 years from 1980 to early 2000s.
The communist Switzerland, with commie regulated, mainly private health care sector. its mandatory uniform basic comprehensive policy, strict rate regulations, medical procedure and drug effectiveness national review board, and existence of multiple public plans (ie, many public options) improved from seventh of 19 for women at age 40 in 1960, to third out of 23 in 2009, for men, from eighth out of 19 in 1960 to first out of 23 in 2009.
Note that universal coverage, strict rate regulation, and national review boards for mandatory plan reimbursements, did not exist in Switzerland in 1960, so it is not the case that the Swiss are naturally longest lived due to unspecified other magic factors, and not the case that the Swiss have some wasteful commie health care system that is essentially mining the naturally good free market health of its citizens.
Edit: number of high income developed countries changes over time due to changes in data availability and a few countries becoming high income during that period, but that is not a significant factor in change in relative US standing.
Edit: also not saying the Swiss system is the best, I just had the numbers prepared for a US and Swiss comparison for some other stuff I am doing.
Hungry Joe
Could not read it. Just couldn’t. I’ve read those stories till I’m semi-permanently blind with rage. Single payer is our only real long-term hope, and that’s what we have to work toward. With what we spend now, it could be silver-, if not gold-plated. For everybody. Not in my lifetime, but maybe in my daughter’s. Or her someday kids. What we have now is — given our resources — barbaric.
Yelli
I could write every hour of every day about the health care system and how is affects us but I won’t to spare you since, for the most part, I am preaching to the choir here. But I will tell you this-We have just moved back from Germany (the hubby is a scientist). He had a fellowship and we lived there for close to 4 years. Although it was a struggle sometimes due to language, we paid very little out of pocket and nothing for the children. In fact, I think I only had to call the insurance company 2X to figure something out.
Since we have returned to the US, I have spent almost every day on the phone with the insurance companies or doctors offices dealing with bills and denials and etc… We have paid over $600 in out of pocket costs & we have another $800 that is pending that I am trying to figure out. (i.e. you won’t cover $200 for a strep diagnosis but you paid for the Dr visit?)
One might think that in my family of 4, we have health problems with bills like these. These are simple routine visits. All of us are healthy and only one doctor visit was for something more than a bad cold. It has been miserable to say the least. I am scared to go to the Dr anymore for fear we will end up with too large of a bill.
I don’t understand how Americans can get used to this. I don’t think I would have questioned it until I experienced a different system all together. I wish everyone would live in a different country to see how health care CAN be done instead of the absolute mess we are in now.
Yelli
I could write every hour of every day about the health care system and how is affects us but I won’t to spare you since, for the most part, I am preaching to the choir here. But I will tell you this-We have just moved back from Germany (the hubby is a scientist). He had a fellowship and we lived there for close to 4 years. Although it was a struggle sometimes due to language, we paid very little out of pocket and nothing for the children. In fact, I think I only had to call the insurance company 2X to figure something out.
Since we have returned to the US, I have spent almost every day on the phone with the insurance companies or doctors offices dealing with bills and denials and etc… We have paid over $600 in out of pocket costs & we have another $800 that is pending that I am trying to figure out. (i.e. you won’t cover $200 for a strep diagnosis but you paid for the Dr visit?)
One might think that in my family of 4, we have health problems with bills like these. These are simple routine visits. All of us are healthy and only one doctor visit was for something more than a bad cold. It has been miserable to say the least. I am scared to go to the Dr anymore for fear we will end up with too large of a bill.
I don’t understand how Americans can get used to this. I don’t think I would have questioned it until I experienced a different system all together. I wish everyone would live in a different country to see how health care CAN be done instead of the absolute mess we are in now.
Ruckus
Was at the recycling center today and an approx 75 yr old man was sitting in the side door of his van sorting his bottles before turning them in. Didn’t notice till I was leaving the bumper stickers – Repeal Obamacare and Proud member of the right wing caucus. I wanted to get out and go yell obscenities at this old coot who I’m sure was on SS and Medicare and maybe a military pension. But I’m trying to be the better person. I may fail at that pretty soon.
Michael
I am dealing with similar issues with my Mom who just passed and my step father who is in a home in AZ with Dementia. I would suggest that you look into a beneficiary deed on the property. The social workers will not tell you that this is possible. But it is perfectly legal.
