Patterico's Pontifications

10/4/2009

ObamaCare: Running Out of Time

Filed under: Health Care,Obama — DRJ @ 9:45 pm



[Guest post by DRJ]

The House of Representatives is running out of time to decide how to fund its health care plan. Meanwhile, the White House hasn’t given up on the public option. And depending on what the final plan provides, Americans may just be running out of time:

Click here for private vs public health care waiting times in Canada.

— DRJ

44 Responses to “ObamaCare: Running Out of Time”

  1. Geez Travis, that led to some depressing insight that we will get ObamaCare in some form or fashion, no matter how many dirty tactics it takes. I feel hopeless, and helpless.

    sybilll (7000b3)

  2. OT – Patterico I think you are being spammed on recent threads, for what reason I do not know.

    Check commentors VA, CT, HO and DN.

    [You’re right and it is now taken care of. Thanks for pointing it out. –Stashiu]

    Have Blue (854a6e)

  3. Nice vid, only it has nothing to do with any of the options now before Congress. A single-payer system is not on the table. What is being talked about is the public option, which, like Medicare, would provide insurance, not care.

    I’ll admit that it’s politically easier to oppose health care reform if you can conjure up the Red Scare, but I don’t find the blurring of such distinctions helpful for any real debate.

    Tom (69f10e)

  4. Tom – That would be true, were the “public option” not going to hamstring the private sector, and as has been admitted by many proponents, simply a stepping stone towards single-payer.

    JD (abe6ab)

  5. Tom: A single-payer system is not on the table. What is being talked about is the public option, …

    Rep. Barney Frank (D-MA):

    I think that if we get a good public option it could lead to single-payer and that is the best way to reach single-payer. Saying you’ll do nothing till you get single-payer is a sure way never to get it. … I think the best way we’re going to get single-payer, the only way, is to have a public option and demonstrate the strength of its power.

    Paul Krugman:

    [T]he only reason not to do [single-payer] is that politically it’s hard to do in one step…You’d have to convince people to completely give up the insurance they have, whereas something that lets people keep the insurance they have but then offers the option of a public plan, that may evolve into single-payer, but you can do it politically…

    Rep. Jan Schakowsky (D-IL):

    And next to me was a guy from the insurance company who argued against the public health insurance option, saying it wouldn’t let private insurance compete. That a public option will put the private insurance industry out of business and lead to single-payer. My single-payer friends, he was right. The man was right.

    Rep. Keith Ellison (D-MN): (interview with Eric Eskola)
    ESKOLA: Isn’t the public option really just a step towards the single payer that you want so much?

    REP. ELLISON: Yes but the reality is that for many people that’s not what it is.

    LarryD (feb78b)

  6. “Nearly 45,000 people die in the United States each year — one every 12 minutes — in large part because they lack health insurance and can not get good care, Harvard Medical School researchers found in an analysis”
    reuters.com/article/healthNews/idUSTRE58G6W520090917

    There’s Canada, and England, and Switzerland and France…
    single payer, mixed private and public etc. etc.
    Why not get involved in trying to fix the problem? And there is a problem.
    Republicans don’t have a plan because the just love the market. L-U-V

    So Todd Gitlin has a question:

    “And who was it, conservatives, you expected to keep you safe? Do you really want the government’s hands out of your hamburger? Or is the paralyzed 22-year-old Stephanie Smith, a victim of E. coli passed down the food chain by Cargill in the guise of “”American Chef’s Selection Angus Beef Patties,” which included slaughterhouse trimmings, a case of collateral damage in the War Against Regulation?”
    tpmcafe.talkingpointsmemo.com/2009/10/04/a_query_for_government-haters/
    Here’s the piece he links to.
    nytimes.com/2009/10/04/health/04meat.html?ref=health

    bored again (d80b5a)

  7. Tom shows us how the dishonest argument against the “Red Scare” is done. But no one is falling for it.

    More bogus again, as agricultural inspection has nothing to do with healthcare insurance. And bogus again repeats the lie that Republicans don’t have a plan.

    Sheesh, confused again is more like it.

    SPQR (26be8b)

  8. Bored again,

    I see your Reuter’s link is to a Himmelstein study. I hope it’s better than his study of medical costs in bankruptcies.

    DRJ (b008f8)

  9. Comment by bored again — 10/5/2009 @ 1:41 pm

    Well, that number pales besides the 90-100K that die each year due to medical mistakes – not malpractice, but just plain old mistakes, and things like hospital-introduced infections.

    But then, the NRA and its’ love for guns is the great boogey-man of “public health”.

    AD - RtR/OS! (03146a)

  10. I hope you are not holding your breath, DRJ.

    SPQR (26be8b)

  11. So if I correctly understand the Democrats who are trying to placate their liberal base, and all of you who seem to be taking them at their word: the public option, though not at all anything like a single-payer system, might eventually lead to the passing of a single-payer system someday.

