You Do Not Have Health Insurance

Right now, it appears that the biggest barrier to health care reform is people who think that it will hurt them. According to a New York Times poll, “69 percent of respondents in the poll said they were concerned that the quality of their own care would decline if the government created a program that covers everyone.” Since most Americans currently have health insurance, they see reform as a poverty program – something that helps poor people and hurts them. If that’s what you think, then this post is for you.

You do not have health insurance. Let me repeat that. You do not have health insurance. (Unless you are over 65, in which case you do have health insurance. I’ll come back to that later.)

The point of insurance is to protect you against unlikely but damaging events. You are generally happy to pay premiums in all the years that nothing goes wrong (your house doesn’t burn down), because in exchange your insurer promises to be there in the one year that things do go wrong (your house burns down). That’s why, when shopping for insurance, you are supposed to look for a company that is financially sound – so they will be there when you need them.

If, like most people, your health coverage is through your employer or your spouse’s employer, that is not what you have. At some point in the future, you will get sick and need expensive health care. What are some of the things that could happen between now and then?

  • Your company could drop its health plan. According to the U.S. Census Bureau (see Table HIA-1), the percentage of the population covered by employer-based health insurance has fallen every year since 2000, from 64.2% to 59.3%.*
  • You could lose your job. I don’t think I need to tell anyone what the unemployment rate is these days.**
  • You could voluntarily leave your job, for example because you have to move to take care of an elderly relative.
  • You could get divorced from the spouse you depend on for health coverage.

For all of these reasons, you can’t count on your health insurer being there when you need it. That’s not insurance; that’s employer-subsidized health care for the duration of your employment.

Once you lose your employer-based coverage, for whatever reason, you’re in the individual market, where, you may be surprised to find, you have no right to affordable health insurance. An insurer can refuse to insure you or can charge you a premium you can’t afford because of your medical history. That’s the way a free market works: an insurer would be crazy to charge you less than the expected cost of your medical care (unless they can make it up on their healthy customers, which they can’t in the individual market).

In honor of the financial crisis, let’s also point out that all of these risks are correlated: being sick increases your chances of losing your job (and, probably, getting divorced); losing your job reduces your ability to afford health insurance, either through COBRA or in the individual market; if your employer drops its health plan, that’s either because health care is getting more expensive (meaning harder for you to afford individually) or the economy is in bad shape (making it harder for you to get a job that does offer health coverage).

In addition, there is the problem that even if you are nominally covered when you do get sick, your insurer could rescind your policy, or you may find out, as Karen Tumulty’s brother did, that your insurance doesn’t cover the treatment you need. But while important, this is a second-order problem. The first-order problem is that as long as your health insurance depends on your job, your health is only insured insofar as your job is insured – and your job isn’t insured.

The basic solution is very simple. In Paul Krugman’s words: “regulation of insurers, so that they can’t cherry-pick only the healthy, and subsidies, so that all Americans can afford insurance.” I know that there are lots of details that consume people who know health care better than I do, and I know those details are important. But as an individual who is worried about his or her own health insurance (and that is the point of this post), that’s what you want. You want to know that if you lose your job, you won’t be shut out because you’re too sick,*** and you won’t be shut out because you’re too poor.

But we won’t get there as long as people remain convinced that health care reform is for poor people. It’s for everyone – everyone, that is, who isn’t independently wealthy or over the age of 65. Because all of us could lose our jobs. (Have I repeated that point enough?)

Now, I admit that if you are over 65, health care reform is not for you, because you are in the one group in our society that enjoys true health insurance – insurance that you cannot lose, that is paid for by taxes, and that is effectively guaranteed by the government. So maybe there’s nothing in it for you, except perhaps an improvement to the prescription drug component of Medicare. But I cannot believe that, as the only people who have reliable health insurance, you would oppose health care reform that would provide reliable insurance for the rest of us.

* This doesn’t necessarily mean that all those people lost employer-based health coverage because their employers dropped their plans; some of it could be that the employee contributions were increased to the point where they couldn’t afford it anymore. 1.1 percentage points of the shift is due to people becoming eligible for Medicare or military health plans.

** If you lose your job, or you get divorced from a spouse through whom you get health coverage, you are eligible for continued coverage under COBRA. However: (a) this only necessarily applies if your employer has 20 or more employees; (b) you have to pay the full, unsubsidized cost of your health plan, which can be particularly difficult after losing your job; and (c) it only lasts for eighteen months.

*** I said earlier that insurers can’t charge premiums that are less than the expected cost of your care unless they can make it up on the healthy customers, and they can’t in the individual market. But if all insurers are prohibited from doing medical underwriting (pricing based on healthiness), then they will all have to overcharge the healthy customers, and the system could work. This is still a tricky issue – and single-payer (like Medicare) would be much simpler – but it can be made to work even in a competitive market.

Update: A couple of small things. and one big thing:

First, I called rescission a “second-order” problem, which was probably surprising, given that my post on it got over 100,000 page views (thanks to the Huffington Post). I meant “second-order” not to mean that it isn’t important, but that it is logically subsequent to the question of whether you have health insurance in the first place, and this post is about whether you can count on having health insurance in the first place.

Second, J.D. points out in the comments that there is a problem with COBRA I didn’t mention: If you relocate to an area where your employer doesn’t have a plan, then you can’t count on it at all.

Third, a few people said that it was the fault of the administration (or the Democrats generally) that health care reform is framed as a “poverty program.” There’s something to that point, but I don’t think it’s quite right (and I didn’t put it right in the first paragraph above). I think it is a poverty program – but the vast majority of us are, actually, poor. The combination of job loss and serious illness could wipe out almost anyone (under the age of 65 – actually, anyone over 65 as well, since Medicare doesn’t cover extended nursing home care), and we all suffer serious economic insecurity because of it. The political problem is that the median American doesn’t identify as poor (although he probably thinks he needs more money) and thinks that poverty programs are for “other people.” I think that middle-class and upper-class people should support poverty programs for other people, but that’s an unnecessary discussion. My point here is that the vast majority of us are poor, when it comes to health care, and therefore we should get behind reform out of self-interest.

By James Kwak

372 responses to “You Do Not Have Health Insurance

  1. Recision is a second-order problem? I guess that makes me a second-order citizen. The only “insurance” I can get in my state as a sole proprietor includes a provision that the insurance company can dump me with 30 days notice and no reason. No reason! So I am forced to self-insure as well. Most sole proprietors cannot afford to do so. I think this is a first-order problem.

  2. E. Barandiaran

    James,
    You have to be careful because your fishy claim about insurance (if you’re sick, you have no right to affordable health insurance; in other words, if you don’t have a house, you have no right to affordable fire insurance) may be reported to the White House. I’m sure you don’t want to go through what Peter S. had to go; see

  3. As far as I can tell, no proposal for Universal Health Care is on the table. A basic plan, covering doctor visits, off-patent medicine, and emergency care, and allowing for simpler medical bankruptcy would (i) provide care for those who need it (ii) be affordable, and (iii) leave a market for many other extended health insurance plans such as physical rehab and dental. This is the model that has worked in other countries. Is Congress proposing this? No. They are just cooking up yet another way to screw the productive elements of society.

  4. James,

    Well-articulated as always. The problem is that the Obama/Democrat plan (and their sales pitch) emphasizes coverage of the uninsured – this is a tougher sell than what I would call a more pure reform plan of solving the problems you point out and tackling the structural cost issues.

    What we have seen with health care is what we see often: Americans can be for something in the abstract (universal health care coverage), but very much against it in practice when it comes time to sacrifice. Obama and the Dems should have taken the pre-election polls that indicated majority support for universal health coverage with a grain of salt – this was their error and because of it we will, yet again, put off the day of reckoning for our pending demographic crisis.

  5. Just one small point about Cobra: it really does not cover you if you relocate, unless a plan is offered in your new area by the same insurer that your employer uses. If you move out of the area, and their insurer has no coverage in your new location, then you are back in the individual market, which, as described, is no market at all.

  6. James writes:

    Since most Americans currently have health insurance, they see reform as a poverty program – something that helps poor people and hurts them.

    Well, that’s because our brilliant Democratic party framed it that way.

    The so-called “public option” is means-tested and subsidized.

    means test + subsidy == welfare.

    In other words, the reason people think it’s a “poverty program” is that it is.

    Of course, it’s also a bailout for the insurance companies, since the mandate creates a guaranteed market for them by forcing people to buy their product, but for some reason, that aspect of the debate is only rarely covered.

  7. Oh, and the alternative?

    Medicare for All with a robust private option.

  8. If you elect COBRA and the plan is discontinued (say the company goes out of business) your COBRA option terminates.

  9. You make some good points, but in no way offer any support for your “solution” other than Paul Krugman’s endorsement.

    I can not see a viable long term solution that does not price insurance to create incentives for cost savings and healthy habits. Plenty has been said about the former, but the statistics show that a small part of the population accounts for a large part of current health care expenditures, and that many of these expenditures are related to behavioral issues such as over-eating. This blog has written about moral hazard quite a bit, but morale hazard is more pertinent to health insurance.

  10. When I lost my job due to chronic illness I lost my employer-provided insurance. When I needed it most. My husband (what a gem!) works a second job so I can have insurance. Eventually I will qualify for Medicare. But many, many people are not as lucky as I am.

  11. “You Do Not Have Health Insurance”

    I can not disagree with that. If memory serves me right, it is the government that (inadvertently?) designed our current system (wage controls during WWII and the HMO Act).

    But recognize that “Single-payer” health care, as provided in Europe and other places is not insurance either. When average Joe, who smokes and is over-weight, pays $X and Bill Gates pays 3,000 times $X that is not insurance. More like extortion.

  12. Michael Wasserman

    There is another potential benefit for those eligible for Medicare. Currently, the major threat to Medicare is its steadily increasing cost. If health care reform includes effective cost-control measures, then the long-term prospects for Medicare would be improved.

  13. Mr. Kwak, I think that Republican Senator Grassley has already solved this problem. If health care insurance is too expensive for you, or your coverage isn’t very good, that’s not very important. Republican Senator Chuck Grassley’s coverage is just fine now, and he doesn’t want to change it. When an Iowa voter asked why his health insurance wasn’t as good as Republican Senator Grassley’s health insurance, Grassley told him “YOU CAN, GO WORK FOR THE FEDERAL GOVERNMENT”. Listen and watch Grassley’s answer on the video link here.

  14. I’d sooner take my chances with my employer than have the government in charge of health care. But in the interests of transparency I should mention that I work for — the Department of Defense.

  15. Let’s see: if I lose my job, I don’t have health insurance. Right.

    But, rather more importantly, if I don’t find a new job, I will eventually have no MONEY.

    And if I have no income, I will eventually become homeless and destitute….and even worse, I won’t be able to buy my kid the GI-Joe Doll with the Kung-Fu Grip for Christmas. But the good news is since I’m destitute, I’ll qualify for Medicaid and I’ll have health insurance, again.

    Along with free health care, let’s have the Government give everyone a job, and a chicken in every pot. Not.

  16. some guy in a cube

    Moral Hazard? On what planet, exactly? Corporate America profits big time from over-eating. Here in America, fast food is a huge industry, and advertising to encourage it is another huge industry.

  17. Recent polls say that ~50% of people now oppose the Obama health care plan. The question is:

    Do they oppose it because it does too much? Because, in other words, they are against any national health care plan?

    Or do they oppose it because it has been watered down so much that it achieves no structural/cost improvements, and now simply extends health care to the uninsured at the current inflated cost structure (in an effort to appease insurance and medical billing companies)?

    More detailed polling data would be great.

  18. Just make the federal government employee plan available to any citizen of this country? Anyone that wants it, gets on it and pays the same premiums and has the same choices and anyone else that works for the Feds. I might not be a perfect solution, and it’s not the greatest plan in the world, but it’s a good start and it seems like it’s a lot easier to implement.

    Or another option: start with something that simply guarantees free health insurance for any citizen under 21. Ensuring that every child has proper health care can be vital to establishing them on a course for a lifetime of healthy living (which lowers future medical expenses). Plus, I can’t imagine many politicians would come out against that for fear of being labeled as someone who “hates children.” I can see the attack ads now: “Senator Joe doesn’t want your child to have guaranteed access to health care. Senator Joe hates kids.”

  19. I agree, Dave – federal plan as an option for everyone.

  20. some guy in a cube

    In reform “American-style”, everything will be done to protect the entrenched interests: corporations, doctors, pharma and the insurers.

    This big, steaming pile will get only bigger, until it inevitably implodes under the mass of its own unsustainability. (Think Mr. Creosote in “The Meaning of Life”).

    In the meantime, the yahoos are still off their leash:

    http://news.yahoo.com/s/ap/20090806/ap_on_re_us/us_health_care_overhaul_ark

  21. 1. Only a small amount the population gets sick any given year. One’s odds of getting seriously sick increase each year.

    2. Despite the the nose stuck in the air tone of some of the above comments (The “I am so much better than the fat working class/Black/Brown people because I make the right lifestyle choices!) I think most people who get sick are the result of random environmental or genetic bad luck. Jim Fixx, who created the running craze of the 1970s and early eighties died at 48 from a massive coronary while running. Mostly bad genes. My Uncle smoked filterless cigarettes, drank like a fish, and, to top it off had lungs scarred by mustard gas and legs full of German shrapnel and lived to be 83 (and of course had Government care, first from the VA and then both the VA and Medicare until he died). Meanwhile a non-smoking friend of mine from law school died of lung cancer at 33.

    3. My point is luck and yes, the wealthy, who receive the most benefits from society should pay the most. As far as productivity is concern, this character at CITIBANK whose trading is earning him a 100 million dollar annual salary and Goldman Sachs billions of bonuses from front-running seem more a kind of theft from the rest of us, a looting, and not productive.

    3. Finally, the massive choices that elites have made to establish a car oriented culture, limit walking, and more sedentary labor a work as well as massive promotions of foods that are designed (as good products to make money to shareholders) to be as irresistible as possible may have more to do with the American obesity epidemic then the weak will of the working classes.

  22. I have had the sorry task of managing lay-offs and terminations for companies, a task which requires advising people about COBRA. I long ago realized that most people actually have no idea how much their employer pays in health care premiums on their behalf. For many white collar firms, the employee share is typically 20-25% for an individual and 30-40% for a family. I’ve met many people who think their employee share is a lot higher than it actually is.

    I recall telling newly unemployed people with dependent families that their COBRA payment for a PPO would be $900 a month and their mouths would drop open. They would ask if they should investigate buying insurance directly and I told would tell them that an insurer would charge them maybe $2000 a month for the same coverage. If the company folded or wound down its health plan, they wouldn’t even have access to COBRA.

    With employer premiums rising by double digits every year while prices for everything else rise hardly at all, employers ultimately have to cut benefits and limit pay increases. If people understood that they have been giving up pay because of the health care system, they might be more supportive of reform.

  23. Some have proposed that every person receive Federal Employee Health Benefits (FEHB). Maybe I can give you some idea of the cost. As a federal employee for 22 years I have tried four different health plans and have settled on Altius (an HMO) with my premiums being $327.67 a month. The total cost of the plan is $1,091.55 a month. There are cheaper plans and more expensive ones. A single employee would pay less. Dependent children are not covered at age 22. This is a problem because I have two children over 21 in college. My wife picks up the slack by paying monthly premiums of $218.86 a month at her company for employee and child coverage. I need federal insurance for 5 years prior to retirement or else I cannot carry it into retirement, hence I choose to keep my insurance and not be insured through my wife.

    Our total cost: $546.53 a month.

    There are many others that are in the same position as I in Utah because at age 19 our sons go on missions and delay entering college for 2 years. Hence one year after their return they turn 22 and fall off the insurance.

  24. James K., your post makes the case perfectly for single payer. We want the maximum number of people in the pool of insured and we want the safety of the most trustworthy source of funds – there is nothing safer than the gov’t. People may laugh but Big Finance knows it’s true…after all who has been their last resort as Wall Street crumbled.

    Yet, we are going out of our way with the legislative proposals for national health insurance to make sure the private insurance companies are protected. Why should a national health plan protect insurance companies that offer nothing of value? What does their profit achieve? How is it “plowed back” in any way to benefit the insured? It is simply invested to make even more profit.

    No, to the contrary, instead of providing more and/or better insurance, private insurance companies try to slip out of their obligations, limit those who they will cover and cannot come close to the clout of the government in negotiating prices with providers. How does any American who does not work for an insurance company benefit from this? The only entrepreneurial skills involved are in finding ways to improve profits by either increasing premiums or reducing payouts. Far from rocket science, insurance is nothing more than “give me your money and let me hold it for you, along with that of others, in case you need it”

    The most important thing that will come out of all this legislative effort will be proof positive of the power of lobbying by Big Insurance, Big Medicine and Big Pharma. They all are using the money that we have paid them to lobby against the public interest, but unlike the latter two that we surely need, Big Insurance is superfluous and dispensable.

  25. It seems disingenuous to pretend that you lose your insurance for the sole reason that you don’t have a job. That’s not the case – you lose your insurance because you can’t pay for it anymore. It’s cheaper under your employer because they pay part of it, but surely it’s obvious that if they didn’t then your take-home pay would need to be commensurately higher. Basic econ, right?

    How is this any different that the home insurance you compared to? If you don’t pay the premiums, you don’t have insurance.

    So I would say you have health insurance to the same extent that you have home (or car) insurance. Are we next going to hear how none of us have home insurance because if we stop paying the premiums then we get dropped?

  26. Blaming obese people may be a talking point to deflect attention from: Big Pharma, Big Tobacco, fast food industry, industrial food production …

  27. That’s all fine and dandy but you still have somebody more interested in keeping the corporate jets fueled and flying than in the operation you may need. I imagine in a couple years it would be down to one company running our national health care. Might help but lets see you get monster premiums out of the healthy. We are back to single payer.

  28. But, Brian, I don’t think most of us really care about having insurance, per se. We care about having access to health care. If that is the mechanism by which people tend to get it, then I’d like to have it, too.

  29. I’m all for health care reform, but I admit to having doubts about the Obama plan. First of all, I’m not really sure which plan we’re talking about.

    But when I hear people talking about it – it does not seem to address costs in any significant way, which is truly one of the most important elements that needs reforming. I guess we’re still going to have docs checking off as many billing boxes as they can in order to get paid, which means a heavy reliance on testing instead of health care.

    The exchange component – how does this work? What is the budget for this? How is it staffed? Is this just more administrative layers being added to a system choking on all the administrators within it? Sounds very similar to what I can find out on e-insurance, but the policies I find on an e-insurance website are not affordable, once I start filling out the forms.

    I think one issue we all face is that most people with their employer supplied health insurance have no idea what the policy costs them – and they’re protected from knowing how much their health care costs over all – they think the co-pay is the cost – which can’t be further from the truth.

    For-profit insurance companies need to bid farewell to health insurance. Their goals compete with the goals of health care. To make a profit, they must shed sick consumers. Simple business model, but not what you need when you’re sick.

    It seems if we’re going to mandate that there are “no pre-existing conditions,” we need to mandate that everyone carries insurance – pairing a desired goal with highly unpopular condition for success, which most likely will ensure legislative failure.

    We will fail if we muddle through this – we need to dramatically redesign how we care for health – but people don’t seem to have the stomach for that.

    Sorry so long. As one who is self-insured, health insurance is an expensive issue very close to my heart – and body – and well-being.

  30. I WOULD LOVE TO BUY INTO THE FEDERAL GROUP PLAN! IT WOULD GIVE ME THE BUYING POWER OF A GROUP AND (HOPEFULLY) AFFORDABLE OPTIONS.

  31. James’ argument is a narrative sleight of hand, so representative of the “single payer”/ ‘public option’ commentary.

    The facts:

    • Basic health care needs of the poor and not so poor uninsured are care for in this country, despite the lack of insurance. No one is turned away . I know of fairly well off people who care no insurance for that reason. Elective surgeries are often not covered however.

    • The public option plan, on the other hand, will absolutely deny coverage to those deemed by our government to be less than worthy from a cost benefit point of view. Typically, those will be the elderly and those will chronic incurable conditions. Untold millions will die prematurely by a bureaucrats’ hand. Further millions will die due to the shoddy treatment government facilities typically produce. The life expectancy of those of those with cancer in those countries with Universal care is typically between 30% to 50% shorter than the US. And the cost, even without caring for the illegals will be at least 30% more. That was the case in Massachusetts and Hawaii. Financial disasters both. The “public option” is absolutely criminal in it’s denial of patient’s constitutional rights.

    • As Linda above points out, most people as employees do not pay for the full cost of their insurance and medical costs. That is why by some polls up to 85% of those covered are happy with their insurance. Employers typically pick up the rest. The “public option” is designed to destroy that private health insurance and public choice relationship and replace it with something that all polls show the public does not want. It is not about a poor sales job; the public is just now learning how ghoulish and fascist the “public option” really is. The more they learn the more they hate it.

    • Yes, if an employee who is insured by their employee is let go, they will need in best of worlds to get insurance. Some will not; that does not mean they will be not be cared for by the medical industry.
    In my state of California, I know of illegals who have better medical treatment for free than I can get as a self employed person who pays for high deductible health insurance.

    • Approximately 25% of medical cost go to legal liability measures. The US, for example, has twice the number of nurses per patient as other less litigious countries just to defensively document patient’s conditions. If you want to make the health care system more affordable, a good place to start is the our tort system.

    • Another cost problem area is that the government substantially underpays for medicare and other government assisted treatment. The cost have to be borne by the insured under the present system. Perhaps a closer look at how the Medicare system, which is by some estimates over 50 trillion dollars underwater from an actuarial point of view, might be in order.

    The government currently by some measure pays for over 50% of all health care dollars, and people still call it a free market system . It is not. The government has grossly distorted health market forces. The cost of medical care began to rise significantly faster than inflation at precisely the passage of Medicare, a huge government intervention into the healthcare marketplace. A rush to total government takeover of the healthcare industry is not the answer. A wiser and more thoughtful approach to government healthcare intervention is.

    Go ahead and snitch on me to our Fascist President.

  32. Rick, the Department of Defense is part of the Government! What on earth do you mean here?

  33. Oh Brian. You’ve never shopped for health insurance, have you? The health insurance market is very different than home and auto:

    -The likelihood of you making a significant claim on your house (unless you live in Hurricane Alley or some region like that) is not that high, which means insurance companies really can bet you’ll never need a payout.

    -Health insurance – completely different scenario. Just to get my twins enrolled in kindergarten this year, they need to see the ped, an eye doctor and a dentist. And since I have twins (and a $4K deductible), their entry into public school is VERY EXPENSIVE. If I had an employer plan – just as expensive, but I wouldn’t be paying nearly as much for it – my plan would cover more, as would my employer.

    - Many people pay the premiums and get dropped by the insurance company for no reason but that they actually need the health insurance because they’re sick.

    - As I know all too well, if you do not work for a large company, insurance is a dicey proposition – you may or may not be able to get some – and if you do qualify for a single family policy – you’ll be lucky if you’re not rated into an extremely pricey category. God forbid you have asthma or serious allergies or worse, cancer. Because if you have to become self-employed and you have had any of those conditions, you will never get insurance as long as you live and are self-employed (or you can get it, if you are very wealthy.)