Get everything in a trust that is out of your names completely. While I know an attorney is costly. I your case I would recommend contacting one to see the right ways. To proceed. Mom had a trust and so far the property is shielded. That is AX so your milage may vary. And I am so sorry for these trials during such a difficult time. Peace to you and your family.
Davis X. Machina
@Hungry Joe: 70 million people who believe that if you get nothing, and they get nothing, they actually get something because you got nothing.
Makes it a heavy lift.
ThatLeftTurnInABQ
@Davis X. Machina:
__
Freedom’s just another word for nothing
left to loseleft to take away from that other fellow over there who doesn’t look like me.Yelli
@hitchhiker:
I was talking with a Republican uncle of mine who is, in general, a reasonable person. If I can catch his rhertoric, he at least admits he was wrong. While we were
discussingdebating healthcare, I wasgrillingquestioning him about who will take care of the poor or what happens if, heaven forbid, he has an accident? His reply? The churches! The churches take care of the poor and sick-didn’t you know that?{facepalm}
Calouste
@gene108:
The USA would be a whole lot better off if the Constitution was treated like a law that it is, rather than fetishised like a combination of the 5th Gospel and the 11th-20th Commandments.
Mnemosyne
@Yelli:
I have a feeling that he thinks all of the Catholic hospitals out there are charity hospitals that don’t require payment.
He is, of course, completely wrong, but I’m guessing that may be what he believes.
Jim, Foolish Literalist
@Davis X. Machina: A Russian peasant who had no livestock was walking home and saw his neighbor had a new cow, and he was filled with jealous anger. As he walked, he kicked over a rock that released a Genie from a hole where it had been imprisoned for a thousand years. In gratitude, the Genie offered the peasant the fulfillment of a single wish. Said the peasant, “I want my neighbor’s cow to die.” We are all Russian peasants, now.
@Mnemosyne:
I think it was on the Tweety show a couple weeks ago, the day of the big hearing, Tweety had the founder (“founder”) of one of the big Tea Bagger groups on, and she was cheerfully dismissing all talk of people without health care dying because “doctors take the Hippocratic Oath!”. The closest she got to addressing costs was “you can work something out with the doctor”. All this with a patronizing smile and tone that said “I can’t believe I have to explain this to you stupid liberals.” It makes that chicken lady from Nevada seem thoughtful.
Ruckus
@cckids:
Although your presented story is OK maybe you should think on it a bit and get back to us. Spice it up a little, add a little drama maybe extend the time a while. Maybe 2 debilitating diseases, or a permanent case of shingles on top of everything else.
jl
@Jim, Foolish Literalist:
Doctors take an oath pledging ethical and professional behavior, but it is not necessarily the Hippocratic Oath. And none of the oaths I have heard talk about a duty to treat everyone, or anyone in particular.
Olde tymey hippocratic oaths did talk about a doctor’s duty of charity to his or her teachers and students. Sounds like sneaking in a little cartel AMA action to me!
What kind of country is this now, where being ignorant and foolish seems to be a criteria for having influence in public debate?
I definitely think having a personality disorder is a criterion for being a big time TV pundit, which only a few (Maddow for example) have escaped. (and yeah, I am looking at you, Mr. Ed, you seem just as bizarre and abnormal as Mornin’ Joe and Tweety, though have to admit, more informed and know how make a good argument on a regular basis).
Punditus Maximus
I’m disabled due to illness, and I’ve just accepted that I need to quarantine my life from that of my family, and that I’m going to die a pauper’s death and be burned and scattered.
Thank whatever is out there that I don’t have kids. I literally cannot imagine passing this burden onto someone I care about. I’d literally arrange for adoption and kill myself first.
Punditus Maximus
I expect a government which exists to promote the general welfare.
eemom
wrt Scalia, while my PREFERENCE would be to draw it out as some have suggested, I was really focused on the result-oriented goal of instant death=Obama-appointed replacement=shifted majority on the Court.
I have no idea what effect it would have on the pending cases, though.
Mnemosyne
@jl:
People don’t realize that most countries with universal healthcare systems do NOT have single-payer and often incorporate the dreaded “private insurance companies” into their system. Japan’s system is entirely based on private insurance.
The difference between them and us is that they have nonprofit private insurance companies that are heavily regulated by the government. We not only have for profit insurance companies, we also have for profit hospitals and other for profit healthcare providers.
