Universal insurance general questions and ideas

[i_am_not_john_galt]

Just a couple of broad philosophical question that seems to be at the core of why we can't get this going:

With the advances in every branch of medicine, virtually everyone will probably use more, and more expensive, medical services than before. A few decades ago lots of people just lived with medical problems (or died from them) for which we now have treatments - everything from chronic heartburn to impotence to congenital heart defects. And as we grow older (esp. us baby boomers) the need and desire for advanced medical treatments will grow exponentially. At some point isn't this unsustainable? How would universal health care plans handle this triage? Would the wealthy always be able to pay out-of-pocket for their needs? Wouldn't health care providers migrate to the wealthy cash-based system, impovershing the public health system?

Should plans make some distinction between maladies which result from choices (like my consumption of donuts) and those which don't? Should a person who makes healthy choices subsidize the consequences of those who don't?

And an idea:
What if health insurance was uncoupled from employment and instead grouping (the basis of the insurance business) was based at the state level? Any company that wanted to offer health insurance would have to do so at universal rates for an entire state. Presumably multiple companies would offer a variety of insurance plans, paid for individually (maybe with a subsidy or tax credit for the poor), and individuals could choose among them. That way freedom of choice would be preserved for all, states would benefit from efforts to contain medical costs and increase healthy lifestyles, and every individual would have the same access to coverage. This seems like an attainable reform - one that people could understand and that doesn't threaten what people like about their insurance.

[ramapo]

1. Good thought

Problem is companies subsidize (sometimes heavily) the cost. Here in NJ , an individual not eligible for a company plan, can buy insurance from a state level plan. But It is incredibly expensive.

Decoupling insurance from employment would remove a major worry. Certainly one of mine, I'm staying in a situation I really don;t like because I need the coverage.

[i_am_not_john_galt]

3. For me it's personal

just got through paying for 18 months of COBRA, now on an individual family plan with Blue Cross. They disallowed my adopted son (one of 6 kids) because he has crossed eyes. Disallowed from any coverage. For a condition that is corrected with glasses. I offered to specifically exempt him from any coverage relating to the condition but some helpful lawmaker somewhere made that option illegal.

The current system is broken. But it sure doesn't seem like we're going anywhere fast on reform.

[ramapo]

52. Pre-existing condition?

NJ is enlightened enough to require coverage of pre-existing conditions as long as you've maintained coverage. If you haven't I believe it's a 6-month waiting period.

Denial of coverage is just one example of the system's illness.

The state-wide plan should give each insurance company a large pool of coverees so rates should be as reasonable (relatively) as they are through an employer-sponsered plan. Kind of like auto insurance (not that that has worked so well).

[blondeatlast]

2. Short-term answer to health care: let every American join the

Federal employees' plan at group rates.

Long term: Universal, single-payer coverage. It works everywhere else.

Your idea WOULD be a good one, but too expensive for most people to manage.

Edit: "Health Care MeltdowN" is a great book on the failings of our system, and how they can be fixed. Another citation:

http://www.physiciansproposal.org/

[i_am_not_john_galt]

4. If it's too expensive for most people

than it just doesn't work as insurance. Insurance presumes that the average cost for everyone is affordable for the individual. The insurance just evens things out.

[i_am_not_john_galt]

6. I think the only people less capable of making coverage decisions

than Blue Cross would have to be the government. I don't want rationing of health care, but multiple companies competing to provide more affordable coverage based on a fair way of grouping people.

[liberalhistorian]

19. You have a point,

but I sure as hell don't trust the damned greedy insurance companies any farther than I can throw them. Their goddamned bean counters don't care about anything but money and how to keep from having to pay for anything, even though they themselves usually don't have to worry about their own coverage.

Insurance companies have denied friends of mine, women with children, certain cancer treatments and even proven cancer treatments or proven treatments for other serious illnesses. My cancer-stricken uncle and his wife have to deal with that shit all the time now, instead of concentrating on trying to get better, they have to deal with constant denials of care and being hounded by the fucking medical collection agencies. So, I'm sorry, but I'd almost rather have the government involved than the goddamned greedy profit-is-king insurance companies.

The real problem is the for-profit nature of our health care system, when it shouldn't be for profit at all. Every other industrialized country recognizes that. I want the goddamned insurance companies THE HELL OUT OF OUR HEALTH CARE ALTOGETHER. THAT would solve 90% of the problem right there.

[area51]

101. We have rationing now.

ianjg said:

"I don't want rationing of health care...."

But we already have rationing of healthcare based on ability to pay. What we have is wealthcare, not healthcare, in the USA.

[apsuman]

102. based upon that logic

Then we have food rationing as well.

Wealthy people buy the more expensive food, I am not wealthy so I buy the lesser expensive and thus lesser quality food.

[liberalhistorian]

107. But at least you have access to it,

and don't starve or have your house or other assets taken away by hospitals and doctors because you don't. And there are plenty of programs to assist with food, including food banks, meals served by hunger groups and churches, etc., etc. Not so with medicine, even the "free clinics" are so overcrowded, understaffed and underfunded, and there's only so much they can do. You can grow your own food as well, you can't grow your own doctor, surgeon, or hospital. And food isn't specialized like medicine.

[liberalhistorian]

105. Wealthcare, that's

a great way to put it!

[liberalhistorian]

5. What about a person who makes unhealthy

choices, and who doesn't get sick, having to subsidize those who make healthy choices who get sick anyway?

I know that sounds absurd, but no more absurd than the other way around. Regarding the issue of uncoupling health insurance from employment, that is, indeed, an excellent idea and one that's been brought up previously. That whole system started right after WWII, when companies wanted to attract and retain qualified employees and offering health insurance was one way they did it.

The whole system is totally broken, it's time to tear it down and completely overhaul it.

I live near Cleveland, home of the Cleveland Clinic, which is considered one of the best hospitals in the world, IF YOU CAN AFFORD IT. Those are the key words, IF YOU CAN AFFORD IT. Go just a couple blocks from the Clinic Campus (it's almost like a college, really), and you'll be in a neighborhood whose residents will likely never see the inside of the Clinic, no matter how bad their illness may be. Hell, they're lucky to get any decent treatment at all at the public hospital.

And if they do get any treatment at all, and they're not on Medicaid, they'll get hounded and harassed endlessly by the hospital's ruthless collection agencies. And if they don't have insurance, they'll REALLY get screwed because they'll be charged the full rate instead of the discounted rate most insurers negotiate with hospitals, and the full rate is often at least TEN TIMES MORE than the rate the insured pay. And hospitals are now the most aggressive, ruthless collectors in the country, according to numerous studies. They will put liens on your property, if you own any, and if you don't, they will garnish your wages and never mind if you're left with an amount you can't afford to live on. Their attornies are notorious for not serving debtors with legal papers while claiming that they have served them, causing debtors to miss court dates and have default judgments entered against them so that their bank accounts can be seized without their knowledge, etc., etc. And some hospitals are now even having debtors thrown in prison using the legal remedy of "body attachment."

So a lot of people without insurance and/or a lot of money are just going without the care they need, even if they're really ill, and that's bullshit. I know first-hand, and from my work with health care justice groups, that all doctors and hospitals really care about now is money and nothing else. We've got to take the for-profit factor out of health care, or we're really in trouble. One of the reasons health care is so goddamned exorbitant is the greed of HMO's and insurance companies, who are taking an ever larger slice of health care profits, thus raising prices higher and higher, enriching themselves while denying desperately needed care to their clients. :puke: :mad: :grr:

[i_am_not_john_galt]

8. "If you can afford it" is kind of a red herring

Lots of things intrinsic to life are more accessible to the wealthy. Good food, safe shelter and transportation, etc. The issue to me is making them generally more affordable to all. Cosmetic surgery is an example. For many people this is not just nice-to-have, it would provide a real life benefit. But it will probably always be a high-cost item, trivial to the rich but costly to the poor. But it would be better for all for it to be as affordable as possible.

