What Do the People Want?

To the New York Times’s credit, they asked them. And this is what they found (from the beginning of the article, entitled “New Poll Finds Growing Unease on Health Plan”):

President Obama’s ability to shape the debate on health care appears to be eroding as opponents aggressively portray his overhaul plan as a government takeover that could limit Americans’ ability to choose their doctors and course of treatment, according to the latest New York Times/CBS News poll.

Americans are concerned that revamping the health care system would reduce the quality of their care, increase their out-of-pocket health costs and tax bills, and limit their options in choosing doctors, treatments and tests, the poll found. The percentage who describe health care costs as a serious threat to the American economy — a central argument made by Mr. Obama — has dropped over the past month.

The article does cite several statistics from the poll, and does show several signs that are favorable to President Obama, including that the public overwhelmingly favors him over the Republicans when it comes to health care, and overwhelmingly thinks that he is trying to work with Republicans more than the converse. But the overall impression you get is that Americans are afraid of health care reform.

But are they?

Here are some of the raw numbers:

  • The government should guarantee health insurance for all Americans, by 55-38.
  • The government should “offer[] everyone a government administered health insurance plan,” by 66-27.
  • Insurers should have to cover anyone regardless of medical history, by 76-19.
  • It is true that 68% of people think that health care reform could limit their access to treatment; but 66% are concerned that without reform, they could lose coverage at some point.
  • Similarly, 76% think that health care reform could increase their taxes; but 75% think that without reform, the cost of their health care will go up.

It seems to me that on the most important issues, America is solidly behind the House versions of health care reform.

But although Americans favor health care reform, by 59-31 they think the current bill will not benefit them personally – presumably, as I’ve argued before, because they are under the probably-mistaken assumption that they currently have good coverage and will not lose it. Now, this does not necessarily mean they would not favor the bill. As Ezra Klein wrote a while back, the administration could have made the argument for reform in moral terms – society has a moral obligation to provide basic health care to all people, and if it costs the better-off among us a few bucks, then that’s the price we should pay. But instead, it went for technocratic arguments instead – we have to “bend the curve” of health care costs. (In 2007, people thought that universal coverage was more important than reducing health care costs by 65-31; after months of being told by both sides that it is costs that matter, universal coverage still wins by 53-43.)

So at this point, I think the key message has to be that health care reform is good for everyone (at least everyone under 65; those over 65 already enjoy the benefits of reform), because it protects you against the risk of losing your job and getting sick.

By James Kwak

153 thoughts on “What Do the People Want?

  1. A few facts that everyone must remember: a) the health insurance lobby has much more money than the other side,and they are spending it on lobbying and advertising to raise doubts, b) the status quo is fine as long as you’re not sick (and most people aren’t sick and don’t think they will be) and c) complexity is NEVER an easy sell to most people, who have little time, interest, or faith in politics, policy or the system.

    Could you ever have imagined how many seniors have been actually saying things to the effect of, “Keep the government out of my medicare?”

  2. But what, exactly, is health care reform?

    We still don’t know what’s coming down the pike. The Senate is on one track, the House on a few others. And the Obama administration itself–well, they tell us almost nothing about what they would or would not sign. How can one really be for or against health care reform when it means so many different things?

    The implications of the differences are huge. To simply extend universal coverage to the existing health care system will bankrupt the country: the costs of that over time will make the Finance Industry bailouts look paltry by comparison. There has to be effective cost control included–yet it is unclear whether that can happen.

    The insurance industry is now in full-battle mode defending their piece of the pie. We have just learned of a backroom deal with PhRMA to give them a stop-loss on any effects of reform on their profits. What else do we not yet know?

    It seems as if the special interests that Candidate Obama said needed to be removed from the system to make it work are, once again, in control of the “reforms.” It is hard to imagine that Washington will come up with anything other than delivering the entire US population as a captive audience of “customers” to the health care industry, while doing nothing that will seriously control costs or improve the horrendous quality of care we now get.

  3. Health insurance, schmelth insurance, the people want the democracy back that’s been stolen from them by lobbying interests and the filth that “serve” them in public office. Sadly, they’ll never get it back by relying on the one vehicle they ought to be able to rely on: The franchise. And to believe otherwise is just over-the-top cuckoo; the present structures are simply corrupted beyond remediation. Nope, it’s going to take mass demonstrations a la Ukraine a couple of years ago and/or something on the order of the Solidarity protests in Poland in the 1980s. Then a new constitution can be drawn up and in such a way as to be impervious to the pathologies from which we now suffer. And there will follow show trial justice for the scum that have caused it all. Next, planned reindustrialization, perhaps a five or ten year plan ordered to the recreation of what has been given away over the last two or three decades by the internationalist clique that has sought new victims, if not here, in every underdeveloped country in the world. And there will be peace, no drones over Pakistan or bellicosity toward Russia, no provocations of Iran so as to serve the cause of ethnic cleansing in the occupied territories. Then it will be that we can worry about health insurance.

  4. The majority of the people I have seen speaking out against health care reform in the so called town halls appear to be of Medicare age. In addition the latest CNN poll said it was the elderly demographic that was against the plan moreso than the younger demo. What strikes me is the elderly are the very people who have the safety net of health care no matter what. They have the comfort of being guaranteed health care, something I do not.
    I am a 39 year old father of 3. I have employee provided health care but as we have seen the job market is tenuous at the moment. As a matter of fact my employer has announced plans for 10% layoffs over the next couple of years (in addition to substantial across the board pay cuts). On top of that my premiums have increased regularly and my copays have more than doubled in the last few years.
    I would like to understand why a vocal segment of the very people who are benefiting from government funded health care do not believe others deserve the same right and sense of security.
    I am for a public plan that ensures my families access to health care at a reasonable cost without being dependent on the whims of my employer. Workers should have that flexibility and not be indentured to their employer to receive affordable health care.

  5. It’s because they are so ignorant, they don’t know what Medicare really is. That’s the answer. They don’t believe that the government is involved. It’s shocking, I know.

  6. In 1994, that last time we tried to reform health care, we were told the market could solve the cost problems best, that government should not intervene. Since that time the total cost of health care in the US has gone from 900 billion to nearly 2.5 trillion. That is epic fail of the part of the market if you ask me. Right now the market is causing disincentives for cost effective health care (for an eye opener on this read this: http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=1)
    One thing that strikes me about health care costs in the US.. If you increased corporate taxes at a 7% a yearly rate everyone would be up in arms about it making it US companies less competitive, how we’d have to move more jobs overseas. Yet in effect that is what health is costing and inflating on a yearly basis, yet there is little recognition amongst the public that this is making the US less competitive and leading to more offshoring and loss of US jobs.

  7. The arguments, moral and rational, in favor of real reform are simple and compelling, while the arguments against are on their face sociopathic and are transparently fraudulent.

    It’s telling that the MSM, always taking pains to frame things in terms of “two sides to every story” even when there is only one side, and always striving to give corpoate-friendly coverage and interpretation, has been consistently unable to do so in this case. Rather, in trying to set up their usual “pro and con” scam, they’ve been unable to come up with ANYTHING to list as a pseudo-plausible “con” for the public where it comes to a strong public plan. Rather, they’ve consistently had to admit that it’s bad ONLY for the private insurance parasite.

    So this is a testament to the intellectual and moral bankruptcy of the anti-reform racket.

    What’s even more of a testament, and this goes directly to the post, Obama has disgracefully left the PR vacuum wide open for all these months. He has refused to use the bully pulpit, refused to directly tell the people basic moral truths, refused to give basic policy primers, refused to draw a line in the political sand as to what he’ll demand of congress (not micromanaging the way Hillary did back in 93 is one thing; failing to establish basic requirements is something totally different and totally stupid), refused to call out Democaratic obstructionists and traitors, refused to mobilize the base, given contradictory statements, just completely failed to engage in any political offensive whatsoever.

    And yet for all that, for all these months that the republicans and feudal lobbyists have tried so hard to fill that vacuum only now are they starting to get any response to all their lies about “choice” and “cost” etc.

    So Obama had to work really hard at dereliction to finally allow the obstructionists to achieve this still meager result.

  8. “What strikes me is the elderly are the very people who have the safety net of health care no matter what. They have the comfort of being guaranteed health care, something I do not.”

    don’t forget.. The elderly you see worked their whole lives under the current system.. I find it odd so many young folks forget the older folks paid into this system their whole working life. They faced the same insecurities we younger folks feel now over many more years than we young folks will have to. I agree .. the system is broke but at least give the older folks some credit for dealing with this broke system over the course of their whole working life..

  9. They forgot to ask the public if they wanted a free pony! :-)

    So who benefits from ObamaCare? As I read it:

    – If you are on plain Medicare like seniors or disabled, you hope for no change. Some mythical cost control.

    – If you have Medigap insurance, I’m not sure what happens to it. It won’t get cheaper, and might get more expensive due to mandated minimum coverage limits on all insurance. Or it might go away somehow, since I think they want maximum deductibles and minimum percentage payouts. On the other hand, AARP would really lay into Congress if they messed with this, so I doubt they cut coverage. If they increased the things it has to cover (like adding mental health coverage) it would get more expensive.

    – If you are employed with insurance, you (or your employer) might also see increased costs due to mandated coverage and reduced deductibles.

    – I’m not sure what happens if you are employed with insurance and lose your job. Is there still COBRA so you can pay your existing plan? Or are you immediately fined for not having insurance, just when you become unemployed? Or are you expected to get subsidized insurance then drop it again when you get a new job?

    – If you are employed without insurance, there’s an 8% penalty on the employer for not insuring you, and a 2.5% penalty on you for not having insurance. The problem is if you make $20K a year, that’s a $1600 payment for the employer, which is cheaper than individual insurance (and a lot cheaper than family insurance), and a $500 penalty on you, which again, won’t pay for insurance. So you might lose $2100 from your salary (employer share has to come from somewhere) and still not have insurance. You get some kind of subsidy, but it would have to be a lot to put a years health insurance under $500, especially for a family.

    – If you are self-employed and have a Health Savings Account with high-deductible policy, it sounds like that goes away. The mandates for insurance make those policies impossible to write. Not sure if they eliminated the HSA program or not, but without the insurance policy behind it, it’s kind of pointless. You pay more for more insurance.

    – If you are unemployed and uninsured, you get a subsidized policy, but you of course have no money. I think you pay a penalty, but perhaps not if those are a percentage of income.

    – If you are homeless or just the type that goes to the emergency room for everything and doesn’t pay, then you probably continue to do this. They still aren’t going to turn you away, and still won’t be able to bill you. The only change is that costs which used to be padded onto the bills of the insured might now be coming from the Feds.

    – Illegals still don’t get insurance, and they are 8-10 million of the famous 45 million uninsured. Another big chunk are the unemployed, and as I said, I’m not sure what happens to them. A lot of the poor still can’t afford insurance (esp. mandated gold-plated insurance) and so aren’t covered. That’s what happened under the Mass. plan.