    Employment does make a huge difference in accessibility to health insurance (not just the salary needed to pay premiums) – and working for a large company gets you access to group plans that are significantly cheaper and cover more with less of a deductible.

    What do you pay each year for your health insurance? And compare that to the actual cost of your health insurance – do you know what the actual cost of your policy is?

  34. It was meant as a joke. That’s why I said, “…in the interests of transparency…”

    I am implying that many people absolutely do not want the government involved but don’t realize how much they are already involved in our lives.

    I will henceforth strive for greater clarity in my comments.

  35. If all you want is health care, then you don’t need insurance. Everyone takes cash, even doctors. You only need insurance if you want someone else to pay for it.

    It costs a lot to get someone to do that, go figure. But if you’re willing to pay for all the cheap stuff yourself (ie, get high-deductible insurance) it actually gets pretty affordable. Which, again, is like every other kind of insurance in your life. The health insurance most people have covers everything (at least part of everything) – the equivalent home insurance would cover 60% of the cost of changing your furnace filter. Try to price that, if anyone even sells it.

  36. Mr. Kwak has in an indirect way explained why there will be no political solution to this issue at this time. Peel off the medicare beneficiaries, federal retirees, military retirees, state and local government retirees. people who are employed and provided some benefit from their employer, people with enough income to purchase good benefits in the free market. What do you have left? The donut hole, not enough people with enough political impact to matter. The medical industry sees this clearly. Things are not bad enough for enough people. Social Security passed because 20 % of the population could not buy bread. The other 80% thought they would be next. Everyone was afraid except the wealthy who were only afraid of taxes and government interference in the fantastic labor market they had access to.

    People that have jobs and insurance now will not support any change required to benefit someone else. Their risk analysis of losing their coverage does not hit the proper threshhold.

  37. Anne, check out this link. Dr Maria Angell teaches at Harvard and is a former editor of the New England Journal of Medicine.

    She says the Democratic plan is flawed because it is trying to fix the problem by pouring more money into the current system; with 16% of GDP currently spent on health care this should be enough money to reform the current system, make it better, without additional money.

    She is for single payer health care.

  38. Brian, that might be possible for some people who either have means or are very healthy. Unfortunately, I am neither. But I don’t think that makes me unworthy of having my health issues addressed.

  39. “The public option plan, on the other hand, will absolutely deny coverage to those deemed by our government to be less than worthy from a cost benefit point of view. Typically, those will be the elderly and those will chronic incurable conditions. Untold millions will die prematurely by a bureaucrats’ hand. Further millions will die due to the shoddy treatment government facilities typically produce. The life expectancy of those of those with cancer in those countries with Universal care is typically between 30% to 50% shorter than the US. And the cost, even without caring for the illegals will be at least 30% more. That was the case in Massachusetts and Hawaii. Financial disasters both. The “public option” is absolutely criminal in it’s denial of patient’s constitutional rights.”

    I don’t understand this. The poor, elderly, and disabled are usually either covered by Medicaid or Medicare. Also, what reason is there of making this about illegal immigrants? Finally, none of us will be seen in government facilities. What is up with the doomsday scenarios? I just don’t follow.

  40. Actually, I have shopped for insurance. I was self employed for several years.

    As I mentioned to Diane, I quickly discovered that high-deductible insurance is relatively cheap – the same way all the other insurance in your life is. Car insurance gets expensive as your deductible drops. Zero-deductible is quite pricey. If your car has trouble then getting it on the road can cost a lot. Maybe not as much as getting twins into school, but then doctors go to school for much longer than mechanics. So, I did the same thing I did for everything else – got high deductible insurance and kept a nice cash cushion to handle the expenses I knew were coming.

    Although pricing for pre-existing conditions sucks for the people involved, it makes perfect sense. It’s like trying to insure a house that’s already on fire – of course it costs a lot. I actually think that should be taken care of, and the industry has already said they would accept that as long as everyone is required to have insurance. I think that makes a lot more sense than a government takeover.

    Despite all the rhetoric to the contrary, if the government starts up a general-access health care program it’ll be the death knell of the private system. The idea that the government can simultaneously participate in the system, regulate it, and tax their competitors is laughable.

    I know pretty well what my employer pays – they tell me every year during “open” enrollment. I pay about 30% of the cost, though oddly if I decline coverage my pay goes up by 1%. Go figure.

  41. Diana, it certainly does not make you unworthy. I hope I didn’t imply that. But it’s not a question of worth.

    Health care consumes resources (energy, buildings, time from highly trained staff). That has to be paid for, if not by you then by someone else. Are those others not worthy to keep their own earnings?

    I believe society should provide some degree of care to all. A civilized society does not leave people bleeding in the streets. On the other hand, a civilized society also does not “take from the mouth of labor the bread it as earned.” Striking that balance is difficult. I’m disappointed that the the only recent attempt I’ve seen has been to declare that it’s just fine to steal from “the wealthy.”

  42. Brian R,

    I was born and raised in Canada and in all my life I have — never heard — a Canadian begrudge a poor person receiving medical care paid for by our taxation. If never crosses our minds.

  43. James, you have explained only part of what needs to be said, and done so elequently. You now need to make the real economic argument, which you haven’t, and to further help people understand that there has been no movement in any of the reform programs toward “socialized medicine,” which single payer, medicare or a public option is NOT. But, there is a truly brilliant argument to be made for (a) elimination of health insurers as market participants, and (b) why real health reform will nearly cure our economy overnight, but only if it is done correctly.

    Good word so far, please keep at it.

  44. Maybe you would care to explain why the largest single reason for personal bankruptcy is health issues, even for those with coverage. Feel free, because you can’t. But maybe your argument will be that those poor schmucks haven’t figured out how to properly scam the system.

  45. For those who did not see Bill Moyers interview former CIGNA executive Wendell Potter and want an insider’s perspective on how Insurance Companies enhance their profits by denying care/rescinding insurance/ denying claims, etc… Here is the link:

    http://www.pbs.org/moyers/journal/07312009/watch.html

    It is a must see and supports many of James’ assertions above.

    I am a physician who opposed reform in 1993. As the avarice of insurance companies has grown to sickening heights I now realize that democratic socialism, just as it is employed in law enforcement, fire protection, infrastructure and in certain health care endeavours (Medicare, VA, Congressional health care) is actually preferable to Capitalism (I prefer Capitalism for most everything else).

  46. This is actually the beginning of a very good argument against any sort of truly long-term employer-based benefit plan.

    At the time many non-cash benefits were instituted – post-WWII America – there was a broader conception that large corporations were essentially immortal; indeed, that they basically grew without bound. So having a claim on General Motors or Penn Central Railroad or Bethlehem Steel or United Airlines was tantamount to a government bond, minus the hassle of getting something through Congress.

    As many employees have learned the hard way but few seem to believe until it happens to them, big companies fail too. No company should be in the position of issuing long-dated paper to unaccredited investors.

    Unfortunately, so many stakeholders have grown up around the current system that we find it impossible to imagine a world arranged differently. Medicare for All wouldn’t require imposing a new bureaucracy, and it’s certainly not the fascism that scares Paul. It replaces the insurance pool of a private company with the national population and replaces private claims adjustor and provider negotiations with CMS. For better or worse, nothing about the doctor or patient experience is changed.

    The public option provides a safety net that is missing in the current system, and that is an improvement. But single payer would be a dramatic improvement beyond this, not out of some defiance of market forces but quite simply because the market we have currently established is completely incompatible with our values.

  47. Paul,

    re: “No one is turned away . I know of fairly well off people who care no insurance for that reason.”

    If it is so simple, then why would anyone need insurance? What is all the fuss about?

    If you can so casually dismiss the single biggest concern that everyone has – about access to reasonable care – then not sure about the rest of your post.

    BTW- I don’t subscribe to the “go to the emergency” argument – what happens if one sees a lump on the shoulder or has diabetes or hypertension – emergency is not going to get into diagnostics procedures or treat the problem until it does turn into terminal pneumonia or the like…

    re: ““The public option plan, on the other hand, will absolutely deny coverage to those deemed by….”

    Diana Lee raises good questions about this assertion of yours.

    I await clarifications

  48. Attractive, healthy, intelligent, kind-hearted, self-employed, American woman looking for a nice European gentleman to make happy. Photos provided upon request. Speaks some French.

  49. thank you for explaining it so that from now on I will be better able to understand a lot of the arguments

    from a German point of view
    has anybody yet figured out what a nice stranglehold that means for employers on their employees’ mobility – if I were an employer providing health insurance I would sure “work on” my employees to be against reform bombarding them with all kinds of scary scenarios.

    but here is just one that immediately springs to a German mind
    if you work at a presumably big outfit that provides you with health insurance and somebody gets a very very interesting small business in your field of expertise started would health insurance provision not be the one consideration to keep you away from it?

    and that in America the country of which we are constantly told that they have totally unfettered ability to move (actually when I worked for an American company job hopping was no impediment to getting hired, while German companies in similar fields would frown on it)

    and not to be onesided
    - as much as I learn reading this blog how much fantasy about America I get fed by German newspapers (the London Times can’t do it, they are not “blessed” with a language barrier)
    - I guess your media do the same – I do not know the French health system (when I worked in Paris in 1962 it didn’t cost anything to see a doctor) but I presume the sudden and uncritical enthusiasm for it that I read a couple of days ago is as ill-researched and as ungrounded as the constant refrain of German chattering classes “but in America they do “it” so much better”.

    (just to be clear that I do not want to denigrate America – I am fully aware that it is richer, younger (therefore less entangled) and much much bigger and in general a uncomparable country)

  50. I know some French people who live in New York and they do miss their health system.

  51. Jackybird
    so I would undoubtedly miss the German system which, when I speak to a German, nevertheless tend to blame for all kinds of shortcomings and which only becomes uncritically dear to me when I read you people about the alternatives

    but it is one of the cruxes inbuilt into SYSTEMS that you cannot transfer them as a whole because they are interconnected with the whole of society’s other mores, ideas, habits, rules and laws.And if you cannot go for cherrypicking either.
    If you are in for doing a real decent job you have to develop an outline of what you want in general and then go very carefully about writing the reulations for it and during THAT process is the time to look at others, evaluate their experiences, draw your conclusions and so on.

    I learned this inevtiable truth when I worked at an American company in Germany which introduced one on one a perk from ithe Dutch legal health system dear to its Dutch branch. We then had shortage of labour so employers were really generous but even though the everyday results were desastrous for employers and a real instrument of blackmail for employees about to be laid off – and now take into consideration how close the German and the Dutch societies are …

  52. Captain Teeb

    Hi Silke and everyone else,

    I’m delighted to see even a mention of a non-English-speaking country’s medical system in talking about the problems in the U.S. I’m an American living in Belgium, and Silke is correct that a country’s system cannot be seen in isolation. It is also true that many slackers game the system (particularly for disability, though that is true in the U.S. as well).

    That said, I think that the U.S. should try to learn from those countries (Japan, continental Europe) which manage to produce better overall outcomes with fewer resources. But oddly, the debate proceeds as if the only other country in the world is Britain, as it provides a convenient whipping-boy and scare tactic.

    But I am pessimistic. Our political system seems to be for sale, our voters largely ignorant of everything outside of their personal experience and media diets.

  53. I think national healthcare is a really bad idea, but if it’s going to happen, at least restrict it to critical conditions. What we don’t want is an open-ended system where you can go see the doctor for free whenever you feel like it.

    And we should keep it at the state level rather than the federal. Allow some competition between programs so if one gets it wrong, another can get it right. We are too fallible to try and “fix” the system for everyone. It will be a debacle. Health care is too important to risk with such experimentation.

    The point about health care being tied to companies is true… but that was due to government involvement in WWII. We should get rid of those tax breaks and promote a real free market.

  54. For a blog that focus’ on our financially precarious status and future risks, I find it interesting that the focus hasn’t been on the real problem in healthcare…. Medicare & Medicaid. Medicare (35% of healthcare spend and Medicaid (15%) are the 800 lb gorillas in the room, and their future unfunded liability is the ticking timebomb that America continues to avoid dealing with in a meaningful way. Our current Trillion $ deficit is a drop in the bucket compared with the future costs of the current programs as they prepare for the demographic timebomb of the aging baby boomers. So, Obamacare is windowdressing and will get us towards a socialized, single-payer model of healthcare, in an era where China and others of our creditors may run out of patience and risk tolerance to fund our debt-crack habit.

    Real reform has to start with modernizing medicare and medicaid( the programs are remarkedly unchanged since the 50′s), and with the government stimulating the market by requiring some basic coverage via an individual mandate (preventitive care, catstrophic hospital care), then leveling the playing field (no-pre-ex) and let the private market compete for supplemental plans.

    But, like our deer-in-the-headlights approach to the banking/financial quagmire, we are politically and culturally unable to see the headlight of the oncoming Medicare/medicaid trains hurtling at us …

  55. Gimme a Break

    More proof that conservatives aren’t really very funny at all (Jon Stewart’s Daily Show should come with a disclaimer: Dittoheads, don’t try this at home) … maybe when the smug little narrator of this piece loses his job and finds himself with colon cancer and he can’t get insurance he can pull out his studio mike and, between retching into a bucket, he can darkly warn about the “government takeover of health care” that’s lurking on the horizon if we’re all not careful.

  56. James, your article while receiving a lot of compliments is loaded with left leaning analysis.

    Tell me what’s wrong with this analysis, because it seems my family does have insurance and that should you choose you can get insurance. My daughter moved to San Francisco about 20 years ago when she was 30 and on getting there joined the Kaiser network. At that time for the sum of $100 a month she got medical coverage and continues to this day to be a member of the Kaiser Permanante. She’s recently completed treatment for breast cancer and is doing well. Didn’t cost her a penny for some of the best care including surgery, advanced radiation treatments(IMRT) and an expensive genotyping test(OncoTypeDX).

    She recalled this weekend that during those early years while starting a small successful restaurant (“Just for You” in SF’s Dog Patch area) she had to choose between cycling or sailing or wind surfing gear and insurance premiums but understood the importance of having insurance.

    So if everyone follows your logic and concludes we “don’t” have insurance then surely they’ll look to current administration to help.

    My point – Individuals can(and should) be responsible and can make tough choices that will moderate financial impact of serious illness.

    Just the facts,
    Joe

  57. sixteen tons

    Employer health care functions like scrip did in the great depression. It’s compensation that ties you to the employer because it’s of no value if you leave the job. Promotes social stability because workers are afraid to quit, or risk collective action or insubordination. Maybe they should put a rider in the health care bill that subsidizes the company store so labor can remain oppressed.

  58. I agree with the statement, “you don’t have health insurance.” In point of fact, none of us do. We’re at the mercy of the insurers. My company’s health insurance employee copay is so high and the coverage so crappy, I opted out. I tried to self insure but that was worse. The ins. company argued about every claim, even office visits.

    So now I have no insurance. I pay as I go and try to stay healthy by eating right, diet and exercise. I’m a 56-year old professional woman.

    I don’t think there IS a solution other than pay-as-you-go and having a health savings account. The federal government can’t afford to foot the bill for 300-million Americans and neither can the tax payer through higher taxes.

    We’re all screwed. Period.

  59. James,

    Thanks for an intelligent essay. But is anybody actually listening to you? The audience for this blog is self-selected, is not it?

    To add to your punchline “you do not have health insurance” -

    Say, one is over 65, or is employed by the feds, or is a veteran, or self-insured, and does not need a plan. But what about his parents, children, siblings, lovers, and neighbors? If you are over 65, and your son has a cancer and no insurance, how good is your Medicare for him? How likely are you to use your retirement assets to treat your son?

    If you are a parent with access to VA hospitals and your daughter is over 22 with diabetes and no job. Who is going to pay for her care?

    If your neighbors default on their houses to pay their medical bills, “here goes the neighborhood”…

  60. If you waited until you have a serious health problem then the costs could very well drive you to bankruptcy. But on the other hand if had chosen to put some of your income on health insurance (see my note below about my daughter’s example) then you could avoid financial ruin.

    It’s the lesson in Aesop’s fable about hard work and preparation. Remember the grasshopper and the ant?

    JOE

  61. I’m sorry but I find that you can self insure. See my note above.

  62. Brian, if you do not have health insurance, you will be charged significantly higher fees for every single medical procedure you have.

    When my husband broke his ankle – a not-so-out-of the ordinary medical issue – the day he broke his ankle, there were 8 other patients treated for the same thing) – the hospital billed the insurance company more than $20,000 just to set the bone.

    If you’re up for those kinds of expenses – have at it! Only the exceptionally wealthy could afford such health care.

    I have a high deductible insurance – and I pay dearly for the privilege of it.

    Again, what is the cost for your health insurance? Do you even know?

  63. Clif makes a great point that I’ve been thing about lately. Why should American’s have any interest in health insurance companies that make a profit? I mean, having a healthy population is vitally important to our national competitiveness. 85% (or so) of our GDP is non-healthcare related, but is 100% responsible for paying for that 15% (or so) in health care. Healthcare is nothing more than a tax on the rest of the country. A necessary tax, but nothing anyone would pay for if they didn’t have too (no sane person would choice to get cancer or get sick for that matter).

    So why should we be interested in allowing any insurance business to earn a profit, which means money is being diverted from paying for something we need (healthcare), but would really prefer not to pay for?

    Now granted profits are a necessary incentive to drive private institutions to reduce costs and improve productivity, but the health care market is not very efficient and allows all sorts of private institutions to accrue huge profits – beyond what would be needed to remain viable. Of all the parties in healthcare, insurance companies are the least needed. All they do is move money around to pay for healthcare. I personally like the private – public competition model being developed. It does keep the insurance industry honest. If they can’t be as efficient as the government then they don’t deserve to be in business. And the public plan always gives people the competitive option to choose. At the same time this model should drive the public option to be as efficient as possible too.

  64. Brian you seem to be a little ill informed. If you have an employer who offers insurance the insurance company HAS to cover you – it the law. If you loose your job and need to find private insurance no insurance company HAS to offer you coverage. And if they do, there is nothing preventing that premium from being more money they you make, which leaves you the option of no insurance or quiting your job and going on medicaid (which does happen).

  65. Yes, the cost of health care is out of whack. Clearly it does not cost 20,000 in time and materials to set a bone. A lot of that has to do with the insurance companies, and even more has to do with Medicare.

    I’m not claiming that the current system is flawless – far from it. But that does not mean the best solution is to tear it down and thus trade those known flaws for a new set of yet-undiscovered flaws in a new system.

    As I’ve said before, yes, I know precisely what my insurance costs. It’s on every paycheck I get – and yes, that includes the part my employer pays. I wish people would quit asking.

  66. Yeah, Canadians are nice people. :)

    I don’t think anyone in the US would object to basic health care for everyone. Fixing broken bones, antibiotics, basic checkups, etc. In point of fact a lot of people do get this for free, unfortunately via the inefficient mechanism of the emergency room.

    Where I get off the bus is paying for coronary bypasses, long-term life support, and anti-retrovirals that cost tens of thousands per year. Basically all the expensive stuff, especially the largely avoidable expensive stuff. I may be wrong here, but I don’t think those things are very available under Canadian health care either.

    If they want to put forth a plan to cover *basic* health care for everyone, then sign me up. That’s not what I’ve seen so far.

  67. And since the bulge in healthcare expenditures occurs in the last 30-90 days of life, we can fix the moral hazard problem by significantly raising premiums on the dying. That will show them.

  68. A pity your comment about insurance protecting you from bankruptcy doesn’t accord with the data. More than three-quarters of people driven to bankruptcy by healthcare costs had insurance at the time they became ill.

    But don’t let that stop you.

  69. Battaile Fauber

    Well said. I think a lot of Americans don’t realize what the individual health care market is like. (Incidentally, the small group market has a virtually identical set of problems to the individual market, if one person on a five man plan gets a high cost ailment, you can count on that plan being re-rated to something unaffordable at their annual renewal.)

    I’ve always felt this coupling of healthcare with employment by a large (20+ employee) firm was at odds with our supposed entrepreneurial spirit.

    On the other hand, just saying insurers shouldn’t be allowed to “cherry pick” does not make sense in a corporate setting. If you have a for-profit insurance company, asking them to ignore medical history is asking them to open themselves up to adverse selection.

    To me the answer is that things which directly impact our well-being like national security and health should be government provided, not private industries. Of course, then I’d be called a socialist with great vehemence (by a group of people who will in all liklihood ride out their golden years on medicare, which is kind of ironic)

  70. “That’s the way a free market works: an insurer would be crazy to charge you less than the expected cost of your medical care (unless they can make it up on their healthy customers, which they can’t in the individual market).”

    Not true. Over time insurers tend to break even or lose money on underwriting and make a profit on the float.

  71. I am not for it at all. I am in a government provided program currently – Tricare. It will be rolled with Medicare into the new program. Tricare is probably the worst run medical program you could be in. I hate it and will avoid visits to the doctor and my over 50 checkups because I don’t want to catch something from all the sick people sitting in the waiting room. The place is disgusting and I would not wish it on my worst enemy. I worked for the government for over 30 years and have found everything the national government does is blighted. No government run anything for me…. I’m stuck with what I have but I hope for better for my grown children and their families and socialism is not it.

  72. And this outfit call itself “reason.tv”?

    Give me a friggin’ break!

  73. Eye Eye, Captain Teeb (that’s what I was taught bei American Movies)

    as to gaming the system for disability: it is not only the slackers who do the gaming

    at least in Germany’s big corporations in the 90s, when McKinsey-ism got hold with its schemes of 10 % of every department have to go, Department heads or personnel would instruct employees in a very tongue in cheek way how to do the gaming, sometimes even recommending friendly doctors, which made the 50+ ones due to be laid off a lot more complying

    - more money for old age is just helpful (and do not think they selected the 50+ones due to merit, it was strictly by birth date and whole departments fell into chaos because understandably a lot of those old long termers were after that treatment too furious to be interested in exerting themselves in passing on the tricks of their trade

    One week you had been told in public that you shouldn’t dare to have a look at any of the premature retirement plans because you were invaluable, the next week you were told you seemed to have a mental problem.

    The mental problem “escape route” became popular after the backache road had been blocked by regulation and now the statistics tell us that mental problems in society are one the rise….

    It is really so sad one only wants to laugh or the other way around all that waste that could have been put to good use if only one had treated people with a little more respect.

  74. “but very much against it in practice when it comes time to sacrifice.”

    Sacrifice what exactly? The notion that “they” deserve health care, but others don’t?

    I’m not criticizing Ben here. Just the notion that there ought to be “sacrifice” just because others who were not covered would be under this plan.

    Tough to repair half a century of indoctrination.

  75. Once you lose your employer-based coverage, for whatever reason, you’re in the individual market, where, you may be surprised to find, you have no right to affordable health insurance. An insurer can refuse to insure you or can charge you a premium you can’t afford because of your medical history. That’s the way a free market works: an insurer would be crazy to charge you less than the expected cost of your medical care (unless they can make it up on their healthy customers, which they can’t in the individual market).

    There are a couple of flaws in your argument.