[liberalhistorian]

22. For God's sake, I'm not

talking about cosmetic surgery, which is NOT necessary, and would generally NOT be covered under any kind of comprehensive program.

And it's a total cop-out to say that the wealthy can afford the best of everything, that's not the issue. The issue is why we allow a person's worth and value to be determined by how much money they have or are born into. Why should the life of a kid born into a wealthy family be any more important than the life of a kid born into a poorer family?

We can and must do better than that.

[Cleita]

10. Honey EVERYONE is going to need health care

at one time in their lives and you are right we have to pull the profiteers out of it.

[Cleita]

7. Here's a proposal for NHI that I like

http://www.physiciansproposal.org/

Click on the 'PROPOSAL' link to the left to get the full text.

[i_am_not_john_galt]

12. My critique

"We endorse a fundamental change in America's health care - the creation of a comprehensive National Health Insurance (NHI) Program. Such a program - which in essence would be an expanded and improved version of Medicare - would cover every American for all necessary medical care."

I have two adopted foster kids and experience the Medi-Cal system, which is a California version of Medicare. It's rationing (reimbursement rates so low there are not enough doctors willing to take it) and buracracy that makes Blue Cross look like kaizan management.

And who is determining "necessary"? Is repair of a cleft-pallet necessary? How about reconstructive knee surgery vs. just a brace? Breast reduction for a woman with back problems? Is a 2nd heart transplant necessary or should that person be written off?

"Most hospitals and clinics would remain privately owned and operated, receiving a budget from the NHI to cover all operating costs. Investor-owned facilities would be converted to not-for-profit status, and their former owners compensated for past investments. Physicians could continue to practice on a fee-for-service basis, or receive salaries from group practices, hospitals or clinics."

The best doctors and clinics could simply opt out, serving the wealthy only. The rest of us are left with those who can't make it in the free economy.

[Kanary]

16. Corporations make the decisions, or government makes the decisions...

You seem to be making the assumption that some disconnected bean counter in a corporation is going to make a better decision for you than a medically trained person in a government office. I can't quite figure out your reasoning on that, but.... that's how you see it.

However, before you dismiss it all out of hand, I *do* wish you'd do considerably more reading about single-payer systems. You might be surprised to find that some of your assumptions may be unfounded. There've been many discussions about this right here on this forum, and over and over, people from other countries have said they are dismayed at the paucity of care we settle for here in the US of A. Surely those comments should count for something?

Many years ago we made the decision to opt for corporations rather than government. We are reaping the results of that choice, and neither drs nor patients are happy with the results. We can continue in the same direction, and maybe put on a patch here and there and still have the same basic results, or we can be willing to start to read and think in other ways.

Kanary

[i_am_not_john_galt]

56. No, my idea moves more of the choice to the individual

Multiple insurance companies should compete, selling individual plans, but based on the "group" being the whole state. That way everyone gets the benefit of being part of the large group (what you want from an actuarial standpoint), yet they can pick and choose what plan or features they want based on the plan details, the record of the insurer, etc.

[Kanary]

83. Get real. The "individuals" who have "choice" are rich

The rest of us get what the corporations want to give us.

I repeat. The med corps make the decisions, or the government makes the decisions. At least with the government, we have some input and some representation.

But, you like the CEO's making your decisions, go for it.

Kanary

[Jose Diablo]

100. I say cut the insurance companies out, totally

"insurance companies should compete", now there is an oxymoron.

The biggest problem I see in health care IS the insurance companies. It is instructive to notice that when the stock market goes down, insurance premiums go up, dramatically, regardless of risk exposure with health insurance policies.

That is why I think the insurance companies should be out of it, totally. No health insurance policies and NO malpractice insurance policies. Out, no ifs or buts about it. Let them get their money by returning from where the came from, selling lightning insurance and lightning rods.

When there is a nation health insurance plan, it should be without the insurance companies involvement in any way.

[liberalhistorian]

106. Amen!

One of the most sickening things about our current system is the for-profit factor promulgated and promoted by the damned insurance companies, medicine should NEVER be for-profit! I want the fucking insurance companies and HMO's THE HELL OUT OF MEDICAL CARE FOR GOOD!

[liberalhistorian]

27. I refuse to settle for a system

where profit is king and where disinterested, greedy bean counters, with no medical training or knowledge, and whose sole purpose is to make money for the company by denying care, even needed care that the person has paid for through their premium and deserves it, make all the decisions for me, my family, and everyone else.

I refuse to settle for a system that considers only those with money to be worthy of the best treatment, that considers only the lives of those with money to be truly important.

I refuse to settle for a system where people suffer terribly and needlessly because they can't afford the treatment they need.

I refuse to settle for a system where people are horrendously overcharged if they're uninsured, and where people can be thrown in jail if they can't pay the full amount of a hospital bill all at once, or can have liens put on what little they may own, if anything, or have their bank accounts attached draining everything in them regardless of how much they may have needed it for rent, food, etc., or have ruthless, bloodsucking medical collection agencies, with their damned collectrolls, the lowest scum on earth as far as I'm concerned, endlessly hounding and harassing them for money they don't have, even if they're terminally ill (as my uncle is dealing with now).

I refuse to settle for a system where people are forced to file for bankruptcy to avoid losing their homes and everything else they own due to a major illness in the family, while the goddamned greedy hospital and HMO CEO's salaries are getting higher and higher, their perks fatter and fatter.

I could go on and on, but you get the point.

[Cleita]

29. I have had to deal with Medi-cal too in the past.

The real problem is that it's underfunded and of course our
Republican reps keep chopping away at funding until no doctor can afford to accept it. If we took the waste out of our multi-tiered system and the Wall Street factor, the money could be put where it was needed. Sick people could get health care and medical care providers could be adequately reimbursed for their services. It's really a no-brainer. We have to take insurance and for profit HMOs out of the system and replace it with a universal system where everyone who needs medical care can get it.

And it's the Christian thing to do. One of the corporal works of mercy is to care for the sick.

[bilger]

9. Tough problem

First you need to control the cost. I think the biggest impact you could have on skyrocketing health care expenses is to do two things:

1) Do not allow pharmacutical companies to advertise. This is controversial I know, but its done in other countries. It would directly impact the cost of the drugs.

2) Allow drugs to be imported if they can be proven to be identical to what is sold here.

3) Limit the lawsuits. I realize this is probably unpopular but think about what is different between now and say 1955? A huge difference is that we didn't have thousands upon thousands of medical lawsuits. Lawsuits result in higher insurance premiums, which results in higher charges for health care. If you do any reading on the subject its alarming how many communities are losing doctors completely due to the expense of doing business.

I think these two items would have a substantial impact on lowering the cost of health care. Once you lower the cost, its a lot easier to talk about who and how we will pay for it.

[Cleita]

11. Fourth item.

Outlaw insurance companies and for profit medical companies, traded on the stock exchange, from providing health care. Health is not a commodity to be traded for cash but a human right.

[i_am_not_john_galt]

13. Health care is not a human right

life, liberty, and pursuit of happiness, free speech, free association, etc. But having your needs cared for by others (which is what health care is) is not a human right.

Are those who provide care obligated to provide it to others free of charge? What about their own freedom?

Health care is no more a right than food or shelter. The are necesities, but not rights.

[Kanary]

17. Sounds like you have a compassion deficit.

Ironically, it's notoriously oppressive governments that espouse the kind of argument you have just put forth.