    So I can’t see who benefits. The cost controls are an illusion at this point, and the Feds run another 15% of the economy. Sounds like a losing proposition all around to me. When push comes to shove and they run out of money, they will ration, the way Britain is doing now. Except I don’t think Americans will take it as well. The NHS was government run from the start. Our system will still have lots of people who remember “the good old days” of private care.

  10. “When push comes to shove and they run out of money, they will ration, the way Britain is doing now.”

    That’s a red herring. The alternative to rationing (of anything) is that everybody gets as much as they want. That does not describe the current US health system, nor any other in the world, ever.

    Rationing has been here all along. The difference between us and the British is that we ration whole people out of the system. Those who are “covered” get a prepaid admission to an all-you-can-eat buffet where the staff earns commissions on what you consume. They are subjected to useless and harmful tests and treatments in abundance. Those who are not “covered” get only emergency care in serious situations–but if they have any assets they will be bankrupted as a result. By contrast, the British let everybody into the system but ration specific types of care for specific situations–they may not do it perfectly but it strikes me as a whole lot more rational and humane than what we do. The Candadian system is a bit less restrictive than the British–but they ration implicitly by queuing.

    The bottom line is that every health care system must, and does, ration care. The issue is not whether there will be rationing, but _how_ we will ration.

    I don’t think we’ll actually get real health reform this year. I fear that we will get the worst of both worlds: the financial burdens of universal “coverage” with no effective constraints on costs or improvements in quality. But if a miracle happens and something good emerges, I hope to be around for a while to remember the _bad_ old days of “market-based” care.

  11. Other really important aspects of the national healthcare reform discussion which get very little attention include:

    1. The tendency to over use very costly drugs, surgery and acute intervention strategies to treat medical conditions and diseases which do not warrant them.

    2. The tendency for many doctors to, as one doctor analogized, keep throwing sponges and mops onto the flooded kitchen floor instead of turning off the faucet on the overflowing sink.

    A video of the Senate testimony of four doctors (Mehmet Oz, Andrew Weil, Dean Ornish, and Mark Hyman) before Senators Jim Harkin and Deborah Mikulski can be viewed here:

    I found it worthwhile not only because it gives voice to credible sources who have useful medical insights, but also because it displays the frustration which some lawmakers feel when it comes to revamping the current medical reimbursement system in both private and public medical insurance plans.

  12. Markets also ration, and more efficiently and in some sense, more fairly than a government.

    After all, if you have a probably-terminal cancer, and you think there’s a drug that might help, under a market system, you could always mortgage your house and buy it. Under a government system, someone will make policy and just say “no.” No recourse except to leave your country and go elsewhere (as some British and Canadians do.)

    The other problem is of course medical innovation. Under a market system, a drug company can always hope to sell the latest thing for a premium price. Under a government system, if they aren’t approved as “cost effective” by NICE, they are out of luck. With that additional regulatory risk, on top of the ordinary commercial risks, look for less drug development.

  13. Now the DNC is deploying AFL-CIO palookas while at the same time hypocritically dismissing Obamacare opponents as paid shills -even running TV ads to slander them- and delirious SanFranNan is seeing imaginary Swastikas.

    This should make clear to anyone just what these power-drunk elitists think of your opinion.

    Note that whenever Obama, Emanuel, or Gibbs are asked about why polls show SO many people oppose their misguided Cap-n-Trade and Obamacare proposals, they ALWAYS segue-right-into “we need to educate the public…”.

    LOL- save your breath… Constitutionally-aware American patriots don’t take lectures from Marxists.

  14. Hospitals also bill extra procedures where they think they can make a profit. For example, if Medicare pays more for an MRI than it costs the hospital, then they tell their staff that “MRIs are no problem — use them as much as you like!” Those profitable procedures make up for all the other items where Medicare pays less than the costs.

    The ability of the medical providers to game the system is being severely underestimated.

  15. You didn’t give them enough credit.

    You left out over $50 trillion in debt, treating oil as an infinite commodity rather than a precious finite resource to be rationally apportioned, general environmental degadation, pumping the atmosphere full of carbon, letting the national infrastructure degrade (a $2.6 trillion dollar hole, including many literal holes), shredding the safety net (except, of course, for their entitlements, which for which they didn’t even build up what they fraudulently call the “trust fund”, but just spent every cent while writing down IOUs to themselves payable by the future), presiding over the radical concentration of wealth, assets, and corporate power, crucifying America on the car and sprawl, overextending a hideous empire and building up the military-industrial, security-industrial, police-industrial, and prison-industrial complexes…

    Yes, they, especially the baby boomers, certainly did alot of “work” here; they’re quite a piece of work.

    I think it would be a challenge to go through history looking for another campaign of looting and plunder like America’s war generational war, decades of radical scorched earth destruction waged against the future.

    the system is broke but at least give the older folks some credit for dealing with this broke system over the course of their whole working life..

    So I guess you think leprechauns or commies or some such broke it.

  16. Well, actually, yes. Government promised them they could have it all, and that it was all paid for. So many of them didn’t save a thing. Unions pushed for more and more benefits, regardless of whether it could be afforded long term.

    So I’ll give a pass to the leprechauns, but the commies…. not so much.

  17. If you look at the parts of the health care system which are more or less market driven (less insurance coverage), from eye care to dentistry, and most alternative medicine such as chiropractics, etc. you see a much lower rate of inflation. Also more choice and better service.

    It’s the regulated, insured, government provided sectors that have the worst result. They are most insulated from the customer, and thus from any cost control.

  18. They know the doctors they see are not government employees. Since Medicare comes out of their Social Security check, I would hope they know government is paying the bills.

    But they are being told that it’s all going to change. That the government is going to push them into HMO-like arrangements where they have less choice.

    This is not an unrealistic fear.

  19. Völker hört die Signale !!!
    don’t forget to listen to the MP3, really uplifting stuff and perfectly correct to consume it in German as
    Lenin had all his hopes on Germany being the first to rally to the movement and what did we do instead? go and see Cabaret http://www.imdb.com/title/tt0068327/
    and do not forget to take notice of the song “money”

    but if you are dreaming of pitch forks I recommend Ca ira – if you scroll down you find a link to it performed by Edith Piaf – that should get you into the mood http://en.wikipedia.org/wiki/Ah!_ça_ira

  20. LB – always interesting to read your thoughts, but you’ve gone off the deep end here – a new Constitutional Convention now? Pelosi and Reid are not, shall we say, quite the caliber of Jefferson and Madison – and who else would be running it?

  21. any Marxist with a bit of pride left will be outraged to hear you calling your present government – the two have nothing in common
    If you want to hurl insult at them come up with a genuine American insult instead of showing that when it comes to Marxism you are just throwing around not even half digested buzz words

  22. “As Ezra Klein wrote a while back, the administration could have made the argument for reform in moral terms – society has a moral obligation to provide basic health care to all people, and if it costs the better-off among us a few bucks, then that’s the price we should pay. But instead, it went for technocratic arguments instead – we have to “bend the curve” of health care costs. (In 2007, people thought that universal coverage was more important than reducing health care costs by 65-31; after months of being told by both sides that it is costs that matter, universal coverage still wins by 53-43.)”

    There is a serious problem with this analysis. The poll results make sense. The financial situation in the country is far worse than in 2007. Also, taxes are already going to be raised, and might well be further raised, without even figuring health care in the mix. Depending upon how these taxes work, they could be less effective than many people think.

    The current plan is better than what we have, and so I support it. But, in terms of pushing down costs, it’s wishful thinking. When you read it, a lot of the ideas put forward take place in the future. Also, it’s not being easy to explain makes sense: it’s not that clear or forceful a plan as to cutting costs.

    I favor a plan that I based upon Milton Friedman’s ideas. And yes, it offers universal coverage. It is clear from that plan how and why costs will be cut. As well, a single payer plan would probably lower costs. It’s also easy to explain, but it involves admitting rationing and problems of funding, since politicians aren’t known for making tough choices. Still, it would be better than the hybrid system that we have.

    A real debate would feature these type of clear alternatives. Without such a choice, we’ll continue to have a very costly and inefficient system. However, we should move towards universal coverage and many of the basic ideas in the bill, so it’s better than nothing.

    I simply think that some people in the middle feel as I do: Let’s pass this bill, but we’ll be dealing with this problem again almost immediately.

  23. I just don’t get Americans right now… Can someone please provide some insight for me? The country I live in has a longer average life span, spends less per capita on healthcare, and has better infant mortality rates (to name a few pertinent statistics).

    Sure, I had to wait a bit to get my shoulder operated on, but it wasn’t life threatening and didn’t ‘really’ impair my ability.. For the ‘greater good’ I would do this again.

    BUT, when my mother had a catastrophic brain aneurysm she received amazing and immediate care, which completely blew my family out of the water. She would have faired no better in the USA, the only difference is that they would be bankrupt by now.

    You leave your unemployed in a position of being ‘screwed’, you leave your marginalized on the side of the street, but expect your society to support equality and class migration.. It just will not happen without a good social safety net and this does not come for free.

    We (YOU AND ME) are better than that and it should not be that difficult to hold up your fellow man (and woman), helping them to a better place and at the same time lifting yourself.

    The USA being the Land of the Free and home of the brave?? Show some moral bravery and change the world you live in for the better. It really is not that difficult.

    Thank God that my family and I live in Canada.

  24. “2. The tendency for many doctors to, as one doctor analogized, keep throwing sponges and mops onto the flooded kitchen floor instead of turning off the faucet on the overflowing sink.”

    This is a pile of BS, how come healthcare costs are considerably less per capita in many single payer systems (along with longer lifespans, lower infant mortality, etc..) than in the USA. Abuses can be rife within any system, but don’t paint my kettle black due to your inability to look beyond a specific market system.

  25. 1. longer life span has little to do with high tech medicine. It’s public health measures, primary care, and lifestyle. If you stopped treating all cancer and just let people die, you’d only knock a couple of years off overall lifespan.

    2. infant mortality rates depend on how you categorize premies. Some countries call failure to save an early premie a miscarriage, and that changes the infant mortality rates.

    3. Our unemployed go to emergency rooms, get pretty decent care. When the hospital tries to bill them, there’s no money to pay, so it gets eaten (and the bill padded on other patients who do pay.) Not the ideal system, but not nothing either.

    4. Canada threatens U.S. drug companies with nationalization of their patents if they don’t sell drugs at the price Canada feels like paying. Canadian hospitals also dump difficult patients on the American system when they are close enough to the border. You are not paying for all the care you get.

  26. Why do you think the new plan is better than what we have? It just adds more layers of administration, and makes it even harder for patients to see the actual costs of the care they demand. I can’t see it making any part of the system better.

  27. It would be foolish to support the “reform” that will come out of this. Obama lost me long ago; he can’t be trusted. He lost his left too, from betrayals.