It’s the requirement that healthcare providers be allowed to make a profit that’s distorting our healthcare system, not the fact that they’re private companies.
jl
@Mnemosyne:
Good points. It amazes me that US health care insurance execs can testify that the system is broken, their business model is falling apart, and something needs to be done and done quick, as long as not one penny of their (excess) profits be touched.
If the US could get a public option, and figure out a way to encourage multiple regional public options, and mandate a minimum universal comprehensive policy that insurers had to offer, those two things would do a lot, and would remove the public’s main objection to the ACA (which is, as I understand the polls, coverage mandate, but with no public option to help keep the private insurers honest and the policies affordable).
Mnemosyne
@jl:
I’m not totally sure that a public (aka government-paid) option is really necessary. A solid nonprofit like Kaiser Permanente that already has a good infrastructure built up might be able to fill the gap nicely.
It seems to me that the objection that people have to ACA is that they have to hand their money over to a for-profit insurer, but I’m not sure they would be quite as reluctant if they were paying a non-profit even though that non-profit would technically be a “private insurance company.”
ETA: I don’t have the statistics at hand, but one of the big differences between 2008 and 1992 was that a huge number of insurance companies became for-profit — in a lot of states, Blue Cross/Blue Shield are now for-profit companies. It’s the profit that’s killing us, not the private company.
Davis X. Machina
@Ruckus: But not asbestos shingles… that would be over-egging the pudding.
The Other Chuck
@Schlemizel:
This doesn’t appear to have hurt Clarence Thomas’s career in the slightest.
gene108
@Yelli:
Hypochondriacs like you are part of the reason medical costs are so high.
A cold? Suck it up and get box of tissues.
On a side note, true right-wingers want to do away with health insurance. They believe if people paid for medical care out of pocket, there would be fewer unnecessary procedures, thus magically lowering the cost of health care and/or people wouldn’t put up with paying $200,000 for a heart operation and the free market fairies would drive the price down.
The converse of this is heart surgeries can be performed for less, since India, for example is able to do this. The flip side is people making $10,000/year would then be upper-middle class, like they are in India.
EDIT: There really is a train of thought on the right that conflates moral responsibility or what should be moral responsibility as being the same as good policy, i.e. a household shouldn’t spend beyond its means, therefore the same should go for government. Wanting people to be more responsible for out-of-pocket medical costs fits this ideology, without even thinking about the reality of what’s driving medical costs.
Yelli
@Mnemosyne: You are spot on. Germany is also ALL nonprofit private insurance companies. The way I understand the motivation behind them is that they want as many subscribers as possible. It seems like this benefits all. I was very happy.
I wouldn’t say their system is perfect and neither would most experts but their life span is longer than Americans & their infant mortality rate is also lower.
Let’s just say I grew very weary of Germans and other Europeans I met asking me to clarify if it was true that Americans lost their houses over health care costs. sigh.
I believe there was an excellent Frontline about health care in different nations a few years back. I would like to see how they compare the US healthcare system to other nations if Obamacare goes through.
gene108
@Calouste:
God came and handed the Constitution to the Founders. Thomas Kinkaide even painted a picture of it.
Divinely inspired works like the Constitution should be revered.
On a side note, most of the “god gave us the Constitution” folks seem to think it only applies the original Constitution and the Bill or Rights, therefore the other 17 Amendments to the Constitution are not divinely inspired and not as important.
You know the ones giving blacks the right to vote, women the right to vote, ending slavery, and allowing the government to tax income.
Yelli
@gene108: A bad cold that turned into a fever that turned out to be a nasty ear infection that required antibiotics for my 1 year-old.
Are you always this much of an idiot?
Why would you even write a comment like that? Can you read AND comprehend what you are reading? Maybe you should stick to simpler blogs and discussions like CNN.com.
Jennifer
Well, I’ll get shouted down again as someone who’s just out of touch, but we could fix this mess in a hurry if we just starved the beast.
That is, if everyone dropped their private insurance, or declined to participate in their employer-provided plan. Even if just those who don’t have expensive chronic conditions did this, the for-profit insurers would be out of business within a year.