All "enlightened" countries, and that includes some 3rd world countries, see health care as a right. Again, I strongly suggest you do some reading. Look, for instance, at the standing of the US compared to other countries as a result of our unenlightened attitudes toward health care.

You stated earlier that you have a child who was denied coverage, and wanted to change that system. And yet you seem to have little or no compassion for people who have no coverage at all. Time for some thinking.....

Kanary

[i_am_not_john_galt]

26. I've done a fair amount of reading and thinking

I have lots of compassion - and empathy, with those who can't get, or can't afford coverage under the current system. My family is among them. But I believe the answer is to make the resource of health care more affordable to all, not to legislate that some people must take care of other people at rates the government dictates.

Single payer coverage is no panacea. There's a reason that cutting-edge medical care originates here. Under our system, as flawed as it is, the very best care in the world is available at a cost. In most other countires it is simply not available at any cost.

[Kanary]

45. Actually, you're incorrect.

We keep *promoting* the idea that "cutting-edge medical care originates here". If you had done a lot of reading on this subject right here on DU, you would have seen lots of references to show that this idea is .... incorrect.

If you believe that corporate medicine is a "panacea", then.... sorry, but you don't have much ground to stand on when you complain about a child of yours not being covered. That's what corporate medicine is all about.

Kanary

[Cleita]

18. We are the only advanced industrial country that does

not have access to health care written into the Constitution as a human and civil right. Even a lot of third world countries recognize this as a human right too. Actually, food and shelter are a human right as well. Mother nature provides us all those things and when kings take them away from us because they claim ownership, then it is their duty to provide those things mother nature once did in exchange. No more hungry and homeless in this country I say.

[xray s]

20. That's right, health care is a necessity

And it makes sound economic sense that we all work together and pool our risks and share the costs over the entire population to make sure the risks and cost for one individual are not devastating.

Anyone who can see past their next heartbeat should understand this.

[liberalhistorian]

21. BULLSHIT!

And BULLSHIT again! You simply CANNOT determine the worth and value of a person's life by how much money they have. I have a friend with breast cancer, in her thirties, with four young children, whose insurance company is already balking at paying for goddamn near anything. You simply cannot tell me that her life isn't worth anything, that she doesn't deserve treatment, the same with my uncle and other good friend with cancer, and many others I can think of.

And who the hell said anything about expecting others to pay for it? We pay taxes, don't we, and we pay our premiums, too. And in countries with far more humane health care systems than ours, which is pretty much the rest of the entire industrialized world, taxes pay for the system and most of the people have no problem with that at all. They aren't getting it "for free."

[i_am_not_john_galt]

32. Of course the value of a life is not based on their wealth

and health problems are not distributed in any fair way that I can determine either. She no more "deserves" treatment than she "deserved" to get ill. I hope your friend gets the treatment she needs. If she were my friend I would help her raise the money. You know nothing of my life or my compassion.

But one obstacle has been removed for her - she CAN get the treatment she needs almost anywhere in the country, and with little or no waiting. That's because our system fairly rewards those who provide those services with market rates. Even under our messed up system, she has a better situation than people in government run systems where shortages of competent physicians (because as smart young people in college they go into other fields) and underfunded facilities (because the investment in these facilities is determined by politicians rather than for-profit investors) produce waiting lists and triage systems.

[liberalhistorian]

37. WTF?????????????????????????????????????????

"She no more deserves treatment than she deserved to get ill"?????? WTF???????????????????????????? Someone with cancer, especially the mother of four young children, doesn't deserve treatment? Good God Almighty, am I glad I'm not YOUR wife!

And you obviously haven't read any of my other posts if you think she can get treatment almost anywhere with no waiting. Because if you're uninsured or don't have money, or good enough insurance, or your insurance won't cover it, and you don't qualify for Medicaid (damn near impossible to do nowadays), you're screwed basically. They want a large amount of money upfront, and if you don't have it, tough shit, you're out of luck. And if you do have even a small amount, they'll take that and then find and take whatever other assets you own (they do a social security number search), whether you needed that money/assets to live in or not (they don't give a shit, gotta pay their CEO's their gazillion-dollar salary you know). And if you make a payment up front and don't have as much of the rest that they want, they'll hound and harass you ceaselessly for the rest, putting liens on your house if you even own one, or any other assets, and even throwing you in jail through a legal remedy called "body attachment." There was just an article on that that was posted here recently.

And if you don't have it, you're screwed. You either don't get treatment at all, or treatment so substandard you might as well not have been treated at all. I'm sorry, but in a civilized society, that is simply unacceptable.

And it appears that you are falling victim to the wingnut propaganda concerning the health care of other industrialized countries. ALL the Canadians I know, which is a lot, love their system and have no problems with it. There's no major wait for everything, the doctors are competent and caring and non greedy and money-obsessed, etc. So please don't try the wingnut propaganda on me, because this is my pet issue, and I've done more research and activism on it than anything else.

[i_am_not_john_galt]

41. I only said one obstacle was removed

if she can come up with the money, the treatment is available. That's better than the treatment not being available no matter what.

I am not at all saying our system works as it is today - my original point is that it is completely, utterly broken. I just don't believe that a single-payer, government run, health care system would be an improvement on what we have. Different, but not an improvement.

[liberalhistorian]

48. "If she can come up with the money."

Well, there ya go right there, you've pretty much admitted that only those with money really "deserve" health care.

And I say that treatment for such things should NEVER depend on whether or not people have enough of the green stuff, that's simply inhumane. And if that's what you're willing to accept, without trying to fight it or change it, then I really, truly, pity you and your family.

[i_am_not_john_galt]

51. Get off the personal attacks

I've said no such thing. I've said that the best answer is to make more health care available at lower cost to all through insurance reform in the free marketplace.

[liberalhistorian]

64. No, you haven't.

Or if that's what you've been saying, you haven't made it clear. When you say things such as "she doesn't deserve treatment any more than she deserved to get ill", and "if she can come up with the money she can get the treatment" and "people have no right to health care", and things like that, people are going to take it that way.

And no one is advocating "free" health care. There's no way to do that, even if you wanted to. The guaranteed health care systems in the other industrialized countries are not "free" they are paid for with taxes that almost EVERYONE pays, and most of them have no problem at all paying for it. And few people would advocate that doctors and hospitals be "forced" into the system. There are private fee-for-service doctors in the nationalized health care systems as well.

The for-profit hospitals and profit-oriented insurance companies are what has gotten us into this mess, not the government. I want the insurance companies THE HELL OUT OF HEALTH CARE! They've only totally fucked things up.

[i_am_not_john_galt]

72. geez

The point of the "deserve" statement is that NO ONE deserves to be ill more than anyone else - deserving doesn't enter into it. Life isn't fair. No one deserves to be poor or rich, hungry or fat.

And government has a ton of culpability in the current mess - they pass the laws! That's why good group coverage is only available through employers. That's why I can't get a "a la carte" plan that would exempt my son's condition.

And I want the really smart go-getters to go into medicine, get rich, buy big homes and send their kids to harvard. They've earned it.

[liberalhistorian]

79. Yeah, they've earned it at our

expense, because all they care about now is money. I can think of a lot of other professions who deserve to be rich far more than doctors. Like police officers and firefighters and social workers. Like teachers (my parents are both teachers, I've seen what they've gone through throughout the years, and they deserve twenty times more than what little they get), and without teachers, there'd be no doctors.

But too many teachers, especially those who are retired (and I know this first-hand because my parents are retired and I grew up around teachers) can't afford the health care they need and their doctors don't give a shit.

[Lars39]

40. Prove it. Cites and links for worse care in government run systems.

Back it up.

