Patterico's Pontifications

9/24/2007

Universal Health Care is “For the Children”

Filed under: Government — DRJ @ 5:12 pm



[Guest post by DRJ]

The next time you read that Democrats want federally-controlled universal health care, consider what it’s done for British children:

The NHS is facing £4.5bn in compensation claims over alleged blunders by midwives and doctors that have left babies suffering severe brain damage, The Observer can reveal. The huge sum is detailed in confidential data from the NHS Litigation Authority, which handles most of the legal claims for medical negligence against the health service in England.

It shows that the organisation has been fighting a barrage of legal cases in which the compensation being sought by families amounted to a total of £4.49bn. Three-quarters of that, £3.3bn, relates to incidents in which a child has developed cerebral palsy, brain damage which is often caused by being starved of oxygen during birth, and been left disabled. A further £739m involves claims over what the NHSLA calls ‘other brain damage’.

The huge sum is detailed in confidential data from the NHS Litigation Authority, which handles most of the legal claims for medical negligence against the health service in England. The disclosure that such large amounts of NHS cash could potentially have to be spent settling such claims has reopened the debate about the quality and safety of Britain’s maternity services.

Mark Steyn at NRO has more thoughts on universal health care.

— DRJ

128 Responses to “Universal Health Care is “For the Children””

  1. How many horrible ideas are couched in terms of being “for the children”.

    JD (c3bb88)

  2. They are learning, first hand, about the John Edwards’ of the world.

    JD (c3bb88)

  3. The challenge for the Republicans is to address how they will solve health care for those who do need it but cannot afford it.
    Simply chanting “socialized health care is not the right idea” is not going to cut it and comes off sounding like “I’ve got mine, pull yourself up and get yours on your own dime”.
    I’m not putting a whole lot of stock in the figure of 47 million uninsured but even if there were only 5 million people who needed health care but couldn’t afford it, that would be far too many.
    If the Republicans care they will need to refine their message and offer a workable solution.

    voiceofreason (ee5c1e)

  4. The swamp beast rears its head, again. Health care and health insurance are two different things. Nobody who needs health care in America is denied it because they can’t afford it.

    nk (7c7414)

  5. “Nobody who needs health care in America is denied it because they can’t afford it.”

    So anyone who wants health care in America can afford it? Do you sincerely believe that?

    voiceofreason (ee5c1e)

  6. voiceofidiocy – That is almost a comically wrong interpretation of what nk said. It is so wrong that it had to be intentional.

    JD (c3bb88)

  7. VOR,

    Every person in America can get emergency health care at the nearest public hospital ER room. It doesn’t matter if you are indigent or illegal. In my community, the poor and the illegal use the emergency room for basic health care, which is why we now have free clinics for general health care – so we can have an ER that is actually available for true emergencies.

    In other words, health care is available. The political issue is over health insurance, and Democrats want it to be federally-controlled rather than quasi-market-controlled.

    DRJ (ec59b5)

  8. Swamp beast,

    Take your disingenuous double-talk back to Glenn Greenwald’s blog. People who need health care in America get it, whether they can afford it or not. No emergency room or hospital will turn you away if you are not stable regardless of whether you can pay. For chronic care, have you heard of Medicare? Public hospitals and clinics? Here’s a challenge for you. Know of anybody who is denied his $100.00/day HIV suppressant cocktail because he can’t pay for it?

    nk (7c7414)

  9. “Medicare” = “Medicaid”

    nk (7c7414)

  10. “How many horrible ideas are couched in terms of being “for the children”.

    Greatest PR of all time – tag anything with this little ditty and it adds an extra measure of earnest goodness to whatever the proposal is and an extra measure of guilt to the naysayers of said proposal… (Thanks to Pelosi who originally coined it).

    Dana (9afe2a)

  11. DRJ,

    And my opinion is that if the Republicans take the position of “it’s not broke, everyone has equal access” they will lose on that issue. Free clinics are great but I don’t think you would contend that it is quality health care such as you and I may enjoy.
    I know people personally who had to make a conscious decision to NOT insure their kids because they couldn’t afford it (10% of their gross income). One catastrophic illness and they would lose everything.
    My point is what will Republicans offer up to fix the problems that are in the system?

    voiceofreason (ee5c1e)

  12. This from people who butch about lawyers in this country. And how many lawsuits are there in the us?

    And even cubs has a lower infant mortality rate.

    England has slashed the health budget and you don’t mention Germany or France. And that Canadian coupl who ‘drove for 8 hours to give birth in a us neonstal unit’ were flown at government expense. There’s a population and baby boom in their area and the units were full up.
    More billshit from you. No knowledge önly assumptions and fear.

    blah (55d03b)

  13. DRJ #7,

    We crossposted. Even private hospitals which elect to operate under certain tax-exempt statuses or government franchises must provide emergency care regardless of ability to pay.

    nk (7c7414)

  14. blah, Canada did not have neo-natal hospital space because they’ve been closing hospitals to cut costs.

    SPQR (6c18fd)

  15. Oh, shucks, NK: You know we don’t have any private hospitals where I live. How would I know that?

    VOR: Actually, indigents and illegals have better emergency health care in my community than my family does. We have to go through the process of registering and arranging for payment before we are seen by the same doctors and nurses that take care of indigents and illegals, who are excused from that burden. It always adds an hour to our wait that they don’t have.

    However, I will admit this: When we really, really need health care, we can afford to go to Rochester MN to the Mayo Clinic. Once we get there, it costs 1/3 or less than the same care in our public hospital … and it’s better. I credit the miracle of the marketplace.

    DRJ (ec59b5)

  16. DRJ,

    Guess we are just looking at it differently. The Mayo is about 1500 miles too far for me to take advantage of.

    Just out of curiousity, is it your opinion that the health care system has no problems and doesn’t need any kind of fixes?

    voiceofreason (ee5c1e)

  17. Amazing volume of legal claims in the U.K. Keep in mind that contingent fees are illegal there, so it’s not being driven by a bunch of John Edwards-types.

    Beldar (46f415)

  18. Oh, shucks, NK: You know we don’t have any private hospitals where I live. How would I know that?

    😉

    nk (7c7414)

  19. VOR,

    We live 1200 miles from Mayo. You do what you have to do, but that’s not the point. The point is that Mayo and similar institutions are more efficient and provide better service because they are competitive. Federally-managed health care would sink to levels we can’t even imagine, except when we read stories like this. As Beldar pointed out, if they don’t have contingent fees in Britain, you can rest assured that all those cases have some merit. Think about that.

    DRJ (ec59b5)

  20. Spqr

    Not in that area, sorry.

    blah (55d03b)

  21. vor – I doubt anyone would contend that there are no problems. If they did, they would be wrong. I would also suspect that any of the existing problems would be made exponentially worse were the government to be managing it rather than the market.

    blah – If the healthcare in Cuba and Canada is so fine, feel free to avail yourself of same. The idea that a third world country like Cuba could have better healthcare than the US is laughable, and ranks up there with the claims that they are more literate. As for Canada, folks in the northern border states, and Canadians themselves, would point out that there is a growing number of our northern neighbors that pay out of pocket for care in the US, because their care is rationed to the point that they cannot always receive the needed care at the time needed.

    Beldar – I was not aware of that. Contingency fees illegal? Nice. That would go over like a lead balloon on this side of the pond, no?

    JD (c3bb88)

  22. Well,

    America has twice the rate of children born with cerebral palsy than Britain has.

    Does than mean our current health care system is twice as bad as Britain’s?

    alphie (99bc18)

  23. ‘Even cuba has a lower infant mortality rate’ than the us. Its old news son. Again, sorry

    blah (c78c78)

  24. http://film.guardian.co.uk/features/featurepages/0,,2167459,00.html

    Here ya go.

    blah (c78c78)

  25. Interestingly, Cuban ethnicity women in the US have a lower infant mortality rate at 4.53 per 1,000 than Cuba’s claimed rate of 5.3 per 1,000.

    Because it varies a great deal more by ethnicity than economic status, comparing infant mortality rates among nations is actually a pretty dishonest method of comparing health care systems. Must be why it is so popular among socialists to brag about it – rather than the waiting times for socialized health care, or even the death rates while awaiting care.

    SPQR (6c18fd)

  26. It must be so hard to be a conservative nowadays, having to convince the American people that their health care system is so great, what with mediocre life expectancy, huge out-of-pocket expense, long waits at those emergency rooms, reductions in availability of medications through Medicaid, the threat of bankruptcy from any expensive illness, etc.

    You see, when you have the heart attack, then you can go to the ER. Probably even get to go the front of the queue. But the health care that might have prevented the attack–you know, maybe some Lipitor, stuff like that–couldn’t afford that.