Yeah, I know, I know, not feasible. But…it is where we’re headed if the SC strikes down the ACA. It’s not as if Congress will be persuaded to take another bite at that apple in the next session, and costs are escalating so rapidly that we’re quickly approaching the time when employers won’t offer coverage and none but the wealthy few will be able to afford it on their own.
I had a really sneaky idea back when it looked like even the watered-down ACA that we got wasn’t going to pass. It was to form kind of a national coalition of people who would be willing to pay into a pot so that all the folks in some small population state – say, North Dakota for example – could tell their private insurers to shove it up their asses. The pool of money would go to covering the folks in those states who opted out of private insurance (with them contributing whatever they had previously) while the insurers in the state went belly-up (since insurance is a state market, they could be picked off one at a time in this fashion). My guess was that by the time we got to destroying the private health insurance market in the second or third targeted state, the insurers themselves would be demanding reform, and of course, our congress cares about those folks.
Maybe I thought of this because I like the idea of burning something to the ground. On the other hand, I think it would be a good lesson to our overlords to do something like this. They certainly have no fear of us now; perhaps we need to look for ways to instill it in them.
cckids
@Ruckus: I hope you’re snarking, because what I described is my son’s life. He’s 29 years old, and had a stroke in utero. He has all the conditions I mentioned, with the added fun of a tracheostomy, colonoscopy & feeding tube. The difference is, he is a sweet, gentle, fun-loving soul who smiles and enjoys what life he has.
I’ll gladly add an excoriating rash plus a bedsore or two to my wishes for Fat Tony, however. Along with a condescending, self-righteous harpy/social worker from either the state or Medicaid to question every aspect of his medical existence.
cckids
@eemom:
Well. . . ok. Though a drawn-out condition, one that is all too common in America, where the person or their mind is just not coming back. . . that is a discussion that is past due in regards to the federal courts and the Supreme Court.
Mnemosyne
@Jennifer:
You’re making the common mistake of thinking that it’s the for profit insurers who are the primary problem. Do you really think that, say, Tenet hospitals would not be thrilled if they were able to demand cash up front from all of their patients instead of having to negotiate with insurance companies? Their CEO made $10.7 million in 2011. I bet he could do even better if all of their patients were paying cash or taking out loans.
The problem is that everyone in our system has their hand out and demands a profit. Doctors, hospitals, drug companies. Everyone. Removing one tiny piece of the system won’t do much to bring it down.
ThatLeftTurnInABQ
@Mnemosyne:
__
You’ll never make the Nach Aetna uns crowd happy with talk like this. Because for them, this isn’t just about policy outcomes, it is also about getting revenge on the insurance companies as a form of long deferred justice for all the evil deeds they’ve done over the years. I don’t disagree with this moral evaluation of what these companies have done in screwing their customers, but given the choice between a better set of patient outcomes which looks to be obtainable and a punitive expedition which looks to be a futile and possibly counter-productive quest, I’ll take the former over the latter.
Interrobang
I’m Canadian and I have cerebral palsy. If I’d been born in the US, I would have bankrupted my parents, and I probably still would be in a wheelchair (that was the original prognosis). Instead, I got then-experimental surgery, a ton of physiotherapy paid for by the province, and lots of other assistance. My parents are upper middle class, too.
Because I had all this and I continue to have regular medical attention with a lot of what isn’t covered by the province (yes, there are holes, alas) now covered by my employer’s supplemental (private) insurance plan, I not only can walk, but I got a Master’s degree, hold down a full-time job, work out at least twice a week, and pay a metric shitload more taxes than I would have if I had been born American.
Which is another way the US’s healthcare not-a-system is screwing the country — there are tons of Americans out there (I know several of them personally, actually) who’d be able to work and be productive, taxpaying citizens, if only they could get ongoing regular medical oversight and maintenance care for their chronic conditions. For whatever reasons, there are a lot of people who just fall through the holes in whatever inadequate state or last-resort programmes out there.
If I were a religious person instead of a godless heathen, I’d thank God every day that I was born in Canada. Instead, I am eternally grateful to Tommy Douglass. :)
twiffer
@gene108: it saddens me that the 9th amendment gets no love, or even acknowledgement. frankly, it’s one of the most important ones:
this is also why anyone who cries “where is that in the constitution?!?!?” is an asshole.
Jennifer
@Mnemosyne: That’s a rather simplistic view of a very complicated system.