    So if his polls are down it is because many of his supporters are have abandoned him, not because he is too liberal, but because he is too much in the pocket of industries he should be regulating and reforming.

    I hope nothing is done on health care, because I do believe what this administration will pass is worse than nothing. So I support the protesters, even though I am on the opposite side of some of them.

    Better to do nothing.

  28. Naturally elective procedures are more responsive to market forces.. because they are elective. I wish all health care transactions could be elective, but the unfortunate reality in life is they are not.
    Also your argument takes on an air of speciousness when you compare non insurance provided health care to government provided health insurance, conveniently overlooking the costs of private health insurance. I could understand your desire to do so since Medicare costs from 1994 to 2005 increased less (102% vs 105%) than private health insurance. This is from the Department of Health and Human Services http://www.cms.hhs.gov/NationalHealthExpendData/02_NationalHealthAccountsHistorical.asp

  29. I usually enjoy comments but this group claims to know a lot and demonstrates little real knowledge of particular issues. Sorry to read James. Good post.

  30. In 1974 average per capita health care costs were $500 per annum. Thats about $1200 inflation adjusted. Today per capita costs are nearly 6 times that. The reality is the insecurities we face today are much greater than in their day. For instance I doubt the number of medical related personal bankruptcies back then come close to comparing to what we have today.
    I don’t want want to make this a young vs. old thing. But I cannot help wondering if they were raising a family today if their feelings would be different.

  31. Hi el Tombre,

    Well, that’s the whole point isn’t it. Reed, Pelosi and all the other rodents like them would be in custody awaiting public trial at the time the new constitutional convention would be convened. And I’d consider it a foredrawn conclusion that the peoples’ constitutional representatives would almost certainly choose to exclude those holding office in the present Regime both from the convention and from public service for life. Why they may even wish to go so far as to exclude family members and forebears of these slime going back a generation or two just to be sure that the problems we’ve experienced haven’t been genetic in some way. And I would suspect further that the leadership figures emerging in the constiutonal convention itself would bear some organic relation to the demonstrations and strikes that gave it birth.

  32. Which is why the whole debate should be about costs. Why have they increased and what can we do about it?

    Instead the debate is about the uninsured. They are a symptom of high costs. Most of the marketing of the health plan is about promising people MORE care, not lower costs.

    Unless we do something about costs, Medicare (and the larger ObamaCare system) will not work for much longer.

  33. I’ve read that Medicare fraud is huge, and that low reimbursement rates for Medicare shift some cost onto the privately insured. So I’m not sure you can compare the costs of private insurance with Medicare. The two are tangled up in strange ways.

    I do think that more care could be like eye doctors (why shouldn’t primary care be that way?) and less like it is now (a huge muddled bureaucracy.)

  34. Do not underestimate the power of a coordinated disinformation campaign, staged on the behalf of special interests now aligned in opposition to any public option: doctors, big pharma and insurers.

    These people will not go without a vicious fight. As has been the case since FDR, they will play dirty and they will play for keeps. Forewarned is forearmed.

    As to the tactical error of the administration not playing the moral marketing campaign – even though this strategy would have been obvious to a group of motivated kindergarten students, such insight is too much to expect from the cabal of incestuous, group-thinking Ivy Leaguers that now dominate every American administration.

  35. While you are correct that losing a job can lead to a loss of coverage, I think you should give greater notice to the fact that this problem has been at least partly addressed through state-level Comprehensive Health Insurance Pools. I became aware of them when my wife went to part time work and lost her health coverage just before coming down with a 9-month condition that made it impossible to get individual health insurance. We finally stumbled on our state’s web site describing eligibility criteria:

    http://www.chiparkansas.org/eligibility/. As you can see, it specifically provides coverage for ‘uninsurable’ individuals who don’t qualify for Medicaid or other means-tested benefits. The premiums were just over $200 a month, and the coverage, provided through Blue Cross/Blue Shield, was good. My wife’s pregnancy cost us less than her sister’s, even though her sister was covered by an employer-provided plan.

    Yes, losing your health insurance because of a job loss or a move is a problem. But it is one that is being addressed through the existing insurance market with government assistance. It’s not free, but if your income is so low that you can’t afford $230 a month for heath insurance when you have a major medical condition, you probably qualify for Medicaid. Besides, the government option as proposed wouldn’t be free, either.

    So please explain to me, in terms of having access to insurance in the event of a job loss or rescission of coverage, what would I gain from healthcare reform that I don’t already have access to through the current state program?

  36. Well, MichaelG contributed a great comment pointing out that the likely “reforms,” don’t have a constituency. It seems transparent that the real benefit will go to insurance companies. It’s the opposite of reform.

    As to other of MichaelG’s comments, they seem unfortunate market apologies, in an environment of failed markets. Still his main point holds, in my opinion.

  37. I have an issue with democracy in this case, mainly that I don’t care what the majority wants. If there was a bill that said 5% of the population would be taxed to take care of all the expenses of the government, you’d probably see a large portion of the population in favor.

    So I don’t think majority rule is terribly relevant here, we should look at what is the best method of reforming health care, and with vague assertions about the benefits of these shadowy bills, no one has done anything to convince me this comes close to it.

  38. LB: I think you should think twice about your desire for a new constitutional convention. I used to think it was a good idea also, but have since realized that the risk/reward is horrible. If the re-working of the constitution is opened, the most probable result is to move further toward totalitarianism and/or world government. Look how far we have strayed from the constitution, while it has been in place. Can you imagine the freedoms granted to the power hungry nymphomaniacs if they could suddenly change it however they wanted? The founding fathers thought that banks were the largest threat to the country they were trying to form, and look where we are now. The Federal Reserve is at bottom unconstitutional, and yet here it has been since 1913.

    If the Supreme Court had done its job of enforcing and following the constitution, instead of trying to be an agent of social change, we would be much, much, much better off. We don’t need a constitutional convention, we just need the constitution we have, back.

    When the economy has collapsed enough that the public is clamoring to be saved, when the cries for a constitutional convention are strongest, when the banks collapse again from Alt-A, ARMs, Jumbos, commercial real estate, and derivatives, and our financial system is in tatters–that’s when we’ll learn that we need a new world monetary system, a new world order, a new world government. Instead of being saved, we will be enslaved.

    As for healthcare, please take a look at http://market-ticker.org/archives/1310-Fixing-Health-Care-A-Real-Solution.html from Karl Denninger. His ideas would actually work, and don’t require an even larger federal government.

  39. Can someone tell me how much a comparable private health insurance policy in the United States would cost? See below.

    In Canada we have national health care, in the Province of British Columbia where I live, health insurance premiums are as follows:

    $54 for one person
    $96 for a family of two
    $108 for a family of three or more

    This covers every genuine major and minor illness, injury or need. For example: birth, premature birth, pediatric care, primary care, specialists, hospital care, vaccinations, cancer, stroke, dialysis, diabetes, organ transplant, HIV/Aids, broken limbs, spinal chord injury, medical imaging, catastrophic illness and injuries, palliative care. You name it.

    In addition, many corporations (public and private) will top this up with benefits including:

    – paying the insurance premium
    – providing dental, vision and prescription benefits extended to dependents
    – life and injury insurance
    – paid sick days, extended maternity leave, bereavement days, extended sick leave
    – and more depending on the employer

  40. Can someone tell me who much health insurance, in the United States, would cost that includes payment for the cancer drug Avastin?

    I was astonished to learn after some questions from Rocky Humbert (at a previous post) that there is a cancer drug called Avastin. This drug extends life by four to five months and costs $50,000.

    What I find astonishing is this drug is covered by the single payer system in my province. In other words, 100% of of residents in British Columbia have health insurance that will pay for the cost of Avastin. A $50,000 drug that will extend the life of a cancer patient for 4-5 months.

    Here are the medical premiums for a resident of British Columbia. (Note: there is no such thing as recission in the province where I live.)

    $54 for one person
    $96 for a family of two
    $108 for a family of three or more

  41. From what I’ve heard, the AMA (purportedly representing doctors) supports Obamacare, and big pharma is planning a $140 million campaign in support as well. There have been promises made.

    Look, we know that Obama is on the side of Goldman Sachs, Citigroup, BAC, etc. Don’t be surprised if it turns out (in the final analysis 10 years down the road) that his healthcare plan benefits the AMA, big pharma, and the insurers more than the taxpayers and common citizens, to say nothing of gathering more power into the hands of the federal government, and out of the hands of the states and the citizens.

  42. Here’s the link if you want to read up on single payer health care in the province of British Columbia. According to the OECD Canada spends 10% of GDP on health care and we have 100% coverage.

  43. And do those polled think that reform would not benefit them because they know, given the bank and AIG bailouts, that reform at this point is all in favor of big business?

  44. I agree Eric W, however the supreme court hasn’t been the problem. Those with political power/money see themselves as above the law. How the laws have been enforced lately basically proves this.
    The Constitution is fine, even the laws (however flawed) are fine. Enforcement of law needs to be done without regard to political or economic status.

    This also prevents the little problem of the military, who happens to take an oath to defend the Constitution. From my prior military service, I assure you the military identifies with the citizens, not with financial and political power.

  45. A friend of mine didn’t quit his job and start up his small business primarily because he was not sure whether he will be able to afford insurance for his family on his own or not. At that time about a few months ago, he used to say that the system is so bad, anything will be an improvement. But now he is skeptical that any change will be good because the message is not clear and coherent. People are not sure what to expect, and in the face of uncertainty, they are leaning towards what they are familiar with.

  46. MichaelG,

    I take it you support a market solution to health care in the United States.

    Can you tell me how much a comparable private health insurance policy in the United States would cost that is comparable to what single payer provides in British Columbia? This means no recision and includes payment for the cost of the drug Avastin. See above.

  47. Would have been much easier just to frame the debate as Medicare for all: allowing under-65 people to pay for Medicare coverage. We’ll keep comping the $9,500/person/year cost for over-65 folks if they’ll just have the decency not to complain about others paying personally.

    But that would have been too complicated, so instead we ended up with the confused situation we have now:


  48. Redleg, I’m not saying that the Supreme Court is the only problem, but one of the most basic. Yes, we need enforcement of the laws already on the books. Unfortunately, those in power give themselves waivers so that they can truly be above the law. (Paulson as announced today, that guy that headed the NY Fed for a bit, for example).

    I have the utmost respect for those in our military, as well as those who take their oaths seriously, and understand what those oaths truly stand for. Hint, hint.

  49. Medicare is due to go broke when the baby boomers hit retirement. That starts in 2011 (1946+65 years). The number of new retirees each year will jump from 600,000 to 1.6 million. Hopefully, since 65 year olds get healthier ever year, it won’t immediately break the bank. But it doesn’t look good.

    Even Congress wasn’t insane enough to offer Medicare to everyone.