    Really??

    Well, I guess that works out well for the opposition. Obviously, it’ll be difficult to defend the passage of any legislation that could someday lead to the passing of something undesirable that is totally unrelated. Good ol’ slippery slope.


    Also, SPQR writes: “Tom shows us how the dishonest argument against the “Red Scare” is done. But no one is falling for it.” Dishonest? You must have skipped the video, which states (at 1:22):

    “‘The problem with SOCIALISM is that eventually you run out of other people’s money.’ The problem with SOCIALIZED MEDICINE is eventually you run out of time waiting for treatment.”

    Again, “socialized medicine” is not in any way being proposed. I maintain that this pithy name-calling is simply an attempt to “conjure up the Red Scare.” You disagree? Explain yourself.

    Also, you called “bored again” a liar for asserting that the Republicans don’t have a plan. If they do, that’s news to me, so please, enlighten us. This is a simple question, so there should be a simple answer: Do the Republicans have a plan to reform health care? (If yes, pray, what is it?)

    Tom (69f10e)

  12. JD, given my experience getting hamstrung by my own health insurance, I’m not sure I mind the idea of them having to worry about some competition, if that’ll (a) give me an option (it won’t; even if the “public option” doesn’t presently become an option for the rest of us who have insurance already, under current proposals), or (b) prompt my company into offering better service.

    Tom (69f10e)

  13. I maintain that the proponents of the public option have stated, in no uncertain terms, that it is a stepping stone to single-payer. The public option as presented, will destroy private insurance, will cause a mass exodus from employer-based insurance, and will result in single-payer. The people that want it state that to be their intention, as quoted above.

    There have been numerous Republican proposals, which have been rebuffed by the Democratic party which controls both Houses of Congress. That you choose to not educate yourself does not place a burden upon us to do so.

    JD (145e30)

  14. Tom – The idea that the “public option” will in any way compete with private insurance is laughable. The same people that create the public option, can allow it to run at a nearly unlimited loss, get to write the rules for their “competition”, and exercise regulatory control over the “competition”. It is like allowing George Steinbrenner the ability to write the rules and regulations for Major League Baseball, all while giving him unlimited deep pockets of other peoples money from which to operate his team. The result is predictable and inevitable.

    JD (145e30)

  15. JD, if you’ve already got insurance, you and I wouldn’t even be allowed to switch to the public option. In present proposals, it would exist only for those who don’t have insurance already. The “mass exodus” wouldn’t be possible, under the present conditions. In theory, however, if non-profit governmental health insurance ends up being cheaper and better for the consumer than for-profit health insurance, why would it be a bad thing for consumers to switch to it? The U.S. government already has a public option for housing insurance (introduced by Senate Republicans(!) following Hurricane Katrina) for the same reason.

    Also, please allow me to clarify: I am under the impression that there is no unified Republican proposal. I am aware of several proposals from individual, but no single Republican plan to contrast with the Democratic plans.

    Nice back-and-forth as usual, JD. Thanks for remembering that I’m not the other Tom this time.

    Tom (69f10e)

  16. What is there to suggest that it will be cheaper or of a higher quality? Is there any history of the US government doing so? Medicare? VA? Indian healthcare?

    If your employer drops their plan because the costs outweigh the tax penalties, there you go …

    Having A plan is meaningless, as it would never even be called for a vote, like all of the individual proposals out there. Many here have outlined their preferences. Kerry had a plan for everything. Sometimes the status quo is way way way better than what is being proposed.

    JD (145e30)

  17. Tom,

    There are a number of ways people will be forced to a public option, probably within a short period of time. First, there will be an immediate end to employer coverage for businesses that can barely afford their existing plans. Those employers will likely drop their health plans because they can’t afford them or because it’s cheaper to pay a penalty than to provide coverage.

    In addition, if the rumored penalty on “Cadillac” plans comes true, some and perhaps many of those insureds will drop out since they can’t afford to pay for both the coverage and the penalties. As that happens, the plans themselves will be in jeopardy.

    Finally, the more people that drop out of any plan — whether it’s a Cadillac plan or a plain Jane plan — the more likely those plans won’t be feasible and their insureds will have to switch to a public option.

    DRJ (b008f8)

  18. Thanks for the food for thought, DRJ, JD. I think another assumption that divides us is whether the feds would screw up non-profit health insurance worse than our current for-profit insurance, which financially incentivizes the denial of claims. I’m simply not worried that it could get any worse, and at the same time, the uninsured folks I know would have much to gain.

    Tom (69f10e)

  19. Tom,

    I don’t share your confidence in the public option vs private health care. Have you seen the public vs private wait times in Canada?