    First of all you forgot the flip side. True if you have a problem medical history your insurance premiums will be more, but; if you’re healthy your insurance premiums will be less. Why should I have to subsidize someone else either though the government, or; though risk sharing plans, why is less healthy then me? If you choose to smoke, put on excessive body fat because of food choices and lack of exercise, do drugs, or generally engage in risky decisions why should I have to subidize your behavior?

    If people have a financial incentive to stay healthy, then they’re more likely to engage in healthy behavior which keeps costs down. I have to buy insurance in the personal market, but i’m smart about it. I have catastrophic coverage incase anything big happens, pay out of pocket for the small costs, and invest in a tax sheltered health savings account so that I can subidize my higher healthcare costs when I’m older with the lower healthcare costs of my youth. Of course more irresponsible individuals may choose not to save money and instead spend it on beer and strippers. That’s their choice, and part of the cost of living in a free society. With freedom comes responsibility for your actions.

    Second of all there is no such thing as “free” healthcare. If you want to make the argument that everyone should have access to healthcare regardless of personal decisions, or their ability to pay for care then that is a moral argument not a practical one. If we subidize unhealthy individuals who can’t afford their coverage though the government then we’ll all pay for it later with higher taxes and lower economic growth due to the dead-weight losses on the economy.

  76. Hi Sarath,
    if I cannot see a doctor when I feel like it, how am I going to find out, if I am in a critical condition or just hypochondriaking myself or feeling lonely for a long look at that beautiful young man with the stethoscope?

  77. Sounds very rational.

  78. So, we must conclude that Medicare is a welfare program.

    Gee! How could true patriots could let this monstrosity com to pass is beyond me.

    It will be a bailout to the insurance companies? Pray explain then why said insurance companies are so opposed to receive a 47 million strong new captive costumers? To the point of organizing all this political astroturfing seen in the townhall meetings across the country.

    I wish the banks had been that active in refusing their bailout!

  79. Is there any evidence that entrepreneurship might be increased if workers didn’t have to stay with an employer for health benefits?

  80. Yea because we all know that these companies force people to smoke and eat big macs at gunpoint. Get real and pick up an economics textbook. Society dictates what they want produced by voting with their wallets, and then companies compete to produce and sell the best product in order to make a profit. Not the other way around.

  81. Already “dead-weight” from the overwhelming inflation of healthcare costs. No one is arguing for “free” healthcare.

    Also, you seem not to understand the concept of insurance: you spread risk across many people. That’s why one would subsidize healthcare through insurance. That’s not to say that healthy and wellness shouldn’t be encouraged. But maybe we should have a tax on junk food?

  82. Or we can just ration healthcare by choosing not to provide medical services during the last 3 months of life. Oh wait that happens in public plans anyway.

  83. Hi Joe
    I am still trying to learn therefore:

    let’s say I started my working life at a company that gave great health insurance to its employees would I have been better off opting out of it and replace it with private insurance to keep my mobility? and would I have been allowed to or would participating in their contract have been part of my employment contract

    and if that company would lay me of around my mid-thirties or so due to nothing I could have conceivably influenced would I have been able to get reliable health insurance after, as you seem to be all fixated on colon cancer, having seen a doctor repeatedly for obstipation?

  84. OMG!
    Single-payer is financed by taxes. Progressive taxation hold as self-evident that the one who earns 10 millions a year can pay more without hardship than the other who earns 10,000.

    If one consult the dictionary entry “Extortion” there is no mention of progressive taxation there.

  85. LOL!!
    Good one Rick.
    We all can use a bit of humor in this incredibly rancorous debate.

  86. Hi, Joe
    grasshopper and ant – really!!!

    which one of the age-old tales by which the mighty/aristocrats discipline the powerless will you come up with next
    - I imagine those tales were told to starving peasants to make them feel guilty that they had had their summer festival when they could have put in instead another day’s work

  87. “Plus, I can’t imagine many politicians would come out against that for fear of being labeled as someone who “hates children.”

    If I recall correctly (and I have the sources in front of me) Bush vetoed S-CHIPS not once, but twice.

    Never heard the press accusing him of hating children, didn’t you?

    Of course, I’m talking about the American press here; the same one that Colbert called “stenographers”.

  88. Good for you. Probably beause everyone takes for granted that it’s the norm. The average Canadian thinks: of course rich people pay for poor peoples health insurance that’s just the way it is.

    I was born and raised in America for my whole life and I have – nerver heard – an American bregrudge a poor person; or even an illegal foreigner, recieving legal counsel paid for by our taxation. It never crosses our minds. Because in America everyone is entitled to legal counsel for criminal cases. That’s just the way it is.

  89. The Chinese have solved this problem in the most market-efficient way: if you don’t have money, you don’t get health care. Simple as that.

    But the Chinese also have a wonderful system of “reeducation through labor”, where a person can be sent to do years of hard labor on the whim of a government official. The U.S. should give hospitals and insurance companies the ability to “reeducate” people through labor if they can’t pay their bill, or they are fat, or they don’t exercise enough, or they smoke or drink alcohol. Minimum of 10 years of hard back-breaking labor for any of these offences. And, if we really want to make this work, let’s impose hard labor on the families and even extended families of these individuals!

  90. I don’t believe you. I broke my foot, and I had only catastrophic medical coverage. I payed out for pocket for everything and it only cost me $1,500. This was only a year and a half ago.

  91. I didn’t bother to read every comment, so this may have been covered. Your premise rests on the concept that current rules must stay in place with no explanation for why these rules are there. Employee based health insurance rose in response to governmental restriction on pay. It was an avenue for increased compensation without increasing pay levels. Another issue unaddressed is the concept that Americans should never be expected to actually pay in full for any service (doctor visits). It strikes me that, while horrified at the prospect of a liberal takeover of medical treatment in this country, if health care can be improved, the American people need a drastically better idea of alternatives than are currently offered by most (and all liberals) politicians.

  92. Just to make sure I get it, your point is that governments can do scary things to people, and therefore we should give our government more power and a greater financial interest in how we run our lives? Sounds great.

    In all seriousness, government sponsored healthcare gives the government and every taxpayer (a minority of the US these days) a real financial interest in the habits of every citizen. That should scare everyone, unless you really like to live like a Puritan.

  93. He already did. Learn how to read:

    Another cost problem area is that the government substantially underpays for medicare and other government assisted treatment. The cost have to be borne by the insured under the present system.

    The government has grossly distorted health market forces. The cost of medical care began to rise significantly faster than inflation at precisely the passage of Medicare, a huge government intervention into the healthcare marketplace.

    And reading comprehension for the win.

  94. Hi Brian,
    I’m sorry you propose another one of those hurdles, everyone seems to be riding his own hobby horse here as to WHERE hurdles should be erected or limits drawn in the health care system and you even have a nice and informative list available there (let HIV-patients take care of themselves – including babies?)

    But you say nothing about the HOW – now here is just one question:

    What would you say about accidents while pursuing a presumably health enhancing sport?
    If let’s say they ended due to bad luck in a crippling back injury should they be covered and how would you sort through the avoidable and unavoidable and how would you have the health experts agree on which sports are so health enhancing they are covered and which ones are not and how are the ones to be covered to be pursued – can you only run on a tartan track or is jogging through the wild where you can stumble on stones allowed?

    If you want to plead for an each on his own strategy that’s fine by me that can have its advantages but if you want to seem to belong to the considerate and reasonable then please make an argument that has at least a small chance of standing the test of everyday life.

  95. Gimme a Break

    Hear, hear! I’ve got a good genetic code for example and I don’t want to subsidize all those lazy people who went out and acquired breast cancer genes and Huntington’s Disease genes — they should’ve picked their parents better. Don’t expect me to shell out for your d*mn extra mammograms, and when you get a breast removed — OF COURSE YOU SHOULD HAVE TO PAY MORE IN HEALTH INSURANCE AFTER THAT, you unhealthy whiner. It’s your bad genetic code, not mine.

  96. Actually, my point was limited to poorer people. People like us don’t need to worry in any event.

  97. Silke, there are a lot of ants out here that aren’t too happy with this. We’re not all aristocrats sitting on our asses at the old boy’s club.

    I’m an ant myself. Started working at 14 so I could afford school, worked hard in school instead of screwing around all the time, didn’t take a year off to “find myself” or work a slacker job & party or whatever, just busted my ass instead and studied up on the side. I’ve saved a bunch of money because I live in a smaller house than I could afford, drive a crappier car than I could afford and buy my clothes off the discount rack. I’m hoping to invest those savings so maybe I don’t have to work so hard in the future. Apparently that makes me a fat cat and legitimate target to pay for a bunch of people, some of whom I know personally, who took the opposite track.

    A lot of people spend their whole life being a grasshopper, and then want to cry about the unfairness of it all and how it wasn’t their fault. Some people do just get unlucky – the proverbial lightning strike – but most people make their own “bad luck.”

  98. 2 things:

    Perhaps one of the least discussed aspects of this whole discussion is the notion of what is a “representative democracy”?

    If polls are correct (and they seem to be somewhat consistent) then the majority of US citizens want a public option. In fact, a very slim majority of both citizens and physicians want a single payer system.

    If this is what “the people” want then how come it is not what “the people” get? It is politics as usual with rent-seeking ruling the day.

    Many economists and those susceptible to typical right-wing demagoguery seem to forget that “Capitalism” is not granted a “right” by the constitution anymore than the “right to health care” is embeded in the document and its appendages.

    If “the people” want a socialistic solution for heath care then democracy should be served.

    If it ends up being a disaster, like today’s health care market, then there always exists the possibility to change it.

    I know if a baby begins to smell bad and it is due to poop in the diaper, everyone agrees that change is necessary. But one diaper change is not the end of the story. Poop will again occur and change becomes necessary again – this is the nature of progress… while not all change is progress, one cannot have progress without change. The health care diaper is laden with poop.

    I find it very curious that the two parties most involved with the day-to-day practice of health care, the providers and the patients, seem to have the “least” input of all the players.

    If anything they are “props” for the moneyed interests seeking PR support for their agenda.

    If this does not reveal how divorced from reality the deliberation is then nothing will. (Proactive comment: Please spare me the platitudes that the AMA speaks for doctors and the California Nurses Assoc speak for nurses and patients – their “seats” at the table are hardly equal to the more moneyed interests of Big Pharma and Insurance companies and the AMA, like AARP, are a big insurance company, too.)

  99. I agree with Mr. Krugman. Unfortunatley, he does not explain the mechanics of his proposal, and in this country we tend to get bogged down in the mechanics of things.

    State the mechanics and the actual cost – and I mean actual cost – to the American people, and they may buy it.

  100. Markel
    the moral hazard is unfortunately not only in depriving people of end of life care it is just as much as through giving them to much of it keeping them alive under any circumstances because only as long as they breathe you can make money out of them and that is not a new thing!!!

    it is more than 40 years ago I witnessed an unconcsious old woman being kept alive by connecting her to an oxygen bottle night after night after night – the nurses didn’t like it and I to this day do not like the prospect of ending that way. These days you presumably do not encounter these people in hospitals anymore because at least in my country they are transferred to so called care homes as swiftly as possible and only if you have an end of life provision that covers your case specifically enough they are allowed to let you go when nature says it is enough.

  101. Already ‘dead-weight’ from the overwhelming inflation of healthcare costs.

    Not compared to the loss which we would incur with a single payer system.

    No one is arguing for ‘free’ healthcare

    May people here are.

    Also, you seem not to understand the concept of insurance: you spread risk across many people. That’s why one would subsidize healthcare through insurance.

    I understand group plans, and risk sharing. But risk sharing only works if each individual has roughly the same risk of incurring a loss. As the pool of applicants becomes riskier at some point it’s cheaper to self insure with catastrophic health insurance and a health savings plan.

    This is especially true for me since I’m young, healthy, and have no pre-existing conditions. When I get older and move into a higher risk category I’ll already have subidized my higher health expenses with the lower health expenses of my youth.

    If we’re forced into a single payer plan then I’ll be forced to share a group plan with high risk people. Which means I’ll be subdizing their bad behavior. Doesn’t sound like a very good deal for me.

    Taxes on junk food are in effecient because it taxes the input and not the result. For example plenty of low income people are able to eat junk food and not become overweight because of good genetics. Why should they pay higher prices for inexpensive food because of the irresponsible behavior of others?

    Or for that matter why should poor people with bad genetics have to go without dinner a couple nights out of the week just because bureaucrats want to lower healthcare costs? The solution is to give people the freedom to make their own choices, and; the responsibility to deal the the consequences of those choices.

  102. Not bold enough. Better to argue that healthcare is not an insurable contingency, because people have more control over it than the insurer. Until the HMO/PPO concept came into being, and they got big enough to have pricing power, insurers had lost money on health insurance from inception.

    Also, better to argue that other nations don’t have national healthcare, because you can be turned away if you don’t meet certain standards. That’s how they keep the costs down, through rationing. Their wealthy then come to the US, where they can get immediate care.

    Finally, Medicare will die, or be transformed into a second class system of care, because we will not be able to afford it as a nation. The actuarial deficit is ~150% of GDP at present, and getting worse.

    No one has health insurance. It is not an insurable contingency.

  103. Someone will have to pay for the additional care. Never mind that we’re all paying for it now, or that the proposals are to tax a tiny, very rich part of the population to pay for it. Americans are used to free lunches. Anything that suggests there is no free lunch looks like a sacrifice, even if it only takes a quarter of a brain to see that the payments will come from people with more money than one can imagine.

  104. Actually this is an argument for private healthcare. If you have bad genetics, and you have to pay for your own healthcare; then you’re more likely to die. You can’t pass on your crappy genetics if you’re dead insuring that future generations are more healthy. Darwinism at it’s best. :)

  105. Gene Freak
    I am not so sure about your argument. You see those with the bad genes may be more often unemployed having then all day and all night to multiply … ;-)))))))

  106. And this is one of the problems with economics textbooks; they ignore behavioral economics, which tells you that yes it does work the other way around, as well as demand driven. If it didn’t work the other way around, no one would advertise. The point to spending money on marketing is to convince people to buy your products, whether or not they would have otherwise.

    And we have brain scan studies that show marketing works and even how it works. As long as humans aren’t computers, we aren’t completely rational. Marketing hooks into that irrationality and emotion and exploits it.

  107. it seems more and more to me that the same people who were all for the distributing of risk via sliced and diced mortgages are adamantly against the distributing of risk when it comes to health insurance – where is the difference between the two and why was one desirable and the other is mortal sin

    by the way after reading for weeks your answers I still do not get what you Americans mean when you say socialism.

    though it is true that Bismarck invented German health insurance in the hope of diminishing the numbers of socialists I think yours are somehow very different from the ones Bismarck hat to deal with – its especially the evil and sinister hue yours seem to have that I find very intriguing

  108. Amazing how Kwak leaves out the fact that in every other nation this has been tried in, the government (not insurance companies) were the ones denying health care to the very people they promised would be 100% covered!

    http://84rules.wordpress.com/2009/03/19/another-example-of-the-horrors-that-socialized-medicine-will-bring-us/

    http://www.biggovhealth.org/

    http://publicplanfacts.org/

    http://84rules.wordpress.com/2009/08/05/a-look-at-some-items-in-the-socialized-medicine-bill-hr3200/

  109. People born with bad genetics and a pre-existing condition, or; people that develop a pre-existing condition before age 18 are a small minority of the overall population. The plan being proposed isn’t to insure only these people. So stop being disingenuous. If you support a public plan thats fine, but; but argue for that option based on valid facts not false pretenses.

    Theres also the fact that life is not fair. Some people in the general population get screwed. That’s just the way it is. Do you support a means test and government subsidies [also known as welfare] for homeless people with schizophrenia? What about people born with an IQ that’s too low to hold down a job that pays a living wage?

    Should we set these unfortunate souls up with a paycheck, and and a free place to stay because of their circumstances? And more importantly how do you propose we pay for it?

  110. That’s true. But refusing to subidize their healthcare will shorten their lifecycle. Thus insuring that they will less childrean then they otherwise would have produced.

  111. What about Big Pharma? They tell the public that manipulating cholesterol will prevent heart disease, knowing full well that it doesn’t, and make $20 billion dollars a year selling cholesterol-lowering drugs. Who created this market? Who created the demand?

    “Healthy Lifestyle” is just another big sell job. It’s a lovely idea that we can behave our way to health, but research already shows that the two most significant determinants of health are: age; genetics; and socio-economic status (being poor is bad for your health). Research also shows that weight does not effect health or all-cause mortality, unless you’re underwieght, which is bad. Really, really fat people live as long and as well(healthy) as their thinner peers. The true statistics (the ones not in mass media) back this up.

    Obesity is not a disease. All of the anti-obesity information bombarding the airwaves and print media is just a massive marketing campaign for the weight loss industry–$40+ billion per year and counting. Again, the medical industry has found a way to sell services to healthy people by convincing them that they’re sick, when they aren’t.

  112. Steps that will improve our “insurance” system:

    1. Eliminate duplication of medical payment reimbursement by coordinating coverage between Health Coverage, Auto Insurance, Home Insurance, liability settlements, and Workers Compensation.
    2. Create a program similar to the National Flood Insurance Program to cover the uninsurable. Surcharged but affordable premiums are paid by the insured, private insurance companies provide the coverage and the government subsidies the rate differential between insurable and uninsurable risk.
    3. Mandate 100% portability of all policies.
    4. Implement medical tort reform.
    5. Attack Medicare and Medicaid fraud.
    6. Develop programs that will increase the numbers of doctors, nurses and other medical service providers
    7. Encourage the use of HSA’s. ( I have an HSA and can attest to a vested interest in managing my families health care cost.)

    Points One and Four will reduce premiums and allow for a federal tax on premiums to help pay for Point Two. Thus a premium tax can be imposed with minimum net impact on businesses or employees. Point Three will eliminate the need for COBRA and over time substantially reduce the numbers of uninsured. Points Five, Six and Seven will create substantial cost savings.

  113. Brian R
    the life story you have to offer made me well-up instantly

    only I have supported myself from the age of 11 and never stopped, beat you on that one, didn’t I?

    and that “normal” people adopt stories invented by aristrocrats as their own and use them to create discord with those who should be their brethren – well, to achieve exactly that those stories were invented

    - go on sneering at the grass hoppers but remember next time you go to a museum or a movie a lot of the work you see there was in all likelihood done or contributed to by grass hoppers – I would even guess that the ingenuities of cars owes a lot to grass hoppers – it takes both to make things work and to depict the grass hopper as a free loader in the fable is just plain wrong. If it were right he wouldn’t be back next year.

  114. Medicare and Medicaid’s long term funding problems are a seperare problem.

    Private insurance premiums have risen at a 9.9% annual rate since 1970. Medicare’s costs have only risen at an 8.8% annual rate. If private costs had been managed as well as Medicare’s the nation could shave 30% off its current healthcare costs.

    http://krugman.blogs.nytimes.com/2009/07/29/medicare-versus-insurers/

    In comparison, why fix what aint broke (not that it couldn’t use some tuning up)?

  115. That was a great article this morning and, in fact, more could be said under that same headline:

    #1 – The American Journal of Medicine finding that 62% of U.S. bankruptcies are medically related and 78% of those people had (or thought they had?) health insurance.

    #2 – Your analogy to home insurance is interesting because, if your house burns down, the insurance company pays to re-build your house. With medical insurance, it is often not possible to restore one’s health, so what do you get? A burnt down house and an enormous bill from the fire department that may go on for years…

    You are exactly right – there is no such thing as health insurance.

  116. “Should we set these unfortunate souls up with a paycheck, and and a free place to stay because of their circumstances? And more importantly how do you propose we pay for it?”

    well believe it or not Germany has been doing exactly that and survived until now and though I’ve minded paying taxes for a lot of things never for that never ever

  117. Gene Freak
    your argument applies only to the genetically unlucky female
    in case you forgot the facts one man can take care of a lot ;-)
    (which is incidentally why it does not improve anything at all if you neuter any number of male cats in a peasant village no matter how thorough you are there will always be a stranger hearing the urgent cries and finding his opportunities) ;-)))
    by the way you probably know that Germany tried all kinds of breeding experiments during our 1000-year-Reich. I have met some of the unlucky whose mothers had been crazy enough to fall for the bull-shit – they were just as talented or untalented as all the rest of us, they weren’t even blonder.

  118. One of the reasons that Medicare is so expensive is that most of the people who have need more health care services. Older people get sick more often. It is not going away anytime soon. Insurance companies don’t need to insure this age group anymore. Do you think the costs would be any different if Medicare did not exist? Would our elderly population suddenly stop getting sick? Or would there continue to be costs associated with aging? How would it be paid for then? Medicare is just the means. The costs would not go away.

  119. Why not abort them before they are born. Sterilize their parents too. Now I’d pay for that!

    As for the ones already in existence, see my post below about forced labor camps.

  120. rjsgso

    just to add:
    the test numbers after which you have to be treated aggressively to save you from an early and miserable death have been lowered over the years considerably again and again thus getting evermore people in the range of those in urgent need of treatment
    - of course I do not doubt a nanosecond that the current figures that divide healthy and those that need to be treated are finally the truth and nothing but the truth and that forever after no revision will occur because now “they” have found the final wisdom and that they may have to go back on their current findings is of course impossible to imagine to ever occur – a Black Swan?

  121. Silke,

    And I welled up three years more at your better story.

    The point of the story is that if you don’t work hard you might end up screwing yourself – and that’s nobody else’s fault and nobody else’s responsibility to fix. Not even the aristocrats are responsible for your “brethren.” My story was not intended as a tear jerker, the point was I worked for what I’ve got and I don’t think anyone else has a claim on it just because they’ve gotten themselves into a position of need.

    Your comment about brethren shows your true colors. You’re all about class warfare, creating a justification to take from others for your own ends. You’re a wannabe thief clothing yourself in self-righteousness. I suppose it’s done well in Europe, so why not try it in American?

    I doubt movies are made by grasshoppers. That stuff is hard work – watch the “making of” sometime. Most of those painters worked doing portraits to pay the bills. I’m pretty sure Henry Ford was the definition of an ant.

    The world does *not* need grasshoppers, just different kinds of ants.

  122. I hope that this is sarcasm…You do understand that most people procreate BEFORE they become unhealthy enough to die…hence, if anything, perpetuating bad genes. More like reverse Darwinism. Let’s just hope that the people with “good genes” are procreating at a greater rate.

  123. This country pays a higher % of GDP to health care than any other in the world already. Collective bargaining power used against, repeat against, the entrenched established interests is the ONLY way to lower the cost, at least until the collapse of the system if it continues along its present track. People who abuse the system by ‘shopping’ to avoid unpleasant or unwelcome diagnoses and advice, and end of life patients who soak up resources while refusing to acknowledge death are the consumers who will have to make ‘sacrifices.’ Otherwise the sacrifices need to come from the entrenched, established interest groups, most GPs excepted.

  124. I agree completely Brian. You owe society nothing. Nothing!

  125. As I read through many of the comments, I couldn’t help but think that there are so many uninformed people in America.

    It is very important to find out first-hand what the Obama care plan is. I see that many support reform, but not Obama’s reform.