[i_am_not_john_galt]

42. here you go

http://www.info.doh.gov.uk/doh/intpress.nsf/page/2004-0011?OpenDocument

[Lars39]

46. Doesn't say what the waits were for.

I had to wait to have my surgeries here in the US. There's also a good 2 1/2 wait for mammograms at certain times of the year. There's probably people in the US that have also had to wait 6 months or more for surgeries.

[liberalhistorian]

50. My mother had to wait

EIGHT weeks for an appointment to get a growth on her skin checked out, and she had insurance coverage. I had to wait almost three months before my hysterectomy could be scheduled, even though I was in a lot of pain, and even though I had insurance coverage that took care of most of it. And I can name about five hundred other examples off the top of my head as well.

[Kanary]

61. Finally, an actual link rather than propaganda

And, your link shows nothing.

Doesn't specify what it's for. It's meaningless.

Unfortunately for you, this forum is a huge one, and there are people from all over. There have been many people from other countries talking specifically about their health care, and shaking their heads at how medieval we are in this country.

Just recently, as a matter of fact, someone from UK wrote quite a post which, in brief, explained why there are complaints about medical care in Britain. It's because of EXPECTATIONS. That's right... in short, they've become so accustomed to very good medical care, that they expect MORE. And, I would point out to you that Britain is not a shining example of universal medicine. There are many countries with better.

Again, there is a lot of wisdom in previous posts, if you would just do the searches. Others of us have.

It sounds like your mind is completely made up, regardless of the facts that are brought out, and your link shows me that the reading you've done is woefully incomplete. So, enjoy your broken system. The bandaids you propose aren't going to fix it.

Kanary

[iverglas]

74. assumptions / allegations / missing data

Just a couple of examples.


Even under our messed up system, she has a better situation than people in government run systems where shortages of competent physicians (because as smart young people in college they go into other fields) and underfunded facilities (because the investment in these facilities is determined by politicians rather than for-profit investors) produce waiting lists and triage systems.


First of all ... she's in a better situation than *which* people in *which* government-run systems? The ones who get the services they need?

How can a situation in which one *cannot* access services because one cannot pay for them *ever* be "better" than a system in which most, even if not everyone (for the sake of argument), can access services regardless of ability to pay?

As you said elsewhere, "better" is always a matter of opinion. But the comparisons one is proposing really ought to reflect the facts.

What basis do you have for asserting that doctor shortages are caused by potential doctors not entering medical training? Might another equally plausible reason be that insufficient places are provided in medical school to allow those who do want to attend, to do so? Is there any basis for thinking that there are places in medical schools going begging, say in Canada, for want of people applying to fill them? I can assure you: no, no more in Canada than in the US.

There is a "doctor shortage" in the US -- or else there would be doctors servicing all those people who can't get medical care because they can't afford it, wouldn't there? Demand exceeds supply ... why don't new suppliers just enter the market? Could it be because the powerful representatives of the existing suppliers don't want prices to drop as a result of competition, and so don't agree to open more spaces in the medical schools?

Supply is controlled in both systems, just by different people. Well, in Canada lately, it's been pretty much the same people -- the current crop of politicians here are pretty much in insurance companies' and right-wing think-tanks (and their masters') pockets, after all.

And that's why, of course, the "underfunding" argument is answered the same way. Underfunding, in Canada, is a deliberate policy by right-wing governments to undercut public confidence in the health care system. Supporters of underfunding just don't get to point to it as proof that the system doesn't work, I'm afraid, any more than supporters of restricting supply get to point to shortages.


That's because our system fairly rewards those who provide those services with market rates.

Hmm. How does this notion of "fair" come into the same sentence as "market rates"? Market rates are neither fair nor unfair; they just are, whatever they are set at by the market. If more suppliers of healthcare services -- doctors -- were permitted to enter the market, prices might well drop. Them's the breaks. At least, them's the breaks for most other suppliers of goods and services in an unregulated market.

Isn't health care just another commodity? Is there some reason that governments should want to collude with providers of it to keep prices high, when they don't collude with hot dog manufacturers to do that by restricting supply?

Oh ... maybe to ensure a sufficient supply of the services at rates that are satisfactory to the people who vote those governments in?

Surprise. That's what single public payer health care does. Those of us who have it want it, in sufficient numbers that we'd be very likely to vote out any government that jeopardized it.

And the damned thing is that the suppliers themselves -- the doctors -- aren't exactly clamouring to have it dismantled, either. Negotiated, government-regulated rates suit them just fine.

If an argument is to be made that the market should control the volume of supply, and the prices at which services are supplied ... and that public regulation of supply and prices is bad ... the argument shouldn't really be so obviously out of step with the facts.

.

[camero]

23. The right to life means the right to exist

Which makes health care , food, and shelter natural rights. We have to get out of this "that's mine" mentality if we are to progress as humans. The earth was not just made for you and me but it was made for all of us. We are just borrowing it. We don't own it.

[Kanary]

25. Wow, what a lot of wisdom packed into 5 brief sentences!

:thumbsup:

:toast:

Kinda the "contemporary version" of Chief Seattle.

Kanary

[camero]

31. Thank you

All of our wars and revolutions have stemmed from the fact that people tell other people that they don't have the right to exist.
Everyone has the right to exist. I don't care what so-called reason they give it doesn't justify taking away someone's right to exist.

[i_am_not_john_galt]

33. No, it doesn't mean the right to exist

otherwise death from any cause would be a violation of my rights. It means the right to live your life as you see fit, to make choices and enjoy their consequences.

[camero]

35. When you live, you exist

Get it through your skull. Then maybe you will find enlightenment.

[i_am_not_john_galt]

38. Follow your own logic

If my right to live includes a "right" to every possible use of other's resources to preserve my life, then YOU must be compelled to keep me alive no matter what. Eat, smoke, and drink because someone else will have to cover my diabetes and jaundiced liver!

My right to life extends to my right to be free from you interfering with or ending my life. But you are not compelled to provide me food, shelter, or medicine to extend my life. For you to do so is charity, a wonderful thing, but not a right.

[camero]

82. There you go again.

Nothing is "yours". The car you drive, the food you eat. The clothes on your back all comes from the earth. The earth is not yours alone but it is all of ours.

[Pithlet]

86. Not even

if something outside of your control happens and you can no longer provide those things for yourself?

You are so stuck on this "rights" business. If you're so keen on everyone having the right to life, liberty, blah blah blah, then why aren't you for those things that make those rights possible. Rights in name only do no one any good.

If you can't acknowledge that we all benefit, and are all more free to live and pursue those rights when society is healthy, physically as well as fiscally, then you are very shortsighted. Rights don't mean anything if there's no one there to protect them for you. And they don't mean anything if you're too sick to pursue them. And they mean nothing when those you need to make society work for you so you can pursue them are sick

[iverglas]

76. you're right -- in the 18th century, it didn't

Things out here in the rest of the world have progressed a little beyond that.

We do recognize a few rights other than those that the 18th century thinkers were fond of.

They're sometimes called "second generation" rights -- equality: economic, social and cultural rights. And the third generation -- solidarity rights -- is being worked on, too. That liberté, égalité, fraternité stuff is taken seriously some places.
http://uichr.uiowa.edu/features/eb/weston4.shtml

Some of us just think that liberté may not be worth too much if you're dead ... and that there is some collective responsibility to help individuals to avoid that fate befalling them prematurely and through no fault of their own. Odd notion, but there ya go. I thought it was one held, to a greater or lesser extent, by "liberals" in the US.

I mean ... why else would it be illegal to discriminate against individuals in the provision of goods, services and employment? A true 18th century liberal would have to reject such limitations on individual action, seems to me.