  50. I’ve paid varying amounts over the years, so it’s hard to come up with a comparable number. From $200/mo to $1000/mo. More for families.

    You’d have to look at what we are spending that Canada isn’t. Possible candidates I’ve read are:

    – more obesity, more violence, more accidents (drunk driving, esp.) causing more need for medical care.

    – more treatment for expensive end-of-life diseases like cancer.

    – more aggressive treatment for premature births, giving a higher survival rate. This is separate from infant mortality, since it depends on how you count them, and how many premies you have in the first place.

    – more drug and medical procedure research

    – better pay for doctors and nurses and lots of administrators (at hospitals, doctors groups, insurance companies, and Medicare/Medicaid.)

    – fancier hospitals, with more equipment.

    – more expensive teaching hospitals?

    – more tests, both for defensive medicine purposes, and just because culturally, we’re not trusting doctors judgment as much anymore.

    – fraud, as in Medicare mills that bill millions for procedures never done and wheelchairs never purchased.

    I know everyone likes to beat up on U.S. costs, and blame insurance companies and drug companies, but those two industries aren’t hugely profitable. And costs are growing so fast that even eliminating their profits would only get you back a couple of years of cost increases.

    It’s not as if the U.S. system just burns $100 bills for fun. The money is being spent on SOMETHING.

  51. I am self-insured, thus have a HUGE stake in healthcare reform.

    I want it. I want it badly.

    Yet I’m not sure what this bill will have that will help someone like me.

    I have no idea how the “exchanges” will work. I fear that they are yet another layer of admin fees on a system loaded with such weight.

    How on earth will they force health insurance companies to insure everyone, regardless of pre-existing conditions?

    What will the government change that will make better health insurance options available to me. The language I’ve read sounds so pie-in-the-sky as to be incredible.

    How will they force insurance companies to end rescission? They cannot force banks to act in a way that reduces the risk of another crash – how will they make sure that the money I spend for health insurance will actually result in me having health insurance when I need it?

    Most importantly – what are they doing to control costs? What are they doing to eliminate inefficiencies within the system? Not much, as far as I can see. The very best way to eliminate inefficiencies and control costs is to rid the system of for-profit insurance.

    But that’s not going to happen.

    So though I’m for health care reform, I’m just not sure I’m seeing that with the proposals coming out of Congress right now.

  52. A single small piece of legislation could obviate all further discussion: repeal through legislation the 1868 decision in Santa Clara County v. Southern Pacific that held that corporation are persons.

  53. They forgot to ask the public if they wanted a free pony! :-)

    I just knew this was going to add to the debate when I read that.

  54. Insurance companies are completely regulated businesses. That’s why they can’t currently compete across state lines, or do any number of other things.

    So Congress IS trying to pass a law which means they won’t be able to turn anyone down. And they won’t be able to cancel policies or refuse coverage. And they won’t be able to offer bare-bones policies (because then they could write policies that exclude AIDS or something expensive.) And I think they are also talking about getting rid of dollar limits on coverage (many policies only pay $1 million in lifetime benefits, for example.)

    The insurance exchanges are mandated so that the government can track all insurance sales (it will be illegal to purchase one directly) and check that all these policies meet the mandated standard.

    The result of all this will be no catastrophic (high-deductible) policies, which have been attractive to self-employed people. Everything will be gold-plated, as Congress adds coverage for rare diseases or mental health coverage. Coverage will therefore be expensive.

    My understanding is that this is what has already happened in Massachusetts with their “universal coverage” plan, and in New York with its community rating plan.

    And what makes you think that when no one has any profit motive at all, they will do anything at all to control costs or improve care? Why should they?

  55. Thanks MichaelG,

    You are saying that a single person in the United States would pay roughly $2400-$12,000 a year for medical insurance that costs a single person in British Columbia $650 a year.

  56. The USA being the Land of the Free and home of the brave??

    …and the patriot act is for patriots.

  57. Yes, I paid $12,000 a year the last year I was self-employed and had to pay for private insurance. The average medical EXPENSE per person in the U.S. is something like $7000/year. I expect that’s mostly elderly and disabled people on Medicare though.

    You should check your province and federal budgets though before you assume that payment of yours covers everything. I doubt it.

  58. OK, this might be a red herring, but it also illustrates just how “fat” single payer is in Canada. Our health care system will pay for a sex change operation if a psychiatrist or psychiatric team (which is also covered by singlepayer) supports a patient’s decision to have a sex change operation.

    All of this at 10% GDP. Canada too is wrestling with apparently the burgeoning cost of health care.

  59. I would love to read comparisons of the standard of care in Canada and U.S. and what is covered by insurance vs. Medicare vs. other public systems.

    If this debate were about costs, as it should be, there would be a lot of those articles. Instead, I’m just hearing the usual yelling about how liberals will destroy the budget and socialize medicine, and how conservatives are heartless monsters.

    I’m reasonably certain that nothing productive will come out of this legislation, and that the system will just get worse. I’m still interested in the outcome though (I’m disabled.)

  60. Life span has everything to do with the medical system, how it is executed and manage (which does encompass high tech medicine, primary care, lifestyle, etc..). Sending your unwashed into a multi-payer system just provides for increased costs over time, to the detriment of all.

    Btw, thanks for the reminder that all good things only originate (drugs, etc..), I failed to recall that the USA was the cradle from which humanity will obtain its salvation (please see the tongue planted firmly in cheek).

    You put no substantive solutions forward, that addresses the failings of the US system, which means that your population continues to die earlier and spends more money to do it than we or many other countries do.

    What’s so wrong with taking care of your fellow man. Are you just so greedy that you want ‘it’ all for you?

    I just don’t get it. Maybe my naiveté is showing through, but it just doesn’t seem that difficult to me, to take care of your fellow man.

    America has the chance, right here, right now, to lead the world again, to make a true difference on how this century unfolds, but I am afraid that you’re letting it all slip away, for the sack of lining your own pockets at the detriment of your fellow man.

  61. You are defining the health care system to include not just the expensive parts (which is what we are arguing about) but the cheaper primary care AND lifestyle, etc. That kind of muddles the debate.

    It’s interesting that between 1900 and 1940 in the U.S., life expectancy increased 15 years (before we even had antibiotics!) Another 5-6 years were added by 1970. None of that is due to the expensive high-tech health care we expect now.

    We could have 1970s standard of care for 1970s prices (corrected for inflation.) That’s not the issue. The issue is how to pay for all the expensive new stuff.

    As for drugs coming from the U.S., and the subsidy that Canada has extracted from the drug companies, that’s just a fact. Sorry.

    I would push the U.S. system more towards markets wherever they could work. I think primary care could be like dentistry or eye care. Other parts of the system aren’t as simple.

    In any case, there’s no reason not to argue AGAINST legislation that you think is wrong, even if you don’t have a better idea.

    Calling people greedy and assuming they have only the worst motives hardly advances the debate. Even the most liberal of liberals understands we cannot afford to give gold plated medical care to everyone, as much as we all (including me!) would like to. It’s not going to happen. The question is how much can you do, and what do you do about the costs. Making this a debate about heartless conservatives and generous liberals doesn’t solve that problem.

    I prefer a market system for improving quality and doing the rationing. Others prefer government for all of it, including developing new medicine, delivering the medicine and deciding who gets the medicine.

    Nothing else in our economy works that way, and centralized systems have a poor track record. So I can’t get too excited about that approach.

    As for “taking the lead”, why does the U.S. have to do this? If you think Canada is superior, then you should be overjoyed that Canada has “taken the lead”.

    The U.S. is different in lots of ways from other countries, and I think that’s fine.

  62. MichaelG,

    Here is the Payment Schedule approved and payable to physicians for insured medical services provided to beneficiaries enrolled with Medical Services Plan of British Columbia. This is just the Table of Contents. Check this link for the contents.

    1. Preamble to the Payment Schedule
    2. Out-of-Office Hours Premiums
    3. General Services
    4. Diagnostic and Selected Therapeutic Procedures
    5. Adult and Pediatric Critical Care
    6. Emergency Medicine
    7. General Practice
    8. Anesthesia
    9. Dermatology
    10. Ophthalmology
    11. Otolaryngology
    12. General Internal Medicine
    13. Cardiology
    14. Clinical Immunology and Allergy
    15. Endocrinology and Metabolism
    16. Gastroenterology
    17. Geriatric Medicine
    18. Hematology and Oncology
    19. Infectious Diseases
    20. Nephrology
    21. Occupational Medicine
    22. Respirology
    23. Rheumatology
    24. Neurology
    25. Neurosurgery
    26. Obstetrics and Gynecology
    27. Orthopaedics
    28. Pediatrics
    29. Psychiatry
    30. Physical Medicine and Rehabilitation
    31. Plastic Surgery
    32. General Surgery
    33. Vascular Surgery
    34. Cardiac Surgery
    35. Thoracic Surgery
    36. Urology
    37. Diagnostic Radiology
    38. Diagnostic Ultrasound
    39. Therapeutic Radiology
    40. Laboratory Medicine
    41. Medical Microbiology
    42. Nuclear Medicine Procedures

  63. MichaelG, you write: “I would love to read comparisons of the standard of care in Canada and U.S. and what is covered by insurance vs. Medicare vs. other public systems.”

    I can answer this question based on my own experience as a Canadian. I was born and raised in British Columbia. My parents had six children and I am a third generation Canadian on my mother’s side.

    I have the good fortune to live in Metro Vancouver which is a large urban centre. In other words, sometimes people who live in remote and rural communities will need to travel to Vancouver for medical care. There are charities like Easter Seals that will provide families a place to reside if, for example, a child needs medical care in Vancouver.

    I would estimate that every Canadian has a quality of medical care that is at least equal to the average middle-class to upper-middle-class American.

    Our health care system is, arguably, 50 years ahead of the American one. At one time both Canada and the United States did not have national health care. But Canada chose a different route than the US.

    Wealthy Canadians can opt to pay for private medicine. There are some private clinics in Vancouver; or they than can opt for “medical tourism” and go abroad. US, Europe, India; where ever they want to go and can pay for.

    Canada like the United States is dealing with the burgeoning cost of medical care. No wonder with new procedures, drugs and technologies like Avastin. A cancer drug that costs $50,000 and will extend a patient’s life for 4-5 months. As I said, I was astonished to learn 100% of residents in British Columbia have health insurance to pay for treatment with Avastin.

    So at what point do we tell people they have to pay for certain treatments out of pocket. Paul Krugman puts it this way: How does society pay when there is a $30 million immortality pill? There is virtually no end to how much we can pour into the cost of medical treatment.

  64. Just glanced at it, but I love this bit:

    “The total of all billings under the codes listed in i) that are accepted for payment by MSP will be calculated for each practitioner for each calendar day. When such a daily total exceeds 50 the practitioner’s payment on these codes for that day will be discounted. Moreover, when a daily total exceeds 65, a further payment discount will be made.”