Suppose you have a state where half of those currently insured say, “fuck it, I’m not buying private insurance from any of you remoras” and instead opt into the pool I described.
Now you’ve got doctors and hospitals in that state seeing half of their patients show up with no insurance. At that point, they aren’t really in a position to demand higher rates for services than they’re getting from their (greatly diminished) pool of insured patients. You get things to the point where you’ve cut their customer base in half, they now have the choice of accepting the $100 you’re offering for the office visit or moving out of the house on the golf course. You’re also assuming that the pool I described has no bargaining power, which again is a simplistic assumption.
The only reason this shit has ever gotten as bad as it has is because everyone is so focused on “I’ve got mine and I’m going to hold on to it as long as I can, regardless of how it’s just perpetuating the system and making it worse.” It’s the same reason we don’t have unions any more – everyone wants someone else to take all the risk. Meanwhile, history teaches that unless people are willing to take risk, things don’t change.
Mnemosyne
@Interrobang:
Here in California, the previous governor tried to end home care programs for disabled people and it had to be explained to him very slowly in single-syllable words that doing that would actually be more expensive for the state because a lot of those people would then be forced to go into state-run nursing homes at far greater expense.
That’s our problem in a nutshell right there — Republicans are more interested in taking away programs that sound like someone is getting something they shouldn’t than in figuring out the most efficient way to serve disabled citizens and their families. Punishment for the crime of being poor and/or disabled is far more important than actually assisting citizens.
DFH no.6
@Yelli:
Umm… I think you need to read gene108 past the second sentence there.
Sure, Poe’s Law and all that for the first two sentences, but after that the initial parody becomes quite apparent.
Mnemosyne
@Jennifer:
Isn’t the pool you’re describing called “insurance”? Where everyone pays in and people use the benefits as needed?
It just sounds like you’re trying to re-invent the wheel when we could take the insurance we have now and make it all non-profit instead of for-profit to get the same benefit.
And then we get to work on the hospital systems.
Jennifer
@Mnemosyne: Good luck with getting ANYTHING done to convert for-profit insurance to non-profit if the ACA gets knocked down. As I said before, Congress won’t be willing to take another bite at that apple anytime soon.
The pool I was describing could be called “insurance” except it differs a little due to the fact that it would be designed to destroy the private health insurance market in whatever state was targeted.
pseudonymous in nc
@Mnemosyne:
Furthermore, those companies operate in a sandbox that excludes conditions where private provision clearly fails. The post-2006 Dutch system, for instance, has a mandatory private component for short-term care (premiums at EUR 100/person/month or thereabouts, with an annual deductible of EUR 220) but “exceptional” stuff like long-term care and disability rehab, like the case described in that op-ed, are covered by the AWBZ and financed by a payroll tax.
That was T.R. Reid’s piece, based on the research for his book, and it was clever in its execution because it focused on relatively late reformers like Switzerland because they better reflect the situation on the ground in the US with entrenched private interests.
Scamp Dog
@Yelli: Your snark detector may need recalibration. The tell is everything after “On a side note,…” Then again, the fear induced by the fraying American social fabric and right-wing rhetoric does tend to impair equipment like that. I’m not trying to be snarky here: when your child’s health is on the line, anyone’s sense of subtlety is tested.
Original Lee
@JPL: Some neighbors of ours had to do that. She is manic-depressive (to the extent that she is unable to hold a steady job even when her meds are working reasonably well) and his employer does not offer mental health care. They did a strategic default on their home mortgage, sold their cars and their dogs (they bred and trained Dobermans as a hobby), divorced, and then started over again, living in his mother’s basement. Heartbreaking.
Turgid Jacobian
God.
*Sobs*
jl
@Jennifer:
You don’t have to convert for profit insurance companies to nonprofit. Most European systems that retain private insurance have a two tier system.
Every provider, profit or nonprofit, private or public, has to provide a basic uniform comprehensive plan (aka, the same damn coverage) to all comers who are within their market (usually defined geographically). The return on this basic comprehensive plan is strictly regulated, and so low in Switzerland that private insurers there regard it as a nonprofit service.
Insurers can also provide supplemental policies, which provide more coverage, usually for services not covered by basic plan, such as treatments and medications not on the list that mandatory basic plan will cover, or amenities such as private room, etc. This sector of the market covered by much less regulation.