    What exactly is Obama’s reform? Short answer is that he wants to provide uninsured Americans health coverage. I wish it were that simple. There are many other behind-the-scene aspects to the Obama plan that need to be publicly discussed.

    While I am leaning toward supporting Obama’s plan, I am still somewhat skiddish as to the details (check my blog for a full explanation of my impending support).

    On the flip side of this, I am irked that people are not being able to express their distastes for the program without being ridiculed and basically threatened by the White House.

    America was built upon the words of those standing up for themselves and expressing their lack of satisfaction with Britain.

    Now it’s wrong to speak up? No, it’s not wrong; support or oppose, we all have the right to voice our opinions and that should never be taken away from us.

  126. Your sarcasm has shown me the way. You’re right, I’m wrong. I owe “society”, meaning people I’ve never met, whatever they ask for.

    And I just can’t believe I’ve lived my whole life giving nothing, Nothing! back to society for my entire life. Haven’t helped out my friends, never volunteered for anything, haven’t paid any taxes, nothing at all. I’ve just been crowd-surfing on the backs of the proletariat this whole time, a giant leech in a sedan-chair. Silly me.

  127. Joe,

    First, you don’t “self-insure”. You pay for you own insurance. If you “self-insured”, you would simply pay out-of-pocket for your therapies.

    Second, your sample of 2 is hardly random or representative. Your statement ignores the cost of medical care or insurance or both and ignores the data as well the experiences of millions of other people. Your generalization suggests that everyone who has no coverage can afford at least one of the available options, that there is always at least one such option available to them and that they can find it. We know all of these assumptions are false.

  128. …but I was not being sarcastic. In fact, I pity you for doing all those things unnecessarily.

  129. In fact, society owes you for working. Big time!

  130. One thing regarding bankruptcies, in health care or otherwise. If someone gets a hospital service and can’t pay because of poverty, or health care cost is huge and they go bankrupt, the service providers still were not paid. Either they raise costs on someone else to pay for that, or go bankrupt themselves and don’t pay THEIR bills, or they kick the debt can off to someone else, as is so common in today’s economy. So even if I’m Joe Responsible and pay all of my bills and have health care coverage, I still wind up paying for what someone else couldn’t.

    Of course my REAL responsibility then is to kick the can one more time, to the taxpayer behind the tree or the next generation…

  131. I don’t believe you Mike.

  132. Go work for the government, good luck. The only people getting government jobs are people with the inside track.

  133. Who is going to pay for the bandaids tossed to the people bleeding on the streets? Who is going to compensate me for the nuisance they cause? Who is going to pay for their funeral expenses when they die?

  134. Brian R
    I am now 67 and have not taken from others for my own ends and have always been too stupid to be a thief i.e. to take commissions/bribes but who knows maybe I’ll learn during my remaining years/decades

    as to true colours:

    brethren?????? well I always thought that was the Christian way of talking about others, if that is not done anymore put it down to my age but will it not be hard to find another word as all inclusive as that one

    Christians: aren’t they considered by some to have been the first and real true socialists?

    and if you object to aristocrats well the version of ant and grasshopper we were taught was the one by La Fontaine and he definitely was an aristocrat.

    and here is the ultimate grasshopper for you

    Karl Marx,

    because if he had stuck to journalism he could have provided for himself and his family but he enjoyed himself much more by sitting in the beautiful British Library writing “his great work” and why not, after all he got his money easily enough by begging from Friedrich Engels.

  135. Bottom line: The same government that has been “captured” by the finance industry must be considered equally compromised by the biggest business of all, the health-industrial complex.

    Anyone assuming reform is going to help the average person is not understanding the government we live under. Change the government. Then reform health care. Otherwise, the rational expectation is that we’ll have a bigger cluster**** than we have now. Certainly we cannot afford the change that has been proposed.

    Fix the economy. Then fix health care. Keep your eyes on the ball, people.

  136. right you are Yakkis
    - the old Hapsburg Monarchy had it right, they threw Mozart in a mass grave, the man had run out of money, hadn’t had a hit for a long time, gambled!!!!
    no use being sentimental about past pleasures provided
    - that’s laudable efficient handling of a Luftikus ( carefree, devil-may-care, freewheeling, happy-go-lucky, harum-scarum, slaphappy)

    - but why did their empire in which at one time the “sun didn’t set” split up into lots of little pieces under the strain of WW1?

  137. If we are talking about the USA…

    Then you’re wrong to omit COBRA, Cal-COBRA, etc.

    Losing your job does NOT mean that you lose your health care.

    Further, Congress now subsidizes COBRA by 65%.

    Finally, employers DO NOT subsidize health care: the employee pays it. It just happens to be paid ‘above the line’ and is not considered part of income subject to taxation. This may now change based on proposals floating around Congress.

    When I had employees I always considered the TOTAL cost of employing someone. They had to earn every bit of it before I’d keep them on the payroll. That means that each employee had to earn the ‘above the line’ FICA, unemployment insurance ( state & federal ), Workman’s Comp, health insurance, etc.

    It’s the ONLY way any employer can look at the situation. Just because a benefit is paid from your income without income tax being levied on it does not mean that you didn’t earn it and pay for it. Rather, this political dodge is schemed up to make Congress look good while mandating expenditures out of your income towards outcomes that previously did not occur.

  138. Keep talking about health care, Mr. Obama!

    From MSNBC online, July 29:

    “As Congress works on its legislation and as Obama campaigns to get an overhaul enacted, 42 percent now say that the president’s plan is a bad idea, which is a 10-point increase since last month. Thirty-six percent say it’s a good idea.

    “In addition, 39 percent — a plurality — believe that Obama’s plan would result in the quality of their health care getting worse. That’s 15-point jump since April.

    “And just 41 percent approve of the president’s job on health care, which is nearly identical to Bill Clinton’s scores from 1994, when he failed to get Congress to pass health care reform. ”

    The more he talks, the more he lies, and the more the lies are exposed. I couldn’t be more pleased. We need more choice, more personal funding of our own individual health care needs, less government control. The only thing that will bring down costs are bringing together the provider and consumer of health care without a third party picking up the tab. This doesn’t apply to catastrophic care, but for everyday care, and what is becoming normal maintenance care like hip replacements, stents and the like.

    A friend of ours who is self-employed and self-insured recently went to Guatemala for a knee operation. We would see much more of this if people had to pay their own way. And that would create pressures on the system to lower costs. People who have to pay their own costs find ways to lower those costs. Period. Too many people are isolated from reality by the illusion that their health care is free or mostly paid for by some other entity. That is what has enabled our sick system. If someone else paid my grocery bills, I would shop at the most expensive store in town.

  139. “but why did their empire in which at one time the “sun didn’t set” split up into lots of little pieces under the strain of WW1?”

    They were just too kind hearted.

  140. My father had good insurance and from all the fancy ads, billboards, television commercials and infomercials I thought he was in the best (hospital) health care system in East Tennessee. Boy was I duped. His care was called “horrifying” by the state of Tennessee, but said it was perfectly within the parameters of what they deem, defend and support as “the acceptable standards of care” in E. TN. He had a nurse playing doctor who was practicing medicine as a physician without a physician’s license. The man was showing all the signs and symptoms of internal bleeding and was going into shock yet the nurses prognosis was Sundowners Syndrome. They finally had a nursing instructor who teaches at The University of Tennessee who said the reason my father was going into (shock, was sweating profusely, confused, no urine output, blood pressure dropping 55/35, heart rate increasing 255,blood sugar was topping out around 600), it could have been caused by the room temperature being set too high. It’s on record in Greeneville, TN Federal Court. Case no 2:04-cv-375.
    See what is called quality health care in TN and VA. http://www.wisecountyissues.com/?p=62 He rotted to death for ten long months, his legs were amputated. He was begging for a gun, looking back I should have granted him that wish.
    There will only be change when those unaffected are as outraged as those who are.

  141. Back in 1994, Jeffrey Flier (now dean of the Harvard Medical School) wrote an excellent article regarding the issues now being debated.

    It articulately examines the complex economic, legal, and moral issues — and also provides a useful historical basis to explain how the current system came to be.

    If you are open-minded and curious, it’s a good read. If your opinions are cast in concrete (on either side of the debate,) don’t waste your time.

    http://ecommons.med.harvard.edu/ec_res/nt/A29698DD-A40C-4FD2-9926-718E04778B37/HealthCareReform_Paper_Fall1994.pdf

  142. “you may find out, as Karen Tumulty’s brother did, that your insurance doesn’t cover the treatment you need.”

    You may find out on the new government plan the same thing if it is ever passed. The difference is that you will no longer have a choice of looking around at other insurance companies or modifying your plan with the current one. I’m not for change I’m for choice.

    Did you know that obese people have 60% more medical cost than the average American? Government health care should equal no mroe transfat in fast food joints. once that happens I’ll think about getting on board.

  143. Joe,
    Your daughter’s experience is not really incompatible with James’ argument. The Kaiser HMO model is really an outlier in the US insurance market, having much more in common with the VA system, for example, than with Aetna or CIGNA. In addition to being a non-profit, Kaiser has a more paternalistic management strategy, choosing actively to manage the health of its enrollees. In addition, its physicians are on salary, and do not make money on individual procedures, so there is no incentive to overuse tests. Since physicians are employees, rather than contractors, they are not pressed to practice defensive medicine, since Kaiser bears the risk. This model has been successful for all of these reasons, and consistently outperforms other private insurers in terms of outcomes.

    The major complaints with the system are as follows: 1) doctors say “no”. Since they don’t make money based on procedures or office visits, they don’t need to worry (as most physicians do) about disappointing patients by not giving them what they ask for. Many physicians, for example, will prescribe antibiotics even when unnecessary because they could work and, more importantly, because the patient will feel that he or she got “good” care. 2) Most Americans don’t like the HMO model, preferring the choice that comes wtih more expensive PPO models in which an insurer contracts with individual physicians to establish a network. Physicans agree to take less revenue in return for having a higher volume of patients from the insurer. Americans fled HMOs for PPOs throughout the 90s.

    Kaiser’s model is better at controlling costs and managing risk, and comes closer to insurance than other forms of private coverage. Nevertheless, since most of the coverage is employer-provided, James’ primary criticism still stands.

  144. You make it sound as if Paul Krugman’s “basic solution”: “regulation of insurers, so that they can’t cherry-pick only the healthy, and subsidies, so that all Americans can afford insurance” is all that’s needed for a big picture solution or that it’s the only big picture solution.

    I believe leveling the playing field between employer and individual based insurance (or groups of individuals independent of their employer), establishing portability, subsidizing coverage for the uninsured / unisurable but only for well and catastrophic care, and increasing individual accountability through e.g. health savings accounts would be far more beneficial than creating a subsidized government run plan for everyone which will not limit costs, will force out other alternatives and will structurally and negatively impact the Federal deficit. There ain’t enough money to subsidize everyone!

  145. The larger the risk pool, the lower the costs, since they can be spread more widely. Morover, incentives to manage the risk change.

  146. To all responders to my comment, I want to point out that I was discussing morale hazard(with an “e” at the end), not moral hazard. Look up the difference in Wikipedia.

    I’ve actually studied economics formally, including behavioral economics and how it pertains to medical decisions. I can say with confidence that people do consistently respond to perceived incentives, and that obesity related illness is pervasive and very expensive to treat. Search The Economist’s website for articles on this issue and you will find plenty of accessible research if you need convincing.

  147. Hi Brian
    just read this interesting bit about super-ant Henry Ford

    http://entertainment.timesonline.co.uk/tol/arts_and_entertainment/the_tls/article6739960.ece

    The movement became increasingly anti-… in the United States, with support from figures like William J. Cameron, the editor of Henry Ford’s Dearborn Independent, who published the infamous International … series.

  148. I have to admit frustration here: I want all American’s to have affordable health insurance, but if the vast majority of the population is too ignorant or lazy to look out for their own self interest I am at the point of saying, screw you. This extends beyond healthcare to economics, if the lower and middle classes are really think the best way to promote their own well being is to provide tax cuts to millionaires and cut services to themselves, let em have it. Also, the argument that healthcare is simply too complex for the average person to understand is ridiculous: ask the average highschool dropout about sports and he will spout statistics that would make a NASA engineer proud, asj the average person about Michael Jackson/John and Kate and they will have the most recent data, but ask them about their own healthcare and you will get a blank stare. One of the most telling tidbits of this debate was the town hall meeting where angry residents were determined to tell the government to keep their hands of his medicare, ignorant of the fact it is a government run program. But I bet the same guy could name the entire starting line of the New England Patriots. Combine this with outright lies (free market health insurance is cheaper then govt run), which can be disproven with 5 minutes and access to google, I find myself just confused. Its like trying to give a blood transfusion to a Jehovah’s Witness, eventually you turn to the ignorant schmuck and say fine, die.

  149. I don’t think you guys realize that part of any employer health insurance cost is covered by the employer as a benefit to the employee. My dad works for the Feds and he pays several hundred a month for his insurance out of pocket and his employer, the feds pay double what he pays. So…. If people wanted to pay their portion and the employer portion I guess that would work, but that’s like $1000 a month, more than most people would pay.

    Here’s an interesting article about real health insurance costs. http://cafehayek.com/2009/07/health-care-lies.html

  150. It looks an informative post..i find few really interesting things here..thanks for the share man!!

  151. The most important alternative that will be forced out is to let people who get sick just die.

  152. Social darwinism for the ignorant. Me likey.

  153. I have catastrophic coverage incase anything big happens, pay out of pocket for the small costs

    This is nice but inapplicable to a surprising number of people, who cannot get even a catastrophic policy in the individual market at ANY price.

  154. WHY do Ins./Pharma co’s spend $1.4M/day.
    Take out the middleman = problem solved.

    As a former Military “brat” with 5 sisters, all born and raised in the Military system = no problem.
    My Father died in a VA hospital (Agent Orange/Vietnam) = no ins. problem.

    - It is not what they say, it is what they do FOR PEOPLE – NOT CORPORATIONS ONLY – that counts.

    When Walter Cronkite took over the CBS Evening News in 1961 there were over 600 individual media companies in the US. Now there are 6. That was on purpose.

    ALL OTHER INDUSTRIAL NATIONS PROVIDE CARE – why can’t we? Oh yeah, the middleman get their “cut” at everyone’s expense.

    Just speak the truth: the bankers and the health insurers and the corporations have been taking your money and buying your government.

  155. That’s how they keep the costs down, through rationing.

    And this is different from what private insurance companies do because… ???

  156. “The difference is that you will no longer have a choice of looking around at other insurance companies or modifying your plan with the current one.”

    Most people don’t have this choice now. You take what your employer chooses to offer, or nothing.

  157. “Just speak the truth: the bankers and the health insurers and the corporations have been taking your money and buying your government.”

    Hey, you elected them.

  158. We are not encumbered by such inconveniences as facts.

  159. The military is always looking for more cannonfodder new recruits.

  160. some guy in a cube

    Get a clue, dude.

    Health care is already rationed…by the private sector.

    Tens of millions have no care, and tens of millions more have useless individual plans.

  161. just read Churchill’s the River War lots of cannon use in it
    - am amazed they are still making and using them?
    I thought even the Taliban have switched to more tricky stuff

  162. Nice talking point Paul. All lies.
    Remember George Bush saying “we do not torture”. When you did hear that You were probably against torture and outraged those libs would say we torture. Now you don’t remember that do you Paul. Though I’m sure your a big fan of torture now. Remember George Bush saying “when we’re talking about a wiretap we’re talking about getting a court order!” No Paul wouldn’t remember that one. Remember after years of lies and conflation of 911 and Iraq Bush finally said “we have no reason to believe Saddam Hussein had anything to do with 911″. Remember how people who were against the war in Iraq were called traitors paul. Remember Bush denying ever knowing NOLA would be flooded and then watching that video of Bush, bored to tears, listening to scientists saying that’s exactly what would happen the weekend before. Remember Bush sending in armed Mercenaries on American soil. Remember Valerie Plame and how Scooter Libby went to prison to protect Bush from treason charges. Remember how Democratic voters lost their votes by Caging which is a federal crime or how the Justice department was corrupted with cronies who just before elections brought bogus charges against Democratic candidates which were dropped right after the elections. Remember Paul how people had to swear an oath to Bush to get into on of his “public” meetings stacked with our Military men and women. Remember what Bush did for Medicare. He made it so medicare couldn’t negotiate for lower drug prices. Who did that benefit? Then he tried to prevent busses full of our elderly going to Canada for cheaper drugs which were made in America. How about the donut hole, a $4500 bill out of nowhere for people generally on a fixed income. Who did that one help? He also rationed care. Rationed care Paul! So a person over 65 who breaks a hip or has a stroke or heart attack only gets $1500 per year of physical therapy. Well Paul you are not one to speak of what is wise or thoughtful and if you want to call someone a fascist then look at yourself or George Bush if you can remember that far back.

  163. So why should we be interested in allowing any insurance business to earn a profit, which means money is being diverted from paying for something we need (healthcare), but would really prefer not to pay for?

    Because the best way to make money in America is for the government to hand over public goods to private corporations.

  164. Those talking points will carry the day: there’s a sucker born every minute.

  165. Regulation of insurers is definitely all that is needed (not a public option), but it’s some really wonkish changes that are truly needed. Allow me to volunteer a few:

    1) Eliminate the group vs. individual market – this makes the individual market a dumping ground for the worst risks (see james’ note about correlation above), thus creating the affordability problem, and also prevents consumer choice from strongly influencing product options.

    2) Make policies “appearance based” like liability policies are “occurence based.” – very wonkish, I know, but think of it like this: insurers are still paying for asbestos incidents from 20+ years ago, but as soon as an insured gets sick, they can be dropped as soon as their policy ends. Since the policy is usually employer provided, that correlation makes the sick-and-uninsured population huge.

    3) Handle involuntary markets with an assigned risk plan or joint underwriting association. There is tons of precedent for this in the property & casualty market.

  166. “This is one of the problems with economics textbooks; they ignore behavioral economics.”

    Really what textbooks are you reading? Because behavioral economics is covered at my university.

    If it didn’t work the other way around, no one would advertise.

    Corporations advertise to make people want to buy goods already desired by society produced by them, not to create demand for a certain item. If you don’t believe me then put your money where your mouth is and start a company that sells dog feces in a bowl. Try to create demand though a massive advertising campaign to see how far you get.

  167. Nope health care is not rationed. You can buy all of the health care that you can afford. Rationing is limiting the supply of an item that you can buy, no matter what price you’re willing to pay.

  168. I could care less if a liar claims that I’m not telling the truth.

  169. I could care less if a liar claims that I’m not telling the truth.

    Prove it.

  170. I agree with Mike. No decisions are ever made about how to allocate scarce healthcare resources.

  171. Another rant: at what point are we going to say, while we can give you more healthcare/drugs, unless the average person stops treating their body as a fat and sujar recepticle, how on earth will health care cost be brought down? Im all for medical technology, but what does it matter when 6 years old develop type 2 diabetes, a condition previously reserved only for the most sedentary adults? Or the fact the while people love watching sports, playing them is not on their list of things to do. I think Bill Maher said it properly when he argued “the call is coming from inside the house”. Im Canadian, so while the healthcare debate doesnt effect me directly, most Canadians have a genuine concern for the US and want it to suceed, both for economics and because we look at you as our southern cousins. While I certainly preffered Obama as oppose to McCain, but at what point will the democrats (Obama included) grow a pair and stand up to the drug companies, healthcare lobby, and banks. Canada had to armtwist our doctors in the 1960′s when we inacted healthcare, and eventually you will to, otherwise you might as well give up now. If you dont have the stomach for a fight, get out of government. Government is about power, and its clear that right now the Whitehouse doesn’t want to exercise its for fear of looking “socialist”. Thats a strech, a Canadian telling Americans to be more aggressive and less apologetic.

  172. If you pay cash and pay in whole within 30 days your costs are more than half what they charge the insurance company. For instance, my buddy’s mom just had to have hip replacement surgery and she has not insurance. Because she was a cash customer she called around, got quotes, and chose the cheapest hospital. They quoted her at $25,000. When all was said and done she only paid $11,000 cash. It’s actually not that bad to pay cash for most things and have a high deductible insurance plan to pay for catastrophes.

  173. Mike is again 100% correct. Advertising a new type of product–never been done, never will be.

  174. “I know that there are lots of details that consume people who know health care better than I do, and I know those details are important.

    A lot of the those details are ideologically important as fashionable memes for economists, but not important in practice. For instance, regulation of insurers, so that they can’t cherry-pick only the healthy generates memes like adverse selection! and market collapse!. These phenomena are not observable in practice, and can be shown to be umimportant in simulations, see this paperhttp://tinyurl.com/da5z7y. This doesn’t seem to reduce their ideological appeal in economics.

  175. Um, the insurance companies have already happily agreed to take on those new customers as long as they don’t have to compete against a public option which would compell them to actually offer effective policies that will serve the interests of the buyers.

    What exactly is your statement intending say?

  176. The thing that seems, sadly, to get no recognition in this debate is that the insurance industry is not truly in the business of providing insurance.

    So economic analysis of risk of illness and rational corporate behavior is misplaced.

    Consult The Economist of 16 January 1999. The relevant article is “Capital Punishment”. It happens to be still available on-line at
    http://boards.fool.com/Message.asp?mid=10564410&sort=postdate

    Private sector insurers are practically certain to deliver bad health outcomes, because the policies they issue are principally a source of funding for sharemarket speculation. People’s health is a side issue.

  177. woodlandnutrition

    I have read most comments on this thread. Only a few have touched on the REAL issue here. I ask, who likes this healthcare idea? Answer; not the doctors, too much control between doctor and patient. Not the citizen, they will have to wait even longer to see their doctors. Not small business, they would be forced to provide it or go out of business. No, the ONLY entity that likes this is the big Pharma. They will get the money. The United States is a member of the World Health Organization. They use the Codex Alimetrius that will further regulate and eventually eliminate your choice to buy nutritional supplements. Every disease known to humans is attributed 100% to a nutritional deficiency. Then why are we getting rid of nutritional supplements? Well, so the world can use synthetic drugs only, that’s why. Doctors get less than two weeks education on nutrition in their 8 years of study. We NEED to teach our doctors about proper nutrition like they do in most other countries. When is the last time you have been treated by your doctor with a nutritional supplement?

  178. some guy in a cube

    “You can buy all fo the health care you can affrord”.

    Thank you for proving my point – health care is rationed…by corporate interests.

    Or as Nader calls it: “Pay or die health care”

    Free market types hate single payer until they get cancer and lose their jobs and their coverage.

  179. I have a hard time understanding how anyone other than the executives and shareholders of the private insurance companies could think that our current healthcare system is meeting the needs of the American people. I’m a medical professional myself and support universal health care reform. I’ve written my Congressman, Senators, and the President on more than one occasion and have also called their offices to voice my support for reform. I’ve also spent countless hours researching what the best overall way is to bring down long term costs in order to provide everybody accessible and affordable health care. Here’s my solutions – http://bit.ly/9QLV8.

  180. Yeah, please be more clear in the future. Fox News commentators make such contradictory statements all the time pretending to be incisive — thus providing easy, unedited, fodder for The Daily Show. Your comments were a joke but it was not clear if you were joking.