    One of my sons was born with a bladder defect picked up on insurance-provided prenatal ultrasound; insurance paid something like $30K or $50K for the operation when he was 1½. (One week inpatient stay.) Or, I suppose, he could have gone to the ER at age 45 with total kidney failure and needing dialysis or a transplant (sort of like the comedian George Lopez, who had the same condition and had no childhood health care). And as a matter of fact, he’d get that dialysis by law even if he didn’t have the money. But if you think that’s any way to run a health system, you’re nuts.

    One reason that public hospitals can be so expensive is to cover the cost of all that donated care.

    By the way, how much money goes to health care bureaucracy in our system compared to the others. You know the answer, don’t you?

    Even employers are coming around on health care; premiums are killing them. Soon the ramparts will be manned only by insurance company flunkies and libertarians in good health with no children.

    Andrew J. Lazarus (6101da)

  27. Alphie,

    Where did you get your statistics for rates of cerebral palsy in the US and UK? This website estimates there are 500,000 cases (mild to severe) in the US. What are the numbers for the UK, and where did you get them?

    DRJ (ec59b5)

  28. According to this site, the mortality rate from cerebral palsy and related conditions is about 8 times higher in the USA than the UK.

    I was unable to find any source that would corroborate a claim about incidence.

    Andrew J. Lazarus (6101da)

  29. AJL – There was a little addendum in your link, which I will assume you did not see.

    NOTES: These statistics are derived from official causes of death detailed on certificates of death by each country. Rather than being a true indicator of the number of deaths attributed to a particular cause, mortality statistics reveal more about a particular country’s reporting processes.

    JD (c3bb88)

  30. Using CP as some baseline for the standards of healthcare is ridiculous. CP can, in some cases, be caused by medical mistakes. There are also about 2000 other reasons why a child can develop CP, none of which have anything to do with the quality of healthcare provided by a doctor, such as infections, other diseases, and simply abnormal development. The existence of CP is not an indication of medical malpractice, as some would have you believe, an idea that John Edwards became wealthy on.

    AJL, alphie, etal. When your child becomes ill, would you prefer for your child to be treated in the US, Cuba, or Canada?

    JD (c3bb88)

  31. Alphie,

    I think your link focuses on a particular kind of CP associated with low birth weight children. There is apparently a European organization that tracks cerebral palsy called the Surveillance of Cerebral Palsy in Europe (SCPE) network. This paper indicates overall CP rates in the UK range from 2.08-3.3 per 1000 births, which I think is comparable to or a little higher than the US rate I found above.

    However, I’m leery of all these numbers without looking at it more carefully. For one thing, you also have to factor in the trends, prevalence, and whether there are more high-risk pregnancies and births in one country or the other. I’m not disputing the validity of your concern but the point of my post was that the British are worried these claims will place an inordinate burden on their ability to provide health care. Put another way, monopolies aren’t always that efficient.

    DRJ (ec59b5)

  32. AJL

    Start with this

    there is no “right” to medicine.

    then take an honest look at the problems that exist with the American health care sector, problems that are the result of government interference.

    Tell me, what do you think you’d be paying for auto insurance if your employer had to offer it and you were mandated to take what your employer offered and your state told the insurer that they HAD to provide insurance that covered tire rotation, oil changes, air filters and tuneups? Add in that the Federal government granted an exclusive monopoly to the American Mechanics Association to decide just how many mechanics and mechanic schools they’d license to work in the US.

    Is it getting a little clearer?

    Our problems are not ones of not enough government control, but way too much.

    Darleen (187edc)

  33. alpee also ignores that America counts as infants deaths a lot of things that socialist medicine counts as still births

    and I’ve never gotten a clear handle on if they count the infants they euthanize in the infant mortality rates

    Darleen (187edc)

  34. AJL – It’s not hard being a conservative these days, especially when you ignore the strawmen libs throw at you about what they believe your position is on the health care situation in the U.S. Your description above was very funny:

    what with mediocre life expectancy, huge out-of-pocket expense, long waits at those emergency rooms, reductions in availability of medications through Medicaid, the threat of bankruptcy from any expensive illness, etc.

    Could you provide citations for conservatives who claim our health care system is perfect since you are erecting that straw man. Why don’t you back that one up rather than just throwing it at the wall.

    Calling a life expectancy mediocre is rather subjective isn’t it? You have to compare it to some other measure. How does our life expectancy compare to 50 years ago AJL?

    Long waits at emergency rooms are another subjective measure. Aren’t people triaged at emergency rooms? If they are, then what’s the problem with a wait? Whayt are you comparing it to?

    Reductions in available medications? Gee, aren’t other medications available to treat the same condition in the formulary? How many people have been harmed by this condition? Do you have statistics or just a generic complaint?

    That big bankruptcy specter! Scary. Not as big a deal as it used to be is it? Maybe this is where people should buy catastrophic healthcare coverage. Who pays for universal healthcare coverage AJL? It isn’t free. Do you want to soak the rich some more?

    daleyrocks (906622)

  35. Spqr making with the racialist arguments. What’s next the bell curve? By your logic Puerto ricans should be on the same level.
    And the best system inthe us is the va and remember Walter reed is not va.

    Darleen you are a loon the likes of which I’ve rarely seen.

    blah (c78c78)

  36. JD – Next time one of my kids gets seriously ill, we’re on the next plane to Cuba dude. I want to go to one of those clinics Mikey Moore showed in his movie, not one of those shabby places the regular Cuban folks go. Those places look sweet. They treat you nice.

    daleyrocks (906622)

  37. blah, racialist arguments? What kind of stupid slander is that? It is an objective fact, reported by such entities as the Center for Disease Control and numerous medical studies that low birth weight rates and associated infant mortality rates vary by ethnicity.

    Comparing infant mortality rates among nations without at least controlling for those factors that are not associated with access to health care, in an argument about access to health care is just not valid.

    This is not a racist argument and your attempt to call me a racist for pointing it out just shows what a troll you are.

    SPQR (6c18fd)

  38. I love it when the progs constantly whine about the fearmongering of the conservatives yet when we have topics like this we get the – we’re all going to die if we don’t get universal health care now speech.

    We get idiots like Naomi Wolf fearmongering about the coming fascist state because some douchebag gets tasered at a lecture.

    We get Gorezilla telling everyone to spend hundreds of billions of dollars to changes their economies and behavior based on phony temperature data and scietific data or the earth will fry.

    Who is really doing the fearmongering?

    daleyrocks (906622)

  39. Or was Naomi pissed off that the Iranian nut job terrorist who hates us might be denied a platform to speak where conservative speakers are denied a platform to speak? With her, it’s always something.

    Bing out the Whaambulance!

    daleyrocks (906622)

  40. This is a fucking joke.
    Compare our situation to France and Germany. Take a look at the socialized medicine that is the va hospital system.
    And start whining as you would put it about the dictators who are our’friends’ mubarak et al when they speak here.

    You assume everyone else is as corrupt as you are. That’s the only logic I can think of for this stupidity

    blah (55d03b)

  41. DRJ,

    British medicine isn’t a monopoly.

    There are private doctors for those who can afford them.

    “Harley Street Doctor” is a good term to start googling.

    alphie (99bc18)

  42. Darleen: a number of state Constitutions recognize a “right” to education, some don’t. The idea that there is no “right” to medicine isn’t self-evident, so the idea that European countries which have adopted such a right have made a mistake is conclusory. In any event, if you wish to argue on the basis of philosophy, you literally can’t care about the performance of the US health system on indicia like infant mortality and life expectancy. For those of us who prefer a more pragmatic approach, there’s a strong argument other countries’ system on balance are much better.

    Daleyrocks: My wife has excellent health benefits. She’s a government employee, one of the last groups for which this is true. If I were lower-middle class, I would much rather have my child treated in Canada. Incidentally, catastrophic health coverage is for rich people who can afford a high deductible and/or high co-pay. It doesn’t help poor people who will be wiped out financially before it kicks in. Illness and medical bills are implicated in half of all bankruptcies. Guess you haven’t had to think about this problem much.

    Andrew J. Lazarus (9b5373)

  43. Lies, damned lies, and statistics.

    JD makes a crucial point at #31, CP is not de facto evidence of malpractice as John Edwards would have us believe.

    I agree with the idea that socialized medicine is not a good cure for our ills, but I am not sure I would appeal to malpractice claims as my evidence.

    I propose it is hard to be an informed and thinking conservative or liberal these days. More media coverage of smoke than serious accounts of the fire, as you can make believe what the billowing smoke looks like.

    Statistics for comparison are valid only when comparing apples to apples, or having some correcting factor. Usually there are many underlying factors involved that are not taken into account. A hospital may have a higher percentage of newborns discharged with CP than another, but it may be because they have the regional neonatal ICU and care for newborns that would have died at most other places or 5 years ago at the same hospital.