    In other words, once you’ve earned too much in a single day, your payment rate drops! Way to encourage doctors to stop working overtime…. :-)

    American doctors would tell Medicare where to put its rules if they tried that.

    Also, the numbers on the General Practice chart are amazingly low. Some of them in the under $10 Canadian range. American doctors wouldn’t even see you for those kinds of rates.

    Do you know if training is free (or subsidized) to medical students? I guess low rates would be more tolerable if you weren’t paying off a huge medical school debt.

  65. “50 years ahead!” I only hope it takes us 50 years to nationalize health care in the U.S… :-)

    Look, if you just want to have a baby, or get a broken leg put in a cast, or get a burn treated, or any of that ordinary care, you could do in it Mexico for pennies compared to either U.S. or Canadian care.

    I was in the hospital for 3 nights of observation, plus some drug thinners back two years ago. The cost to Medicare was $20,000.

    I read a blogger who was RVing in Mexico and got pneumonia. He’s in his 70s, so they admit him to a hospital there. Four nights of observations and some drugs. He paid cash, $450 US.

    So the issue is not primary care or simple treatments. Unless we are completely incompetent, we should be able to do those cheaply.

    The problem is the expensive stuff like gunshot wounds resulting in head injury requiring lifelong care. Diabetes leading to organ failure, requiring transplants. Cancer treated with multiple rounds of expensive drugs. Etc.

    We really should get over this idea that if you don’t get the absolute best care, you’ll die in the street at age 50. I would guess that 90% of the care Americans and Canadians get is the cheap stuff, and wouldn’t cause any of these cost explosions. The problem is with the rest.

  66. Apparently the average GP makes $200,000 in Canada. Specialists make more. So this is not too bad. If they want to get super-rich, in Canada, they might try working in the banking or financial sector.

    I assure you Canadian doctors would not take kindly to Americans contending that because they earn less than their American counterparts it means they must not be very good.

    The average GP in Canada apparently makes $200,000 a year. Specialists will make more.

    Under the Canadian system — income is not a barrier — to medical care. So doctors and specialists in Canada have to live with this. If they want to make more money they can move to the United States. And some come back because they find there is so much paperwork and red tape in the American system they cannot follow their vocation.

  67. I don’t think Canadian doctors are worse than U.S. doctors. I don’t think I even implied that.

    To make $200,000 a year if your entire income came at those payment rates, you’d have to be doing a lot of procedures!

    Is there a base salary as well?

  68. MichaelG you write: “The problem is the expensive stuff like gunshot wounds resulting in head injury requiring lifelong care.”

    We have gun control in Canada.

    I would estimate that 99.99% of Canadians do not want to own a hand gun. The people who own rifles are hunters. We also have criminals who are getting their guns from the United States. But they mainly kill one another and once in a while a civilian gets caught in the cross fire.

  69. There was a president of the BC Medical Association. He was leading a campaign for more pay for doctors. Then a newspaper columnist found out he had billed our Medical Services Plan for $600,000 in one year. This while having gone on two Mount Everest expeditions and was training for a third when this all came out. He claimed that he billed so much because he lives in a rural community (with great mountain climbing) and that is why he billed so much.

    In my mind, what exactly was he doing? Churning while providing high quality care? What I find even more amazing is that he had time to train for this kind of extreme sport while practicing medicine. Maybe all that mountain climbing made him super competent and full of vitality to allow him to provide so much medical service.

  70. In terms of base salary. I believe doctors who have their own offices or group practices are not salaried. But doctors who work for a health authority would be.

  71. IMHO, Canada is 50 years ahead of the United States when it comes to medical care for the following reason:

    – We have 100% coverage and we provide medical care that is equal to what the average middle-class to upper-middle-class American will receive.
    – In British Columbia a single person would pay $650 a year in medical premiums. There is no such thing as recission in Canada.
    – As a rough estimate (based on figures from MichaelG) a single American would pay roughly $7000 a year for similar health insurance coverage. But coverage is subject to recission.

  72. No not stupid and greedy. But American capitalism may need to re-examine its priorities when it comes to health care.

    I heard Republican Senator Grassley put it this way: If there is a public option it will drive for-profit insurers out of business. In my mind I have to ask what is going on here? Grassley wants to protect the right of private medicine to make money in the United States. But what priority is he giving to American citizens who need affordable and comprehensive health care?

    The United States is the wealthiest, most powerful country in the world. But there are charities that provide medical care in third world countries that are also treating the rural poor in the United States! As I said, it is possible your country has its priorities wrong when it comes to health care.

    Some might consider what is shown in this video a national embarassment and shameful.

  73. MichaelG, its past midnight, so my final comment for now.

    The Canadian counterpart to the Republican party is our Conservative party. The Conservatives share the same views with Republicans on taxation and trade (ie, tax cuts, deregulation of trade barriers, are good). The Conservatives would have most likely followed the United States into the War on Iraq. (But the Liberals were not in power then and Canada did not. Although we are in Afghanistan.)

    Canadian and American Conservatives differ on health care. Tory Senator Hugh Segal put it this way: Canadian Conservatives do not believe in equal distribution of wealth. But they do believe in equal opportunity. They believe that in order for a Canadian to achieve their potential they need to be healthy. If they are burdened by ill health and cannot pay for medical care their chances of achieving their potential and being useful productive members of society are diminished. So this is where Canadian and American conservatives differ. I was quite touched by Senator Segal’s eloquence on this matter.

  74. The Republicans have been mostly useless in this debate. Not only have they not put forward a proposal (and there are market-oriented proposals out there), but they haven’t educated the public as to what is wrong with the current system from a market point of view, or come clean about what will happen if nothing is done.

    There is evidence that Medicare drops some of its costs onto the private sector. Any primary care doctor who takes Medicare patients will complain about the reimbursement rate. Many will no longer take new Medicare patients for that reason. Hospitals are clearly over-billing Medicare and private insurance to pay for charity care.

    So it’s not unreasonable to say that if a new government plan comes along, it will grow until, like Medicare, it can push its costs off on private insurers or just refuse to pay market rates for drugs or procedures.

    From my point of view, I’d say the politicians want to have it both ways. They want all this charity care, but they don’t want to raise taxes to pay for it, since that would be unpopular. So they try to shove all the costs under the cover, onto someone else.

    And of course, it’s always easier to be generous with someone else’s money. This is why not only do they promise great care for everyone, they keep upping the minimum level of care that they want to force insurance companies to provide.

    The ironic thing about that video is that there are plenty of large cities where the emergency room is full of people who never pay. It’s just not true that Americans let the uninsured suffer. All they don’t get is preventative care. If they are willing to ruin their credit rating, they can just go to an ER and demand service. The ER won’t turn you away and they can’t get money from you if you don’t have any.

  75. “You are not paying for all the care you get.”

    well we Germans are paying for ours and are not sending patients over borders

    and as we are well known around the world for our making complaining a national pastime anytime somebody finds something to nitpick about it gets great media attention and thus I would know about

    – to date if there is a rightly outcry of scandal it is about treatment of the elderly bed-bound in some care homes
    – a neighbour of mine recently spent her last month while she was dying there and was kept in comfort and decency by considerate and mindful personnel – how many of them are not is hard to guess but the outcries are huge whenever a patient with a bed-sore is discovered so I hope the system is making progress there also

    I know nothing about the Canadian system but to say your way is the only reasonable way beggars belief

  76. well when the call of the day was to fight Fascism you were quite happy to have those Marxism-indoctrinated Russian masses on your side

    and in the years of the Nazis’ ascendance the Commies were the ones who provided the most courageous defenders of decency and one of the reasons why they couldn’t succeed was that all those “socialist” “marxist” “trotskyist” etc. groups too often preferred excluding even maligning eachother for difference of dogma to building a united front against the even before 1933 murderous brown-shirts.

    You see your throwing around Marxism the way you do proves that it is fresh from the mints of demagoguery and free of any historical context

  77. and would I object loudly and strongly to paying only half of what a family pays
    – the family after all provides the kids whose labour provides the money for my income as a (mandatorily according to law) retired as I provided it for my elders while I was still employed

    Comparing one system to another is notoriously difficult there are too many side considerations involved

    First you have to decide on what you want and then trim it down to affordable not the other way around

  78. Redleg

    the military identifies with the citizens, not with financial and political power.

    that is my feeling reading up from afar also – that’s why I try to argue in its favour wherever I can and whenever I can think of something I consider effective against the common sport of maligning the US-Soldier

  79. Yes, I’m sure Stalin would know how to handle our uninsured. They’d be no problem at all after he was done.

  80. ER No. The more people understand this unconstituitonally criminal health care proposal the more people hate it.

    Contrary to James Kwak, Scoot Rasmussen on the 7th had polls that said:

    49% of voters were against the proposal; 47% for. Among independents 60% against, only 35% for.

    63% of voters want it a priority to make health care affordable, but only 28% wanted to raise taxes. Also an overwhelming majority thought that the public option would raise taxes on the middle class.

    74% of voters rated their health care as good or excellent and 50% of voters thought Congresses’ “reform” plan would lead to a decline in their health care.

    Rasmussen said the momentum is strongly against the proposal.

    New York Times polls now have become legendary for their heavily skewed Democrat sampling, and are now totally unreliable.

    As the public becomes more informed about the repressive crimes of Obama and his SEIU goon squads, the anger will grow to a boiling point. The anger will last for a generation.

    If the insurance companies are spending so much money, where are their ads? I haven’t heard or seen one. As for “Astroturfing”, Axelrod and the Obamanazies perfected the practice. The Republicans couldn’t ‘astroturf” to save their lives; they have no ready and able goon squades to call up like the Democrats’ SEIU, ACORN or the New Black Panther Party. Those protesting the plan all to often have canes and walkers! What are you going to do, all you fine ghoulish socialists, beat up Grandma because she wants to live?

  81. just realized:

    one detrimental or beneficial consequence of having a highly uniform health insurance system in a country is that whenever an issue arises people will rally behind an opinion in greater and even huge numbers

    while when peoples’ health insurance varies as much as the US’ obviously does the power of the people to define government’s decision is greatly diminished

    this of course may lead to more wisdom (high amount of solidarity) just as much as it leads to more idiocy (like partly paid for yoga classes in Germany)

  82. if you don’t get the absolute best care, you’ll die in the street at age 50.


    I spent two full years on a Greek island of roughly 2500 people
    with besides from a dispensary with a doctor fresh from the university with no previous practical training whatsoever and the next advanced health care 12 hours away by boat if the weather allowed travel which in the winter it quite often wouldn’t and a helicopter pad which I saw never being used during that time

    Working hours in the summer were back brakingly hard with very very little sleep – all those lazy southerners napping at the harbour have been up most of the night! and will most likely work another job in the afternoon and evening – but overall health was quite impressively good – I do not know longevity statistics but to be able to die at home with lots of family sharing the burden did make some lost time of life span not such a horrifying prospect – and the islanders deficient in their knowledge of the world, their sons having travelled the seven seas to get the money to start a business and the ones who moved to Athens to make a living seemed to me as urban as they get whenever I stayed with them.

