The Question that Stopped Him in His Tracks

[berni_mccoy]

This is a great Kos diary. I have used this argument on someone who has tried to debate me on HCR. It is a wonderful way to make them consider it. The only two responses I've ever gotten on this are "well that won't happen to me" and "I don't want no welfare", to which I laughed at both of them.

The Question that Stopped Him in His Tracks

by ProfJonathan


Mon Oct 05, 2009 at 10:39:47 AM PDT

I've diaried in the past about my next-door neighbor, a very nice guy with whom I disagree politically. He also likes to invite me by to "get into it" with his family members, who are both generally conservative and often "informed" by the NY Post/Faux News/Hannity world.

The other day, he invited me by and asked me about my views on the current health care debate. (As it happened, I walked in with my own lunch guest, a Soviet emigre, who had some interesting reactions when my friend's family member described President Obama as a "Socialist," but I digress. grin) We talked for awhile, and I pointed out that while doctors make money by providing care, for-profit health insurance companies make money by refusing treatment. Then, I sprung my trap.

ProfJonathan's diary :: ::
I suspect many of you have done this as well, but if you haven't, go up to your favorite possibly reasonable opponent of a public option for health care reform, and ask him/her the following simple question that I posed to my friend:

If you lost your family's health coverage from work, what would you do?

I've asked it many times, of many people, and never gotten even a partial answer from most of them. My neighbor, to his credit, stopped, fell silent, thought for a bit and then finally said, "Well, I guess I'd do what you did when you lost your job : apply for New York State's plan."

And there it is. The only possible answer reasonable people can give. The need for a public option, or at least an affordable choice not driven by profit, because reasonable people understand that for-profit insurance is simply inaffordable if it's even available.

Go ahead, try it on someone who at least understands what private coverage actually costs. Someone with a family, someone who is willing to give an honest answer. At best, you might change some minds. At worst, you might cause them to look at the talking points spewing out from Murdochland with a bit of skepticism, or at least stop spewing them in your direction.

[Nederland]

1. Why do you assume

...that everyone opposed to granting the public option to everyone would also be opposed to providing health care for the poor and unemployed? I don't see the connection.

[Vincardog]

2. If you are not going to offer the PO to the poor and unemployed what good is it?

[Nederland]

4. I think you misunderstand

I would offer the public option to ONLY the poor and unemployed.

[Missy Vixen]

7. Do you have any idea how much private insurance premiums are for anyone over 40?

IF you can get through underwriting...

The vast majority can't afford a four-digit per month private insurance policy premium.

[Nederland]

10. Yeah, and it's a crime

Insurance is a scam. We need a more sensible way of paying things that doesn't involve a third party.

[berni_mccoy]

8. That is ludicrous. What about those who have been denied coverage who can afford it?

What about those *with* insurance who are denied claims?

The PO needs to be offered to EVERYONE in order to work.

[Nederland]

11. Why do you assume

...that I'm in favor of insurance at all? I swear, most people around here are completely incapable of thinking outside the box. They think the only two options are insurance plans or government plans.

[Fumesucker]

13. Sure you can pay as you go for checkups and routine stuff..

But for catastrophic illness there really is no substitute for some sort of insurance for the great majority of people.

[Nederland]

14. Yes there is

Singapore has an excellent model for providing health care that is better than anything in the US or Europe. Yes, it involves a great deal of government regulation that Republicans would throw fits over, but it works way better than anything the West has.

http://worldfocus.org/blog/2009/01/27/singapores-health-system-saves-money-and-lives/3786/

[Fumesucker]

15. A savings account does you no good if you have a catastrophic illness..

Before you have accumulated enough money to pay for the treatment.

And Singapore is such a model of freedom and democracy. :eyes:

[Nederland]

18. I think you need to actually read a little

The Singapore model works a little like the US system of Social Security. The system forces you pay into an account every paycheck. On the outside chance that you get a really expensive illness early in life, government picks up the tab--just like Social Security will give you retirement benefits if you get permanently disabled early in life and can't work. For most people though, really expensive medical care only happens later in life, when you've got lots of money built up over years of saving.