    Diagnosing the health care problem is like diagnosing a patient. There are many reasons for chest pain with different treatments. It takes information gathering and thought to know the right thing to do.

    I think unintended consequences of actions over the last 100 years have contributed to the mess, and before more problems are created it would be good to reexamine what some once thought of as good turned into results we can’t live with.

    (Does anyone know a good book looking at examples of unintended consequences?)

    MD in Philly (3d3f72)

  44. Whether or not “universal” health care is the right policy or not for the government aside for a moment, I would like those on the left to at least admit that if they got their favored policy of government health care for everyone, the average american’s health care will become more expensive (much higher taxes) and will be lower quality (i.e., longer waits, less access, etc.).

    If they will at least admit those two facts – that in order to give everyone equal health care, the cost must go up and the quality down (as evidence by every single country that already has such government provided health care), then at least we will be having an honest debate.

    B/c they will never admit this, an honest debate is impossible. If the left said to me – sure, you will pay more in taxes then you now pay in your portion of health insurance (i.e., deductibles + the amount my employer does not cover) and that the quality will go down, but that is a small price to pay to insure everyone has equal health insurance, at least it is an honest argument.

    To try and claim that “universal” coverage can happen without being more expensive and lower quality is simply ridiculous, when we have multiple examples from every country with universal health insurance to prove the opposite.

    Unfortunately, I think the average american simply does not understand this, no matter how many times we try to tell them (after all, the media never reports these facts). thus, the average american believes they can have “free” health care that is just as good as what they have now. thus, the left will lie their way into power on this issue and then screw all of us with more expensive health care that is less quality.

    I believe there are potential solutions that will improve america’s health care system that would expand coverage to many more people and keep costs down and keep the same quality, but I just don’t see any republicans truly selling such ideas. So, ultimately, I fear we are going to be saddled with the expensive and worthless government controlled healthcare that the left wants.

    And remember, once government controls healthcare, they also can begin to control lifestyles. After all, why should the gov’t pay for you to have an operation if you smoke? Or if you are overweight? Or eat too many trans-fats? If you believe the nanny-state is out-of-control now, wait until the government (and the left) is in control of our health care.

    Great Banana (aa0c92)

  45. First off, Blah, have you ever been to Cuba? I have (2004) and it’s no picnic. I’ve seen the “wonderful” health care and I wouldn’t bet my life on it. On top of that, as has been pointed out many countries esp. Former Soviet block and Soviet satellites define birth in a statistically friendly way. Also there was an article just yesterday where the French finance minister said (we’re broke). No I’m not going to find the link because, A) I’m busy and B) you wouldn’t care anyway.

    Laz has a point that there are some real problems with health care in this country, and benefits from socialized med. However, that does not mean that it would be a net benefit for the U.S. as a whole or most people as individuals to move to a national health care system. While it might be beneficial, based on the governments track record on other programs (Social Security comes to mind) I don’t fancy trusting them with my health. HMO’s are a pain as it is.

    Dr T (69c4b2)

  46. Several individuals have commented on infant mortality and life expectancy in the US. Post 44 has points out that comparing statistics is only valid if comparing apples to apples – Does it seem logical the US infant mortality his higher than in Cuba? of course not – the often repeated stat that US infant mortality is higher than cuba has been debunked so thoughly that it is suprising that stat is still repeated. Better questions to ask are what is the life expectancy after age 30, after age 40, etc? What is the survivability 2 years, 5 years after discovery of cancer?

    Yes there are problems with the US health care system – Though, it is still the best in the world. Ask why other countries are trying to move away from socialized medicine? Why destroy the best health care system in the world for 80-90% of americans to make slight improvements in the system for 5-10% of the population?

    The single biggest difference in US health care costs vs Canada and other european countries is not malpractice costs, not insurance administrative costs, etc,. The single biggest cost difference in the US is extrodinary expense incurred in the last stages of life for the elderly.

    As everyone should recall, Hillary Care I (which wont be much different from Hillary Care II except in name) was modeled after the canadian system. Hillary then addressed the problems occurring in the Canadian system by prohibiting then very things canadians were doing to circumvent/solve the canadian problems – the prohibitions included criminal offenses. She also had provision that women could not get mammograms prior to age 50.

    joe - dallas (0388d7)

  47. AJ

    I bring up the non existent “right” for a reason. Because considering any THING as a right has consequences in human behavior.

    My eldest daughter is a paramedic who runs on a very poor section of town. The population there knows that the ambulance is not allowed by law to refuse them a ride for just about any reason and they don’t have to pay if they don’t want to.

    Consequence of that “right” to an ambulance? Her company collects less than 40% of billings and the people use the ambulance as a taxi to get to the hospital for care (and in some circumstances she’s watched as the person lingers in the ER waiting room only for a few minutes then leaves..they just wanted to get to that side of town)

    Do we have a right to “food”? Certainly that’s more important then even medicine, but no one is talking about nationalizing grocery stores.

    Pragmatics must take into account what motivates people’s BEHAVIORS and telling people they have a RIGHT to a certain thing or service that must be provided by someone else has those ‘unintended consequences’ MD brings up above.

    I notice I gave a very pragmatic example (auto insurance) which you didn’t address.

    Darleen (187edc)

  48. AJL – You’re full of it!

    Daleyrocks: My wife has excellent health benefits. She’s a government employee, one of the last groups for which this is true. – Of course she does. That’s one reason our taxes are so high any many municipalitities are on the brink of banrkruptcy, retirement and health care programs, typically Cadillac versions in the public sector. What don’t you understand about this? Do you think they are free or something?

    catastrophic health coverage is for rich people who can afford a high deductible and/or high co-pay. It doesn’t help poor people who will be wiped out financially before it kicks in. – How about for anyone, rich or poor who believes they can pay for normal well care expenses out of pocket and only need a safety net for extraordinary circumstances.

    Illness and medical bills are implicated in half of all bankruptcies. Guess you haven’t had to think about this problem much. – I think about it a lot. Did you know that most Americans priorities are so screwed up they don’t stop paying for cable TV until after they’ve skipped mortgage payments.

    And that Harvard study, with average out-of-pocket costs of $13K concludes – According to study co-author Dr. Steffie Woolhandler, an Associate Professor of Medicine at Harvard and primary care physician in Cambridge, Massachusetts: “We need to rethink health reform. Covering the uninsured isn’t enough. We must also upgrade and guarantee continuous coverage for those who have insurance.”

    Gee, maybe instead of blaming it entirely on the health care and insurance industry they could focus a little on changing consumer behavior, maybe increasing the savings rate, but that’s just me. Seems like a predetermined conclusion was reached in this study – reform is need.

    daleyrocks (906622)

  49. nk/DRJ:

    It’s true that the uninsured can get basic healthcare from their local emergency room (ear infection, wound treatment, etc.)… but what about care that requires a specialist; an oncologist, perhaps, or a cardiologist? How is an uninsured person going to get an appointment in that realm?

    DRJ:

    If “indigents and illegals” have better emergency healthcare in your community than your family does, why do pay an assumedly exorbitant amount of money for health insurance? With what advantages does it furnish you that a trip to the emergency room would not?

    Leviticus (3c2c59)

  50. AJL – I’m sure the commenters here at Patterico are very happy to pay for your wife’s excellent health care benefits in her government job. Don’t bother thanking them.

    Myself, I usually resent those public sector benefits because they are paid for with my tax dollars and they exceed anything I’ve experienced in the private sector. That’s the way the cookie crumbles, but that’s just me. I’m a giver.

    daleyrocks (906622)

  51. How is an uninsured person going to get an appointment in that realm?

    Levi… It is illegal in the US to be denied needed treatment because you are unable to pay.

    If you need the specialist, and don’t get to see them because you can’t pay, laws have been broken.

    Scott Jacobs (425810)

  52. A few thoughts on the general topic-

    Yes, an emergency room/hospital faces trouble if they turn someone away who needed care but couldn’t afford it.

    That said, depending on that system to be the safety net is expensive not only in direct medical costs but in a broad way. Often it means an illness doesn’t get tended to at an earlier and less costly stage (less costly both in money and human suffering, loss of work, etc.).

    On the other hand, people wandering into the ER at 3 in the morning for a sore throat because they were up and the wait was shorter then than in an outpt office during the day is pretty ridiculous too.

    Human behavior is a VERY big issue.

    A few things would be really helpful:

    1) A system that fosters a sense of reponsibility in patients to get good care and keep costs down. I don’t see how a universal system could do anything but make this issue worse.

    2) A system that encourages all of the components to work toward overall efficiency, not shift costs to another component while maximizing profit.

    Personal relationship usually encourages a sense of mutual responsibility. The doctor and office staff want to provide good care to the patients. The patients appreciate good care, are thankful, and try to work with the doctor- no calls at midnight over a cold you’ve had for two days.