Matter of degree ... and very often of which side one perceives one's bread to be buttered on ... is how it always looks to me.

.

[Pithlet]

54. Not a right?

When it comes down to it, how can you pursue those other rights if you don't have decent health care? I guarantee you my family would not be in the position it is in if we didn't have access to health care. All the other rights we enjoy, and things we have would be meaningless. If health care isn't a human right, then none of the other rights matter. I bet the woman dying of cancer and leaving her children behind, who won't get coverage for her lifesaving medical procedures, will be comforted by the fact that she can say whatever she wants.

If fewer and fewer Americans are denied this "non-right" what do you think happens to our society?

[i_am_not_john_galt]

58. Somehow the founders of this country enjoyed their right to life

without forcing others to pay for their needs.

[Pithlet]

62. You're kidding, right?

Number one, more than one of our founding fathers owned slaves. So much for them pulling themselves up by their own bootstraps.

Number two, the founding fathers didn't enjoy the scientific advances and modern medicine that those of us lucky to afford it now, do. So, you really can't compare it now, can you?

[liberalhistorian]

66. Not only that, but they

were all fairly wealthy anyway, and could pay handsomely for their needs. And it was a totally different society back then, as well, they had nowhere near the medical knowledge and advances and social structure we have now. And most of them, frankly, believed in a society whose members cared for each other however they could. They called it civilization.

[Pithlet]

71. And, not to mention

that those of us who are lucky enough to have access to health care benefit when others do, as well. My kids will benefit when the kids they go to school with are also healthy, and not spreading disease. I'll benefit when some epidemic doesn't spring out of the slums that would happen in libertarian land and kill a quarter of the population. Whether or not you want to call it a right, it's a win win situation when everyone has health care. Makes that whole life and liberty stuff a lot easier.

[Kanary]

87. Then give us back their 1700's and 1800's world

Where you could go out in the wilderness and shoot your dinner.

Where you could go out beyond the current settlement and build your own house, because there was still land for the taking, and trees for the chopping.

Where you could pay a doctor with a chicken or a basket of fruit.

Get the idea?

If you think that time was so perfect and wonderful and everyone did so well, you haven't been reading your Dickens. I suggest you give that a try.

Kanary

[tkmorris]

67. Aye, there's the rub

That in a nutshell is why I don't agree with you. I believe necessary healthcare should be a right, and you don't.

[iverglas]

77. and there ya go

I believe necessary healthcare should be a right, and you don't.

And rights are, after all, exactly what we decide they will be. No more and no less.

Mr. Not-John-Galt (I gather there is some John Galt other than the one who surveyed southwestern Ontario many years ago) doesn't have any more of the rights he claims than anyone else has of the rights they claim, unless everybody else agrees. His rights didn't fall from the sky any more than ours.

.

[eridani]

90. Health care is infrastructure

Effectively convincing people who haven't spent much time thinking about health care policy requires countering the blather that the likes of Harry and Louise have been using to make people in the US afraid that however bad the current situation is, change is too scary and government is bad anyway. The market is good, no matter what problem you are addressing. A way to effectively counter this attitude occurred to me after listening to Dennis Kucinich speak in Seattle. Talking about his universal health care plan, he said, "The market has failed!" three times, with an invitation to the crowd to join in, which people mostly did. He was, of course, preaching to the choir. This is a slogan that will cut no ice with the "market good, government bad" crowd, and it caused me to think about the various ways in which it could be taken.

Obviously, what Kucinich meant was that the market has failed to deliver health care, but the statement taken plain could also be seen to refer to markets in general. In that case, anyone who bought a computer ten years ago and has upgraded recently (and who almost certainly doesn't spend any time on being a health care policy wonk) is going to think "What on earth is this idiot ranting about?"

Clearly the markets for health care and the market for computers are pretty different. If you ask free market believers what governments should bedoing, they will often say something like "Roads and police and firefightingare legitimate government occupations because that is infrastructure." What we need to do is to present a good case that health care is infrastructure too. Almost no one will argue that government should have no role in creating and maintaining infrastructure, other than a few Libertarian hard cases whose arguments are ignored by average citizens anyway. Health insurance paid for by individual is extremely expensive, and people who pay that way commonly feel ripped off because after they pay, they never see a penny of it. But if health care is infrastructure, it is analogous to police and fire protection. These services are also expensive, but do people feel that if their houses don't burn down and they don't get assaulted or robbed, the property taxes paying for these services are a ripoff? Should the expenses for these services be paid only by the people who are immediately served by them? Obviously not.

The slogan "Health care is infrastructure" beats "Health care is a right" as well. The latter makes people think of endlessly inflating entitlements that will drive the country into bankruptcy and still not satisfy everyone. Saying that health care is infrastructure not only directly and inevitably implies that health care is a right, but it gets people thinking about the issue in the most productive manner, namely as active citizens responsible for helping to determine public policy.

The reality is that health care providers and firefighters are very similar in an economic sense. Computer makers want to sell more computers, and people always want more memory, more bandwidth and more speed, but people would rather not get sick and rather not have their houses burn, but want effective help fast should those things happen. Imagine a city with three or four fire departments, paid for by dozens of different employer insurance schemes plus a few subsidized plans for the poor which a lot of low income people earn too much money to qualify for. A real mess, right? The firefighting equipment has to be duplicated several times, and the private insurance is always shifting around with employment patterns. ("Whaddya mean you won't send a truck out? My employer turned in the new insurance paperwork last week!" "I'm sorry sir, but you must still be with Company X. We don't have you in our records.") And you'd also have a bunch of sorryass parasites sitting around trying to calculate which zip codes are likely to have the most fires, so they can stick their unlucky inhabitants with higher fees. Also each company would adjust prices dramatically upward to include profits as well.

Since no city in real life is actually stupid enough to have several different fire departments, there is no way of comparing that hypothetical situation with the current state of affairs in the provision of health care. But this was not always the case. There used to be private fire departments, and markers designating fire protection eligibility can still be found in antique shops. If your neighbor's house caught fire from the cinders of your fire, your personal firefighting service would just let the other house burn. If there was a dispute about coverage, competing services would often spray more water on each other than on the fire. Before the revolutionary war, that well-known commie rat bastard Benjamin Franklin put a stop to this practice with America's first public fire department in Philadelphia.)

We do know what happens to health care prices in towns with more than one hospital compared to towns of similar size with only one hospital-namely that the more hospitals, the more expensive health care is. And it's perfectly obvious why-if you think about the proper economic analogy, namely that of the fire department. And it's exactly the opposite of what happens with restaurants, barbers and computer manufacturers-more of those means better and cheaper products and services. Since firefighting is paid for as a public investment, they'll go to a house of $100,000 assessed valuation just as rapidly as one with a million dollar valuation, even though the property taxes are higher in the latter case. People in wealthy areas may have some overall service advantages, but the difference is trivial compared to the difference between people with and without health insurance. In addition, the fees would be jacked up even higher to include as much profit as possible.

Competition actually degrades performance directly as well. The single most important factor in determining your chances of surviving a complex operation is the number of those operations previously performed in that hospital. Divide the number of operations by the number of similar facilities in town, and you have calculated the relative incompetence factor. The same goes for firefighters-they keep their skills up by practicing on buildings slated for demolition that have been set on fire, or on fire towers which have serious restrictions as to where they can be located. Therefore there are limited numbers of these, and dividing them up among competing departments would mean that everyone would have lower skill levels. Compare this with computers, where sales and product improvement efforts mean more computers are made and sold. Somehow you just can't sell people on the virtues of having more heart attacks and house fires, so more competitors means less real life practice for everyone.