  83. of course you are neither more stupid or more greedy than the rest of us – it often seems as if on the whole you tend to be more generous …

    – systems any kind of systems whether they have grown piece by piece into a patchwork or whether they go back to an initial solid plan will grow and entangle in unexpected ways
    – to keep them within reason will always and everywhere and under all conditions be a never winnable struggle
    – think of the junk tending to accumulate in your cellar or wherever you tend to store stuff for possible future use – once in a while you will have to do something about it no matter how glorious your system of storing it was at the beginning

  84. If they are willing to ruin their credit rating, they can just go to an ER

    sounds like a horrible consequence, even punishment to me

  85. “Yes, I’m sure Stalin would know how to handle our uninsured. They’d be no problem at all after he was done.”

    that’s not an adequate answer and you are obviously smart enough to know it or are you so ignorant of history that you forgot that FDR was quite impressed by Stalin’s charms at Yalta much to Churchill’s distress who had no doubts about the guy (have we slaughtered the wrong pig he is quoted as having said)
    I am not blaming FDR for his behaviour at the time – there were US-soldiers’ lives to be spared and Stalin had command of the masses which were needed to wear the German military down.

    and by the way there is a thing called Stalinism which shouldn’t be blamed on those for example who in pre-war Germany fought and died for trying to keep society on a more humane track than Hitler had in mind.

    Any kind of belief in a big theory has the potential to get horrifyingly off track (yes even capitalism) but one should remain respectful of the people who tried to do the right thing under the pressure especially if too many paid with their life for it.

  86. With the insurance industry looking to spend $100-200 Billion on lobbying in anticipation of upcoming legislation (using my insurance premiums among other people’s), I was wondering if there was any money for going around to different blogs and posting pro-freemarket stuff.

    You know, generally disparaging the government, the idea of public health care, calling it “socialist”, making up facts or distorting them in my favor in long bulleted lits, writing long polemical replys under a variety of different pseudonyms full of talking points etc.

    If anyone knows how to go about doing this, please let me know. I’d be willing to work for a 50% reduction in my health insurance premium…actually, any little bit would help. Thanks!

  87. If there is a public option it will drive for-profit insurers out of business.

    This could never happen because private enterprise is so much more efficient than government.

  88. Yakkis
    come to Berlin as many Americans seem to be doing now, take the first job you can grab no matter how menial, but not on the black market and you are in. You then can become unemployed destitute or whatever nobody can kick you out with premiums paid by the system or easily affordable
    – if the lobby people then pay you 50 % of your US health insurance premium you should be able to make a good living after all online it doesn’t make a difference where you reside and some of the total coverage while living in Germany may even extend to prolonged visits to the US – never mind the language barrier, lots and lots of Germans will only be too glad to practice their English on you to the extent that it will be really hard to acquire even basic German.

  89. yes they urgently need disciplining those people who managed to fall of the waggon, oh sorry forgot it happens only to grasshoppers

  90. after all the restrictions and public competition they have suffered German private health insurers still seem to have ample money for ads trying to sell their schemes (daily chats with the Supreme Doctor covered etc)
    – also they still advertise for private insurances of the whole package,
    the next thing hitting them will be that they will be forced into offering an insurance forcing them to accept everybody forbidding them excluding ANY prior condition. If they do not do that they will loose their access to the market.
    After they have survived more than 125 years of this severe treatment by the public option and still want to insure more of those pampered demanding and heavily protected patients this time they will most certainly not be able to cope, vanish and leave us all at the mercy of the socialists.

  91. I don’t want want to make this a young vs. old thing. But I cannot help wondering if they were raising a family today if their feelings would be different.

    It’s not my first choice to look at it that way, but since the first commenter brought it up I felt the need to point out who created all these problems.

    And it’s a clear moral truth that no one on Medicare has any right to an opinion against extending it to everyone, or to any kind of anti-reform opinion.

    You’re either for public health care or not, for the brutal Hobbesian anarchy or not. You can’t be “for socialized medicine for my large cohort”, against it for others.

  92. Yes, it is well known among economists and other hacks that post comments, that doctors only respond to economic incentives.

  93. well I like my doctors to be people open to reason and so I pick the ones who are interested in keeping me a faithful happy patient but who are also concerned about their finances.

    I do not think that a person having secure access to a good income becomes more trustworthy if he bankrupts himself for my well-being

  94. “Didn’t Stalin come from a long line of insurance adjusters?”

    I do not know if his first “mentors” were insurers (if they even existed in the Georgia!!! of his youth or who might have been their equivalent) but Stalin learned the tricks of despotism early on in the kneecapping business
    according to Simon Sebag Montefiore

  95. if you have the grasshopper gene or genius and have painted it wildly first you might make it on that
    – oops forgot the market for modern art is about to brake down because all those recently impoverished gamblers stopped their “collecting” wholesale

  96. Decrying the European system for a living whilst living with the Berliners’ superior welfare system–the hypocrisy appeals to me.

  97. go ahead – that’s not the kind of hypocrisy I get upset by

    – as long as your judgement of human beings remains within the parameters of decency I think a system that is stupid enough to be exploitable deserves it
    – after all I am from the generation who considered cheating in school a highly valued skill (do not know if youngsters are more honorable today) a confession by which I could always send Americans into convulsions of horror.

    only I do not understand the preference for Berlin except that rents seem to be really low there
    – too many tourists, too much government, too little business

    if I were still of working age I would even today always opt for the area of Frankfurt again, not least of all because the local dialect is good for really mean commentary of the more sarcastic kind and because, believe it or not, even today peoples’ overall demeanour seems to be more relaxed more tolerant of human folly in the former US “territory”
    – as much as I prefer British literature, everyday behaviour improves when influenced by Americans.

    and one other point in favour of your moving:
    You’d find a much more willing market to gobble it up over here
    Europeans love to be criticized we have a real craving to get told that we are on a lower rung of humanity (I consider the French strutting around just a show)
    – no seriously,
    our journalist thrive on it obviously being able to sell any article demeaning our ways by pointing out how much better the Americans do it much easier than anything in favour. Doesn’t keep them from selling their next piece peddling the argument that Americans are detrimental to the well-being of the whole universe.

  98. James, I love baseline scenario, but when you wrote:

    It seems to me that on the most important issues, America is solidly behind the House versions of health care reform.

    I think you must have meant to write:

    It seems to me that on the most important issues, America is solidly behind the what they believe are the House versions of health care reform.

    There’s plenty of informed opinion that’s looked at the House Bills and seen no net positive, and a complex and unproven system.

  99. “I heard Republican Senator Grassley put it this way: If there is a public option it will drive for-profit insurers out of business. In my mind I have to ask what is going on here? Grassley wants to protect the right of private medicine to make money in the United States. But what priority is he giving to American citizens who need affordable and comprehensive health care?”

    Thank you, Tippy! It is this wildly warped sense of priorities that has been driving me crazy. The majority of Congress appears more concerned with the interests of insurance and health businesses than with those of their constituents.

    I suspect that many poll respondents who express reservations about proposed reforms do so because, like me, they really want single payer and are disappointed by Obama’s apostasy. I have yet to see a poll so designed as to examine that possibility.

    Thanks, too, for continuing to tell us so much about your admirable health care system!

  100. Note to Simon and James – stick to economics.
    Posts like this quickly (it started with comment #2) descend in radical political vitriol and are a waste of everyone’s time.
    There are blogs out there that cater to this stuff – I hope this one stays above it.

  101. I wonder how many members of the U.S. Congress, let alone the American public, have actually read the 1000+ pages of text of HR3200? I have. Frightening that lawmakers really think they possess the ability to encode into words how a person’s health should be managed. Such hubris…

    Until the question, “Should health care be a for-profit business?” is discussed, there is no real debate, only rearranging deck chairs on the Titanic. Just my take…

  102. ‘I prefer a market system for improving quality and doing the rationing. Others prefer government for all of it, including developing new medicine, delivering the medicine and deciding who gets the medicine… Nothing else in our economy works that way, and centralized systems have a poor track record. So I can’t get too excited about that approach.’

    So.. medicare, medicaid, social security, the library system, state universities, etc.. don’t count?

    A market based system always does the right thing? This is what you prepose?

    Funny, I think that’s what got this blog started, that it doesn’t alway create or define the appropriate road to take.

    The market, left to its own devices and run by private sector interest, well, it sometimes it builds a highway that manages to cause a few to many accidents, killing many along the way, destroying value, ruining societies and families (both locally and globally); all the while it is said to deliver incredible value to the captains of its marketplace.

    That sure doesn’t sound like something that’d be in the common good.

  103. If corporations are persons, then why aren’t corporations held to the same political contribution limits as persons?
    That’s one thing that needs fixing.

  104. Stop price discrimination

    Being a foreigner living in the US I have thanks God not needed to get too acquainted with its so heatedly debated health sector; and I pray it stays that way.

    That said I cannot refrain from pointing out something seems to go against any sense of justice; and which is that the uninsured are often required to pay many times the price insurance companies pay for exactly the same medicine or treatment.

    If beer companies compete that is good for beer drinkers and does not affect those who do not drink beer. But in the case of health services it is obvious that many of the cost reductions negotiated by the competing insurance companies end up expected to be recovered from those uninsured.

    If it was in my hand (and perhaps it is lucky that’s not the case) I would put up a prohibition to charge anyone more than 20% over the minimum price offered to any insurance company… and then take the reforms from there. Not doing so forces millions of uninsured who could perhaps pay reasonable fees into either swamped free service emergency rooms or into being financially abused.

  105. Hi Eric,

    You don’t think the present regime is totalitarian? It tolerates spying on its citizens, torture and use of the Big Lie to launch aggressive war. Who does sound like? And do you consider your “franchise” worth two dead flies? What meaning has it when the politicians elected through its wear for sales signs and are wholly in the employ of financial, arms, drug and foreign policy lobbies interests? And in what sense is there a meaningful opposition? The second, ostensible “opposition” party is a fable designed to funnel public outrage into a black hole, that’s all. To participate in an election in the United States is simply to reinforce the insanity that things will ever be any different. Some of us come to these understandings late in life, some earlier. Lets hope you are a much younger man than I am.

  106. The Chicago Way: Obama Reaches Not-So-Secret Deal to Not Push Down Pharmaceutical Prices Any Further; In Exchange, BigPharma Will Spend Up to $150 Million in Ads to Push ObamaCare

    Yah, that health insurance lobby sure has knocking the Obama Care Plan. Yah, right.

  107. Ugh, while this blog remains strong, i perceive that it has hit a level of public exposure that is threatening to lower the level of discourse to the unreadable/irrelevant level.
    New Black Panther Party goon squads? Seriously?
    Where do you come from? Why do you read this?