    When healthcare becomes a principally a traded commodity like the proverbial “widget”, all that responsibility is undermined. You don’t have a doctor, you have a contract with an HMO. You don’t have patients, you have names listed on your “panel”.

    I don’t think healthcare is a “right”. But I also think we have a responsibility to care for our neioghbor as we would like ourselves to be cared for. That makes for a system based on responsibilities, not rights. Just think, if everybody fought to exercise their own responsibilities rather than demand their own rights.

    We make foolish decisions and expect others to help pay for them. In one of my areas of practice, HIV disease, the advent of highly effective treatment lead to a decreased concern on avoiding infection for some with high risk behaviors. This was an unintended consequence, in part, by drug manufacturers and consumer groups advertising the new breakthroughs. The message should have been, “Yes, if you already have the disease there are now treatments available, which is good news. If you don’t have the disease, you still don’t want it because the treatments are a major hassle, so act responsibly.

    When the state of PA first went to HMOs for Medicaid coverage, one of the compnaies had a prominent add, “And I can even ask my doctor for a prescription for Tylenol for my child.” How assinine. The HMO tries to attaract business with a give-away that encourages overuse of the medical system for inappropriate things. The insurance company gets money and makes the doctors work harder, until patients start complaining about waiting too long at the doctor’s office because too many people are there for unnecessary reasons, then the HMO yells at the doctor’s for unacceptible performance. When everybody should step back and realize how they are contributing to the problem.

    Medicine is more complicated (and effective) than ever before, why shouldn’t it consume more money and time? Like said above, people want to demand more things are a right so they don’t have to do without their luxuries, like cable TV played on a big screen.

    MD in Philly (3d3f72)

  53. Levi,

    I have health insurance for the same reason I have auto and home insurance – because health care providers will sue me and get a judgment against me if I don’t pay, and I have assets that they can take from me once they have that judgment.

    DRJ (8b9d41)

  54. Leviticus #50,

    The spam filter ate my earlier comment — to the good because MD in Philly said it better.

    For my two cents’ worth, protocols vary but every hospital will stabilize you and then make arrangements for your long term care by transferring you to a public hospital, charity ward, arrangements to pay by a third-party charity, helping you get SSI and Medicaid ….

    I believe for self-pays, the primary physician is all important. I have defendant people who ran up tens of thousands of dollars in hospital bills. They got first-class treatment in first-class hospitals because their doctor had admitting privileges there.

    There are “boutique” doctors and hospitals who, as policy, demand payment from self-pays up front but their protocols allow that to be waived. I am privileged to know some such who do waive it.

    nk (7d4710)

  55. MD in Philly,

    Calling a life expectancy mediocre is rather subjective isn’t it? You have to compare it to some other measure. How does our life expectancy compare to 50 years ago AJL?

    Good question. It would also help to look at the rates of things that impact life expectancy, and have nothing to do with the efficacy of the health care system, such as obesity. Diabetes, heart disease and cancer are all killing people because they’re too damned fat. Cuba, of course, doesn’t have that problem.

    Pablo (99243e)

  56. Pablo,

    I’m not sure I’m following, as your post refers to me then to a quote that I didn’t make.

    The significant life expectancy increases have been primarily because of advances in sanitation and vaccination.

    As you state Pablo, life expectancy has to do with a lot of things that are not involved with health care.

    Perhaps a better (but not without problems) measure of health care would be life expectancy for people with a specific condition.

    When Castro was suffering from post operative complications he went to Spain for care, correct? When the Shah of Iran was ill years ago he came to the US/Mayo, correct? Didn’t George Harrison come to the US/Mayo for evaluation/trt. for his brain cancer?

    I know that I was in language school in Costa Rica many years ago, the literacy rate was higher than in the US. That did not mean their universities were more advanced or they had produced more Nobel Prize winners in the sciences per capita than the US. Perhaps it meant they had fewer televisions 😉

    MD in Philly (3d3f72)

  57. “I have assets that they can take from me once they have that judgment.”

    -DRJ

    I assume that you’re implying that many people who utilize emergency rooms as a way to avoid the cost of medical insurance have no assets to seize (which is fairly reasonable). However, what about a family that has, say, just enough money to afford their house payment/car payment/rent, with nothing left over for medical insurance? What happens to their assets when they are unable to pay an ungodly medical bill?

    Let’s put it this way: Approx. 40 million Americans don’t have medical insurance. Now, either those Americans are at some disadvantage when it comes to healthcare, or insurance is useless. My argument (and it’s not a particularly well-formed one, nor one where I’ve stymied internal debate) is that it ought to be a government’s responsibility to attend to the health of its citizens (“Health” falling solidly under the category of “Life”, insofar as “Life, Liberty, and the Pursuit of Happiness” goes).

    Leviticus (b987b0)

  58. It is illegal in the US to be denied needed treatment because you are unable to pay. If you need the specialist, and don’t get to see them because you can’t pay, laws have been broken.

    This is simply untrue. An emergency room must treat people regardless of ability to pay. A particular specialist is under no obligation to treat anyone, paying or not. The ER is required to stabilize the patient; they are not required to perform ongoing care by a specialist or otherwise. (Check my kidney example.) One of the perverse results is that the indigent do best to wait until their condition is so deteriorated that they must call an ambulance (which must respond) and go to the ER (which must take them). To Darleen, this shows the indigent are devious scum. To me, it suggests that our current system is not cost-effective (as this system is unnecessarily expensive) and it is also not delivering good care. (Also, Darleen, auto insurance is about liability, not auto health. It’s no more comparable to health care than the price of tea in China.)

    Daleyrocks, so far your rebuttal consists of telling me that I am full of it. This from an ignoramus who thinks that catastrophic major medical is the way to go for poor people. (If an insurance agent said that, it would probably qualify as malpractice.) Just suppose that the working class increased its savings rate: in the face of care that requires $50K, a little bit of extra savings just means being able to pay 20 percent of the bill instead of 5 percent before going bankrupt paying the rest. I show you a study that medical emergencies are a major factor in bankruptcy, and you say that the investigators reached a pre-existing conclusion. Maybe. But how about you? The only “fact” you presented was false, and it, too, is leading to a pre-existing conclusion. Even worse, I’d say.

    I certainly agree that we could use some government-led initiatives to lead healthier lives instead of mere blank-check medical care. That can even be a bipartisan issue: check out what Republican Mike Huckabee did when the doctors told him how bad his physical condition was. But we aren’t going to have a meaningful thread when the conservatives (MD in Philly completely excepted) are presenting arguments rooted in delusion.

    From MD in Philly, I’d like to hear some ideas about reducing the “moral hazard” in readily available care, such as telling those at risk for AIDS that the treatment is unpleasant. Income staggered co-pays? I’m not up on the latest ideas here. But I’d also point out that I could have bought a big-screen TV for less than the co-pay on my last dental crown. What is a “luxury” can change pretty fast these days.

    And as a final point, the USA is behind Cuba in adult life expectancy, too.

    Andrew J. Lazarus (d39cf9)

  59. And as a final point, the USA is behind Cuba in adult life expectancy, too.

    Unless you disagree with the government…

    Then all bets are off…

    Scott Jacobs (425810)

  60. Andrew,

    Thanks for the excellent post. I think you captured the reservations of some of us very well.

    Voice of Reason (10af7e)

  61. Ah, that wonderful Canadian health system! Apparently at least one Canadian MP, Liberal party of course, thinks the US is the place for her to receive treatment.

    AJL, all Cuban health statistics are suspect. Even the ones that come to us via the UN. The UN does not verify statistical information that member states send to it.

    Stu707 (adbb5a)

  62. Levi,

    However, what about a family that has, say, just enough money to afford their house payment/car payment/rent, with nothing left over for medical insurance? What happens to their assets when they are unable to pay an ungodly medical bill?

    If they are really spending every penny on basic living expenses, they almost certainly qualify for CHIPS and other government assistance. However, most people include in their “basic living expenses” what are really luxury items — new cars, HD TVs, satellite receivers or expanded cable, eating out, cell phones, etc. In other words, they have flexibility in their budgets but they make the choice to forgo health insurance in favor of discretionary items.

    Where people have income over and above necessary expenses but they incur medical bills they can’t pay, they can make payment arrangements with their health care providers. In my community, it’s common for health care providers to provide long-term interest-free loan repayment plans with anyone, regardless of financial status.

    The biggest problem for most people – regardless of how much money they have – is dealing with collection efforts by collection agencies. The extent to which creditors can make debtors’ lives miserable depends in large part on the amount of the debtors’ assets and the state laws governing what assets can be attached to satisfy debts. If you live in Florida (as, for instance, OJ does – which may be why he moved there) or Texas, the exemptions granted to debtors are liberal and it is harder for creditors to take assets from debtors. Other states have less liberal exemptions.