In one respect, public payment for health insurance is more like paying for roads than firefighters. Just as roadbuilding is paid for by the public but almost always contracted out to private outfits, medical providers would continue to be private operators even though publicly financed. Road maintenance is done by both public and private employees-how you decide between the two optionsis by putting the matter up to public debate and arguing about it. (This is called "activism" these days, although it used to be just plain old "citizenship.")

That firefighting is a public business leads to putting arguments of how to pay for it in the public venue. Service providers will always want to do less work for more money, and service recipients want more service for less money. No conceivable social arrangement can alter that basic fact of life. What happens is that unions and professional organizations argue about the solutions in public, bond issues and tax rates are proposed, and everybody comes to a compromise arrangement. And there is no reason to think that the same process won't work with health care providers. You can't cover everything and pay everyone what s/he thinks s/he deserves, so you put all the arguments on the public table and come up with a compromise.

And this segues into other public policy areas as well. In the case of firefighting, there are building codes and enforcement to argue about, fire safety and extinguisher training, smoke alarm requirements, etc. In the case of health, there is urban design (making walking and biking easier, for instance), health education and awareness, arguing about how to evaluate various technologies for proven results, etc. By comparison, making matters of computer design subject to this kind of public dispute would be unbelievably stupid.

And finally there is the question of how do we afford single payer. Establishment opinion says that the Kucinich proposal is outrageously expensive compared to the proposals of other candidates. Of course they fail to mention that we would no longer have private insurance expenses, that out of pocked expenses would be dramatically reduced, and that we would continue to have the government funding that we now have. The fact is that we are already paying for universal health care-we just aren't getting it. Suppose your electric bill is $400 and you don't have that much. And suppose that you check your back yard and find out that someone is tapping into the line between the power provider and your house, siphoning off as much as they can get by with. All of a sudden the fact that you don't have $400 isn't the main problem any more.

The health care plans of all the other candidates (note that Sharpton and Braun just advocate single payer--they have no specific plans posted on their sites) are in fact more expensive than that of Kucinich, because they all assume that we continue to spend what we are already spending, but should add more to that total in order to further subsidize private insurance companies, who would continue to drain off funds in the pipeline flowing from the public to health care providers. For those who like equations, those plans would cost out as

Total proposed health care spending = Current spending + incremental proposal extra expenses - x, where x is whatever unknown amount of savings would be produced by the plan. (Extending preventive care, no matter how incrementally, can be expected to produce some saving.)

Kucinich plan = current spending only - x.

So remember boys and girls-HEALTH CARE IS INFRASTRUCTURE!

For a nice analysis of Canadian Single Payer with references, see below.

http://www.geocities.com/stewjackmail/pdf/uhc-canus.pdf

A note on cost control--an analogy is controlling the movements of a herd of cattle. You can do the sensible thing and build a fence around them, allowing them to move freely within the confines, or you can hire a passle of cowpokes with sets of reins controlling each cow individually. The former is what Canadians do with global budgeting, and the latter is what HMOs and insurance companies do in the US. It's obvious which system gives providers and patients the most choice.

[Kanary]

91. Very effective reframing...

I'm interested in talking more with you about this.... some good thought here... when my brain is more awake.

Is it possible you could also post this in Cleitis' thread?

I'd really like to see this developed into a theme that would answer the common objections!

Thanks!

Kanary

[eridani]

93. Please link to that thread, and I'll do it n/t

[Kanary]

94. Here ya go...

http://www.democraticunderground.com/discuss/duboard.php?az=show_topic&forum=104&topic_id=1046122#1047629

If for some reason that doesn't post right, the title is "eighteen thousand....."

Thanks!

Kanary

[camero]

92. I've been arguing this point for quite some time

Though not as articulately as you have. It's the perfect analogy but it will have to be hammered on constantly to reverse the brainwashing of the masses by the Insurance lobbies.

Thanks alot for your contribution. It's much needed.

[liberalhistorian]

96. WOW!

NOW we're getting somewhere! That is an excellent analysis, one that is likely to make much more sense to most people than just the "health care is right" slogan, as you said.

[i_am_not_john_galt]

97. Very informative and interesting

I still don't agree with single-payer and think that an unencumbered market would do better, but this is a much better way of contrasting single-payer with market driven (compared to the rhetoric of health care services as a fundamental right).

I live in the LA area and our infastructure aint doing that well - the freeways are a bitch. In fact, the freeways function about as well as Medi-Cal.

If we want to know what single-payer health care would look like, wouldn't the Veterans Health Care system be a proper reference?

[iverglas]

104. I note

... this is a much better way of contrasting single-payer with market driven ...

... that you haven't responded to the post in which I pointed out that your current system is no more "market-driven" than a whole lot of other markets for other services are in your economy.

The health care market in the US is supply-managed. There are enormous barriers to entry for would-be providers of services.

The limited number of medical school places is a big one. (No, not all the bright young folk who want to become doctors are able to, your wishful thinking notwithstanding.)

The need for doctors to form relationships with HMOs or insurance companies is another: no doctor can hope to earn a living unless his/her patients are covered by some form of insurance.

The supply of services to patients is then not a matter of a bargain between the provider and the patient, the way it is in other markets (say, computers). The "demand" comes from insurance companies and HMOs, because they and only they determine what services patients may receive under their plans -- and there is no way that patients can afford to receive services any other way. So there are no bargains being struck between the providers and receivers of the services, the doctors and patients, and the economic power of the insurance companies and HMOs determines prices within the range that the doctors are willing to accept -- and the range that the insurance companies and HMOs have to pay in order to acquire the services that are kept relatively scarce by restricting the supply of doctors, etc.

The individuals receiving health care are not actors in the healthcare services market in your system -- they are in a much more real way the "product" that the doctors deliver to the insurance companies, and are paid for by the insurance companies.

The patients are not purchasing healthcare, they are purchasing insurance -- and their choices in that respect are limited to the point of being non-existent, in most cases. Employers, too, deliver them as "product" to insurance companies: they purchase the employees with wages and benefits, and resell one aspect of them, the part of them that generates profits by providing them with a service that costs less than is paid for it, to the insurance company they contract with.

It's no different from an employer retaining a food services company to feed its employees lunch. If it didn't do that, it would have to pay the employees more so that they would be able to pay for their own lunch. The employer pays the food services company, but this still costs it less than it would have to pay employees if they bought their own lunches.

If the employer's food services company provided only a bowl of rice for lunch, would the employees agree to a contract that deducted money from their wages for lunch? No -- they would either bargain a better lunch, or bargain wages in lieu of lunch. Lunch, after all, is a predictable and minimal expense.

Individuals simply have no bargaining power when it comes to health care. Their future expenses are unpredictable and very likely substantial. Insurance is the only reasonable option, as it is for any other unpredictable, substantial expense. And individuals simply have no bargaining power with insurance companies.

Unpredictable, substantial financial loss can be absorbed. Your uninsured house burns down and you can't afford another one, you live in your car; your car gets stolen, you go to a shelter. But: you get cancer? You die.

Demand for basic and essential medical services simply is not price-elastic. People *need* treatment for cancer regardless of price. The commodity in question just isn't socks. People *can't* forego medical treatment -- without dying or losing their fundamental, essential ability to earn a living. That there is the bottom line, and it is what makes health care quite simply different from just about any other "service" in any other market.

To talk about a "market-driven" system for the services that people need in order to stay alive therefore means something quite different from saying that the system for sock distribution is/should be "market-driven". In a market-driven health care system, people are sick and people die.

And yes, the notion is offensive to many of us who think that our species has progressed beyond that kind of outcome.