[Fumesucker]

20. Then what is the point of having an individual account?

I don't follow the logic.

And anyone who thinks the US government is going to regulate private medical care with any degree of severity is terminally naive.

[Nederland]

24. It helps control costs

The accounts are setup so that you can borrow out of them if they grow to a certain size, and anything remaining at the time of your death goes to your heirs. That creates an incentive to be smart about your health care spending, an incentive that is completely lacking in both the idiotic system of insurance in the US, and all single payer systems. If you doubt that arrangement results in lower costs, ask yourself this: why has the price of cosmetic surgery in the US actually fallen while the price of all other types of health care risen?

[Selatius]

25. I think you're also ignoring the role for-profit hospitals have had in the system.

I remember a time when most hospitals in America were run either by city governments, county governments, and churches or other NGOs, and they largely operated as non-profits. In the 1960s and 1970s, for-profit hospitals slowly started springing up. Many hospitals nowadays, as far as I'm aware, are for-profit in nature having the fiduciary burden of satisfying shareholders, and your average shareholder is simply interested in dividends. An extra day of rest in the hospital could literally cost $1000 per day more if one were paying out of pocket.

There would have to be regulation in this area.

[Nederland]

28. Cosmetic Surgery is 100% for profit

...and yet it's costs are falling. Why?

[Fumesucker]

26. Dentistry has gotten ridiculously expensive .. and yet very few Americans have good dental insurance

There is a good deal of incentive to economize on dentistry and yet it has become outrageously expensive, I see threads on it regularly here on DU and have dealt with it myself.

Dental insurance is almost uniformly pathetic too.

I'm not sure that your example of cosmetic surgery really means what you imply it means.

[Nederland]

29. Why Dentistry has gotten expensive

In 1970, a mere 6 percent of all Americans had private dental insurance. Today, nearly half the U.S. population is covered by employer-sponsored dental insurance.

http://www.avma.org/onlnews/javma/nov04/041115o.asp

So we've had a huge increase in the number of people that have dental insurance, and over the same period dentistry has gotten very expensive.

See the pattern?

Whenever insurance companies get involved, costs increase dramatically. That's because: 1) they make a profit, 2) they obscure the true costs of things, and 3) they remove the incentive people have to reduce costs. Having a single payer system can help with the first problem, but cannot help with the second two. The cosmetic surgery example shows you the way costs behave when people are spending their own money out of pocket.

[ChoppinBroccoli]

31. Let Me Tell You How Single Payer Controls All That Stuff

I'm going to give you an example from MY personal milieu. I'm an attorney who does a great deal of court-appointed work. When I am appointed by the Court to represent an indigent person, that person gets my services free of charge. When the case is over, I submit a bill for my hours to the Court for payment, and the Court submits a request to the State of Ohio to be reimbursed. So, in my scenario, the State of Ohio is the SINGLE PAYER for Court-appointed legal counsel.

Some people question what will stop folks like me from submitting outrageous bills or charging way too much for my services (in other words, how does the single payer control costs). Here's how. In order to be put on the list to accept court-appointed cases, you have to agree to the set rules. One of those rules is that your hours will be compensated at a set hourly rate. If you think that hourly rate is too low, than that's fine, you don't have to accept court-appointed cases. So, first, you're agreeing to how much you will be paid per hour. It's considerably less than you can make in private practice, but it's much more reliable income (whereas private clients are a feast-or-famine proposition).

Your next question is probably going to be, well how do we control against someone like me spending unnecessary hours on the cases he's given, thereby running up bills (this equates to the unnecessary tests/procedures some healthcare providers perform in order to bill more money--and don't tell it doesn't happen; my brother-in-law, who is a cardiologist, just QUIT a medical practice because they were asking him to sign off on unneeded tests/procedures because they were struggling in the Bushonomics economy). The answer is so simple that it will make you feel foolish. Another term you agree upon when you joint the court-appointed list is that you agree to the caps the State of Ohio has put in place. For example, the maximum you can get for a misdemeanor is $500.00, felonies are more, and the caps for various other types of cases are set according to the amount of work involved. If you go over the cap, you're stuck with the cap amount. In the rare event that you go WAY over the cap on a case that drags out forever, there is a procedure in place to petition the Court for what's called "extraordinary fees." But that is very rare, and attorneys who request extraordinary fees only get them approved in a small number of cases.