    DRJ (b008f8)

  20. DRJ, do you think that a private medical service in Canada looking for customers is the best source for comparative wait times? Wikipedia has much shorter times. (Not that Wikipedia is necessarily correct either; perhaps this is a place that Google is not the best method of research?)

    For example, Wikipedia says:

    The median wait time in Canada to see a special physician is a little over four weeks with 89.5% waiting less than 3 months.[42]

    The median wait time for diagnostic services such as MRI and CAT scans [43] is two weeks with 86.4% waiting less than 3 months.[42]

    The median wait time for surgery is four weeks with 82.2% waiting less than 3 months.[42]

    Another study by the Commonwealth Fund found that 57% of Canadians reported waiting 4 weeks or more to see a specialist, broadly in line with the current official statisitics; 24% of Canadians waited 4 hours or more in the emergency room.[44][45]

    (I should add that two of my three most recent visits to the ER in the United States involved waits of over three hours.)

    Andrew J. Lazarus (47acf1)

  21. Tom – There is recourse if you feel your insurance has unjustly denied coverage for treatment.

    AJL – Even accepting the wiki numbers you quoted, that would be entirely unacceptable to me. Those numbers are horrible.

    JD (b78ff7)

  22. “I am under the impression that there is no unified Republican proposal.”

    Tom – I am under the impression that there is no unified Democrat proposal. Otherwise, with your majorities, a bill already would have been passed.

    daleyrocks (718861)

  23. “which financially incentivizes the denial of claims”

    Tom – I disagree with you on this. An insurer who develops a reputation for unfairly denying claims is going to lose customers. Businesses are going to renew with competitors as employees complain about claims handling, they don’t want the hassles. Insurers who actually unfairly deny claims are subject to fines and penalties from their respective insurance departments. It’s not all the broad brush “big business is bad” crap that liberals slap on the companies and there’s a reason the margins are skinny.

    daleyrocks (718861)

  24. AJL,

    The official Canadian statistics for wait times start at approx page 30 of the link. The wait time for diagnostic services in 2007 (the last reported period) says that 32% of patients waited 1-3 months for services and 10+% waited over 3 months. The wait time to see a specialist (page 36): 40% waited 1-3 months and 13% waited over 3 months. The wait time for non-emergent surgery (page 38): 40% waited 1-3 months, and 17.8% waited over 3 months.

    But apart from whose data is more reliable, you also have to consider whether Canada provides adequate care. This study entitled Long-Term Mortality of Patients With Acute Myocardial Infarction in the United States and Canada reports Canadian doctors do fewer procedures per capita and its citizens have a worse prognosis as a result:

    “Our results suggest, for the first time, that the conservative pattern of care in Canada may be associated with a detrimental effect on long-term survival. Canadian rates of revascularization after myocardial infarction are, if anything, higher than those in Britain and most of continental Europe. For hundreds of thousands of patients who suffer an acute myocardial infarction in developing nations, revascularization is inaccessible. The results of our study may therefore have important policy implications for the delivery of cardiac care services worldwide.”

    Why do you think they do fewer procedures?

    DRJ (b008f8)

  25. Daleyrocks,

    An insurer who develops a reputation for unfairly denying claims is going to lose customers.

    I know this is predicted by Teenager-Libertarian Theory, but can you find a single example of it in practice? California’s largest insurers have a 21% denial rate. That would suggest that they’re all in it together.

    JD, whether you find Canadian wait times acceptable is not that interesting until you compare them to USA wait times. Perhaps you would find them even more unacceptable.

    As far as I can tell from Google, Canadian wait times are slightly longer than in the USA, and all those other silly little industrialized countries are shorter than both. Now, from a few minutes of research, that may or may not be correct. What is curious is your willingness to look at half the absolutely-necessary data before making up your mind.

    Andrew J. Lazarus (47acf1)

  26. It is not curious at all, AJL. The numbers you quote are exponentially longer than what I have experienced personally, and with my children. My 1 year old was referred to a specialist on a Thursday, and we were able to get approval and an appt the following day, where surgery was scheduled for Tuesday. This was an important, though non-emergent surgery. My personal experiences with ER’s, hospitalizations, and surgery mirror same. Move somewhere else if you are getting crappy service. Just don’t inflict that crappy service nationwide, as I do not want it.

    JD (6cce87)

  27. Andrew,

    Are you sure you are comparing apples and oranges? Because I don’t think your Wiki link matches up with my link. For example, how quickly you see a specialist doesn’t tell us anything about how long it took to get lab work that is probably necessary to get a referral to a specialist.