And it is still complete nonsense to claim that there is a market-driven system in the US for the supply of medical services to individuals, given the mechanisms in place to restrict that supply and the interference by third parties, insurance companies and HMOs, in the choices made by suppliers and consumers.

.

[liberalhistorian]

108. The VA system

is NOT based on the single-payer model!

[eridani]

109. Correct

In the VA system, doctors are government employees. Single payer is socialized insurance, with care privately delivered.

[xray s]

14. A better idea on your point #3

How about we try to limit malpractice, instead of the lawsuits that arise from malpractice?

No one ever delves into the fact that thousands of people die from malpractice every year. A small percentage of the doctors in the country are responsible for most of the malpractice claims and yet the profession does little to remove them from practice. The delivery of medicine has many opportunities for errors that could easily be prevented (prescription errors top the list).

Do something about those before you start taking away our rights to the American justice system.

[liberalhistorian]

15. Excuse me, but

it has been proven time and time again that medical malpractice suits ARE NOT the cause of either skyrocketing malpractice insurance rates or higher health care costs. The real culprit is the insurance companies lowering their rates during the boom times in order to attract clients then, when the market goes south and takes the companies' investments with it, they have to raise prices in order to make up for their losses. It has NOTHING to do with lawsuits.

And as a paralegal (and no, I don't work for a plaintiff's attorney) I can guarantee you that attorneys DO NOT just take any case that comes in the door. There's a lot of research that is done to determine the viability of a case before it will even be accepted. If a case doesn't have at least a 60% chance of winning, the attorney isn't likely to accept it. There's too much work and advanced expenses involved to take much of a chance. So if a case is filed, chances are there's merit to it. And more than half of the medical malpractice cases that are filed and that aren't settled before trial are not successful at the trial level, even if the evidence against the doctor or hospital is overwhelming.

And you simply CANNOT take away the rights of people to seek redress if they've been injured or disabled by medical malpractice, which happens far more often than people like to think. Many people who are injured or disabled due to medical negligence are permanently disabled, or their children are, and they deserve reparation for that, for lost wages since they likely can't work anymore and for medical expenses, or for the enormous expense of caring for a disable child who will never get better. NO WAY should doctors and/or hospitals be let off the hook for negligence and malpractice. NO WAY.

I remember when I had my son. When my water broke, it was noted that there was merconium staining, which meant the baby had a bowel movement in the womb. What's supposed to be done at that point is a caesearian section, since it can be poisonous to the baby. But what did my idiot doctor do? He let me stay in labor for another twelve hours because (as a couple of nurses later angrily told me) I was on Medicaid at the time, and they and the hospital wouldn't get as much money if I had a ceasarian section. I ended up having to have one anyway, but TWELVE hours later, and not when it should have been done. And that kind of shit is a helluva lot more common than you'd think. It's lucky for that doctor that my son was okay. He has Asperger's Syndrome, a type of high-functioning autism, but that has nothing to do with what happened. He was lucky, there are so many things that can happen to a baby exposed to merconium staining, especially for twelve hours.

The medical profession used to be worshipped, people took their word for everything, believing they knew best no matter how strong the evidence otherwise. People quite often never thought to question their doctor or hospital, and they often didn't have access to their treatment records and hospital and chart records and physician records, either. They left everything up to the doctor, and didn't take charge of their own health care. Things are different nowadays, and it's a good thing.

[camero]

24. The medical profession has turned into Buyer Beware

Doctors just love money too much now.

[liberalhistorian]

28. I know, and the hospitals

are even worse, and it's really "sickening", so to speak.

[camero]

30. It is sickening

They continue to do unnecessary things and overlook or ignore necessary things in order to make more money. My route to my diabetes diagnosis is a perfect example.

It took four doctors just to come up with the correct diagnosis and 3 years to find the correct treatment when all they had to do was follow their own guidelines which would have cost much less.

It's way past time to get the love of money out of health care.

[i_am_not_john_galt]

34. Let's get the love of money out of car care also

I have a right to work, which entails a right to get to work, which entails a right to a car that runs.

So those that work on cars should get over their love of money and fix my car for free.

[camero]

36. Your car is different from your life

You can live without your car but you can't live without your life. Sheesh what have you been smoking?

[i_am_not_john_galt]

39. I can live, kind of, without a lot of medical care also

So is universal health care coverage only for life-threatening issues?

[camero]

81. A case could be made for that I suppose.

But if you want to compare it to food and shelter. That's where you mess up. Because you have a right to life not a right to lifestyle.

The common cold could lead to death if not treated. So prevention could also be considered a right.

[liberalhistorian]

43. Oh, Good God, I simply

cannot believe you would equate a fucking car with a LIFE!!!!!!! And NO ONE on here is advocating that health care be totally FREE! People can do without a car. They can't do without a life. EVERY life has value, regardless of how much goddamn money they have or were born into, or not born into as the case may be.

Boy, I'm glad I'm not your wife or one of your kids.
"Honey, I know you're scared because you were just diagnosed with breast cancer, but you don't really deserve, or have a right to treatment, you know. We'll just have to learn to live without you. Besides, I have to get the car fixed next week so I can go to work since you won't be able to work, and the car deserves the treatment more than you. So here's some Advil for the pain, since it doesn't have to be prescribed."

Or, "Honey, one of the kids was just diagnosed with diabetes and will need daily medicine and injections from now on."
"Well, forget it, who does he think he is, Bill Gate's son? Besides, he needs to learn that he doesn't really "deserve" anything, he chose to be born, now he has to suffer the consequences. Besides, the car needs to be fixed anyway, which has to be done if he wants me to drive him to WalGreen's to pick up some sugar pills so he can at least have some relief."

[i_am_not_john_galt]

49. Lots of people argue that health care should be free

Look earlier - some are arguing that health care is a right, ergo should be guaranteed by the govt. Some are arguing that all health care providers should be compelled to work within a government-run system and accept government established rates for their work. My comparison with car care is simply to take the same arguement into a less emotionally charged atmosphere than health (admittedly I've failed at this). What kind of car care would we have if the government was in charge of running or paying for it? Crappy car care!

[liberalhistorian]

59. And we have a crappy

health care system that's about to totally melt down because of the practices of the for-profit hospitals, medical corporations and insurance companies! The government is not the enemy here, I'd much rather have it involved than the goddamned greedy insurance companies and for-profit hospitals and medical corporations, which have shown how badly they can screw everything up.

[apsuman]

47. I work in Healthcare in Kentucky

I am a peyon but, but I had lunch with the CFO one day in the cafeteria.

We were discussing insurance. Our employer subsidized health insurance and our hospitals' malpractice.

According to the CFO, the Kentucky constitution prohibits caps on jury awards, he speculated that it had something to do with black lung cases back in the 30's.

As a result, insurance in Kentucky is REALLY REALLY expensive. There are far fewer companies even willing to write group policies. The malpractice insurance want up astronomically as well.

I asked, specifically, that I were to work in Indiana (closest neighbor) then the insurance would cost less, and would probably go up less each year. He told me yes.

Also, he told me that there is a clinic practice that has offices in both Indiana and Kentucky and they are now requiring new patients to be seen in Indiana for their first office visit so litigation will take place in Indiana or federal courts avoiding the limitless caps of Ketucky.

[Cleita]

53. This is the reason why the insurance companies

need to be outlawed from selling health insurance. It's not a good fit and the money doesn't go where it's needed to take care of the sick.

[liberalhistorian]

57. I don't doubt that, but

again, it's not entirely due to lawsuits, but more the practices of the insurance companies. And I'm sorry, but people have the right to be compensated for medical negligence and mistreatment.

[apsuman]

99. I am not disagreeing with you...

I was only trying to piont out what was told to me by a reliable source.