And keeping oversight over the entire works is the State of Ohio, who will ask for an audit of your records if they notice anomalies (like a certain attorney who ALWAYS bills the maximum cap number, or who always seems to have a lot of out-of-court hours they can't account for, etc.) It's a good system. It works. And it's been working for as long as the Constitution has been in place (that would be 220 years now). And let me assure you that NONE of the horror stories you hear right-wingers screaming about single payer healthcare have happened with single-payer legal services for the indigent. NONE of them. In 220 years.

If you'd like more information, or you'd like to know about a certain, specific right-wing criticism of single payer, and how it fits into the framework of my experience as a court-appointed attorney, just ask and I'll try to elaborate. But getting back to the topic at hand, single payer can avoid ALL the problems you suggest simply by dictating the terms of pricing beforehand, and putting caps in place to control unscrupulous providers who are used to getting rich off of other people's misery, as opposed to simply making a living helping them.

[lildreamer316]

32. Great post! Thank you

for your work on behalf of the indigent, btw.

[Nederland]

33. Legal Services != Medical Services

The demand curves for these two are completely different. The proof is in the data. Here are a sampling of per capita cost increases from 2000 to 2005:

Canada: 33%
France: 37%
US: 40%
U.K.: 47%

If single payer controls costs so well, why have the per capita medical costs in single payer countries increased at rates similar to the US?

In contrast, from 1997 to 2001 per capita health care costs in Singapore fell by 13 percent. It is the only place on the planet that has ever seen falling health care costs. Coincidence?

[Fumesucker]

34. But my point is that dental insurance rarely covers even a fraction of the cost of major procedures.

Correlation does not imply causation.

If dental insurance were good and covered most or all the cost of major procedures I'd agree with you but that is not the case. I had a tooth extracted a couple of years ago and the insurance I had at the time only paid for roughly a third of the cost, it was almost two hundred dollars out of my own pocket.

So your cosmetic surgery example is not the only form of medical care in which people pay for procedures out of their own pocket, dentistry is that way also and yet most people have to pay a good portion of the cost of major procedures out of their own pockets.

How about your own dental insurance? Does it cover all or most of the cost of say, a root canal?

Edited to add a phrase..

[Nederland]

35. A few points

My own insurance is incredible, so I am not a good example. I rarely pay anything more than my $20 co-pay for anything. The reason is that the CEO of my company had a bad experience with insurance a long time ago and is committed to making sure his employees don't suffer the same problem. I am very lucky. I would also say that I am part of the problem. When you have a bunch of people like me running around, people that don't have to worry about costs, it drives up prices for everyone. I never ask about the price of anything, because it doesn't matter.

Along those line of thinking, did you know ahead of time what the root canal was going to cost? Would it have even been possible for you top find out? I ask because lack of transparency is another problem with both insurance systems and single payer systems. People like to say: "Wait a second, if I need a root canal or have a heart attack I'm not going to call around and find the best price." Obviously this is true. But imagine what would happen if you got that root canal and found out later that paid twice as much as what a friend of yours paid for the same procedure. Might that make you change dentists? If hospitals were forced to publish their prices, would you be surprised to find web sites springing up comparing costs and offering up advice on what kind of value different places offered? If people knew that certain places were a lot more expensive than others, AND they had to pay out of pocket, don't you think that would impact their decisions?

I'm not saying that the market is a cure for everything. Certainly the Singapore model that I favor is not a market based system. However, the laws of supply and demand are pretty easily applied in this case, and the laws of supply and demand say that if you create a system where the price of a service is irrelevant to the consumer, demand skyrockets and costs are hard to control. That is the real problem with the insurance model and the single payer model, and it is the reason that health care costs are exploding all over the world.