    Finally, whether or not a person has assets that can be attached to pay health care costs, another option is to file bankruptcy. There are different kinds of bankruptcy, depending on how much money you have and can afford to pay. Some people are able to completely discharge their debts while others – who have some ability to repay – can repay what they are able and discharge the rest.

    DRJ (ec59b5)

  63. DRJ,

    I think you are overlooking a couple of aspects.
    Take the example of the Fast Food worker not allowed to work 40 hour weeks because it would qualify them for health benefits. They are making less than 15000 a year. 400 dollar rent, 150 utilities, 300 a month in groceries, 100 a month for car insurance adds up to over 11K in expenses before their tax, FICA, etc. is deducted. HD TV, Satellite, new cars, and the other things you mentioned are just not much of an option.

    In addition, many don’t realize they do have some relief that is cost free as you mentioned. They only go in when they are so sick they may not be able to work.

    I honestly don’t think you mean that “it’s a tough ol world suck it up” but am curious as to how you view the options of people in their shoes.

    Voice of Reason (10af7e)

  64. What’s missing from the discussion is that healthy insured wind up paying for the care of the sick insured.

    Take the example of Andrew’s dental work: But I’d also point out that I could have bought a big-screen TV for less than the co-pay on my last dental crown. With comprehensive dental insurance, Andrew’s crown would have been paid for by thousands of other members of his group who did not need one and he could have bought his big-screen TV.

    Also, Darleen, auto insurance is about liability, not auto health.

    It’s about protecting your pocketbook. Which is also what health insurance is, for most people. So that an illness won’t bankrupt them. For those who are judgment proof, that risk does not exist.

    nk (7d4710)

  65. Pablo,

    I’m not sure I’m following, as your post refers to me then to a quote that I didn’t make.

    Ah, indeed you didn’t. That was daleyrocks. My mistake.

    Andrew,

    And as a final point, the USA is behind Cuba in adult life expectancy, too.

    Yes, 78.2 to 78.3. A staggering 1.2 month advantage.

    Now, let’s look at the difference in diet between the two. (Cubans don’t have access to the sort of food we pig out on without a second thought.) Let’s look at the incidence of traffic fatalities. (The comparatively few Cubans that even have cars are driving US bombers from the 50’s.) Let’s look at deaths in industrial accidents. (Cuba doesn’t have much industry to speak of.) Let’s look at gang related/violent crime deaths (Cuba doesn’t allow it’s people to carry guns)

    Are you suggesting that the trivially higher life expectancy is a product of the health care systems?

    Pablo (99243e)

  66. VOR,

    I’m not overlooking those people. They are the ones that qualify for CHIPs, Medicaid, low-cost clinics, etc. In addition, as NK points out, they are generally judgment proof. While they may not have the option to go to the Mayo Clinic (but remember that even fewer people would have that option under universal health care), they have options – and when compared to those of us in the middle class, they have far less economic downside.

    DRJ (ec59b5)

  67. I certainly agree that we could use some government-led initiatives to lead healthier lives instead of mere blank-check medical care. That can even be a bipartisan issue: check out what Republican Mike Huckabee did when the doctors told him how bad his physical condition was.

    Was that because of a government-led initiative, or was that a matter of personal responsibility?

    Pablo (99243e)

  68. We are not going to get anywhere while people approvingly quote statistics from Cuba, a government with a long history of inventing statistics. That is living in a fantasyland.

    If you want to cite approvingly to Canadian and/or British healthcare systems, then you are approvingly of governments cutting costs by limiting access by long waiting lists, disapproving medical treatments to undeserving patients.

    SPQR (6c18fd)

  69. AJL – We are not going to get anywhere if you keep distorting people’s points.

    You said high deductible, catastrophic medical insurance was only for the rich. I said baloney. Reread what I said.

    Why do the rich need any medical insurance at all? Doh!

    How does that 40 million break down AJL? Can you please give us the categories of people?

    daleyrocks (906622)

  70. AJL

    Also, Darleen, auto insurance is about liability, not auto health. It’s no more comparable to health care than the price of tea in China.)

    It is, indeed, comparible. Oil changes and tuneups are analogous to checkups and vacinations.

    WHY is it mandated that one insurance cover those things and not the other?

    Why is there a good chunk of the “uninsured” not those that CANNOT get insurance but those (20 somethings in good health) that voluntarily refuse to get insurance?

    Because, dear AJL, a 20 something looks at either paying hundreds of dollars a month for the “right” to pay a $10-20 co-pay on a $60 office visit once or twice a year …… and says “no f**kin way”.

    Why should they (or anyone) be allowed to carry a catestrophic coverage; ie coverage for hospitalization, for a really low premium because regular care (checkups) will be out of pocket?

    I’m 53 y/o… I don’t even want to think about the thousands and thousands of dollars extorted from me all these years for over-coverage when I’ve never ever had any serious illness. Why should not I have been allowed to choose my level of health insurance like I can my homeowners insurance or my auto insurance?

    Darleen (187edc)

  71. Daleyrocks: High deductible insurance is useful only for the rich. And they get insurance because unless they are Bill Gates, even they can be wiped out if they get the wrong very expensive disease. That’s the idea behind insurance. Rich people can easily pay for routine medical care. Poor people can’t. Do you know what Advair (for asthma) costs on the open market? About $175/month. If you have two kids (or an adult couple) with asthma, that’s a nuisance if you are a $100K lawyer, but it’s a real crimp if you’re a $30K clerical worker. This is all pretty elementary stuff.

    NK: People who drive without auto insurance (including adequate self-insurance) and get in an accident might go to jail. People who get sick without health insurance might die unnecessarily or be permanently disabled, especially with conditions not amenable to those free ERs we keep hearing about. Do you not see a difference?

    DRJ: Bankruptcy is of course another form of cost-shifting, where more solvent patients have to cover the unpaid portion of the bankrupts’ bills.

    Andrew J. Lazarus (353498)

  72. Darleen, your mortgagor required you to carry a minimum amount of homeowners’ insurance and the state required you to carry a minimum liability auto insurance (or to post an equivalent surety bond). Leaving aside whether these types of insurance are comparable to health insurance, you start from mistaken premises.

    Even overlooking your errors, the argument has some serious flaws. The first is that you are welcome to argue libertarian-philosophical points here, but as long as the pragmatic consequences of this philosophy are unnecessary illness and death, not that many people are interested.

    But the really flaming error is the assumption that since you have been healthy so far, the insurance you paid is wasted. Do you feel that way about your homeowner’s insurance? Your auto insurance? Your life insurance? At the very least you would see this issue differently if you had children. I can’t say that I see my life insurance premiums as wasted, even though obviously I have never needed to collect.

    Andrew J. Lazarus (353498)

  73. I get to choose from whom I purchase my automobile insurance, my professional liability insurance, my commercial and general liability insurance, my E&O insurance, and my life insurance. I also get to choose what types of coverage I wish to carry, the carrier to whom I will pay my premium, how I wish to pay my premiums, etc …

    I fail to see how universal healthcare coverage would be in any way comparable.

    AJL – You reference state mandatory minimums which are poor analogies. No states requires 1st party coverage for your vehicle. The state mandatory minimums are in reference to liability coverage, for damages and injuries caused by you or your vehicle. Again, not similar to universal healthcare.

    JD (4c1b7c)

  74. From Andrew J. Lazarus —

    But we aren’t going to have a meaningful thread when the conservatives (MD in Philly completely excepted) are presenting arguments rooted in delusion.
    Thank you. (Though I wouldn’t agree that the conservatives here are giving arguments from delusions.)

    From MD in Philly, I’d like to hear some ideas about reducing the “moral hazard” in readily available care, such as telling those at risk for AIDS that the treatment is unpleasant. Income staggered co-pays? I’m not up on the latest ideas here.
    If I had the answer I would probably win Nobels in both Medicine and Economics. I think things begin with telling the truth rather than slanting it for someone’s marketing purposes. Anything that encourages personal responsibility, including a system that encourages a professional doctor-patient relationship, not a contractual provider-consumer relationship.

    But I’d also point out that I could have bought a big-screen TV for less than the co-pay on my last dental crown. What is a “luxury” can change pretty fast these days.
    Well, the question is whether buying a big screen TV is more important or saving the money for a dental crown. I don’t anticipate ever buying a big screen TV.

    And as a final point, the USA is behind Cuba in adult life expectancy, too.
    Pablo answered this one. Why trust any data that comes from a country with an authoritarian regime?

    MD in Philly (3d3f72)

  75. but as long as the pragmatic consequences of this philosophy are unnecessary illness and death, not that many people are interested.