Now, I don't know what the exact law is in Indiana, but I am sure that you can sue and receive payment for actual loss and for pain and suffering due to negligence and mistreatment.

What are their (Indiana's) caps? Since I don't hear people complaining about it, I make a very broad and general assumption that for the most part, they work.

It's something worth investigating.

[i_am_not_john_galt]

44. Lest you think I am a heartless libertarian survivalist nutcase,

my original point in this thread was to discuss an idea of how states could HELP their citizens get affordable health insurance while preserving the best parts of our market-based system.

[liberalhistorian]

55. "Best parts of our

market-based system?" There ARE NO BEST PARTS of the system!

[i_am_not_john_galt]

60. Our messed up system has some great points

Every freakin hospital out here has the full compliment of MRI and other imaging systems, I have access to the most qualified and experienced doctors in the world, etc.

It's just too expensive as structured now.

[camero]

85. That experienced doctor

Who wanst to give you a $300 dollar blood test when a $10 meter and $25 dollar pack of test strips would have done it.

[Kanary]

89. You have it all, but it's not accessible to you.

Have you actually listened to your own arguments?

Of COURSE it's too expensive! Can't you hear what people are telling you? Or, do you just want all this attentiong?

One more time.... It's too expensive because the Insurance Companies Are In The Business Of Making MOney (BIG MONEY!) For Themselves, Not For Taking Care Of YOU.

Paste that on your mirror and reread it several times each day. It will start to sink in.

Kanary

[eridani]

111. And that guarantees that you get worse care

--because the demand for MRIs is related to the number of cases requiring it, which is relatively constant. The more MRIs, the less use each gets, and the less practice your doctors get, insuring that the overall skill level is down.

Remember, the most important determination of survival of and benefit from complex procedures is how many of them the facility performs. The number of cases stays constant. Two hospitals in town means more expensive and worse health care, just like two competing fire departments.

[apsuman]

63. here's an answer or two.

Fund medical schools to the hilt.

1. If you are in a program to become an RN, you sould qualify for some type of tuition reimbursement from the government.

2. If you have the grades and are accepted, the feds should pay for your medical school to be a doctor or a nurse practicioner.

3. We should have federal and state student loan forgiveness programs for service in free/subsidized/hardship clinic/hospitals.

4. Federal laws to make writing insurance policies for doctors (malpractice), and group health more affordable. This means if you have to put federal caps on jury awards, you do that. If you have to increase the depreciation on new medical equipment, you do that.

5. Medical savings accounts.

In a few years would could double the number of doctors practicing and make it more affordable for them to practice.

If we assume that the need for a doctor/nurse practicioner remain relatively constant but the number of them increases, cost would go down.

Soon, everyone has an uncle that is a doctor, and if you have a problem with that ugly rash, just wait until next week when cousin Jenny will be in for the reunion.

The costs that group insurers negotiate are really not that bad. My wife had to have her gall bladder removed, and I saw the actual bill. I could have paid it off in installments and I don't make a lot of money.

And to that end if people are required to pay the bill with THEIR money they will think twice about going to the doctor. If I had a medical savings account and I knew that in 10 years I would get this year's contribution as actual dollars, I would give SERIOUS consideration to every doctor visit.

REAL costs are procedures that require a long recovery and/or a long hospital stay. I am suprised that some LIB hasn't floated the idea of national health insurance for everyone if your yearly medical expenses exceed a large number, like $30,000. In other words, if you break your leg you have to pay that bill, if you need a heart transplant, the feds will pick up that tab. With a policy like that where every group insurer would be able to have actuaries work out the projected costs of insuring a person for values less than that group insurance would drop to real cheap.

[i_am_not_john_galt]

65. regarding your last point

this is what I and most of the people I know who have to pay for their own individual coverage do. We have a very high deductible, no HMO or prescription coverages, and basically just have catastrophic coverage.

[liberalhistorian]

68. Well, I'm sorry, but

with the horrendously astronomical costs of most prescriptions (those drug companies just gotta keep on spending gazillions to advertise, ya know) I thank God I have prescription coverage. My monthly estrogen prescription (I'm 39 and had a total hysterectomy last year), which I have to have, is quite expensive even with coverage, as is another prescription that I must have, it's not a luxury, it's a necessity. Both of these cost me a pretty penny just in co-pays, and there's no way in hell I could afford either one if I didn't have prescription coverage.

[Lars39]

69. I have catastrophic coverage.

I had 2 surgeries, one in July and one in September. If I had had them in December and January, my family would be facing bankruptcy right now.

[Kanary]

88. Too late, that thought was formed long ago....

[reprobate]

70. Universal health care is a national security issue.

If you take a look at many inner city areas, and even rural areas where people can't afford health care, you'll see an epidemic just waiting to happen.

Especially in this country, where there are little or no safety nets, it would be very easy for some virus or bacterial disease to take a foothold in the poor areas, infecting huge numbers of people before anyone is even aware of it. And with no treatment it would easily spread to the not so poor areas, infecting the rest of us before anything could be done.

But maybe that's what the repugs want. Kill off the poor and you don't have to worry about health insurance or public education.

[i_am_not_john_galt]

73. If they killed off the poor

who would mow their lawns?

[liberalhistorian]

80. ROFLMAO!

Or cook their meals, or clean their houses, or watch their children, or serve them at their country clubs, or launder their clothes, etc., etc., all at starvation wages with no benefits.

[Cleita]

84. If they had to do those things themselves?

eom

[iverglas]

78. and not just national security

The national economy. The cost to the economy of people being unable to access health care far exceeds the cost of providing health care.

What was that business in that 18th century document about "the general welfare"? If it can be said to depend on individual liberty, I don't know how it couldn't also be said to depend on individual health.

.

[Cleita]

75. Here's a link that connects lack of health care to homelessness.

http://www.nationalhomeless.org/universalhealth.html

But for the grace of God, there goes all of us.

[i_am_not_john_galt]

95. Why is the present system so expensive?

If the main issue is that the insurance companies charge too much, what is to prevent anyone (DuCross anyone?) from forming a new insurance company and undercutting the existing ones? I looked at 4 companies before signing up for my individual policy. They had rates and policies and programs all over the board, from catastrophic traditional insurance to HMOs to PPOs and everything in between. Everyone (individuals and businesses) migrates to what they perceive as the best deal for themselves, so price pressure is maintained (paste THAT on your mirror!).

The problem lies elsewhere. You can't pin this all on "greedy" corporations, doctors, and nurses.

[Cleita]

98. Okay, administrative costs are 23% for HMO and insurers as

contrary to 2% to 3% administrative costs for Medicare, a government administered program. This is passed on to the insurer or HMO enrollee. There are many, many other abuses that have been documented that are too numerous to post here right now. I will try to do a post on these abuses in the future.

[eridani]

110. Because it is impossible to make money insuring sick people

Therefore all those plans are open only to employed people (a much healthier bunch than the general population) or people without bad family history or 'pre-existing conditions.' In other words, private insurance is essentially an immoral diversion of funds from the very risk-spreading function of insurance. Its purpose is to take money from healthy people (and note that in any demographic, 20% of the people account for 80% of the costs--most people will never get expensively sick or injured) and give it to overpaid CEOs and stockholders. The purpose of public insurance is to take money from healthy people and give it to providers to take care of sick people.

What would you think of a fire department that only served 80 out of 100 census tracts, choosing the 20% that aren't eligible for service on the basis of observing statistically that they are more likely to have fires?

[area51]

103. If universal health care (not health insurance)

is good enough for Shrub & Tricky Dick Cheney & members of congress, it's good enough for the rest of us who pay their salaries.