This about it. In every other industry technology has the effect of lowering costs, and technological items steadily decrease in cost. The price we pay for TVs, microwave ovens, PCs, and DVDs has steadily fallen over the years--and that occurred without any intervention in the market by government. Why? Why is it that the medical field seems to be immune to the cost benefits that technology usually brings? Why is it that the cost of medical procedures not covered by insurance or government has fallen dramatically? For example, the cost of LASIK is 80% lower today than it was when it was introduced. Why?

Answer these questions and you'll realize that as much as our system of delivering health care is fucked up, single payer systems are not much better.

[Selatius]

17. The French health care system is superior. It was ranked the best in the world, actually.

At least according to the World Health Organization's last rankings. Singapore came in at sixth. Why not aim for the best?

[Nederland]

19. One word: Cost

From 2000 to 2005 the per capita cost of the French system increased by 37%. That level of cost increase is unsustainable, just like the increases of health care costs in the US are unsustainable. In comparison, Singapore actually saw their costs drop.

[Selatius]

21. I don't think, given the political realities, that the Singapore option is even being considered.

The liberals have already invested all their time into a public option, a strong one if they get their way, and conservatives have offered nothing but resistance to any reform, any. Whatever the outcome of the fight, it likely will either be failure or a system with a public option. Whether that option is strong is yet to be seen.

[Nederland]

23. Unfortunately, I would agree (nt)

[BrklynLiberal]

3. To whom are you addressing this question? The OP or the Diary writer?

[Nederland]

5. The OP, assuming s/he agrees with the sentiment (nt)

[Missy Vixen]

6. Great question

Ask them what they'd do if they can't qualify for their state's plan, like Mr. Missy Vixen and me. The high-risk pool in Washington State is not an option, either. Our premium would be $1400 per month.

The "I don't care because I got mine" folks can't imagine how quickly the rug can be ripped out from under them re: reliable, affordable health insurance.

[truedelphi]

12. No, people who have it rather good just cannot imagine.

One of the things we are up agaisnt is that so many who lived through the Great Depression are dead and gone now.

But they understood that it could all be turned around. Hwever, people born after 1960, when the nation was getting used to most people ending up as middle incomed folks, with a hosue in the subrurbs, maybe another home in the nearby summer resort area, a car, health insurance a two week vactation, and constantly improving living conditions, just don't udnerstand that that is not a given.

They are still "waiting to see" if Obama's economic advisers are going to help us out. They are unaware that eleven trillion bucks and counting has gone out the window - and bernanke won't even say where it has gone.

MEMO - the money has been given oout - and it isn't going to the people, except tfor the people who are the upper one percent.

And I am pretty damn sure that some of the money given out to the Big Players has helped to pay for creating a disastrous, non-workable, give-away to industry that this current montage of "health reform" has become. There are no lobbyists standing in the unemployment lines.

[gratuitous]

9. Another question to stop him in his tracks

I suppose if you won the lottery, this would cease to be a concern. After all, a gazillionaire can buy any kind of insurance he or she wants. And why should that person, blessed as they are by the capitalist system, be required to subsidize insurance for someone not quite so fortunate, or who made the wrong choice in being poor?

Now, I'd like you to write down your estimate of your chances of hitting the lottery. Now, write down your chances of getting sick or injured over the rest of your life expectancy. Compare the two, and if you're honest, you'll see about 5 million to 1 balanced off against a sure thing, that is a 1 out of 1 chance. So what's the more reasonable investment: The lottery or health care funded by tax dollars?

[BlooInBloo]

16. I kan haz link plz?

[Quantess]

22. Great post. And yes, a link would be nice.

[BlooInBloo]

27. My request was merely rhetorical. But since the OP is apparently unwilling to not plagiarize...

Here's the link:

http://www.dailykos.com/story/2009/10/5/789912/-The-Question-that-Stopped-Him-in-His-Tracks

[Quantess]

30. Oh. Well thanks, anyway!

:D