    I, for one, am interested, Andrew. I don’t want anyone deprived of health care. We are America not Bangladesh, for crying out loud. The issue is do we make health care available to those who cannot afford it (and I believe that by and large we do) or do we make health care less onerous to those who can afford it but would rather have their fellow citizens help them pay for it?

    nk (7d4710)

  76. But the really flaming error is the assumption that since you have been healthy so far, the insurance you paid is wasted. Do you feel that way about your homeowner’s insurance? Your auto insurance? Your life insurance? At the very least you would see this issue differently if you had children. I can’t say that I see my life insurance premiums as wasted, even though obviously I have never needed to collect.

    ALJ

    I have had no choice in my insurance. With auto insurance, for instance, I can choose between a number of companies and a number of different levels. Indeed, if I have the pink slip on my car I can forego collision completely.

    Why shouldn’t I be allowed to choose an insurance policy where I pay for all my routine care out-of-pocket and get hospitalization coverage? or choose among vehicles with differing coverages of prescription medicine?

    what I object to is being TOLD that I’m too stupid to be allowed to make my own checkup appointments. What I object is that first the government creates the problems that exist with healthcare then tells me there is no alternative but to hand over the whole enchilada to them to run…including scheduling my mandatory appointments, what BMI I’m allowed to carry, what my cholesterol levels should be and heck, whether I’m allowed to go skiing or be retired to a rocking chair

    all for my own good of course and because if the government is paying for my “free” care they get to dictate my “healthy choices.”

    all the while ignoring that the more nationalized a health care system the worse it is for any truly unhealthy people.

    Darleen (187edc)

  77. AJL – You seem to have an elementary problem understanding the way insurance is priced. I think it stems from the idea that by purchasing it (or having someone, say an employer), that it will somehow cost less than the expected claims you incur. That is the liberal free lunch fantasy and not the way insurance works or is priced. Insurance is priced toward expected losses. With the working layer, say routine office visits and prescriptions, the insured is just trading dollars with the insurance company. The real risk is in catastrophic illness or injury, just as Darleen described. Poor or rich can trade dollars with an insurance company or health care provider if they choose to go uninsured for routine care, you’re just looking for the a hand out or freebie. It’s too bad you can’t see that. Darleen explained it very well. I think your wife would be very surprised if she saw the real cost of her excellent health benefits package. My guess is she is paying a very small, if any, portion of its true cost. Does she feel like she is getting full use of that benefit if she had to spend that money out of her own pocket?

    How about answering some of the questions that have been directed at you for a change?

    daleyrocks (906622)

  78. As far as I can tell, Darleen is worried that under Hillarycare, agents in black helicopters will force her to checkups she doesn’t want and pump her stomach if she eats fried foods. I’m not aware of that component of the plan. What I am aware of is that insurance companies exist to make profits, and that some of the ways in which they would rationally act, such as cherry-picking from the pool, result in an overall situation that to the practically-inclined appears non-optimal. For example, if we’re going to have guaranteed free emergency care (probably over Darleen’s objection), but not free routine care, we’ll have to deal with the aforementioned paradox of indigents’ having to wait until you’re at death’s door. (FOAF anecdote: diabetic stupidly runs out of insulin, and there is no all-night pharmacy in town. Diabetic goes to ER. Diabetic must wait until near-coma to qualify for insulin injection at hospital.)

    Under some proposals, you could continue to obtain private insurance, which you might want for faster service or to cover elective operations, etc. Fine with me. The fact is that for some reason competition in the health insurance industry does not seem to have introduced much efficiency, and that profitability seems predicated on short-term strategies like denial of claims, raising of co-pays, etc.

    I think 53, BTW, is a little young to believe you won’t be stricken with a difficult or expensive illness in your lifetime. If you ponder this, you may become less inclined to view your health insurance premiums (but somehow not the auto and homeowners’ premiums) as wasted.

    Andrew J. Lazarus (f26c24)

  79. AJL,

    We seem to have an economic disconnect here. Of course bankruptcy is cost-shifting but that doesn’t mean we might as well adopt a socialist system like universal health care. We also have cost-shifting when consumers have to pay more for goods because a few shoplift, but that doesn’t make it a good idea to regulate the sale of all goods through price controls.

    DRJ (ec59b5)

  80. Andrew #79,

    You’re still equating “health insurance” with “health care” and that just ain’t so.

    nk (7d4710)

  81. What was that old quote “from all according to their means, to all according to their needs”.

    AJL – Reducing others arguments to a caricature of their position does not come across as a good faithed way to discuss matters.

    Edwards plan specifically requires annual checkups. Hillary envisions a day when people will have to show proof of insurance at their job interviews. These do not come across as anything other than nannystate idealism cloaked under the concept of the collective good, as defined by our betters. No thanks.

    JD (4c1b7c)

  82. Daleyrocks: As it happens, the university’s contribution to insurance is listed on every pay stub. And now it only covers the employee: we pay all of the additional premium for myself and children. I am somewhat confused why you think your argument that our existing system is successful is advanced by showing how expensive health insurance is (perhaps, cough, even more expensive than we would pay under a more comprehensive single-payer plan?). But perhaps this confusion comes from the same blindness that does not recognize that a plan with out-of-pocket expenses of $X is no use to a person who will already be ruined by out-of-pocket expenses totaling $X-1. It does not really matter to people without savings that the high-deductible plan is affordable by itself, any more than they can make use of lifetime free gasoline thrown in with a Rolls Royce at list price.

    If you read the thread, one child had an operation that cost at least $30K. So, yeah, even if we’ve paid more than $30K in premiums, that was something we could plan for spread out over many years. Are there really people who think their life insurance was a waste if they live to see their children become adults and no longer need so much life insurance? This isn’t economics, it’s some sort of weird psychology.

    I do recognize that the insurance company will not find paying for routine medical care profitable. Trading dollars, as you say. Your conclusion is that poor people should not obtain routine medical care. Mine is not.

    Andrew J. Lazarus (04365f)

  83. Bastardizing others conclusions to the point where they no longer resemble the original is not really good faithed either. Just sayin’

    JD (4c1b7c)

  84. I’d have to look it up for Hillarycare, but when I worked in a foreign country with national health insurance, I had to show my USA insurance to get out of joining the national plan. They wanted to make sure I wasn’t planning on being a charity case should disaster strike.

    I have to show liability insurance to register my car. I don’t hear many complaints that this is the nanny state. Why? Are people more afraid of getting hit by an uninsured motorist than of cancer? Or is it the other way around, that cancer is so scary we don’t want to contemplate what will be needed to treat it.

    Oh, and on the list of backlogged questions: OK, toss out Cuban life expectancy. We’re still some of the worst in the industrialized world.

    Andrew J. Lazarus (04365f)

  85. DRJ: cost-shifting via bankruptcy, good. Cost-shifting via taxes, bad.
    Uh, OK.

    Andrew J. Lazarus (04365f)

  86. AJL #86,

    We already have cost-shifting through taxes, including charitable deductions that promote giving for need-based aid, tax credits that encourage people to have families, health savings accounts that promote savings for medical purposes, and the earned income credit that helps our poorest workers with direct cash payments.

    Why do you also want blanket transfers that do nothing more than redistribute income from one group to another?

    DRJ (ec59b5)

  87. Andrew,

    I’m sorry. I seem to care about rescuing those who are drowning and you seem to care about those who are tired of rowing.

    nk (7d4710)

  88. Andrew – It is a laughable assertion to state that our healthcare is some of the worst in the industrialized world.

    When registering a car, we do not have to show proof of liability insurance to protect ourselves, it is a measure of financial responsibility in order to protect others in case we cause damage or injury to others, hence the name liability insurance. I know of no states that require Comp/Coll coverage to register a vehicle. Again, bad, very bad analogy.

    You need a job to get insurance in many cases. But under Hillarycare, you would have to show proof of insurance to get the job. You had damn well better hope you are never uninsured under Hillarys plan, as not only would you be uninsured, but disqualified from interviewing for potential jobs. Brilliant, I tell you, brilliant.

    JD (4c1b7c)

  89. AJL

    You have a problem with profit making insurance companies (and doctors? nurses? pharmacists?) but you have no problem with the government running what is (IIRC) 14% of the economy? With LESS overhead?

    I mean, they do SUCH a great job with education.

    I never said my premiums were “wasted”, what I’m saying I am paying for insurance for things I would have paid for out-of-pocket by choice.

    I believe it is Walmart who is going to be putting basic health clinics in a number of their stores – cash and carry – where for $40 or $50 one can get basic physical screening or treatment for minor ailments. What person, even low income, is going to go bankrupt stopping by the clinic for $40 rather than buying a couple of DVD’s that month?

    You seem to trust yourself to make choices in your own best interest, but you seem not to trust that guy over there.

    Allow people to save for clinic visits in medical savings accounts and increase the number of doctors and the availability of insurance. Reserve to the government to provide a safety net only for those too sick or too poor to be covered in the private market.