  181. And as a medical professional who has done his research, what makes you think you are more qualified to comment on the health needs of the American people than the average MBA executive for a health insurance company?

  182. I actually care about people more than money. I went into healthcare to help people not get rich and therefore my only motive is to find the best way to provide healthcare for my patients. And by the way I’d gladly take a pay cut if it meant I was doing my part for everyone to get affordable access to quality medical care.

  183. Oh, the snark is so FUN! Meanwhile the opponents of the congressional plan have been going out telling seniors that the new plan will force euthanasia….

  184. Hello WLN. You bring a very valid point to the debate table regarding improper nutrition. However, one must also take note that not all doctor visits are due to disease.

    Emergency visits are typically due to accidents resulting in some sort of trauma or broken bones.

    Don’t get me wrong though, a huge portion of non-emergency can probably be linked to poor nutrition. After I read a book entitled “Empty Harvest” by Dr. Bernard Jensen and Mark Anderson, I realized the true importance to organic foods and proper nutrition.

    I personally think the gov. wants to take away the nutritional supplements as a backdoor form of population control. Take away all of the good nutritional products and feed us the chemically laced foods that spill off the grocery shelves.

    For everyone who reads this, check out the book that I mentioned earlier; it will definitely shed some light on the FDA.

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  186. Thankfully there are doctors like you. I hope you know I was kidding.

  187. Personally, I commend you Dustin for being genuine.

    The problem in America is the overbearing lack of compassion for our fellow Americans. Everyone who is opposing universal health reform seems to be worried about losing money (among other things).

    What happened to the American camaraderie that we experienced after 9/11? Do we even care about people who can’t see a doctor because of affordability? From the looks of it, no. The opposition seems to be saying, “Screw those people, I’m insured and I don’t want to pay into a plan just for them.”

    They fail to understand, if anything went bad in their life and they were dropped from their health coverage, they would become one of them.

  188. Dustin,

    Unfortunately, this post has been swarmed by cyber hooligans who jeer, ridicule, disrupt have have nothing of substance to say that is defendable.

  189. Who are these nutcases with paranoia.tv? It’s quite obvious what’s going on: the GOP has been able, over the years, to convince quite a few people through the use of communications that travel under the radar, including chain e-mails. People start popping up who believe the most incredible things. (Like, Barack is a Muslim.) The medium is chain e-mails. So the White House wants copies of these things so they can refute the charges.

    It was the Bush White House that snooped on our e-mails looking for terrorists, tapped our phones, and probably put the CIA to work inside the United States. Nary a peep about Big Brother when it was actually going on. Now, when it’s not, they go crazy.

    This is just another example of the fact that the conservatives can’t think of any tactic except lying.

  190. The other thing about COBRA (I know) is that your premium rises by more than 100%. And you have to come up with that while you’re unemployed.

  191. Jim,
    I seem to recall endless mentions of Big Brother over the last few years. And despite all his posturing during the election, Obama is continuing the warrantless wiretap program and most (all?) of the other Bush-era intelligence gathering programs.

    I think the reason is that the new White House program is reminiscent of “report on your neighbors” programs that are/were popular with totalitarian regimes. The actual intent may be totally innocent, but the similarities are unfortunate for the administration.

  192. This post is one of the clearest, simplest and most insightful anywhere in the blogosphere on the topic of health care reform. Great job!

  193. sippycupnation

    I’m not talking about the plan they’re proposing – I’m talking about the insurance all Federal employees are provided TODAY! I’d LOVE to sign on with that group!

    (Haven’t read that story yet, but from your description, sounds like it matches my concerns for the current proposal.

  194. sippycupnation

    Rick – what is your deductible? Is your plan for just you and your wife?

    Maybe I don’t want the federal plan if the HMO for one person is nearly $1100 a month! Bummer…. I would have thought they’d have gotten a better deal, given the size of their group.

  195. Mike – You don’t need to believe me if you don’t want to. This was three years ago – I’ve got the EOBs to prove it. And why would I lie?

    We have a friend who had a similar break and her EOBs showed a similar expense – roughly $20K. Both my husband and friend required surgery to set the bone.

    What’s interesting is that the well care visit for my five yr old twins cost almost as much as your broken bone (More than $1K for the doctor to see both.)

    Costs are out of whack, Mike!

  196. woodlandnutrition
    any doctor who would show the slightest sign of being in favour of such crank medicine would have lost me as a patient immediately
    - because luckily in our “socialist” system I am free to switch doctors to my heart’s delight even see three or four or ten with the same complaint, specialists included – presently they try again to reduce doctor-shopping again by market-incentives, hopefully it works this time around

    but any doctor who would try to make an extra buck out of me on such superstitious stuff as nutritional supplements*) would have outed himself as being after money grabbing only – as long as our kind of public-private insurers can keep us convinced that their choice of medically necessary treatments is reasonable and has only small hitches to correct here and there, doctors’ chances of selling their patients extra-stuff is fortunately quite inhibited.

    should make doctors really keen on getting something more private in place but does only very half-heartedly here and there because the secure income and the non-stress of having to be a salesman to their patients under the current system seems to be satisfying for most of them. After all even today most of them became doctors because they want most of all to heal in the millenia old ideal of “First, do no harm”

    *) I do not know how the stuff is called in English but they sell it to believers to make your nails, skin and hair more healthy from the inside – only the stuff is added to almost everything from Ketchup to the soles of your trainers – but of course if you can consume it in the shape of a nice pill it does otherwise unachievable miracles as beliefs in placebo tend to do quite often
    However as an ingredient of Ketchup and any other stuff that needs a certain viscosity your body doesn’t recognize the miracle stuff and thus considers it to be as useless or as useful according to his own demand for it

  197. Dustin
    please read Yakkis other stuff on this post – I promise he will be dear to you after that

  198. How awsome it would be if all the
    > media and others who are so determined to take this man
    > out…took time out to PRAY FOR A MIRACLE, and to Pray for
    > the President and mostly Congress to make some good choices
    > to behoove the Citizens…aka; the brothers and sisters of
    > the world to come through these dark days of trials,
    > tribulation and adversity of Life here on Earth.
    > AMEN…..now send a message my Dear Brother to your brothers
    > and sisters to adopt
    > an OPTIMISTIC POINT OF VIEW…and get off the BIG BLACK
    > TRAIN rollin faster down the track. Now off to work I
    > go…I owe, I owe and I owe.
    >

    Posted by: FromtheDeskofSusanJ | August 6, 2009 11:56

  199. HANG IN THERE PRESIDENT….the majority of people are resistant to change…especially the ones that are not effected either way by the issue’s of our Nation and simply can’t get over themselves. GO PREZ GO….don’t give into these NEGATIVE, WEAKNEED, SPINELESS GREEDY IDIOTS that have no compassion for the UNINSURED! And for the difficulties you are having in Congress, ask if they would like to have all their BENEFITS taken away…awhile they waste precious time debating this important issue of concern….Bottom line…it’s hard to put Faith & Hope in something another hasn’t seen…but if we only BELIEVE, change for a Better World may be seen. TAKES GUTS FOLKS. If we do not try to make a Change then where will we be? What then will our nation look like? CHANGE OR LIVE IN A NATION that will remind you of an old movie entitled “SOY LENT GREEN”. So which path do you choose…the most difficult or the later? The easiest path most traveled, will result in a pathetic society of desperation for ALL MANKIND………….

  200. Not that it really matters to this “poor” person as I will probably die before there is any kind of national health reform in America.

    However, nobody really has the money theu think they have and they will find out when it is too late. When you need the treatment and cannot afford it.Health care is sucking America dry and more people end up like me. So protest all you like, the poor are too far gone for you to hurt them and you are next in line.

    You can read more about it on my blog-
    http://axewielderx.wordpress.com/2009/07/22/health-care-in-america/

  201. I started out reading this post so I could understand health care reform.

    Dude, you have some serious issues.

    Nobody owes you anything. I think it was John F. Kennedy that said “Ask not what your country can do for you, ask what you can do for your country”.

    Everyone can lose their job and get sick. You avoid that by taking care of yourself and investing in yourself. Invest in education. Start your own business. Position yourself so that you have a better future.

    What you just posted here is called the welfare mentality. It is this attitude that is taking this country down a path of failure.

  202. what a day dreamer you are –
    though I am glad that you have been lucky so far I assume that you must be afraid like hell that “it” may hit you too why else would you feel the need to trample on somebody already down

    has nobody ever told you that that is not only highly improper by the commandmants of any religion I know something about but also by the mores of every society that has existed on earth so far is considered very very bad manners

    Tell your mantra of “jeder ist seines Glückes Schmied” (everybody is the smith of his luck) to all the people currently and in the past caught up in war through no fault of their own, some of them happened in your own country which also not to forget educated these wonderfully polite and friendly people I was lucky enough to meet in Europe on and off the job for decades.

    Reading people like you makes me after all those positive encounters very very sad (I met my first American in 1946 at the age of four and he smiled at me and gave me a chocolate bar and boy didn’t we have such stuff ourselves completely through our own or rather our parents’ fault – but he smiled!!!)

  203. I wonder if those who are against socialized medicine would mind if the government took away Medicare.

    Oh, you would mind? Then support socialized medicine.

  204. Mike,

    You believe that private insurers will happily dish out treatment after treatment for terminal patients? Hah! These companies look for every possible way to get out in these situations, often leaving patients to pay for their own end-of-life care.

    I don’t know why people like to pretend that insurance companies are somehow *more compassionate* than a public plan would be. These companies are essentially *obligated* by their Wall Street stockholders to cut their payouts every single year. They’re in a contract with Wall Street to deny more claims than they did last year.

  205. Two additional points:

    (1) Most plans for employers with more than 50 employees are TPA (third party administrator) plans. The company is actually paying the health care out of pocket, although they may have a reinsurance policy to protect against aggregate claims over X dollars. So you don’t really have insurance–you have someone else paying your medical costs, and if there is a very costly treatment, there is every incentive to either find a way to not pay for the treatment or to terminate the employee.

    (2) Health care costs are cost-shifted. The uninsured still get care, but they generally pay for it by standing in long lines and not paying bills, so the dollar costs get shifted to everyone else. Similarly, very large companies have access to consulting companies who negotiate PPO contracts at the lowest possible cost. So the parties who pay full freight–and then some–are small businesses and individuals.

  206. No sir, it is not about money. It is about freedom. In some cases that means bad things will happen. But bad things will happen under the new system too, if it is passed. The President implies we can cover everyone, and there will be no pain associated, except a few rich people will pay higher taxes. Most people know in their gut that this is like believing in perpetual motion. There will be pain. There will be restrictions. There will be a loss of freedom.

    I choose choice. There are many things I do not want to be insured against, because I do not want treatment for them. Not conventional medical treatment, at least. The government would take away my money, and thereby take away my choice of those other options.

  207. Yes, it was “organized” by the GOP. Next, they bring their “swasticas.” LOL. These accusations by the left are signs of increasing desperation.

    Some people simply want freedom. They want to be left alone. They don’t want to be herded into a government-controlled system like so many cattle. That freedom is something they value more than the supposed benefits you claim reform would offer.

    How can one defend that value? Either you feel that in your heart, and you’re willing to accept the consequences of self-reliance, or you don’t.

    Ridicule? Well, I think Congress voting on 1000-page bills they haven’t read is worthy of ridicule. I think the President’s claim that no one will suffer under the new regime, Pelosi’s claim that health care reform means “a cap on your costs, but no cap on your benefits,” to be useless, illogical drivel worthy of the highest volume of ridicule.

  208. Since Medicare is what is dragging us into the debt hole, from which we probably cannot escape until the system collapses, you are not exactly helping your case here.

    If the government had proven it could manage the costs of Medicare, then maybe we would trust it with national health care for all.

    But you seem to forget — have people forgotten one of the main themes of this blog??? — that the government has been captured by special interests. They have bailed out the finance industry to the tune of trillions of dollars, telling us it was in our best interests. Now they seek to cement a government-industry partnership in the largest industry, health care, with total control. Again, a few will reap unbelievable profits, and the rest of us will eat ****.

    But go ahead, believe that the lefties only want to “help you” with a government option and total control over the insurance system. And believe that they are great managers of health care, in contradiction to what we see with the bankrupt Medicare program.

    Who you gonna believe? Obama, or your own lying eyes?

  209. And then there are the dark-humor wielding clowns like me.

  210. Thankfully there are patriots like Eric who will die fighting for the freedom to not receive health care!

  211. Unfortunately, it was the greatest lefty of all– George W. Bush– who bailed out the banks to the tune of trillions of dollars. We need to abolish the left-wing institition called the Republican party and replace then with right-wingers like the Chinese communist party. There’s a party that’s good for business.

  212. You can take comfort in the fact that even if you did pay health insurance premiums, your insurance company would have dropped you like a hot potato as soon as you got sick (or increased your premiums to more than the cost of your treatment) if they couldn’t first weasel their way out of covering your condition.

  213. We all know the government has been captured by special interests.

    The problem is with the finance industry, not the government. In addition, I haven’t heard of any government-industry partnership, nor do I find any evidence of it in what news I read, which is generally extra-American (BBC, anybody?).

    I think I’m going to believe my own quite truthful eyes.

  214. soylentgreen

    “most men lead lives of quiet desperation”

  215. Any scarce resource has to be rationed. The question is by whom for what purpose? I much prefer that individuals who will be receiving the health care do the rationing by choosing how much they will pay, and whom they will go to (doctor? pa? uncredentialed medical provider?) I seriously dislike the Canadian plan, where you take whatever the government rations out for you, or else leave the country to buy it on the open market in America.

  216. Which is exactly why employer-provided insurance (which only dates from WWII) is a bad idea. We should be looking to Britain’s pre-WWII Friendly Societies as a model. We had something similar in the US, but Britain’s model has a much better name. :)

  217. I don’t think people in the UK, Canada, and other places that have universal health care see their coverage as poverty programs. Americans’ overemphasis on appearance is hurting them (and me!) far more than “socialized medicine” ever could.

  218. Good article. But you overlook another essential point: Even if you maintain your job, and your company still provides “health care coverage”, you won’t really know how adequate that “coverage” is until you become seriously ill or injured.

    A lot of us walk around thinking, “No problem. I have health insurance. I’m protected.” Nonsense.

    Did you know that insurance companies frequently cancel policies as soon as they hear someone gets very sick?

    Did you know that insurance companies will usually refuse to pay for the treatment or surgery your doctor recommends?

    And, did you know that because of insurance industry-invented terms like “co pay” and “yearly limit” and “lifetime limit” and “procedure limit”, even if you “have insurance” you could still end up paying tens or hundreds of thousands of dollars?

    I seriously hope that you or no one in your family ever gets seriously ill or injured. The worst thing about it is the illness or the injury—but the next worst thing is the fact that you can often watch your life savings be stolen overnight. All for the profit of these insurance companies that don’t produce one single thing for our economy.

  219. Shameful. Selfish. Stupid. All of these adjectives apply to your immoral and obtuse comments.

    Anyone can go bankrupt due to serious illness or injury, whether you have insurance or not.

    I know solid middle class families who lost absolutely everything due to no fault of their own. What was their crime? They had the audacity to become seriously ill, or their child did.

    And the insurance companies effectively laughed in their faces.

    No matter how good your job, or how many degrees you hold, or how hard you’ve worked, any American can go bankrupt due to our private, for-profit “health insurance” system, that makes money off of people’s medical needs.

    I seriously hope you never get seriously ill or injured. But if you do, you’ll then see how the insurance companies “take care” of you, after you’ve paid them, every month, for years. It’s very typical to get a bill for hundreds of thousands of dollars, even when you “have insurance.”

    People who claim that only “the lazy people” will go bankrupt over medical bills need to wake up and smell the reality.

  220. I prefer the present system of rationing where a business school flunky at the HMO decides who gets to live (hint: how much does it cost?).

  221. Let’s name ours “happy care”!

  222. watch your life savings be stolen overnight

    And this is a problem– why?

  223. I agree. The responsibility should fall squarely on the shoulders of people who are unaccountable.

  224. Progressive taxation is not logical. It assume that not only should we tax the rich at the same rate as the poor and middle class, we should tax them at a HIGHER rate. And yet if they didn’t want the money, why did they bother to earn it? Taxing them at a higher rate can only give them a lower incentive for the most productive people in our society, who employ the most people.

    And what do they do with their money? They INVEST it, usually back into their own business, but into the general economy as well.

    Progressive taxation is taxation of capital. If you ask any economist, they will explain that taxing capital is eating your seed corn.

    If you want to understand that progressive taxation is unfair, then give four pennies to one boy, and eight pennies to another. Then charge the first boy a penny for some candy, and the other boy three pennies. When he objects, and surely he will, tell him “but you have twice as much money.” If he can do simple math and then says “But that’s not fair! I should only be paying twice as much”, you can then try explaining how it’s “no hardship” for him to pay three times as much.

  225. Ultimately, we should have a more efficient health care system. How to get there? Should we get the government’s tentacles OUT of the health care system and let the free market do its work? Or should we form a great big monopoly which pays all of our health care bills? Or perhaps I should say “some”, because you know it’s going to limit the amount of health care.

    Which is more efficient: free market competition or monopolies?

  226. The reason why profit-making insurance companies are a problem right now is because the people paying the bills are NOT the people receiving the services. When companies have to pay the bill for patients, then OF COURSE the insurance companies will view good customer service as optional — because the customer doesn’t need to be served well. The customer (the corporation) isn’t the one getting the service.

    That’s why we need a free market health care system rather than the corporate / insurance health care system we have now. We NEED change, but it has to be the right kind of change. Moving from corporate / insurance to government is jumping from the frying pan … well, not exactly into the fire, but into a *different* frying pan.

    Free the patients!

  227. Fortunately, the U.S. doesn’t have this horribly unfair system of progressive taxation. Warren Buffet commented recently that he pays a smaller percentage of his income in taxes than his secretary. Now that’s fair!

  228. You can be rest-assured individuals in individal plans now get worse service than corporations.

  229. I’ve always thought that was the cruelest part of COBRA. You have virtually no income, but your former employer is so generously letting you stay on the plan at a price RIDICULOUSLY higher than the premium you’re paying when you ARE employed? Where is that addition money supposed to magically come from, anyway????

  230. How about a free market monopoly. Private insurers with no competition between plans. Sort of like what we have now but more so. Instead of paying 30% of every health dollar in administrative costs, we can pay 90%.

  231. “Free market types hate single payer until they get cancer and lose their jobs and their coverage.”

    Well-spoken! My mother, a cancer survivor, whose treatment cost my father’s (her husband’s) insurance carrier WELL into the 6-figures (they paid… are you ready? wait for it… a $20 co-pay. OMG.), is against national health care. It’s as though HER cancer is more deserving of treatment than someone else’s! And it’s not even HER insurance… she’s “married in.”

    I have an employer-sponsored plan and I STILL pay the first $5000 of family medical expenses each and every year. She had a $20 co-pay.

    The Baby Boomers will eat us alive until they die.

  232. Having been involved in the current “debate” about reforming health care and following a career as a human resources executive (and having to develop various benefit packages), health insurance was the most challenging area. Over time our offerings of health insurance as a part of our benefit package took more of our payroll dollars that any other benefit and caused the most problems for our employees.

    Most of the time the famous Blues (Blue Cross/Blue
    Shield or BC/BS – a name that the Blues did not like – I wonder why?) who also handled our “reimbursement” payments from government programs. They would use this leverage to assure that we did not change carriers (shop around for a better price and better coverage) or they would hint that they could effect our income – never stated in writing but made well known by the Blue’s reps.
    Now after studying health care reform I find that more and more companies do not offer health insurance at all or if they do, it is a high deductible and high co-pay plan. I also question the statements about employer provided health insurance – with many people out of work and COBRA payments mostly unaffordable, these unlucky people just hope that they remain well enough so they will not need care and that their children remain healthy as well. Many of my young acquaintances do not buy health insurance because they are healthy (at least at this time) and do not feel the need to spend their income on something that they will not need – now.
    If the reasons for the high cost of the current health insurance policies is analyzed, a good portion of the premiums paid go to the profit of the health insurance company and to pay their executives and to build extremely nice buildings (has any one ever seen a shoddy Blue Cross/Blue Shield company building?) Have you looked at the insurance companies’ marketing materials – they usually are prize winners at health insurance industry annual meetings and are sent out like junk mail to every one who ever owned one of their policies.
    One other place to look for saving a lot of money is in the process of collecting the money that the hospitals and clinics think that they are owed – called the “costs to collect”. In addition there is what Professor Merton Bernstein of Washington University Saint Louis calls the “Big Leak” the time that is spent matching up the procedure done on or to a patient with the policy that the patient has in force. And along with this, the time it takes to receive “prior approval” or to get this approval before you can get the needed treatment.
    One last example of how far a hospital (and most likely clinics too) go to get their money – at one hospital for which I worked, the owner of a local collection agency would appear every two weeks to get the list of patients who have fallen behind in their payments so he could begin the “collection” process immediately.
    There are many horror stories about the American health care system, but the one that sticks out in my mind is the lady who had breast cancer and who needed a double mastectomy to survive was required to have $35,000 account in escrow (not borrowed) in the bank before the surgeon would even schedule her surgery. This lady was fortunate and found someone to give her the $35,000 and she survived…this time.
    To solve the health insurance problem we need to have a system that is funded by (that dirty word) “taxes” that would pay for every procedure that the patient (a real person) and her or his physician decides is necessary without any one else reviewing this decision, we would have a better country, we could compete with the “low cost” countries and we would have fewer bankruptcies and our mental health would improve a lot.
    Or we could keep on talking about reform and doing nothing – the result would be your best guess!

  233. I think the “rich” should be willing to pay an outsized portion of taxes for those things which allow them to enjoy their property. They should be happy to pay a lot more for effect policing, for a uncorrupt judicial system, for high quality regulations of properties (SEC, FDIC etc). But what special interest do the “rich” have in health care? There is a strata of society that is so impoverished that they clearly need assitance from others, but I have read figures as high as 7 times poverty level to receive subsidies. If families with incomes that high think they need a subsidy to pay for health insurance, then I question how valuable it really can be. Try this thought experiment: write the law so that you can get a subsidy, but only if you don’t purchase cable/satellite TV service. Do you think people are going to say “That makes sense. My family’s health is more important than TV service.”?

  234. I think you’ve proven that even moms (let alone freemarket types) who get cancer still don’t want other people to get treatment.

  235. Your point is moot. The rich don’t pay taxes.

  236. Eric obviously you feel strongly about your freedom of choice and your opposition to health care reform. Please provide me with a link to any current proposed health care bill in the House or Senate and list the exact Bill#, Title#, Subtitle (if applicable), Part# (if applicable), and Section# that you is concerning to you and I’ll be happy to read it myself to familiarize more with the specifics of what you are talking about. I’ve read a couple of the Bills myself and can’t find any of this information about specific limitations on being able to choose your own insurance company, doctor, and hospital. I appreciate your help. Thanks.

  237. Dr. Frankie:

    1. You think Medicare is means-tested? You might consider doing some research on that point.

    2. Assuming that the insurance industry is funding the astroturfing (as opposed to the Republican party), they’re trying to pull the bill right as far as they can. Or did you imagine they were negotiating in good faith?