  108. I’m afraid you will not be getting public health care. You will be getting government mandated insurance company rent seeking and profiteering, and you will be paying for it through the nose unless you are among those who remain unemployed (although probably not counted) long after they have declared economic victory on the strength of a newly inflated largely jobless bubble. I don’t think you can blame people now retired for the last forty years; they only give us a choice of two in those elections and the differences are never more than cosmetic. They didn’t even count the votes in 2000 or 2004. Johnson got elected by promising not to escalate the to war, Nixon got elected by promising to end it, Reagan got elected by promising to return us to the Eighteenth Century, and Clinton got elected by promising us prosperity, which as you know is measured by counting the volume of bank lending most of which goes into speculation as a result of which, here we are.

  109. What’s wrong with expecting my fellow man to take care of himself?

    Altruisim is the excuse for the totalitarian state. Health care is the problem it is because nobody wants to pay for it himself. Well, this is what you get when everybody wants something and nobody is willing to pay for it. What makes you think that this government, which has bungled everything from day one, is magically going to solve this problem?

  110. For $108 a month you might get one visit to a primary care physician, after which you would be bumped from the plan for reasons of medical history. A medicare supplement plan costs more than this.

    One perfectly healthy forty-five year old woman will pay $500 a month for a Blue Cross Plan with a hefty deductible and oonsiderable limitation on provider choice. You can also expect gatekeeper interference. This is the best you can expect to do, unless you are part of a corporate group.

  111. ake chase
    wonderful to the point comment only one thing is missing

    if health care is totally at my expense and therefore discretion and subject only to free market conditions should then doctors willing to kill painlessly on demand not also be given free access and most of all be freed from those silly restraints the presently maligned as “Doctor Death” have to adhere to like only for the terminally ill but mentally awake?

    imagine all the tourism you could attract “death with a view of the Atlantic, the Pacific, the Mountains and with a bit of fiddling relatives wanting to get rid of nagging ol’ grandma would stream in from all over the world hopeful to find a way – it could solve so many problems at once and America would once again lead the way.

    I for one am all for it, living in a system where the health providers’ financial interest is keeping me breathing as long as possible and the more apparatuses are needed the better the cash flow. (my apologies to all the decent health care providers out there whose numbers dwarf in my experience those of the money-grabbers)

  112. Sorry, I’ve been working all weekend and am only catching up to this thread now. Most of what I could say has already been said but I felt the need to address this assertion:

    3. Our unemployed go to emergency rooms, get pretty decent care. When the hospital tries to bill them, there’s no money to pay, so it gets eaten (and the bill padded on other patients who do pay.) Not the ideal system, but not nothing either.

    I am trained in emergency medicine and work in a large city hospital in the US. I can unequivocally say that anyone who thinks that the “unemployed” (more realistically, those without health care coverage) get “pretty decent care” in the emergerncy department has absolutely no idea what he is talking about.

    Emergency physicians are trained to respond to emergencies of all kinds including trauma, stroke, severe infection, life threatening blood pressure and sugar elevations, and heart attacks to name a few. They are not trained in the art of primary care or “fill in” care as Michael G might suggest. Beyond not being trained to take care of these types of complaints, the emergency facilities are ill-equipped to handle this additional volume without compromising their primary, sacrosanct mission of providing the nation with emergency care.

    For this reason, the emphasis of a non-emergency primary care-type visit in the emergency department is one of expediency in order to allow the nurses and doctors to tend to the true emergencies. We don’t really like to make changes to patients treatment regimens because we likely won’t see these patients again and we aren’t adequately trained to do so.

    Now if you come in the an emergency department with a true emergency, regardless of your ability to pay, employment status, or immigration status, you will receive excellent care. But if you are coming for non-emergent care, you will likely pay with your time (instead of your dollars) and the focus of your visit will be on getting you out of the bed you occupy in order to have it available for the emergent patient currently en route to the hospital. That’s not good care.

  113. “The current plan is better than what we have, and so I support it. But, in terms of pushing down costs, it’s wishful thinking.”

    Seems to me like a contradiction in terms. Universal coverage without real cost control will be an unmitigated catastrophe. The costs of that over time will dwarf the financial sector bailouts and will utterly choke all the life from our economy. Indeed, even with just the pathetic levels of coverage that prevail today, we cannot sustain the current levels of expenditure growth.

    I would fervently like to see some kind of assurance of reasonable health care availability to all, but we must restructure health care so that we can afford that. America’s problem is not too _little_ health care but too _much_, misdirected. The fact that we spend roughly twice as much per capita on health care as any other OECD country alone shows that. Serious estimates of overuse of tests and procedures suggest that about 1/3 of what is done is useless or worse. Of course, we can never make all of that go away, but we should not settle for a “reform” that does not come to grips with this in a serious way.

    I am the last one to let the perfect be the enemy of the good. But proposals that do not control costs while expanding access will only make things worse, not better.

  114. Yes, but why do they want it so much? You cannot leave it to consumers/patients to defend themselves from predatory health care institutions–they lack the knowledge to do that. Health care is aggressively marketed in this country on many levels, using messages that prey on fear and ignorance. Doctors themselves are often totally ignorant about what treatments work better and which ones don’t. (Even when the research has been done, which, in far too many situations, it hasn’t.) And I won’t even go into the instances where drug companies, device makers, or doctor organizations have tried to suppress the evidence when they did know about it.

    If the typical patient were cognitively able to assess the real value of health care, demand for it would subside to far more reasonable levels. But most people just think more is better and, in the current environment, are dreading the thought that it will be “taken away” from them. We should only be so lucky! Meanwhile the health care industry isn’t going to just stop doing things that are useless/harmful but highly profitable.

    So we need to change the system in some profound way. Either we must take the profit out of exploiting unknowing and fearful patients, or we must impose regulation. But the health care industry is growing like a cancer on our economy, and if we don’t stop it soon, we will join the Soviet Union in the dustbin of history.

  115. But health care _is_ an economic issue. In fact, it is the biggest economic issue our country faces. From a purely economic (excluding political) perspective, we will survive the finance industry bailouts. We will _not_ survive the continuing growth of our health care industry on its current trajectory.

  116. Well, that’s just it. Cavuto asked that question this afternoon – are the legislators actually reading this 1000+ page bill that they’re about to vote on?

    The answer, from one of them? “It’s not practical. Nobody in Congress wants to actually read all that.”

    So then this guy goes in to this big long-winded explanation of how the legislative staffers are the ones who really write all this stuff and summarize it for the legislators, and how you really couldn’t know what some of it is talking about anyway because the text refers back to laws that are amended by this bill, but not actually quoted…yadda, yadda, yadda…

    Not practical? You gotta be kidding me. How the heck can you vote honestly if you don’t do that? It’s a good thing some of us are keeping up with the details – hopefully the extra noise will wake people up.

    There’s plenty of room to rearrange the chairs. They forgot to add half of the lifeboats.

  117. Hey Sam, catch up on the news will ya!

    The New Black Panther was indicted for voter intimidation at 2008 elections in Philly . Only intervention by the Obama administration prevented conviction. The SEIU goons’ actions speak for themselves. Last Friday outside a St Louis Town Hall meeting, Kenneth Gladney, a conservative afro-American, was severely beaten by SEIU goons and sent to the hospital. Not that the MSM would ever cover it. SEIU roughed up people at several healthcare townhall meetings around the country. So much for honoring the first amendment.

  118. Like the Punch and Judy show (take THAT! Whop! And THAT! Bang! Boom!) surrounding the financial mess and defining TBTF and, should we patrol venture capitalists instead of protecting consumers? …or, simplify financial products? …or prop up the auto industry with more subsidized funds? – or all of the above That Benefits Wall Street? – the health care mess about Who Pays and How is a diversion guaranteeing that Big Pharma, like Goldman Sachs, comes out on top: heads I win; tails you lose.

    The important, but forgotten, health care issue should be: do we make people well?

    No one, in the present debate, is dealing with that. Vitamin supplements, natural hormones and simple remedies are being challenged by Big Pharma, hiding behind the skirt of the FDA.

    Intravenous Vitamin C is cytotoxic to cancer cells only and cures most all cancer, even late stage. Are you reading about it?

    Several years ago a very promising “supplement” MGN3 was yanked from circulation and the company forced into bankruptcy by, I assume, the bidding of Big Pharma.

    Amino acid supplements alone (L-glutamine, L-tyrosine, etc.) do more to eliminate depression, brain fog, and other emotional malaises than all the mega-side-effect anti-depressants on the market combined.

    Chelation is cheap, non-invasive, effective, without side effects. But by-pass heart surgery is where the money is.

    I know nothing about osteopaths, except that there aren’t any anymore thanks to The Medical Establishment.

    The War on Cancer was begun almost half century ago. Chemo and radiation make as much sense as leeching. (Actually, leeching makes more sense.)

    Information in the American media isn’t banned, only demonized. Linus Pauling: crazy ole Nobel Prize Winner…

    The present health care bill is a mess no one understands and the gotchas, I’m sure, are endless. Simple, honest reforms would be welcome, but is there a chance, short of spilling the blood of tyrants and patriots?

    I have trouble disagreeing with any of New Majority blogger David Frum’s recent list:

    “As healthcare passions rise, let’s keep in mind reforms that Republicans and conservatives can and should support. Here’s my (non-exhaustive) list:

    * We should favor national health insurance exchanges to permit the self-employed to buy insurance with untaxed dollars, just as employees do through their employers.

    * We should favor the creation of non-government health cooperatives – provided that they truly are non-government, i.e. no government subsidies and no government guarantees. More Blue Crosses, yes; a healthcare Fannie Mae, no.

    * We should favor the creation of government bodies to compare the effectiveness of different healthcare practices. It really is true that some doctors and hospitals spend radically more than others without getting better results. The government has supported such research in the area of agriculture since 1914 without plunging the US into death-dealing totalitarianism.

    * We should respond to proposed new federal insurance regulations on a case-by-case basis.
    For example: We should oppose federally required community rating (although of course insurers should be free to adopt community rating themselves if they wish). Community rating destructively forbids insurers to offer incentives for healthier behaviors, and it can price younger workers out of the insurance market. On the other hand: The practice of imposing a “lifetime cap” on health coverage is outrageous and should be banned. The idea that a cancer patient might be told by an insurer: Sorry, we’ve reached our limit, the rest of the cost falls on you, violates the very purpose of insurance and exposes Americans to intolerable risk and fear.

    * We should work where we can to move away from employer-provided care to individually purchased care that can follow the insured person from job to job. Extending the length of COBRA benefits could be a good way to start, but the health care exchanges are likely to be the ultimate answer.