    Darleen (187edc)

  90. Darleen,

    The government pays for doctor’s education through Medicare.

    More doctors equals more government spending.

    alphie (99bc18)

  91. Liberal economics at its finest, alphie. Bravo!

    JD (4c1b7c)

  92. Well,

    We could bust up the doctor’s union and send a U.S. passport and a plane ticket to the world’s medical school graduates.

    alphie (99bc18)

  93. AJL – I don’t recognize what you say I said or the conclusions I presented. That seems to be a problem of yours on this thread and topic. Honesty works well. Give it a try.

    Please point out where I said our system was a success.

    It’s great that your wife’s university points out the cost of the health care benefit on each pay stub. Think about what MD in Philly and I and Darleen have said about behavior and choice. If the university gave your wife the cash to pay medical bills instead (but still provided coverage over and above the cash cost if needed), do you think there would be cash on hand at the end of the year or not?

    Can you point me to where I said poor people should not get routine medical care?

    daleyrocks (906622)

  94. alphie, how does the government pay for doctor’s education through medicare? Long ago in another millenium the feds did give money that helped support medical schools and residency programs. (I don’t know the details, only that it was cut early in my career and put financial strain on teaching hospitals, read as cut in staffing of nurses, etc.).

    More doctors equals more government spending.
    That was the argument in the 1980’s when the reigns were put on med school admissions, leading to the doctor shortage, for which multitudes of foreign born doctors have already come to this country.

    We could bust up the doctor’s union.
    Doctors generally don’t have a union (I don’t specifically know of any, but some may exist).

    and send a U.S. passport and a plane ticket to the world’s medical school graduates
    See my note above.

    RANT WARNING:

    Remember that I have already said many things are wrong with the US health system and I have spent my career working far below average doctor salary because of the underserved areas I’ve worked in, that said:

    1. 50 years ago we did not have ICU’s for heart attack patients, (and maybe no cardiology specialists, either). Heart attack patients were often observed at home.
    40 years ago, in the 1960’s, it was understood that many people die of sudden arrhythmias post MI and observation in a CCU could save many lives, so it was done. Cardiologists came into being.
    30 or so years ago, heart catherization with angioplast was being developed.
    25 years ago we no longer had only cardiologists, but clinical cardiologists (who didn’t do caths and angioplasties) and interventional cardiologists (who did).
    20 years ago we added cardiologists who specialized in electrophysiology studies for patients with arrythmia problems. We also added cardiologists that specialized in nuclear medicine and 3 dimensional echocardiography. The length of a cardiology fellowship went from 2 years to 3 or more. (Fellowship, Residency, Internship= read as years of work for pay less than a factory worker if broken down into an hourly wage, after incurring up to $100,000s of debt).
    Oh, along the way we added heart transplantation and Cardiologists specializing in advanced heart failure. In some big centers heart transplantations are almost “routine” surgeries. certainly nothing like when Dr. Barnard did the first one 40 or so years ago.

    I don’t think it is hard to understand why the cost of caring for someone with heart disease has gone up in the last 50 years.
    On a purely economic level, which is an inappropriate measuring stick, many people who would have died 10 years ago from a heart attack have continued to live productive lives, economically and socially. So one really needs to look at health care spending in light of what part of the GNP is contributed by people who would have not added to it, as well.

    Ditto every other specialty, which weren’t even in existence 30 years ago.

    As far as non-US born doctors, my grandmother lived in a little town in NW Ohio. Her family doctor, cardiologist, the surgeon who evaluated her in her small town, the gastroenterologist at the medical center in Toledo, and the cardiologist at the medical center in Toledo were all from India/Pakistan/Iran.

    MD in Philly (3d3f72)

  95. AJL – Clarify the paystub comment. Is the amount shown on the paycheck what is deducted from your wife’s paycheck or the cost of the actual insurance to the university. If it is the payroll deduction and you are assuming that is the cost, are you sure university employees pay for 100% of their health insurance?

    daleyrocks (906622)

  96. Daleyrocks: the paystub both indicates the amount deducted for the additional coverage (family) and the University contribution on the employee’s behalf, not just for health care but for other smaller fringe benefits.

    I am not quite sure what you mean “if the university handed us cash for medical bills”. Either you mean the University goes into the insurance business itself, covering our bills whatever they might be, or it’s just giving us a raise to spend on the medical bills or something else. So are you asking, would we trade the university’s contribution for cash? The answer is no, that would be economically very stupid. The university is able to get a much better deal than we would as individuals because the insurance company’s risk (variance) goes down with the size of the pool. That’s why people like to get their insurance through groups like employers, especially under arrangements where everyone is covered and there is no cherry-picking.

    I would say that if we had followed your idea, we would indeed have had cash on hand all but one of the 16 years I have been married. That one year, we would have been $30,000 behind. Wait, two years: same child needed another operation (less expensive) the next year. And you know what? Even if my son hadn’t been born with a reparable congenital defect, I still would be glad of knowing I was covered. I retain the impression you and Darleen don’t know why most people buy insurance, nor how insurance is priced.

    JD: Please name criteria on which we don’t trail most of the industrialized world. Child mortality? Life expectancy? Immunization coverage? The only place we are totally number one is money squandered on medical bureaucracy, exactly the waste that you decry when it’s in government.

    Andrew J. Lazarus (c299ee)

  97. AJL,

    Your employer may be able to negotiate better group discounts but if you were spending your own money, you would make better decisions about how you choose to spend or not spend that money. For instance, as a member of a group, you probably have to go through gatekeepers to get to specialists, and your choices are limited to specified doctors, labs, and facilities.

    In addition, you probably have a limited ability to discuss alternative costs and treatments. If you are like most people, you have no real choice but to do whatever the authorized group doctor recommends unless you want to pay for independent evaluations from other doctors (which is, by the way, not the same thing as getting a second opinion). And good luck getting the group insurance to pay for that alternative treatment.

    Frankly, medical care today is very close to socialized medicine anyway. I’d like to preserve what little choices we still have left.

    DRJ (ec59b5)

  98. MD,

    It’s not just the federal government that subsidizes medical education, it’s also the states:

    Another example of institutions driving the system is the way the State pays for graduate medical education. New York’s Medicaid program has spent more than $8 billion over the last five years on graduate medical education – $77,000 per graduate resident in 2005 compared to similar states like California that spent just $21,000 per resident.

    http://www.ny.gov/governor/keydocs/0126071_speech.html

    alphie (99bc18)

  99. The idea that those evil insurance and HMO companies are the only thing between us and affordable health care is just more anti-capitalist rhetoric. A study published in the British Medical Journal compared the British National Health Service to Kaiser Permanente and concluded that Kaiser provided better service at an equivalent cost to NHS.

    SPQR (6c18fd)

  100. I’m thinking that health care providers like MD in Philly are just going to love a transition to government managed universal health care. When they get told that they can’t practice a certain specialty because there are enough doctors in that field or that they can’t set up practice in a certain geograpgic area because there are already enough doctors there, I think some real fun and games will start.

    I think the prospect of the government telling people where they can live and what specialty they can perform to make their livelihood makes a whole lot of damn sense. That’s a basic government function isn’t it? Doesn’t it say so in the Constitution somewhere? I think I may have missed it, but I sure it’s in there somewhere.

    daleyrocks (906622)

  101. AJL – I think you are incurably dense on this subject and as one commenter pointed out last night continue to confuse health care with insurance. I can assure you that I have forgotten more about the insurance business than you will ever know and still retain more knowledge than you. I appreciate you attempts to explain the business and am more stupid for having read them.

    daleyrocks (906622)

  102. I’ll bite, daleyrocks. I like Internet liars dice. What exactly have you done that makes you an expert on insurance.

    Incidentally, if you claim to have been licensed to sell it, I’d like your real name to run your unusual ideas about catastrophic health insurance by the state board.

    Andrew J. Lazarus (9b5373)

  103. AJL – You can bite my ass. That’s all you deserve.

    daleyrocks (906622)

  104. AJL,

    I don’t like it when people threaten to take this stuff into real life.

    Patterico (2a8eaa)

  105. Looking for a Mike Adams piece I just noticed John Stossel put out a column on health insurance yesterday that begins to explain differences between routine care and catastrophic illness. The discussion is basic enough that even AJL might be able to learn something and understand various comments that were made on this thread that were obviously beyond his comprehension. Any others in AJL’s boat, it’s worth a read.

    http://townhall.com/columnists/JohnStossel/2007/09/25/our_crazy_health-insurance_system

    daleyrocks (906622)

  106. Darleen,
    The government pays for doctor’s education through Medicare.
    More doctors equals more government spending.
    Comment by alphie

    alphie, how does the government pay for doctor’s education through medicare? Long ago in another millenium the feds did give money that helped support medical schools and residency programs. (I don’t know the details, only that it was cut early in my career and put financial strain on teaching hospitals, read as cut in staffing of nurses, etc.). MD in Philly

    MD,
    It’s not just the federal government that subsidizes medical education, it’s also the states: … alphie

    alphie,
    I looked at your link (plus looked up some others that were more of a discussion of the topic).