  238. The nature and effectiveness of the competition to which the insurance companies will be subjected is very much an open question — since “public option’ really only exists as vague talking points, and its proponents are unable to point to a single example that proves their claims for it.

  239. If you think the problem is guaranteeing the insurance companies profits by forcing millions of Americans to buy junk insurance or break the law, then the “public option” on offer is a fine solution.

    If you think that the problem is getting similar health outcomes as the rest of the industrialized world, for about half the cost, then the “public option” on offer is no solution at all.

  240. You do too have insurance! I will admit that commercial insurance is term insurance with limited guarantee of renewal- but it is insurance (Insurance, in law and economics, is a form of risk management primarily used to hedge against the risk of a contingent loss. Insurance is defined as the equitable transfer of the risk of a loss, from one entity to another, in exchange for a premium, and can be thought of as a guaranteed small loss to prevent a large, possibly devastating loss.) Medicare on the other hand is not insurance at all—It is a Law! the transfer of risk in Medicare is not equitable. Medicare pays Doctors at well below market rates, rates that often do not even cover the overhead costs of the Doctors. Quality of care will be drastically cut if the whole country goes on a system like Medicare. Medicare does limit what can be done like commercial insurance. My Father-in-Law’s life was probably shortened because when he first broke his hip he did not qualify for a hip replacement–only a pin (8-12 weeks bed rest required)–so we delayed his treatment to “medically stabilize” him. After 3 days waiting the bone had moved enough that he qualified only for a partial hip replacement, not the full hip replacement that I (a family physician) and his orthopedist thought he needed. The partial surgery did not do well, 2+ months later he needed the full Hip replacement that we wanted to do in the first place. Pain and inactivity had caused 40+ lbs of weight loss and he was never able to get out of bed much again, and of course he did not qualify for the tube feedings that might have given him enough protein and calories to regain some muscle until he had lost another 30 lbs. When he finally qualified for the tube feedings he started them but after a week decided to stop them and go into Hospice instead…
    He died of Malnutrition due to pain from a hip fracture.
    There is real reason to be afraid of “Government run Health Care”.
    Some people say that health care is a right and should be available for free.. many of us know there is truth in the words “You Get What You Pay For”.

  241. 102% is the maximum

  242. Yes, because while the public option works to halve costs in every other civilized country in the rest of the world, it can’t in America. Don’t ask why, it just can’t.

  243. Mark, perhaps you would like to explain to the readers out there in cyberspace how you, a family physician, could not save your own father from malnutrition.

  244. Here is a plan that keeps free market competition, choice, and innovation alive, while insuring all Americans have access to affordable (subsidized only when needed) real insurance.
    First plans that won’t work- Employer Mandates will not cover everyone. Employer Mandates cause waste. Do we have to double cover the person with two jobs? Does your employer have to cover you even if you have insurance from your spouse or parents?? That would waste Billions, and cause employers to cut jobs, or alter jobs to avoid falling under the mandate. \

    Government Plans will disappoint us. The government ran out of money in 4 1/2 days in the Cash for Clunkers program. They will do no better if they take over management of our health care.

    Now for a plan that is fair, and would work!!! Medical costs are 15% of GDP- everyone is going to have to pay or it will not work. If you think it should be free-you will get what you paid for.

    First- Head of Household should be responsible to obtain commercial insurance to cover everyone in the household. They could get it from their employer or their spouses employer, from family, on the open market, or allow church congregations and other community groups to form insurance buying groups. Cost for an individual policy would also drop if all of the uninsured had to buy it in a competitive insurance market place. The fact that health insurance is optional makes individuals buying insurance a self selecting high risk group (The healthier a person is the more likely they will opt out).

    If the head of household did not have insurance on them self and their dependents then 10% would be held out of their income. For the 10% withholding HOH could select from the most popular commercial insurance plans in their county. The rest of the premium would be subsidized out of tax dollars. A person making twenty four thousand dollars a year could get a $700-900 policy for only $200. When they got a raise to 36K a year it would cost them $300, and eventually between 60K and 100K a year they could buy a policy for less than 10% and then they would no longer have the money withheld. If an employer was able to obtain insurance for them then the 10% would no longer be withheld. This would put pressure on employers to either have benefits or pay more because they did not. People would be encouraged to work, and improve their position, instead of struggling to keep earnings low enough to qualify for the government subsidized plans. I know of people who have turned down promotions and raises, and limited the number of hours they worked, because if they earned a dollar more their family would loose the state medicaid “insurance plan”. Medicaid only insured they would stay in poverty and dependent on the government handout. (And maybe it insured a vote for the politician who promised to keep those troubled medicaid plans alive).
    Current government plans insure that when someone has climbed 3 rungs up, to get out of the pit of poverty, that the ladder will be pulled out from under them.

    Taxing health benefits to pay for health care is a stupid idea! If people have commercial insurance they are paying 100% of their own way in the health system. Leave them alone! If you tax them and their employers to pay for health care for the people and employers that are not paying for their own care you will force the employers who have sacrificed to do the right thing and help buy insurance to drop it! I know of people who left jobs with benefits (Insurance and retirement match) to work somewhere without benefits for only 50 cents an hour more. If the government increases the income taxes of the employees who are working for their own benefits to pay for the health care costs of the people who left for 50 cents and hour we should be very angry.

    There should never be a time in our government tax and subsidy programs when earning a dollar more means you take home less than if you hadn’t earned that dollar! There should never be a time when doing the right thing is taxed more than doing the wrong thing!
    Many government assistance programs actually pay more if people make bad choices. When I was in medical school my wife and kids qualified for food stamps and WIC. The Social Worker actually told my wife that if she left me (“that Medical Student Husband who had no income”) that she and the kids could qualify for rent subsidy and aid to dependent children payments of more than a thousand dollars a month. We have good reason to be wary of Politicians Bearing Gifts.

  245. When the pain was too great for my father-in-law -because he did not get the right operation in the first place- his appetite was suppressed. Also he was nauseous because he needed high doses of narcotic pain medications. Medicare would not pay for the tube feedings at first because he didn’t qualify under their rules. After he had lost 70 lbs he did qualify but by then he was too weak to get out of bed and this inactivity further suppressed his appetite. Also as a relative my direct supervision and control of his care is limited. As his condition worsened he was transferred to a hospital away from where we live. I spoke to the doctors there, but they either did not listen to our concerns about his nutritional status, or as mentioned above he did not qualify at that time under medicare rules. If he had commercial insurance, maybe I could have written a letter and gotten an exception to the rules, but that doesn’t happen with medicare-either you qualify for the treatment or you don’t– When it takes an act of Congress to change the rules nobody bothers.
    Was your question a search for more information? or an accusation?
    My point was that James Kwak in his article at the top of this blog implied that medicare didn’t have the bothersome rules and partial coverage like insurance companies do. I know that medicare rules and the paperwork to go with them are as bad or worse than the insurance company rules (this does not mean that I like the insurance company red tape either).

  246. see my post farther down. Socialized medicine has serious problems also. We have better access to medical care in this country than most of the world does. Canada has one of the better Socialized systems in the world, but I have had patients who brought their parents down to the US and paid cash to get a stress test after they had been to the ER for chest pain, because it was going to be 4-6 months wait for them to get a stress test in their part of Canada. A threatened Heart Attack- and emergency here for anyone and it was going to be months waiting. We need to do something–But many of the proposals I am hearing will destroy the good things in our system. I am an employer who sacrifices to select and provide insurance for my family and our employees (they work hard for it too), I am a consumer, and a health care provider who deals with the red tape of the insurance companies and the Medicare and Medicaid plans. Insurance companies hassles may be bad, but government hassles are worse.
    Congress passed a law that all doctors would have one ID number for insurance claims–to make it easier and less complicated doing claims– The only “insurance” that doesn’t follow the rule is Medicaid.
    We can keep Medicare or replace it with the plan I suggested below–either would be fine.

  247. Mark F MD,

    Why was your father in Medicare in the first place? Why was he not being cared for in the private health care system?

  248. tmullins,

    Thanks for your courage in sharing your story. I hear your anger and sadness. My thoughts and prayers go out to you. Best of luck with your website.

    I’d like to share one of my fables with you. Here it is,

    Let’s not dispair. Consider the Butterfly Effect:

    “the idea that a butterfly‘s wings might create tiny changes in the atmosphere that may ultimately alter the path of a tornado or delay, accelerate or even prevent the occurrence of a tornado in a certain location. The flapping wing represents a small change in the initial condition of the system, which causes a chain of events leading to large-scale alterations of events.

  249. Dustin-your link mentioned malpractice reform-Why was it 12th on the list? The Malpractice Lawsuit abuse crisis is one of the cracks in the foundation of the US health care system- If it is not fixed, any attempts to fix the system above it will fail.
    I would put a cap as you suggested, but also lawyers advertise that it will cost you nothing if you sue unless you win- but it will cost the defendant tens or hundreds of thousands of dollars to defend themselves even if they win. Looser should pay legal fees period. Lawyers should be paid hourly– If a lawyer wanted to take a % contingency then they should be liable for the defendant’s legal fees if they lost also.

    Also 11th you wanted to prohibit lobbying by any health related company– doesn’t that restrict Free Speech?

    Reducing administrative cost is good–do we really think the Government can do it better than private companies?

    Also I hear a lot of outrage when an insurance company makes a Billion dollars or more in profit- But if we are really spending 2.4 Trillion dollars on health care– then 24 Billion is only one percent of that– is a one percent profit margin immoral?

  250. Once you are 65 years old you have very limited choices–1)Keep working full time at a company that has insurance benefits 2) MEDICARE– with its laws and regulations or 3)buy insurance on your own–Which is not readily available past the age of 65 because Medicare is a virtual Monopoly, and as I mentioned in my other post, voluntary individual insurance plans are unreasonably expensive because individuals who buy insurance on their own are a self selecting high risk group.. as the cost of the plan goes up the healthy individual thinks they won’t spend that much on health care (Until something goes wrong) but the sick individual with expensive medications and ongoing health problems sees the plan as costing less than their care.. this drives up the average cost and the premium has to go up to cover it, as the premium goes up more of the responsible healthy people who are buying the plan decide they cant afford it and when they drop it the average cost per insured person moves even higher..etc etc.

  251. sippycupnation (love that moniker :)

    What Dr Maria Angell has to say makes sense. That with 16-17% of GDP already paying for health care, pouring more money into the system will not fix the problems. Rather she says 16-17% should be more than enough to reform the system and she is for single payer.

    I also like what Howard Dean has to say. I found this link on on FORA.tv … I haven’t checked it out yet but it should be interesting. He is for a public option that will compete with private industry.

  252. anne— It is awkward that insurance contracts require a discount from doctors. The contracts often state that the insurance company will pay X dollars or 80% of the charges -which ever is less.. This means that the doctor has to charge at least 20% more than the insurance company will allow them to be paid–and the person without insurance has to pay more than the person with insurance–. At our office we were able to partly get around this by offering a 20% discount on our services if payment is made in full on the account at the time of service. This way we do not have to send a bill to them–and since the insurance companies cannot pay until we have sent a bill to them it allows us to give our uninsured patients a discount equal to the discounts that the insurance companies get.

  253. Bankruptcy is emotionally and personally devastating. But if you think about it, when someone goes bankrupt because of health care costs, then the hospitals and doctors who gave the care aren’t going to get paid.. The home and most personal assets will usually be protected by the court, and Bankruptcy (no judgment of the people forced into bankruptcy by medical disaster) is another way that people transfer the cost of their medical care to others. For those who had paid for insurance and still went bankrupt after medical problems it can be truly no fault of their own. I Know of waitresses who get $300-400 a night in tips, Insurance is available for $225 a month and they turned it down, if they get Lupus or MS and run up thousands in bills and bankrupt on them then they acted stupidly in turning down the opportunity to get insurance at a reasonable cost, and forced other people to pay for their mistake.

  254. Silke—you mean the starving peasants under the socialist Chinese in the cultural revolution? or the starving peasants under Stalin in Russia? What many of the hard working people that you think are “aristocrats” are trying to say is that the system needs to reward good choices and hard work! Most of us don’t mind a poverty safety net, but what we see is a welfare system that can pay you more for doing less, and will pull the ladder out from under you if you start to climb out of poverty! Ben Franklin said that democracy could only last until the people realized that they could vote themselves money out of the treasury! Some of us are worried that it wont be long until more than 50% of Americans are getting more from Social Security and the Welfare programs than they pay in taxes. At that time we will just keep voting for politicians to raise taxes until more people give up and quit, then fewer will be working and we will all have less, and the remaining workers will get tired and quit, etc– Will the last person working remember to turn out the lights before you die?–Sorry this is harsh and has an angry tone– But I pay taxes on my student loan payments–A business expense–and I pay taxes on the money I send my kids for college– By the time I am done paying off my student loans I will have paid more in income taxes on the payments than I borrowed in the first place!— now if I had spent 2-3 years and 30k on my education instead of 11 years and 200k, I would have 1/10th the loans and 1/5th the income–then I could deduct the loan payments from my taxes– But it gets even stupider! If someone else went to Juliard and Spent 250K for an education and was now making 30 K a year teaching in home music lessons they could deduct their loan payments from their taxes–But wait– you cant make the payment on 250 K on 30 K a year income so their monthly payment would be reduced to the same as the person who went to community college on 30 K and was now making 30K, but it gets ever worse, if you qualify for reduced payments on your student loans due to low income, and make the payment on time for 8 years the government will pay off the rest of your loans.– the Community college student will have to make the same payment for 20-30 years sooo if you can spend the most money on the least profitable education you will get your loans forgiven, if you spend a little and get a modest income you will pay it all back tax free over 25 years, if you invest a lot of years and money on an education that gets you a job with long hours that pays well you will have to pay back the loan plus interest (Fair) Plus taxes on the loans and interest(unfair)– all so the home music teacher can get an almost free ride. —Music is great, I love it! but the tax system is unfair

  255. Silke,

    Thanks for the links you sent. I will try to listen to the program on Heidegger soon. I must say my education is deficient in philosophy. I have somewhere a book explaining Hegel. A kind of Hegel for Dummies which is quite a stretch given Hegel’s formidable reputation. I will own up here. I cannot claim I can say anything intelligible about Hegel.

    Now on another matter.

    I have enjoyed your comments. An elegant turn of phrase at times with just the right degree of wit. I am reminded of one of my favourite movies. It is called Ridicule. A period piece when wit was essential for an entree and indeed survival in the decadent court of Louis XVI at Versaille.

    Le Marquis Grégoire Ponceludon de Malavoy is a rustic aristocrat gifted with true wit who goes to Versaille because he needs financing to drain the malaria-ridden swamps on his estate. There he is pursued by Fanny Ardant in the role of Madame de Blayac. She becomes his patron but he is really in love with beautiful and brainy Mathilde de Bellegarde. It is really a delightful movie. The story ends with our hero and heroine (having abandoned the aristocracy and joining the Revolution) beginning a new life as Citizens Malavoy and Bellegarde.

  256. Anthony Craig

    There’s enough money in the system already, just take away the money grubbing CEOs, run the whole system as a non-profit, digitize records and simplify the paperwork – all of this will pay for universal health care, i has already been proved that it can be paid for in savings alone. So stop complaining and get on with it!

  257. A bit more of the story,

    The brainy and beautiful Mathilde de Bellegarde is secretly in love with de Malavoy but she is engaged to an aristocrat old enough to be her grandfather. They have a contract for a marriage of convenience. He wants a trophy wife. She wants to pursue a life dedicated to science (among her inventions something akin to scuba diving gear) and he is willing to provide the financing.

    Mathilde’s father Le Marquis de Bellegarde has of course given his daughter the best education, and there is a school for deaf children on his estate .. and on the story went.

  258. Anthony Craig

    I am from the UK and have lived in the USA for 23 years so I think I know a bit about comparative healthcare. The system here simply sucks! You think you have the greatest healthcare in the world but it is an out-right lie. If and when I get seriously ill, I’ll return to the UK. I have had the worst treatment here for the problems that I have had over the years, and it is simply not worth the money you pay. There is no quality to price ratio that can account for the appalling health care in the USA.

  259. Jerry– you said a “High portion of health insurance premiums go to profits..” I would be surprised if profits exceeded 5% of revenue in most for profit insurance companies. Other insurance companies Loose Millions or even Billions, I remember a few years ago Humanna was in the news for near bankruptcy. Many Insurance Companies (Kaiser, Group Health, and maybe Mayo Clinic?) are non profit and the insured are the company owners. If executives are Overpaid companies and individuals should switch to a company that does not have overpaid executives. The market can take care of most of these problems if people have information. Congressmen do not go onto Medicare when they retire they are some of the few who have access to a better plan.

  260. Yakkis–another quirk of medicare is that it is illegal for a medicare registered health provider to accept more than the amount of money medicare allows from a medicare patient. If Warren Buffett were to have heart surgery as a Medicare patient it would be illegal for his surgeon to accept payment in full even if Warren Buffett wanted to pay him his full fee. If a service is not covered there is paperwork that the patient must sign that they have been told that medicare may not pay for the service, and that they are willing to accept responsibility to pay for the service if it is denied. If this paperwork is not properly filled out, then it is illegal for the provider to attempt to collect or accept payment from the patient… This makes mixing treatments that are covered and treatments that are not covered awkward and tricky. This may have resulted in my father in law not being fully informed of the options he had if he were willing to pay cash.

  261. Think you hit the nail on the head.

  262. Great commentary. I spend half my time trying to get the email chain right to stop and think this through.
    It’s like invasion of the body snatchers how they blindly follow.

    One comment. I think you might be wrong about medicare. It’s costs are too high too for a lot of people over 65. I think the average is $450 a month and that doesn’t include meds. So a lot of older people can’t afford medicare completly either. I know it’s a lot more that what we co pay for employer coverage. A lot of retired and retiring Boomers won’t be able to afford health care as it is now.

    I’m guessing if we could really get a good Single Payer plan it would be a good idea to roll medicare in too if we could reduce costs for the elderly as well.

  263. There is one point that needs to be taken care of in your otherwise fine article: The people who don’t grasp that paying into the system while you are healthy is an integral part of the system working.

    I can’t tell you how often I’ve heard people complain about Massachusetts’ plan, saying they don’t like it because they are required to have health insurance, and they don’t need it, so why should they have to pay for it?

    These same people are the reason why pre-existing limitations exist. If they didn’t, if the insurance companies COULDN’T refuse anyone or exclude any condition, then why would any of us pay for insurance until we got sick? Skip the premiums, do something more sexy with that money, and then, when some sort of major illness occurs, run out and buy an insurance policy.

    I agree that insurance companies should not be allowed to drop you if you get sick, and I agree that insurance companies should not be allowed to refuse you if you’ve had continuous coverage and lose it due to loss of job or other legitimate reason.

    But it’s entirely unworkable to expect anyone insuring anyone to be “medical welfare”, standing by taking in no money from some segment of the population and then being forced to donate to those same people when they get older and sick.

    Liam.

  264. Ridge_Runner

    You and the others responding to you appear to be unaware that what you paid while employed was only a fraction of the total plan cost that is billed to your employer.

    Employer-subsidized plans are farther down the medical services food chain than Medicare/Medicaid so your cost includes costs shifted from Medicare/Medicaid to your employer’s plan, and now to you (a tax that your were kept unaware of so the govt shills could dump on the insurance companies for “overcharging” you).

    Third party payer systems, whether public or private, are a perverse way to handle medical service costs. However, given the status of the public discussions on this question, that’s what your going to get. Enjoy!

  265. Mparker–not all of Paul’s talking points were lies, But I do wish he didn’t call the President a Fascist.
    Medicare does woefully underpay for services–if I had only medicare patients I would be lucky to make $10 an hour after expenses. –Does any want their doctor making life and death decisions for $10 an hour?? Does anyone want their Brain surgeon making $12 an hour??
    Liability insurance costs, and the extra tests Doctors feel pressure to order because of the threat of lawsuits do add a lot to health care costs, and drug costs (Lawsuits are one of the main reasons drugs cost more in the US than in Canada).
    Everyone by law is guaranteed access to care at the ER, and the hospitals and ER doctors eat much of the cost of providing care to the uninsured patients in that setting.
    I do disagree with Paul on the point that employers actually pay for insurance–our company pays for our employees health insurance, and makes it available for the employees families at cost–But the employee did the work to help earn the money we use to pay for the insurance– so we (The employers) really didn’t pay for it– The employee earned it– They are paying their own way.

  266. Mark
    thank you for making me realize where there is competition in our “socialist” German system and for the umptiest time realize how often our constant complaining of our health system is just plain stupid

    Our doctors, hospitals and you name it are competing with the health insurers every step tooth and nail to get the best and most expensive cure for their patients and why wouldn’t they, that’s the way they earn their income (they do not get rich anymore but really really well-off). This is of course a strain on the system because it is in the doctor’s discretion and his alone and also his interest, kind of supremely ruling the procedure, to get the most fancy stuff for his patient even where simpler things might generate more well-being. Alternative medicine is as far as I can tell very restricted if not banned altogether but doctors are free to sell it against cash. The same probably applies up to a point to stuff not yet having been stamped evidence-based but if it should apply to one of the drugs which are quoted here in the blog as a reason to keep everything private there would probably be means to get a hold of them for those who can and want to pay for them.

    I have yet to encounter a rumour however that there is a cap to any evidence-based and therefore approved medicine and as a patient you don’t even get told the cost of the procedure to your insurer and for what purpose you would be interested in knowing it I can’t imagine. On the contrary if at all the system has to fight to keep surgeons away from patients for the benefit of the patient (hysterectomy being one example of overenthusiastic surgeons but since the media and especially the tabloids have published the figures widely again and again, women who are interested in staying whole know of their right to ask other doctors’ opinion before they say yes).

    some years ago a young politician wanted to further his career by saying that one should think about capping hip replacements for over 80 year olds – he is only now 3-4-5 years later being publicly heard again and each interview starts with him having to explain himself about that gaffe and he sure sounds apologetic. Liver transplants for alcoholics are sometimes tried to be made into a topic by the tabloids but it does not catch on

    not denying that in any system managed by a bureaucracy absurd decisions may have to be fought I cannot imagine a story like yours happening in Germany – and that in a country where for big parts of the population public health insurance is mandatory and probably the majority of the rest of the people has opted to stay in or thinks up all kinds of tricks to get in – and mind you while I was privately insured in the seventies, fighting of overenthusiastic doctors iwas much harder, while I was such a cash cow, and you better check carefully his/her incentives before you say yes to anything major.

    Oh and in the seventies a number of doctors had separate waiting rooms for private patients and they got appointments while others just had to take their chances and wait it out (nobody asks that from any patient anymore. Maybe they channel their “private” patients now independently from us public ones through their office but if so they have to take care that the public does not find out.)

    You see, we consider health care such a basic human right, that any preferment is making good headlines for the tabloidsand all the serious media also. The extra perks you can cover via private insurers like a single bed hospital room instead of three to a room and personal attendance by the Chefarzt (chief doctor) are to be had but I rather take my chances with the Chefarzt’s assistant hopefully young and open-minded than help filling the coffer of his boss.