    I can tell you from personal experience that a big problem in any health care is getting a diagnosis. If you have a difficult or unusual condition, it’s critical to have access to multiple doctors and prompt tests and procedures. An extra week or two or four — multiplied by several doctors, procedures and tests — makes a huge difference.

    DRJ (b008f8)

  28. JD, is there any reason to believe your personal experience with health care is the median experience? Statistics suggest otherwise.

    What is your insurer’s wait time to treat narcissism?

    Andrew J. Lazarus (47acf1)

  29. Andrew,

    Your link is to Ezra Klein. You object to my link and you link to Ezra Klein for your statistics?

    DRJ (b008f8)

  30. Why, Andrew? Are you shopping for a new insurer?

    John Hitchcock (3fd153)

  31. DRJ, it’s possible that we are comparing apples and oranges. I’m not all that up on medical statistics. I do know that even right-wing Canadians of my acquaintance prefer government insurance to the US system. And, again, numbers within Canada need to be compared to numbers in the United States (not just JD’s sample of one, if you don’t mind), and that takes some adjustment.

    Andrew J. Lazarus (47acf1)

  32. What is your insurer’s wait time to treat narcissism?
    Comment by Andrew J. Lazarus — 10/5/2009 @ 9:46 pm

    I’m sure we can get your treatment started within 72 hours AJL. Quick enough?

    Stashiu3 (44da70)

  33. Why, Andrew? Are you shopping for a new insurer?

    As it happens, I changed insurers last year. Every insurer I have had to deal with has caused at least one major headache, including one which took many hours to resolve and resulting in our owing zero. (The hospital thought it would be easier to fix their billing errors by sending us dunning letters for the difference.)

    I don’t know why Ezra Klein should be considered unreliable. Maybe he is, although he does link to the underlying sources. I do know that relying on advertising for statistics is dubious.

    Andrew J. Lazarus (47acf1)

  34. Now I am a narcissist because I do not want a lesser standard for my children’s well-being? It never takes long for your inner-asshat to emerge, AJL. If you do not like the care you get, go elsewhere. Change plans. I just do not want your misery inflicted on my kids. If that makes me a narcissist, then so be it.

    JD (6cce87)

  35. It took hours to deal with the insurance company, and I am the narcissist? Unintentional irony is always funny.

    JD (6cce87)

  36. “can you find a single example of it in practice”

    Crazy Andy – Perhaps I shoul;d have inserted the word “legitimate” in front of the word claims to throw you of the scent and your typical talking point, since paying illegitimate claims is a disservice to all policyholders and only serves to raise rates.

    Examples in real life, sure, my prior employer switched health care insurers after the carrier botched the handling of a claim for the CEO’s wife. I worked directly for the CEO and got to witness the fireworks and help select the successor carrier.

    You can deride it as Teenager libertarian theory, but since you have heretofore demonstrated no knowledge of actual business on this blog, I don’t take much of what you say on such matters seriously. Where do you think the nurses got the data you linked to come up with those stats? Any idea how they were calculated? Are you presuming that all claims presented are valid? Are you seriously that dumb?

    daleyrocks (718861)

  37. AJL – Did you know according to the latest hot liberal talking point that 45,000 Americans died due to lack of health insurance last year? How many died with health insurance?

    daleyrocks (718861)

  38. Oh, here’s a thought. My sister-in-law is a Czech national and an RN in the US (after being an RN in the Czech Republic and taking more classes here). She spent time at the local hospital in the ER “can we help you” box. She told head-ache victims the grocery store with the aspirin was across the street. She has no patience for American idiots who take their “free lunch” card to the emergency room.

    John Hitchcock (3fd153)

  39. In AJL’s world it is simple, you must sacrifice your children’s health and your money so he never has to deal with an insurance claim again. And, if you do not agree, you are a narcissist. And prolly racist too.

    JD (848a9f)

  40. Andrew,

    I do not concede that my link is to an ad but if it is, it may well be subject to Canadian regulations that prohibit false and misleading information as well as to an advertisers’ Code of Conduct. Does Ezra Klein meet that standard?

    DRJ (b008f8)

  41. Tom, doubling down on the deceptive argument is not impressive.

    SPQR (26be8b)

  42. I believe the link below may be the source of data for the claims made by Andrew in comment #27 above. With his surface knowledge of the subject, he automatically assumes the figures are dire and reflect bad faith on the part of the insurers. Taking a few minutes to dig into the method of calculation of denials in the study would have yielded a more rational response since they include claim edits, claims subject to deductibles, noncovered claims, claims where information is missing, among a panoply of reasons to be categorized as denials. AJL’s patellar reflex anti-business instincts are on display once again as he willingly spews contemptible talking points before investigation.

    http://www.ama-assn.org/ama1/pub/upload/mm/368/reportcard.pdf

    daleyrocks (718861)


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