    You are correct, that kind of programs that I thought had been phased out still exist. I distinctly remember a conversation years ago where the general topic was discussed. Whether the discussion was about threatened change that never happened, or what, I don’t know.

    That said, while the Feds and state contribute, they do not pay all, for med students generally pay considerable tuition, as well as contribute labor, and postgraduates contribute significant labor at less than market rate.

    Also, limiting the number of doctors will not likely improve the quality and lower the cost of health care. In fact, I’ve read that there is expected to be a significant difficulty for Massachusetts to absorb the influx of patients with their reforms bringing about universal (or near universal) insurance there.

    MD in Philly (3d3f72)

  107. FWIW,

    I learned today that the average debt burden for a doctor coming out of residency is currently $1,800/month for 30 years. (That is primarily from undergrad and med school, which can be deferred for a few years while in residency).

    MD in Philly (3d3f72)

  108. OK, no more “threats” for the real life world. But daleyrocks couldn’t come up with justification or credentials for his alleged knowledge of insurance even under a pseudonym. Bluff called. He knows nothing.

    If his previous blunder wasn’t evidence enough, linking to John Stossel—who’s a specialist only in giving a major media outlet for Big Business fairy tales—cinches the case.

    Andrew J. Lazarus (98fb31)

  109. Thugging it up isn’t calling a bluff, Andrew. Its just being a thug.

    SPQR (6c18fd)

  110. AJL – Standard lib operating procedure, attack the messenger when they’ve got nothing. Great job once again!

    daleyrocks (906622)

  111. ALJ:

    JD: Please name criteria on which we don’t trail most of the industrialized world. Child mortality? Life expectancy? Immunization coverage?

    AJL, immunizations are universally available and essentially already free via government to those who ‘can’t afford” them/income. So just why do we trail the rest of the industrialized world in rates of immunization – assuming we do?

    If you wanted to eliminate the relatively small gap the granted-for-the-sake-of-argument stats show in infant mortality and life expectancy, maybe you should get more worked up over things like teenage pregnancy, maternal smoking while pregnant [low birth weight], drug abuse, different ethnic practices [and political balkanization], nutritional ignorance, the sad state of a significant proportion of public education, out of wedlock births [poverty by choice], the rate of still-leaving-babies-in-cars, obesity, murders, motor vehicle deaths, failure to comply with medication regimes, choice of “alternative” care, excess reliance upon magic bullets, and so on – maybe even looking at overall and specific gene pools for inherent differences/country.

    That is, do that instead of blithely blaming everything on the current, vaguely conceived and too-conveniently demonized “Health Care System”, then jumping to a magic governmental panacea, which already has a trial record known as the “V.A. System”.

    J. Peden (a4fb8c)

  112. J. Peden – Some people unfortunately believe everything Michael Moore spews. ALJ clearly does. Most rational people if they are ignorant on a topic would not expose that ignorance on a thread or attempt to universalize idividual experience with healthcare insurance. Not ALJ.
    Some intellectually honest people would attempt to understand concepts explained repeatedly explained in a thread and even supported by a link. Not AJL.

    I’m declaring victory.

    daleyrocks (906622)

  113. Daleyrocks: the approved Bushite way to declare victory is to announce Mission Accomplished. Wrongly.

    Let’s roll the tape. Evidence that you have forgotten more about insurance than I know, zero. You presented none. Zero. Zip. The only “fact” I recall your contributing is the suggestion that catastrophic health insurance is the way to go for poor people, something that no one who knows anything about how insurance works would believe. Your arguments since that blunder have been insulting and remarkably free of anything remotely testable or verifiable. Your claim that I don’t present anything are silly. I even related for your benefit just how useful health insurance had been for my family. You? Nothing. Perhaps too shy to admit you’re still a dependent on mommy and daddy’s policy, or something similar.

    J. Peden: The VA has some of the best health services in the country, despite the Bush Administration’s attempts to cut it back. (Bush likes soldiers only as photo ops.)

    A RAND Corporation study published in the The Annals of Internal Medicine concludes that the VA outperforms all other sectors of American health care in 294 measures of quality. In awarding the VA a top prize in 2006 for innovation in government, Harvard’s John F. Kennedy School of Government gushed that “While the costs of healthcare continue to soar for most Americans, the VA is reducing costs, reducing errors, and becoming the model for what modern health care management and delivery should look like.”

    (Other links to similar studies can be found starting at the quote above.) Nice try, though.

    Andrew J. Lazarus (63fc6e)

  114. No, AJL, the “nice try” was when you attempted to “win” a debate by threatening to report someone’s statements that you didn’t care for to a licensing board. That was when you forfeited.

    SPQR (6c18fd)

  115. Most veterans only go to VA for their medicines. They prefer their private physicians and the hospitals those physicians are affiliated with for their care. And don’t ask me how I know. Just take it or leave it.

    nk (7d4710)

  116. SPQR: Yeah, I’m the bad guy for calling daleyrocks’ bluff. Here’s what Daleyrocks had to say before I challenged him (#49) “AJL – You’re full of it!” Really brilliant argumentation, that. Do I detect a certain biased lenience towards conservatives’ rudeness here?

    Remember that cartoon: On the internet, no one knows you’re a dog? Daleyrocks hasn’t shown much understanding of elementary household economics. For example, he also viewed it as a scandal that some number of people continue to pay their cable TV bills while missing mortgage payments. As it happens, I don’t like TV much, period, but if your cable bill is $49 a month and your mortgage just ballooned to $2500 a month, both of which I think are typical figures for where I live, skipping the mortgage payment isn’t an irrational economic choice. Paying or not paying the cable bill really won’t make much difference in the ability to pay the mortgage. Who knows, maybe daleyrocks really does run an adult household in that real life I’m not going to talk about any more. If so, all that’s happened is that a desire to play “gotcha” against liberals’ arguments has overwhelmed his ability to think sensibly about what he is saying.

    Andrew J. Lazarus (6bb523)

  117. Its not rudeness that is the issue, AJL, although you would like to characterize your conduct that way.

    What you wrote was a threat to engage in retaliation. Your indignation on being called for a thug is false and comical.

    SPQR (6c18fd)

  118. I’ll tell you a secret, SPQR, in case you don’t know it. Daleyrocks’ failure to justify his claims to know his ass from a hole in the ground about insurance have not been thwarted by my thuggishness. They were thwarted by the fact he was bluffing.

    The Bush 28 percenters so well-represented here are an echo chamber of urban legends (cf. comment 112).

    Andrew J. Lazarus (672dcf)

  119. You continue to beclown yourself AJL!

    daleyrocks (906622)

  120. Assholes like Andrew and others libs illustrate why it’s not a good practice to give out personal information on the internet. They’re unhinged.

    daleyrocks (906622)

  121. AJL,

    The VA system is not directly comparable to “other hospitals” for a number of reasons.

    MD in Philly (3d3f72)

  122. MD: I’m sure that’s true, but it suggests to me that (1) we might want to make other hospitals more like the VA to the extent practicable and (2) the idea of certain conservatives that the government invariably screws up everything it touches (exempting for no reason I can see certain uniformed services but not others) is falsified.

    Andrew J. Lazarus (b12c84)

  123. AJL, I’ll tell you a secret. Your thuggish behavior is not a surprise.

    SPQR (6c18fd)

  124. Michael Moore certainly didn’t do me any favors on this topic. He’s as bad as Media Matters for cripes sakes. Next thread I guess I’ll just have to do some actual research instead of relying of hopelessly biased and untruthful sources. It’s not fun getting pwnd on everything you post ’cause

    IT’S ALL ABOUT MEEEEEE!!!!!!!

    AJL's Bruised Ego (906622)

  125. So, Andrew, the VA rations, and so manages to stay ahead of City Hospitals? That’s impressive.

    J. Peden (eba008)

  126. Oh, and on the list of backlogged questions: OK, toss out Cuban life expectancy. We’re still some of the worst in the industrialized world.

    Comment by Andrew J. Lazarus — 9/25/2007 @ 9:03 pm

    Actually, if you remove deaths from violent crime from the numbers, we are #1 in the world in life expectancy…by a long shot. Too bad we are #1 in the world, again by a long shot, in violent crime. Let’s compare apples to apples here.

    Marty G., RN-PICU (8ad700)

  127. wow :)
    its very reasonable point of view.
    Nice post.
    realy good post

    thx :-)

    Slothes (3d6597)


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