  267. Mark F MD

    I meant the starving peasants of La Fontaine’s lifetime of course – what else could I possibly mean? For me the historical context of the time when something was written may not be neglected. If you need an image for our time create a new “non-aristocratic” one but do not peddle pre-revolution French ideas.

    I happened to glimpse that there seems to be a Disney-version of the fable – so maybe that’s the one you are all referring to – no matter how much I love Disney-movies I’d probably stay with the to the best of my knowledge to date “approved” text (for the same reason I would object going back to Aesop)

  268. Mark F MD
    maybe you can explain to me why when I buy health insurance for a vacation in the US as an over 65 I have to pay THREE TIMES the amount I have to pay for any other country with an advanced health care system like Australia for the same coverage (unlimited health care for all emergencies until transport back to Germany is hazard-free – no prior condition exluded
    in order to justify that the care you provide in the US for a heart attack or a stroke would have to be three times as beneficial as in Australia????????? Is that so?????????

  269. Actually, it’s a 5-10.6% profit margin, depending on who is talking about it.

    I’m with you Mark. The freedom of speech for industry reps to wine, dine, schmooze and then make large financial contributions to politicians while on expensive junkets should never be abridged!

  270. maybe the “right” should look to our founding father of universal health care for a model!!!

    Bismarck*) after all was as aristocratic and authoritarian in short Juncker-ish as you can imagine and he invented universal health care to successfully fight off the growing influence of the socialists and amazing enough the system is after two WWs still alive and kicking (by the way there was a social welfare system run by the Fuggers in Augsburg, financers to the empires of the time and as “capitalistic” as they came at the time – I think the by the standards of the time very decent houses they built for the poor still exist today)

    You each-for-himself advocates on this blog remind me very much of a talk I heard about Calvin “ruling” in Geneva – boy did they have freedom at the time – after they got over him it seems the Anglos took a liking to him somewhat softening the virtue parts though

    *) nick-name “the iron chancellor” – won a war against France and united Germany (possibly better he hadn’t succeeded there and we had stayed a lot of feudal somethings to be gobbled up one by one by our neighbours)

  271. Also, I want to say that it’s absolutely disgraceful how doctors can be sued over such trivial issues as performing the wrong surgery, or leaving sponges and surgical implements in the patient’s body.

    It’s also absolutely disgraceful how their malpractice insurers won’t cover their legal fees in these cases.

    What a waste of everyone’s resources!

  272. Yakkis
    as humans are fortunately fallible I check a new doctor I consult by asking a humility test question – if he has a problem giving the answer “I do not know” to a sensible question but starts instead chatting me up from high above i.e. veiling his innocence I switch to another.

    The reason for this is I want to have a doctor whom I can forgive on a personal basis should he make a mistake.

    Of course I can easily take this stand as our system of damage payments does not even compensate adequately let alone makes me stand a chance to get rich – some cases I read about or have witnessed make me think this is a major flaw and should be intelligently corrected

  273. Basic health care needs of the poor and not so poor uninsured are care for in this country, despite the lack of insurance. No one is turned away .

    I’m with you Mark again, it’s absolutely right that no one is turned away from emergency rooms. Of course, these people die much more often than the general population from inadequate care, but this is of no concern to anyone right?

  274. The idea being floated by many that insurance companies cover everybody regardless of pre-existing conditions coupled with a mandate that everybody buys insurance sounds so reasonable (and on a moral level is) but is seriously flawed. The value added that an insurance company brings to the table and distinguishes one company from another is the quality of their underwriting i.e. the ability to exclude risk and pick the ones that are likely to cost them the least. Eliminate the underwriting requirement to be a profitable insurance company and what you will end up with is gigantic marketing companies whose sole value added will be in the quality of their advertising.

    Bottom line universal coverage and private insurance companies are simply incompatible. I would note that nobody finds it in the least bit objectionable when an insurance company refuses to insure a reckless driver or home owner.

  275. now a days these insurance policies are increasing day by day will they perfectly do their jobs ..and this article is good,and this had cleared many of my doubts

  276. just heard that the biggest producer of pharmaceuticals in the world is still German BASF –
    those of you who claim that only under US-conditions innovation can flourish therefore imply that BASF doesn’t invent in any significant measure.
    Is that right so?
    Or asked the question differently is BASF’s staying the biggest based exclusively or predominantly due to producing their stuff under US-licence for patents having originated from US-companies (of course independently of where those companies have their research actually performed)?
    If that were so how then would they be able to operate under the oh so socialistic oppression they have to cope with in old Europe?

    by the way BASF’s boss said a short while ago in a radio interview that if they would have to reduce personnel due to the crisis they would of course first cancel contracts with small businesses in favour of their employed. The small businesses were encouraged and sprang up all over the place when reduction to core competence became the mantra of the managers dreaming big.
    Some of those small entrepreneurs most certainly had been brain-washed by BASF at the time how much better they would do as a free entrepreneur as compared to somebody labouring under the yoke of way to strict German labour laws and the constant meddling of the unions.

  277. Smoking has become less in USA since GOVERNMENT has had TV has outlaw cigarette ads. So now they run it to Europe and Asia, where the advertising is not shunned. How about advertising good food ads? Wishful thinking. Having come back from cleansing the body of toxins, and then looking at those ads, is hard. If only there was more organic fast food joints!! Remember we are what we advertise!!

    Seriously, having had health care and then getting a catestrophic illness, had me sell my home for loss of money, loss of savings and loss of ability to work the way I use to. Yet with my divorce I am not entitled to disability until I am 62. Catastrophic doesn’t wait until then. Can my ex husband get disability before 62? Then why can’t I? hmmmmmmmmmmmmm seems to always be discrimination, usually toward the female. Not enough females in government yet to balance it out for us in the “lost society.” But I still have health Ins. that beats me up every month I pay $700, plus still have to pay enormous testing fees that don’t ad up to the 30% I have to pay.

    When you are upper income, lose it all, and let them eat bread instead of cake attitude call me, I use to belong to this group!!!!!. Wake up and smell the onions

  278. Wake up, the cost of living thru cancer, diabetes, arthritis, and other longevity illnesses keeps the health care high for a loooooooooonnnnnnnngggggggggggggg time. Let’s ask the ceo’s of ins. companies to let go of their 73 Million they get when they retire like at Cigna! Yes? Health care is high because the Ins. companies are running the show along with their co-horts the pharmaceutical companies!!! Ins. companies are happy with all they have is 3 weeks for the patient, try 6 or 10 or 15 years of expense, lots of it!!

  279. Boy with 4 pennies and girl with 8 pennies. End of year, boy with 4 pennies get taxed for the 4 pennies and pays 33% of 4 pennies.
    Girl with 8 pennies, finds loopholes to save 5 of the pennies and gets taxed on 3 pennies and so pays 33% on 3 pennies. The more you got the more you know how to loophole

    And how about???

    Ya got it now??? Is it fair now? Oil loop holes, air loopholes, water , and oh by the way, girl and boy of country X that we are fighting against at war can own our water companies, our shore freighting system attached to the edge of our country.

    And girl pays 33% on 3 pennies, but girl and boy from country X take these companies and loophole them to not belong to this country, they bring the company to country X, even though the physicallity is here.

    My water company is owned by some french people. The shores off my state were ALMOST owned by middle east company!!! What happened to our constitution.

    So now the middle east just “Rents” our docks, ouuuuuuuuuu where is the economy of it?

  280. Do we want some Government clerk making health care decisions for us? NO WAY! I want my health care decisions made by a health insurance company clerk. Wait…. do health insurance company clerks get paid more when they deny care that my dr. says I need?

    A government run health care system would make me see THEIR doctor! My private plan lets me choose ANY doctor I want – as long as he/she is on the plan’s list. hmmm, I did have to find a new doctor when the old one dropped my insurance plan…

    If we had govenment health care, then we’d lose private health care! Just look at schools – the government took over and now EVERYBODY can go to government run schools so there are no more Private Schools! oh, wait, umm…

  281. I cannot remember a single doctor in all of my 67 year long life who would not accept patients from the German “socialistically polluted” insurance system Thus I am free to chose any doctor I want i.e. if I wanted my next severe bout of sinusitis (which I hope will never happen) being taken care of by my former specialist/surgeon/doctor about 700 kms, i.e. half way through the country away in another one of the German federal states on top no problem
    and mind you I would have to ask nobody for permission or notify anybody, not my GP, not my insurance, nobody, I would just go and see my favoured specialist, of course incurring the travel and hotel expenses. (Of course I would tell my GP but I am under no obligation to do it)

  282. forgot
    of course during that trip I would be covered for doctor visits, hospital, surgery you name it and no insurance clerk would even dream of balking, it just wouldn’t cross their mind.
    I am sure of that because I have quite often helped my colleagues from my health insurer with translations of receipts*) from foreign countries for which patients wanted reimbursement a field where the insurers have a lot of wriggling room if no contract with the other state as to the handling of such expenses exists. Every one of those colleagues from the insurer biased his/her decisions as much as possible in favour of the patient.

    In case you wonder:
    our public/private system of mixes allows companies to run their own independent health insurers, called Betriebskrankenkassen (no they had no back-up from private insurers, i.e. nothing like employer provided health insurance there).
    In the good old times they were subsidized as to fringe expenses like cost of office space etc. by the corporation. They were a lot cheaper than normal insurers and very generous. Probably that has stopped in the meantime because during one of the bouts of reform we had they were forced to become “normal” and accept not only their own employees (who could elect to stay in, if they quit) but anybody who applied (no prior condition eligible for exclusion)

    - the most important reason why this system of preferment for employees of bigger companies had to be destroyed is probably to be found in the fact that our social system originally was based on having a different one for blue and white collars – the elimination of these differences which could be found all over the social system is a work in progress since decades and was wanted by white collars just as much as by blue collars – in the old times the blue collars were forced to insure via an outfit called AOK which was also open to white collars who didn’t like it and when competition between insurers was introduced because insured with the AOK did not chose to go insurance shopping but stay with the outfit their parents had already had (maybe more advertising had helped). Now since blue collars for a lot of reasons tend to be less healthy than white collars that made the budget of AOK look more and more dismal in comparison to the others so more egalizing tools had to be introduced.

    by the way if it takes us decades to get rid of the old class system in our social security provisions in existence sind 1883 i.e. 126 years, why do you think you can fix health care in one big leap which has had it’s own development over probably 223 years
    - if you come up with a goal in accordance with your ethical standards and then take steps towards it wouldn’t that be a wiser way to go about it, not total salvation by one big leap but careful steps some big some small over and through highly entangled ground.

    besides these corporation affiliated insurers being a hard to quantify benefit they were just as independent as any other insurer, i.e. no knowledge of a condition or treatment would ever be available to the employer – I have heard of no case where this barrier was ever broken and one couldn’t avoid hearing of it the scandal would be so big that it would dwarf any other news.

    *) names carefully blackened of course

  283. there’s also an interesting twist on the side of the insurer. as you have stated, insurers really only insure the employed. that makes our employers — not us — the customers of the insurance companies.

    insurance companies are happy to insure you if you’re employed, because you had to be healthy enough to convince the employer to hire you; and if you can keep going to work, you’re probably healthy. but what if you get sick?

    answer: the insurance company wants you to die.

    i’ve said this to a number of people, who thought it was silly, because the insurance company would ‘lose a customer’. but as i said, your *employer* is their customer; and if you’d just be so good as to die, please, your employer could replace you with someone healthy and keep collecting the premiums like always. maybe your replacement would even be 26 with no dependents. yum!

    obviously, your employer would prefer that you *not* die, because you’d be taking stuff with you to the grave that they’d just as soon keep (knowledge, experience, a level of competence, etc.). and your employer might even have paid for some of your learning-curve. and of course, interviewing new candidates is quite expensive. but the insurance company would rather lose 3 months of premiums during the search for your replacement than have to pay for your bypass surgery. you can bet on that.

    the people who think their current health ‘insurance’ is fine have never been sick, and are pretty much in denial about the possbility. i think that may be the greatest hurdle to overcome among voters. ‘we’ don’t tend to become activists until we personally are hosed. i am employed, ‘insured’, and have not been hosed. but i know people who have been hosed; and it is a truly frightening scenario.

  284. Exactly correct! Which is why our corporate/insurance health system needs to be changed to a free market health system. Rather than having your employer pay your health insurance, they’ll give you the money, and you can pay it.

    What’s preventing this? Our tax code! It needs to be changed so that individual health care is just as deductible as is corporate health care.

    Once everyone is paying for their health care out of pocket, health care will be cheaper AND better at the same time.

    (yes, there are situations where people have bad luck, e.g. genetic or accidents-not-their-fault. And I’m fine with the government covering their care.)

  285. really really amazing how you people do not seem to be able to grasp that free market does not work whenever the balance of power is tilted to one side

    a sick person being in need of help is per se in an unfavourable position and it is very good if there is protection besides that being able to afford it

    and no matter how the power distribution might look while regarded when the powers of reason are unimpeded because the need for medical help is not there it will be always disadvantaging the patient once he/she is even slightly apprehensive which doctors tell me they tend to be as their blood pressure shows even during perfectly routine visits

    a person in NEED of medical care cannot be expected to be as cool as the buyer of a gadget and that holds true even for those who tend to regard their bodies as machines somehow separate from themselves.

  286. First time I’ve read something here…this article/commentary is riddled with errors and filled with far left political bias….I won’t be back

  287. Now it all makes sense – just read your praise…a veritable who’s who of far lefties

    One of the most informative news sites in the blogosphere.” — Bill Moyers

    “A must read.” — Paul Krugman

    “A terrific primer on the financial crisis.” — Arianna Huffington

  288. Wow Kevin thanks for pointing out to me who else is a fan of this blog – your list however confuses me, because

    whenever I “encounter” Bill Moyers, Paul Krugman or Arianna Huffington via columns or even better via podcast I object and do not make it to the end they get each in their own way on my nerves (exception: I heard a series of interviews by Bill Moyers with famous writers and those were really top class and totally free of his usual proselytizing)

    Do you have any explanation why in the light of the above how it can be that I regard Simon Johnson’s pieces from my first “encounter” with his Atlantic-piece so unwaveringly high and why James Kwak’s explanations seem to be so refreshingly down to earth reasonable and understandable to me?

    Seriously, how can that be?

  289. Sanjay, you hit the mark.

    The only way I can see that things can change for the better is if there is a single payer and all Americans are in the pool of insured. To have public and private at the same time is unworkable if any cost savings are expected.

    A pool of all Americans gets around the cherry picking and the dumping of the high risk folks.

    Insurance companies are for-profit. They are doing what profit making companies are supposed to do, as underhanded as they can sometimes be.

    So single payer is the thing to do, but too many very strongly entrenched oxen would be gored for that to happen, not to mention the screams of socialism heard throughout the land.

    I see a train wreck coming with no real gain and quite possibly a loss over the creaking system we now have. Things look bad.

  290. Just keep towing the party line Kevin. You’ll get your reward in …errr…heaven.

  291. I love the free market. It cures all ills. Like the banks.

  292. “It will better” Yes, because the health insurance execs will be paid more, and the shareholders will get more. Cha-ching!

  293. My private plan lets me choose ANY doctor I want

    I think you’re forgetting the part about pre-approval. You only get pre-approval if it it’s “medically necessary.” And a clerk at the health insurance company determines what is medically necessary in his sole and unreviewable discretion.

    If you’re lucky, they might let you see a nurse practitioner. Muahhhahahaha.

  294. answer: the insurance company wants you to die.

    Not true. They want you to keep paying premiums.
    They just dont’ want to pay for you to get better.

  295. Actually, you are paying three times as much for coverage that is three times worse.

  296. Here is a one sentence summary of this article: A plan to put the U.S. healthcare on par with every other civilized country will fail for the same reason America won the cold war.

  297. What? If you don’t have a house that could burn down, there is no NEED for fire insurance, but so long as you are alive, you should have a right to health insure. As with the house, if you are dead, you no longer have a right to health insurance either.

  298. how can you harmonize your demonizing anything SOCIAL with being probably the last country where the Christian faith is still thriving

    the way the word socialist/socialize is peddled by the Hayek etc. admirers is just pure demagoguery pulling the wool over the public’s eye via using buzz words that history has charged with all kinds of obscure side meanings. Come to think of it reminds me of the finance industry yelling SECURITIZED debt obligation.

  299. must defend the honour of nurses

    - the ones we had at the company dispensary were very very good not only on taking care of small injuries but also on advising whether one should bother to see a doctor or just let the pain or unease blow by

  300. must defend the coverage I get from the German insurer

    - it is perfect except maybe for them pushing too hard on getting me on that plane back home and thus out of their obligation back into the general health system but there the interest of the US-doctor/hospital should “protect” me against, after all such a care-free cash cow probably doesn’t come his/their way every day

  301. The reasonshealth care is a problem are (a)the profit motive of the insurance companies, (b)the high cost passed on to employers (ie. another added business expense), your health insurance claim can bean denied (even though you pay premiums for years w/no claims), and (d) the fact that there’s no end in sight to costs for everyone due to (a).

    So if you want to let the people who got us into this mess decide on its “reform” (like the current financial situation), just let the health care and insurance industries buy off Congress (whose health care is FREE via U.S. taxpayers) and all will continue along on the same road (to ruin).

  302. OrganicGeorge

    I was upper middle class until my 4 year health crisis. I am now bankrupt, my business is gone, I’m unemployable due to my credit rating.

    The current health system creates poverty.

  303. Dear Americans,

    It seems like if you want to have health care you should follow this plan:

    1.) Invest in the stocks of the major insurers and health care providers.
    2.) As soon as a congressional plan passes, the value of your shares will skyrocket on expectations of massive profits.
    3.) When you need health care, sell some overpriced shares and fly to a country where health care is still affordable.

  304. My mistake.

    I was referring to the fact that the American medical system achieves worse outcomes than the German one.

  305. The real question is “how can you harmonize your Christian faith with the teachings of Jesus Christ?”

  306. Yes, the irony is that nurses can be better than doctors, and residents in training better than the head doctor.

  307. Yakkis
    a wheel chair bound colleague of mine suffered a heart attack in Hawaii and he said it was just as OK as it would have been in Germany and also that he received all the extra care advised for a person restricted around the chest due to sitting always slightly bent forward because of the paralysis of his spine.

    Your system may seem mind-bogglingly complicated and diversified and terribly unjust to a pampered foreigner (not only Zweiklassenmedizin= two-class-medicine, our German horror idea but a multiple class system with very open borders especially downward) but I hope your individual doctors are still as good and even fabulous as the doctors of the air force in the Wiesbaden of my youth were reputed to be. The wives of military personnel who could go to the American doctors made us all green with envy.

  308. the really really smart choice is to ask around for a doctor who volunteered for driving with an ambulance while still a teenager or youngster or even still does it they usually know a lot better than the others how to handle their needles and knives – working under stress in an emergency situation must do wonders to the human brain and manual skills

  309. Yakkis
    I have been thinking about it now for 6 hours
    I don’t get it
    - or is it an irony/reference only an American can get?
    wouldn’t be your usual style, which I have become quite a fan of, that’s why I am asking

  310. I would like to add to this clarification that your employer is allowed to use those insurance payments as a “cost of doing business write-off” reducing profits and thus taxes to the IRS. All the while hopefully along the way getting his American dream. If his/her plan doesn’t work out, well – we will cover it, via bankruptcy .. smartly done a ladder rung will be climbed. Heard the phrase “Private Profits / Public Debt”?

    This aspect has so many tenticles I’m not going to bother here, but think about it.

    Earlier in this thread I nearly replied .. but will here .. business gets its cash from customers made possible by its employees .. when someone points out the uber-rich must pay for HC or why should we pick on only the uber-rich .. or they don’t pay taxes via loopholes .. the tax laws and accounting systems in place create this uber-rich schemes, the dream of most Americans, but rarely attainable thru truely moral means.

    Both these points are so obvious but often forgotten.

  311. I keep forgetting to tell y’all

    we Germans pay exactly the same for our health insurance whether we are single or whether we are a family with any number of all kinds of children no matter how disabled
    - the consequence is that a single hard working high-achiever has to finance the health insurance of the lazy sit-at-home procreators.

    Isn’t that plain horrible?

  312. My daughter just did a stint as PA student in Veterans Hospital, and was in awe of the surgeons there. There are great dedicated doctors who work for the VA.

    I wish we had healthcare that was one price for all. So the single person as i am pays the same as a family of 12. We are just putting in the pot as a family. If we are a family of 1 or a family of 12, I like this idea they do in Germany. Thanks for that info.

  313. The problem will not be solved in the United States until Corporate profit is removed from the picture. Corporations do nothing but skim off that pot which you as a family of one or twelve pay into. Their billion dollar profits are made after their multi million dollar bonuses and their millions in advertising and the millions they are spending every day to prevent real reform. Their profit and all those other costs come out of the money US citizens and their Government pay for health care. Why are they between me and my doctor?

  314. Good point, mparker. I wonder why the good of 300 million people (minus those on Medicare) is being blocked for the benefit of a few thousand health company execs, politicians, and lobbyists.

  315. we call it the Solidarity Principle

    and isn’t it great that those fear mongering by crying “socialized” medicine seem to be exactly the same crowd that would congratulate Solidarnosc*)=Solidarity on their success
    *)the Union by that name that punched a first big hole into communism in Poland and elsewhere)

    - but when it comes to introducing a bit of a solidarity principle into your system they yell SOCIALISM before having even thought about it, totally forgetting that it was the rise of solidarity which brougt down the “in reality practiced socialism” (real existierender Sozialismus – as communism in East-Germany was called) thus winning a battle in the cold war for the “West”

    this just as an extra remark on how free of contextual and historical knowledge their peddling of the word is – it is pure sloganeering for the purpose of Volksverdummung (making the folk stupid)
    (wow you guys sure make a lot of forgotten clichés pop back up inside my head)

  316. but the only way to get negotiating power/influence as a group is to stop this inter-group-bickering of I am an ant I will not support the good grasshopper or my individuality is more precious to me than a common good

    as I am by now convinced that you will be given no quarter from the self-defined ants those of you open to ideas will have to come up with some reasoning that makes the ants come on board (will disempower the socialists!!!) or go on with your obviously funded by no one lobbying

    the guy from the Heritage Foundation talking here to Krugman might give you ideas for possible tactics of persuasion
    http://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?i=57317413&id=214089682

  317. I hear ya Tom. I quit my private practice because I could not get health insurance. I now work at a large firm. The medical insurance at a large firm that offers pre tax deduction of medical insurance has to insure all, no preexisting conditions. I am save for now, but far from protected.

  318. I fear my bad sense of humor is rubbing off.

  319. It is often in this article that America won the cold war because capitalism vanquished socialism.

  320. what a treat, thank you!!!
    have printed it out will treat myself later in bed to it in order to hopefully get some enhanced nightmares from it
    (nightmares being the only thing that remains to the elderly single to introduce some kind of thrill into the bedroom)

  321. Their job is to convince the other 349 million people that they have all the power whereas the 349 million have none. Don’t you think they’re doing a wonderful job?