Could this approach work in US? I think it would have to, in order to approach effectiveness and efficiency of best health care systems.
BTW, I think Mnemosyne makes a good point regarding insurance companies not being completely, or only, bad guys. Cartelization, market power, lack of transparency in health care delivery (general license hospitals and large medical groups) and regulatory and reimbursement arbitrage (private specialty license hospitals and ambulatory care centers) play a big role in driving up costs in US.
Yelli
@Scamp Dog:
Egads you are correct. I hereby apologize to @gene108 and banish myself to the CNN simpleton blogs. {goes back to lurk mode}
In my defense, I haven’t had much sleep lately… :)
Mnemosyne
@Jennifer:
If ACA gets knocked down, then all bets are off, especially since comments by the court seem to indicate that they would also be willing to knock down the expansion of Medicaid, which would leave a whole lot of people even more screwed than they are right now. You can look at any third-world country if you think that the for-profit hospitals wouldn’t be able to make huge money just by catering to rich people. The only thing holding them back now is the Reagan-era laws that require them to treat people who come into the ER without insurance, and the court was questioning those as well.
David Koch
But, but FDL says you can’t be a True Progressive® unless you “Kill the Bill”
jl
@Mnemosyne:
The conservative justices on the Supreme Court seem to be operating on a basis of political partisanship and the rankest arrogant ideologically motivated ignorance and incompetence.
I think if they strike down individual mandate and Medicaid expansion, that will do nothing to solve problems of dysfunctional markets for health insurance and health care due to both inherent nature of those markets, and an inconsistent patchwork of state regulations.
I cannot see how that situation does not bring in interstate commerce clause. To fix it need to ban interstate commerce in health insurance and health care provision, or individual mandate, or feds have to mandate minimum uniformity in state regulations. Any of those would be big changes that might be interpreted as unprecedented, or hurt big corporations (and there seems to be now a doctrine that anything that does not increase corporate profits is now assumed unconstitutional).
So, what is left? As health care scandals, crises occur and general misery increases, gradual expansion of tax funded federal social insurance, is what is left, IMHO. In the long term, the reactionaries will regret not cooperating with national Romney/Obama care policy. Only problem with that outcome is so many people will have to die or live in misery to get a sensible policy gradually installed.
Even becoming barbaric by eliminating federal laws requiring emergency care will not help much, since many states have similar laws.
The depressingly low quality and alarming ignorance of the SCOTUS hearings signaled trainwreck to me, even more tha what the US has tolerated over last 30 years.
ThatLeftTurnInABQ
@Yelli:
Please don’t. Poe’s Law level of snark/spoof is an art form around here. You aren’t the first person to get taken in and certainly won’t be the last. Stick around and participate, we only kill and eat the trolls.
Ruckus
@cckids:
Sorry about your son. Never intended anything for him. Sounds like he had more than his share of life.
I was discussing the treatment you and eemom desired for Fat Tony. I liked what you wanted for him, I just want to go farther, as in more painfully and longer.
C Thomas reminds me of a fellow I knew a long time ago. Every day was a new life for him. The rising sun was a reset button.
Nora
@dp:
I did the same for my Tea Bagger Representative. She, too, is a doctor, but she has no more empathy for people struggling with our dreadful health care system than the biggest blockhead in the state.
Sammy
@Mnemosyne: “… the objection that people have to ACA is that they …” have no clue about the ACA.
The majority of these people have NEVER takeen a single minute to actually find out what is in the ACA. NOR WILL THEY EVER.
Fox Noise told them what to think and that is what they think. No critical think is involved here.
Also, too, the guy who finally got a health care law passed at more than 70 years of NOTHING is BLACK.
Of this, I have no doubt, you are already aware.
Period. End of story.
Procopius
@JPL: Hmmm. That sounds suspiciously like the decision that many black men (and poor white men, but nobody ever talked about white people on welfare) had to make back before Clinton adopted the Republican “reform” to the welfare system. Why is it that the Republican Party not only exists but often prospers? I have to attribute it to the inexorable workings ot the Law of Karma; do something good and you get rewarded in future lives, do something bad and you get punished in future lives, and only a Buddha can tell you when you will receive the fruit of a particular karma. Anyway, every decent person should work as much as they can to destroy the Republican Party and drive its adherents from public life. Pass it on.