    * We should demand tort reform and medical malpractice reform. As the Senate Finance committee’s white paper notes:

    Medical malpractice insurance premiums have risen steadily over recent decades, at times increasing an average of 15 percent a year. Some states have seen even more dramatic increases. Pennsylvania, for example, experienced increases ranging from 26 to 73 percent in 2003.

    * We should endorse the Obama administration’s plans to shift Medicare away from fee-for-service medicine to payment-by-the-case and to seek other money-saving reforms within Medicare.

    * We should of course fight against any so-called public option. Direct government provision ought to be the conservative red-line; No deal at all is preferable to a deal that includes a bigger government entry into the insurance business.”

    At the same time, it is all a Punch and Judy show, is it not?

    …Lady in Red (not old, today. smile…)

  119. This was disgusting…. in the extreme.

    ….off to bed …to forget it. WHO did this?
    …Lady in Red Red Red Red!

  120. Actually, the Oregon Health Plan has provided 60,000 low-income Oregonians health coverage that they would not have otherwise been able to acquire.

    The video distorts the process by which medical procedures are approved for inclusion in the plan.

    The Plan, proposed by John Kitzhaber (An ER doctor who became Oregon’s Governor) in the 1980s was one of the first, if not the first, plans in the nation that utilized a “best-practices” list to determine which medical procedures would and would not be included in the plan. The list was drawn up by doctors and public health experts using the best data on procedural effectiveness and cost. This included such concerns as expected survival rates and post-procedural quality of life, wellness and lifestyle choices, and other factors that optimized overall societal costs of the plan. The number of procedures included in the plan was determined by the funding approved by the legislature. Individual procedures were NOT decided upon by the legislature. Unfortunately, adequate funding was never approved, and so the “cutoff” has had to be made lower than we liked.

    The Oregon Health Plan as originally conceived was innovative and to my mind quite sensible. Many in and out of the state consider it an excellent model for a results-based national health system. The experiment continues, and more information is available at


    This video, on the other hand, should drive one straight to the authoritative sources of information on the Oregon Health Plan.

  121. To clarify…

    The Oregon Health Plan medical “formulary” was created by ranking procedures with regards to their cost effectiveness according to the criteria I have mentioned. Those providing the least benefit for the most cost ranked at the end of the list; those providing the most benefit for the least cost ranked at the front. The total funding provided by the legislature for the plan determined how far down that list procedure would be covered by the plan. This “formulary” is frequently reviewed and updated by medical and public health experts with the latest evidence.

    Note that since the plan considers long-term individual and societal costs, some low-cost, high long-term effectiveness procedures ( such as pre-natal care ) might wind up higher on the list than a high-cost E.R. procedure IF that procedure doesn’t improve the individual’s quality of life.

    One of the beauties of this plan is that, over time, plan costs per capita go down because the design encourages lifestyle decisions that improve individual and community health, and major medical procedures that actually do some good.

    Health care is NOT just an individual concern. The entire community is involved in maintaining an individual’s health, and that individual is also involved in maintaining the community’s health. We ignore this at our peril.

  122. Obama’s plan is based by Jacob Hacker. You can find the basis of the plan in a presentation at the Economic Policy Institute, a liberal, progressive think tank.

    Amazingly enough, as much as the later Lewin report has been villianized, the plan was introduced with research to back it from the Lewin group at the request of the EPI (remember a liberal progressive think tank).

    The plan does vary some from the original plan, but very little overall.
    HR 3200 would be Obama’s preferred plan.

  123. Yes. And what will happen to those who refuse to buy into the brewing charade of a “health care insurance reform” barring (as the name suggests) that further thought be given to a satisfactory public–preventative as well as therapeutic–health care program. (Single payer in this country? when pigs can fly!) There is much more to add about the glorious culture of extortion in this country; the taxpayers (well, not all of them) are not done doling out their turnip blood.

  124. Michael,

    I’m sorry I didn’t answer you in a timely fashion. The plan does address the following important issues:

    From Matt Yglesias:

    “The administration is proposing:

    — A ban on discriminating against people with pre-existing conditions.

    — Caps on out-of-pocket spending.

    — No cost-sharing for preventive care.

    — No “rescission” of coverage for people who get seriously ill.

    — No gender discrimination.

    — No caps on coverage, either lifetime or annual.

    — Extension of family coverage for kids up to the age of 26.

    — Guaranteed insurance renewal.”

    It’s important to remember this, in my view:

    MF= Milton Friedman
    RK= Robert Kuttner

    “RK: So in other words someone who is elderly, just wouldn’t be able to get insurance, because the insurance companies couldn’t make a profit insuring that person.

    MF: Well that’s why I am saying there could be a government role

    RK: In what, subsidizing the ability to purchase insurance or&.?

    MF: In providing catastrophic insurance for people who cannot afford it.

    RK: Now is that a humanitarian argument or is that an efficiency argument?.

    MF: Humanitarian.”

  125. CBS,

    I agree. That’s why I said that we will be addressing these issues right after this bill passes. As I said, I favor the plan for humanitarian reasons, in the short term. But I completely agree with you that these hybrid plans are a mess and a waste.

  126. New Rasmussen poll numbers:

    “Public support for the health care reform plan proposed by President Obama and congressional Democrats has fallen to a new low as just 42% of U.S. voters now favor the plan. That’s down five points from two weeks ago and down eight points from six weeks ago.
    A new Rasmussen Reports national telephone survey shows that opposition to the plan has increased to 53%, up nine points since late June.

    More significantly, 44% of voters strongly oppose the health care reform effort versus 26% who strongly favor it. Intensity has been stronger among opponents of the plan since the debate began.

    …As for the protesters at congressional town hall meetings, 49% believe they are genuinely expressing the views of their neighbors, while 37% think they’ve been put up to it by special interest groups and lobbyists.”

  127. Massachusetts has achieved healthcare coverage of 97% of its population via a combination of employer coverage, government assistance for purchase of private insurance and Medicaid and Medicare. Health insurance is available if you become unemployed; private insurers can’t discriminate based on pre-existing conditions.I think that is pretty good.
    The cost of healthcare is still a problem, but plans are being made to address the cost issue.
    PS. Neither the free-market righty types nor the one-payer lefties approve of the system… no matter the results.

  128. yes, this is a good example of this concept that Obama is embracing that we are all individuals and we should never think as a collective or worry about the group as a whole. In other words, Obama is continuing this free market thinking that each person is on their own and should only care about themselves and that the individual can step on top of anybody as long as it gets them ahead. Health care should be about the good of the nation and that as a nation we are in this together. but he has totally framed the debate around the individual looking out for himself and not making sacrifices unless they benefit himself. divide and conquer. we all want health care reform, but he won’t bring us all together to work out a plan, he just keeps trying to placate to the individual.

  129. Yakkis
    I am not up to date on immigration law but in the seventies US citizens had special status, they could get in and get a work permit as comfortably as any of the most privileged of our neighbours – even though we were a sovereign state by then the US had taken care to receive continued well-treatment and I hope they were smart enough not to have that changed in any way.

    So all you need is take any job subject to mandatory health insurance (I think there might still be found openings for window-cleaners in big cities) for a short time, get yourself fired or give notice yourself and then be careful to stay in while you establish the life you want for yourself. The staying in part is not hard to do because the insurers will give you all the advice you can dream of and they are keen on keeping you in.

    All this of course if you happen to carry a US-passport – if not I think you must come up with something a lot better i.e. really horrifying before you can claim refugee status and the procedure will be messy and fraught with hitches but while it lasts you will – to the best of my knowledge – be covered.

  130. I think we should go to the Basel Committee for advice on health reform

    They would prescribe health rating agencies to check up all citizens and all those who present some risks would have to pay the costs of additional capital requirements to be placed on the insurance companies when they insure the risky.


  131. Yakkis I forgot

    do bring all your kids and your wife

    – they are all included for the same amount you pay as a single (that’s why the (young) single’s premium in public insurance is higher than in private insurance which calculates premiums per person and risk – recission could be easily excluded and I can’t imagine that that has changed – the doctor will charge for his certificate of course most of his fee to the public insurer which continues to cover you while you look around for a cheap private option – but beware they have made getting back under the public umbrella harder to do – they claim they have made it impossible which I based on prior experiences doubt is possible)

    – as to multiple wives that might get a bit tricky, so look carefully into the procedure before you embark on it

  132. as to multiple wives that might get a bit tricky, so look carefully into the procedure before you embark on it

    multiple wives!?

  133. multiple wives

    yes there are still some societies who practice polygamy – I remember there were some cases where the British took second or so wifes from Somalia? under the “umbrella” and I think I remember a German case too
    – anyway if you are a refugee it is probably only a technical thing good for your dignity, kind of a way to recognize that your marriage is in a way legitimate even if not legal if you know what I mean

    – to the best of my knowledge refugees have theoretically somewhat capped health care coverage anyway but taking the second wife “in” means it is not charity any longer but she has a right of her own to it

    and don’t you ever forget when I give you all this advice about how to plan your future life that from my part of the world the things you are telling about how you do things in the US seem just as crazy

    ooops and there was a story of Somalis in New York with multiple wifes who benefitted from the same welfare as the one and only wife, whether it was through fraud or correctly so I do not remember, probably was in the NYTimes

  134. Coverage and cost are not independent issues. Make health care cheaper and you get more coverage. Make it more expensive and you get less.

  135. The true sadness in all of this is that while it is important to educate yourself about what is happening to you by way of your country, for the big picture it remains futile.

    Pretty much all of our politicians are corrupt in the true meaning of the word not in terms of just the law, in fact our entire system is corrupt with the exception of a very few individuals.

    For example a heath care reform committee headed by Max Baucus- what a farce. Or how about all the republican politicians fighting against a public option(whether it is good or not) using lies and inflammatory fables to convince their constituents to follow their lead. Baaaa!

    Aren’t you unnerved that we let outright liars run our country!

    There are too many selfish corrupted people that hold office- republican and democrat alike- that only see as deep as their own pockets or that of their friends.

    There are too many hateful, ignorant people in this country too trusting of the side that best suites their hatred and ignorance- that give these pigs their power.

    It’s all a joke.

    Goverement run option- the goverment is corrupt! Whatever they seem to do that benefits people always has a silver lining for someone’s or some company’s pocket.

    I personally work in health care and specialize with Medicare D run through private insurance companies( and their processors don’t forget them.) Do you have any idea how many lawsuits there have been against this insurance companies for not following the law for screwing over sick people when they needed coverage most?

    I hath seen it with mine own eyes. I have fought insurances companies on this stuff, they bend the laws that may protect you.

    Everyone one of you who comment here, I can see your intelligent and that you care. I do not mean in any way to negate that, but it will never really be OK unless everything changes and there is really accountability.

    The government distracts you with one token good bill or law or measure or funding and while your head is turned they pick your pocket or cut your legs out from underneath you- again and again- unless your their friend or writing them a big campaign check.

    Think of the defense budget and how much of that is for useless things we don’t need for our politicians supports- big companies. It’s sad.

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