  322. Yakkis

    “I fear my bad sense of humor is rubbing off.”

    that is the inevitable price to be paid by the brilliant*)

    first they acquire fans than those fans try to launch their own success via imitation

    *) thanks a lot for all those “Oh yes that’s it” fuelled laughs I got out of you during the last days – you are so good at it that the first few times I read you I wasn’t even quite sure I had understood

  323. Thanks!

  324. The difference is you can sue a company, you can’t sue the US govt.

  325. And yet over 50% of the population pays no income tax? The top 4% pays over 20% of the total income tax revenues? The true hypocrasy of the system are Democrats stumping for the poor while using S-Corps to avoid paying income taxes (Edwards) or underreporting their income (Daschle). Democracy – 2 wolves and a sheep voting what’s for lunch?

  326. Anonymous

    “The difference is you can sue a company, you can’t sue the US govt.”

    Hä????
    What does “sue” mean?
    that you in the US cannot take a government agency to court?
    I can’t believe that, surely I must be something getting wrong here?

  327. anonymous is referring to “soverign immunity.”

  328. dont,

    The reason you pay so much on COBRA is that YOU are paying 100% of the cost (plus a 2% admin charge), where while you were employed the employer paid a large part of the premium. But you are dead on in pointing out that few unemployed people can afford COBRA, even with the help the government is now providing under the stimulus.

  329. Yakkis must not have read Buffett’s article. He was saying how unfair the system is because on his capital gains and dividends he pays 15%, while his secretary likely pays 28% on her salary PLUS 7.65% for FICA. He need not pay FICA on dividends or cap gains. Also, most wealthy people receive a lot of TAX FREE income from muni bonds. A person with $500,000 in capital gains and a $1,000,000 in muni bond interest, pays $75,000 in federal income tax — 5% of his total income. A person with $100,000 in earned income will pay over $20,000, including FICA.

  330. I’m not sure how it happened, but we seem to have lost sight of the fact that the biggest government-run health program, Medicare, is going broke. So why would anyone think that a new, bigger government health program is going to fare any better?

    But the truly scarey thing is that if the government picks up a bigger percentage of the healthcare bill, it will feel justified in imposing new and oppresive “lifestyle” taxes in an effort to control peoples behavior and reduce it’s costs.

    And as the government imposes new taxes even fewer people will be able to afford their own health insurance and they will be forced into the so-called “Public Option” which at that point will not be an OPTION at all. Insurance companies will begin to go belly-up (they can’t spend money they don’t have, like the feds can)and we will be left with a single-payer health insurance system run by the federal government.

    So much for freedom of choice and competition. Oh……and where is the discussion on the need for tort reform to reduce medical costs? The lawyers seem to have been able to hush that important subject up rather nicely.

  331. Don’t you think, Kent, that private insurers impose “lifestyle taxes?” If you’re over a certain age, they won’t even insure you. (“Old” lifestyle.) If you smoke, they either charge more or won’t cover you. (“Smoking” lifestyle.) If you live in an expensive area, they charge you more. (“Location” lifestyle.) And so on.

    Frankly, I would have no problem paying more tax if my insurance and medical costs were to go down as they would if everyone were covered and there were a single payer. Right now my husband and I are paying more than $1200 a month for insurance between us, and we have $6500 in deductibles. That doesn’t even count the co-pays. All in all, we’re paying 20-25% of our income to insurance companies, doctors, and labs, and we’re not sick. What can we do about it? Nothing. We’re in our late 50s and self-employed. If we try to change insurers, they’ll turn us down because of our ages.

    So much for freedom of choice and competition.

  332. Cobra ?

    The “insurance” company just stalls on paying claims, running the insured and their Doctors through layers of “representatives” and phony appeals until the 18 mo limit runs out or the unemployed stops paying the $1000/mo premium. That’s what United Health Care did to us.

    What a joke.

  333. Russell, did you not read Kwak’s article? If you did, what part of it would you dispute? Letting the “free market do its work” is what has brought us to our current situation in which health care for serious illness is impossible to afford for most people – even if they have insurance. And health insurance is unaffordable for anyone not employed by a company large enough to subsidize it or anyone not rich enough to pay a $2,000 a month premium. Furthermore, if you are lucky enough to work for one of those large companies that can subsidize the premiums of its employees, you could easily lose that job, get transferred, or find other employment where the insurance provider decides it won’t cover your pre-existing condition.

    Health care is precisely where the free market does NOT work because the consequences of demand elasticity (i.e., the “rational” decision to forego the purchase of health care because the price has become too high) are too great. Demand for health care (treatment) for serious illness is almost perfectly inelastic – i.e., if I am having a heart attack or a stroke, I am not going to choose to forego that visit to the emergency room because it’s too expensive. What if I have a raging case of TB and have no money to pay for treatment or even diagnosis? That “rational” free market decision to forego treatment has serious consequences for everyone who comes in contact with me.

    Finally, the government by definition is not a monopoly. It is not a for-profit enterprise. You free market fundamentalists live in a fantasy world. You think you are too smart to ever get sick, or ever find yourselves in a precarious financial position. What Kwak is trying to get through your silly heads is this: to get sick in America is to PUT yourself in a precarious financial position. And that is if you are lucky enough to be upper middle class. If you are middle class, getting a serious illness means being in a DEVASTATING financial position. Oh, and free market man, you WILL get sick some day. Talk to me then about your Darwinian free market.

  334. You seem to be operating under the delusion that all sickness (or even most) is the fault of the sick, and all poverty is the fault of the poor. I’m sure you are equally deluded that your own health and wealth are entirely due to your own great virtue and industry. I’m wondering, do you by chance live in Texas?

  335. The “small part of the population” that accounts for the vast majority of health care expenditures is people within 2 weeks of death. All of us will get there.

    The question is, do we want to be hooked up to respirators violently blowing us up like balloons, injected with antibiotics so that death can’t take its natural course and with 24 hour ICU? Frankly I’d rather die peacefully at home.

  336. I pay $479 a month to carry an individual policy in addition to the group policy offered by my employer. I have a “pre-existing condition” with treatment that would leave me destitute if I ever lost my job and could not get on another group plan. This is absurd, but that’s the country I live in.

  337. Our current system seems more like a cartel than a free market. If you’re lucky enough to work for a large and profitable firm, a diminishing entity in this economy, you gain the benefits of their ability to diversify the risks and bargain with insurers. Everyone else – individuals, small employers, struggling firms – is basically screwed. The current system works against the free market because it makes it difficult for entrepreneurs and small business to flourish. There are many people whose ingenuity cannot be released because leaving a corporate job, even if they hate it, puts their family at risk.

    Any solution that creates a level-playing field for all individuals is better. Some have argued for the formation of health care co-ops to cover individuals and small employers and that may help. However, all groups are still dealing with an insurance industry whose objective is to make a profit and which has a considerable administrative overhead. It’s an industry that has done far too little to deal with preventative care. While it might compete with attractive prices for a new group contract, in the second year the premiums always take a big leap because they know the switching costs for an employer are considerable. A firm can’t switch as easily from United to Blue Cross each year the way you switch from Staples to Office Depot. Frankly, I’m quite happy to let the government, as a non-profit, have a shot.

  338. Tim,

    There are umbrella policies you can get for way less than $479 a month. Of course the kicker is that they have high deductibles. But you might look into that.

    Best wishes,
    Paula

  339. I thought the same thing, lol. If you don’t have a body, then yes, you lose your right to health insurance. But for people who DO have bodies… what does this have to do with not being able to insure a non-existent house?

  340. How about if you just steal cable? ;-)

  341. next time I meet a German complaining about our health care I’ll quote this to him and you fearmongering with social-something tell your private insurers no German insurer offering private health insurance to those not bound by the mandatory system AND willing to leave it would even dream of daring to restrict his choice of doctors – how could he when the public system doesn’t do it – what an insane absurd system you let your insurers get away with but I always knew there was something wrong with market totalitarianism

    In the survey, patients were insured but saw doctors who were out of their networks of medical care providers. When patients go outside their networks, doctors have no obligation to accept the out-of-network fee from insurers as payment in full. Patients may then be accountable for the balance.
    http://www.nytimes.com/2009/08/12/health/policy/12insure.html?hp

  342. I am 62. My sons are in their mid 20′s one a college graduate. They have already had numerous employers, lapses in employment while in school, part time jobs that do not provide insurance. This is the way so many Americans of all ages work today. Each new job, insurance changes. In between employers, they are not insured. My husband was hardworking & self employed for many years while the family was growing up. I worked with him. Our insurance was exorbitant & still left us to pay deductibles & medications.
    There needs to be an option for those not employed or self employed. A smaller percentage of Americans will be working long term careers in this changing society. If a business can afford & provide health care for it’s employees, great. But we need options to take the burden off of small employers & the uncertainty from the employees. It’s true….we don’t have health insurance.
    We need a National Healthcare. To be a strong America, we need to prioritize HEALTH in all ways. An American citizen should never have to worry about healthcare – preventative, medications, major medical. Everybody’s health should be everybody’s concern.

  343. Math from other peoples numbers– 2.4 Trillion is 2400 Billion, 24 Billion would be one percent of that,,,
    10.6% may have been one insurance companies’ profit, but the industry as a whole was much less. Some insurance companies lost money– is a 5% profit margin immoral??
    or is it just a strategic reserve in case they have an unexpected number of triplets in the plan and they want to be sure they can meet the needs of the dear little babes.. I know of insurance plans that have been bankrupted by just that — Who would have guessed that 5 sets of triplets would be born in one area in just one year– 15 NICU babies and the company disappeared.

  344. Silke-
    There is some inerrant conflict of interest in most service industries–How often do you go to get a $40 oil change without being offered a new air filter, transmission flush, Radiator flush, and at least $200 dollars worth of other stuff.. you can interpret this as trying to squeeze more money out of you or as someone trying to look out for your best interest…Both can be true–depending on the shop, and the individual working there.
    The Investigative news programs like to talk about how doctors are getting rich doing unneeded surgeries. Hysterectomies are often listed as the prime example of this. I do not do hysterectomies and so do not get rich off of them, although I have been falsely and angrily accused of referring people for labs, X-rays, or surgery for some mythical “Kick-Back” (Those have been illegal since long before I went to med school). Most of my patients who have had Hysterectomies laugh at the news programs that are saying the surgery was usually unnecessary. They know the pain, or bleeding, or other problems they were having prior to the surgery, the non-surgical treatments that had been tried, and how they have felt since the surgery—Most of them say it was the best thing they ever did. Most doctors are trying to do the right thing for the patient. I try to give the best possible treatment in the most efficient way. If two meds are just as good as each other and one costs much less I try it first, but if a more expensive treatment is a truly better choice, I will recommend it.
    Our President said that pediatricians would send kids for tonsillectomy because they would earn more money, when in fact it is the surgeon who makes the money in that case. This demonstrated lack of understanding of how our system works now and that lack of understanding causes me concern. He appears to have bought into the false accusation that most doctors are money grubbing greedy heartless abusers.
    -

  345. Many of us free-marketeers are looking to get paid to shill for the insurance companies while living in Europe where the care is affordable.

  346. We are talking profits after paying billions of dollars of bonuses, cranking up reserves, paying to litigate every claim, hiring an army of actuarys, etc.

  347. I can’t believe they are bad-mouthing doctors either. Doctors don’t even earn enough to pay for their family members’ medical expenses.

  348. And I might add, after donating hundreds of billions to political campaigns and hundreds of billions more for lobbying–all standard operating expenses.

  349. Silke– Maybe part of it is because we have 3 times the number of lawyers. or 3 times the paperwork, or that the Governments in other countries may cover part of your care while you are there, or that since Medicare has a virtual Monopoly over the ave of 65 here that the insurance companies here must think that anyone buying full (not just supplement) insurance at over the age of 65 must be filthy rich???– Just some Ideas– Care here is also Expensive–Government regulations add to our paperwork, Medicare makes us fill out forms in addition to the prescription so people can get enough lancets to poke their finger or arm and test their glucose–Like people would buy extra of these just for fun! a full page paper to explain why diabetics need testing supplies–Stupid– but if the government takes over health care I fear that same paperwork for every prescription we write.

  350. Thanks for your compassion and concern.

  351. Mark F MD
    I cannot follow your car service example
    - I do not go to a shop which does not operate according to the manufacturer’s prescribed services lists so I never get asked anything, only have to give my approval beforehand if they find something broken, – quite botherfree it is – it used not to be but when the sales shops found out that they could make money by standardizing service and making the cost predictable, things improved fantastically. In the bad ol’ times especially being a woman without a man at your side a visit to the repair shop meant to go on an adventure trip.

    as to hysterectomies I repeat I am a German in Germany covered by our public health insurance and only to illustrate how you can never compare two countries to eachother here is my personal investigation of hysterectomy which I started when I found out that in the remote mountain village in the vicinity of Frankfurt where I lived way too many women had “empty bellies” often acquired while they still were in child-bearing age. And they were all happy with it for a reason besides being rid of the monthly bleeding, it meant pregnancy, getting another child or anything like that was off the table. Yes I know there are simpler procedures to prevent pregnancy but none so socially acceptable as being forced to do it due to medical difficulties.

    and our in some parts of the country presumably still persisting German “love of hysterectomy” is not based on doctors’ greed at all but on the following:

    if a doctor wants to become a gynecologist he has to have performed a certain number of operations, so when he happens to have to get his schooling at a smaller hospital he may have a problem to get enough of them fast enough, scenarios like that tend to tilt advice since human nature is what it is and I sincerely hope doctors are human and will stay so for a long time, it is one of their most endearing traits.
    So if you have a very good incentive to tilt your advice in doubtful cases and there must be lots of them and if you happen to have a rather enthusiastic clientele your chances are good you may come by your specialist certificate in time. I must add that gynecology as a topic seems sadly to have left the GPs practices altogether over here.

    In case you want to disregard my story – I used to be on very good terms with the employees of my health insurer who were kind of colleagues of mine. I got the story that it is due to the education system first from them and checked it any way I could. When I first went to my Frankfurt gynecologist he asked me what gave him the honour that I came to him from so far away. I said the empty bellies frightened me, he said “ah yes” smiled and then did his check-up, denying after having performed every check-up in the book prior to taking tissue out of a breast that there was any reason to suspect anything – the opposite by which an established female doctor in the country had alarmed me and which fortunately for me I couldn’t quite believe because everything seemed as it always had been and her manual check-up seemed to have been quite fast.

    There are wonderful reliable and trustworthy doctors but there are systems which create quirks/false incentives also and most of all you cannot compare one country to another – see car-example above
    - by the way I flee from every doctor who deems it appropriate to compare me to a piece of machinery, to date I happen to be still of flesh and blood

  352. Yakkis,
    let me know when you put it into practice so I may send you a bunch of flowers to make you feel welcome

  353. Mark
    maybe you have 3 times the number of lawyers*) I have no way to check but as to having 3 times the paperwork you really hurt my German national pride
    - nobody I repeat nobody in my lifetime has ever accused any German agency of having less paperwork than anybody else in the world

    therefore I feel I have the right to feel terribly humiliated by your insinuation

    *) your US patent law certainly has rules that provide heaven on earth for lawyers

  354. TheDarkPassenger

    Hmm. So while suffering from a severe illness and trying to recover, I’m also supposed to rush out, assemble a “Dream Team” of attorneys against your average large health insurance company, which has teams of lawyers on retainer or in-house, and sue them for care they won’t provide me with? And where will I get the money to hire my even one decent lawyer to fight an entire legal team? I’d rather take my chances with government-run healthcare. Millions of senior citizens already do, and I don’t hear loud outcries from them. But in fairness, some doctors won’t accept Medicare patients because the payouts have been reduced so much.

  355. Danke sehr fuer ihrer Gastfreundlichkeit!

  356. kim.brew@medtronic.com

    My husband and I would like to comment on Mr. Kwak’s article. My husband has been in the insurance industry for almost 30 years as have I in one form or another. I am also a Registered Nurse. I have personally been involved in watching more and more government regulations imposed on the health insurance industry and the effect that it has had in increasing the cost of healthcare to everyone, including us. My additional comments are in pink.

    The author thinks he sounds smart and is on to something…Yes we need health reform. We need to get the Government out of health care. That is the type of reform we need. (By the way, the government is the reason we have health coverage dispensed by employers in the first place).

    The author tells us we do not have health insurance. He is correct about that, but for the wrong reasons. What we have that is referred to as health insurance, is actually a health maintenance plan. Meaning every little thing we could possible have wrong with us is a covered visit to the Doctor (this is one of the main economical problems we have with uncontrollable costs). The reason for this is due to Government mandate. In the 80’s I helped start a managed care plan here in Jax. The Federal government mandates requiring the plan to offer an extensive array of benefits were incredible as well as limitations on what the plan was able to charge in premiums and list as exclusions.

    It has been illegal to sell real health insurance (meaning coverage for unexpected high cost health issues, while the insured handles all expected smaller costs, you know individual responsibility) in all of the States for almost 20 years. That is the main driver for health care cost being out of reach of actuarial stable programs…Check with the States that have tried Government backed health care, they are all bankrupt and going down fast. Oregon tried this a few years ago and has been struggling ever since.

    Our Government politicians knew exactly what they were doing in mandating first dollar coverage. It was to actually ruin the private health insurance marketplace, and they succeeded. I would have expected the economist to pick up on these real causes of the problems with health care.

    Also, the nonsense about helping out the uninsured…is a fraud. The current House health care reform bills being pushed admits that under the plan they will still have something like 30 million uninsured after 10 years. If this is to take care of the uninsured, how is that possible?? Make no mistake this has nothing to do with making sure everyone has health insurance. This is all about transfer control of health care over to the Government. We already have government sponsored programs to assist the uninsured or people at the poverty level. The sad part is that there are many people who could qualify for assistance but don’t bother to sign up. They actually have to make the effort to get their government program but they don’t bother.

    While the statement about difficulties with private individual insurance policies and the cobra issues are out there, the main reason for those difficulties are government coverage mandates. The actual solution to this huge problem was and is the individual health care accounts (which will be outlawed under the proposed “reforms”). Again the democrats/Marxists do not want the people having the power to decide what to do with their money.

    Bottom-line, people want someone else to pay for the health care they should take personal responsibility for. Heck, why do that when you can get some politicians to force someone else to pay it for you???

    Rich and Kim Brew

  357. This is a great explanation, thanks. The point about health reform being regarded as a poverty program for ‘other people’ is important. But what about Medicaid actually being a poverty program? Lifting the burden of Medicaid from state budgets seems like an all around good deal if genuine health reform was really on the table (thus eliminating a poverty program as well as complaints about it).

    I’m wondering if you can address an issue about the economic impact if this country actually did create universal healthcare and put health insurance companies out of business. Many people would lose their jobs and that would be an issue, esp for regions where health insurance companies are major employers. Would it be like the impact of shutting down a military base? Can the methods used to manage base closings be applied to manage the shut down of health insurance companies? The reason I ask is that genuine health reform threatens health insurance companies, which threatens the people employed by them, and which gets in the way of this country having a fully informed debate about all options for achieving universal healthcare. Our political leaders won’t touch this issue but citizens can ask about it. What would be the impact of this country losing for-profit health insurance companies? Can that impact be measured and can the transition be managed? On the upside, health insurance employees might lose their jobs but with universal coverage they wouldn’t lose their healthcare :-)

  358. MB,

    I am not an expert on the economic impact of single-payer, but it seems to me that there would be lots of new jobs created that could easily be filled by the displaced workers at insurance companies. I haven’t heard any discussion of this idea.

  359. Rating for that is way beyond AAA
    says great-granddaughter of a village teacher

  360. I don’t have any real disagreements with the points made in the piece above… but why the solution to the problem needs to be government run is beyond me. If the goal is universal health care regardless of health status, then why can’t regulations be written that way without creating/enlarging a government provider? I have no problem with regulating insurance companies… I have a problem with the government BEING an insurance company.

  361. Don’t worry Rich and Kim! The health-insurance lobby is on it, and they will swoop down with capes and cargo containers full of cashola, and save the day!

  362. And I have a problem with the government providing fire departments. This tends to discourage competition among private firemen, leading to lazy and inefficient government firemen who don’t even know how to hold a fire extinguisher.

  363. Right MB, and don’t forget the legions of staff that every doctor must employ in order to deal with the insurance companies. What will happen to them?

    And what about the vast battalions of lawyers who defend the insurance companies? What about the ones who make a living suing them? And what about THEIR support staffs?

    And how about all the people in billing departments at hospitals who negotiate with the insurance companies? And all the HR people in companies who negotiate with them?

    Who will stop the catastrophic deflation in the price of health care if these people engage in other productive activities?

  364. wasn’t it in your country (or was it England) where once upon a time there were private firemen companies who would compete who would get the fire sometimes getting into a fight with eachother while the fire kept burning

    so why not introducing competition to the health care system by putting an appendicitis up for auction? Never mind that the patient might die while the betting goes on as long as it would be a sure way to lower prices.

  365. Absolutely brilliant Silke. In this age of remote surgery, why not have a kind of ebay for doctors?

    http://en.wikipedia.org/wiki/Remote_surgery

  366. reminds me there was quite a brouhaha some years ago that remote hip replacements would open a new age of excellence, give small hospitals access to the market, eliminate human fallibility etc.
    If I remember correctly some of those surgeries had “little flaws” with bad consequences for the human guinea pig and it’s a long time that I have heard no bragging about this branch of technology advance

  367. There is so much more debate about this issue than there ever was about going to war in Iraq. We are a morally conflicted nation. Pump every available resource into a pointless, dangerous folly. But try and insure the uninsured?

    Riots! Brother against brother! Mayhem at the Town Hall!

    I say all Americans on Medicare and Medicaid voluntarily give up their benefits as a symbol of their dedication to the fight against demon Socialism.

  368. I agree. I am a self-employed small business owner and so is my wife. We work hard, pay taxes and are not eligible for ANY government handouts. But for Christ’s sake, let’s get it together on health care.

  369. I am replying about healthcare and the high cost. I have been married to a Family Practice Medical doctor for over 14 years and my family havn’t had any medical insurance due to the high cost. My wife has a solo practice with 3 employees including me, and the cost for a medical plan was too extreme. We have tried a plan paying over $1500 a month and it was horrible experience trying tyo see a doctor or a dentist so, we dropped it and have been paying in cash. When we planned to take the family to South America to visit family my Uncle who is a airline pilot informed me it would be best if we had a insurance plan to protect me and my wife and kids if we happen to get sick on the trip. I was informed of the bad water and germs that can be easy to catch and i once when i was single i got yellow Fever and with a bad Insurance i suffered weeks of pain. We searched two global insurance companies and decided to go with Pacific Prime which gave us a good price and made me feel protected. Actually i was glad to have a insurance but hoping not to have to use it so the trip will go well. Everything went well until my son got a bad sun burn that we had to rush him to a hosipital. His back was totally red and burning and i was a wreak worrying what we will have to encounter with the hospital and getting him treated. on the way to the hospital i called Pacific Prime’s number and was told what to do and what to say. Everything went as well as possible, i cant compare the experience to another time but everything moved forwards and my son was treated smoothly. One thing i will say is that on our next trip it will be a must to be insured before we take off.
    good luck, Luis