Sunday, July 19, 2009

Do we need comprehensive health-care reform?

I know President Obama wants this to be his signature achievement. But he hasn’t yet persuaded me that America needs to radically overhaul its health-care system.

I’m willing to bet reform won’t happen. Maybe it shouldn’t happen.

The people pushing hardest for it are leftists who embrace the ideology of government control of markets (not to mention “soaking the rich”). Leftists such as the folks at MoveOn.org and the Huffington Post class warrior Jason Linkins.

But Barack Obama knows he can’t sell reform to the American people as a matter of wealth redistribution.

That’s why he hardly mentions the uninsured any more. He’s trying to talk the talk of middle-class populism, saying we must control the “skyrocketing costs” of health care.

Question one: Why is it the government’s business to “control” the cost of health care, as opposed to the cost of food, clothing, gasoline or movie tickets?

Question two: How will a trillion dollars in new public spending “control” the skyrocketing cost of health care?

This morning on “Meet the Press,” NBC’s David Gregory did a good, tough interview with Kathleen Sebelius, Obama’s health secretary. (It’s embedded below.) She did not state a clear, compelling case for health-care reform.

If any readers have given thought to this issue and would like to explain it to me, please let’s carry this discussion to the comments section.

72 comments:

CNu said...

That’s why he hardly mentions the uninsured any more. He’s trying to talk the talk of middle-class populism, saying we must control the “skyrocketing costs” of health care.

violent revolutions have NEVER originated among the poor. always and only the dispossessed or disaffected middle and upper middle classes.

let the egregiously underestimated unemployment figures hit 15% - and you'll see exactly what that means.

Question one: Why is it the government’s business to “control” the cost of health care, as opposed to the cost of food, clothing, gasoline or movie tickets?

the government DOES control the costs of food and energy, or hadn't you heard of farm subsidies, food stamps, and AFDC? (we'll let the cap and trade bidnis ruminate for a minute or two, but wrt the control of energy costs, its import should be fairly self-evident)

phuk a movie ticket....,

Question two: How will a trillion dollars in new public spending “control” the skyrocketing cost of health care?


If it does nothing more than to implement a longitudinal electronic medical records system modeled on the MUMPS-based system in use throughout the VA and Tri-Care medical industrial complexes, it will have acted so as to profoundly control the skyrocketing costs of healthcare in America.

Undercover Black Man said...

let the egregiously underestimated unemployment figures hit 15% - and you'll see exactly what that means.

Rather than salivate at the thought of widespread chaos and pain, CNu, why not work out on a heavy bag or go down to the shootin' range? Vent that displaced rage.

the government DOES control the costs of food and energy, or hadn't you heard of farm subsidies...

According to my understanding, the purpose of farm subsidies isn't to keep the price of food low. Indeed, it's to prevent the price of food from falling too low.

Which is why farmers lurv farm subsidies.

When Prez talks about "controlling" health-care costs, contrarily, he's talking about the federal government bogarting the market to keep prices down.

Question one (restated): Why?

Question two: How?

thehoustongirl said...

Capitalism isn't dead, speacially when it comes to Health Care! Same shit differnt box wrapped nicely in wrapping paper.

I'm not sure if there is going to be a Universal health care in the U.S. because its possible that some companies that backed his CAMPAIGN will lose money [and that's what all of this boils down to: MONEY. They don't give a damn about insuring everyone, like McCain said....they don't have to worry about anything because the GOVERNEMNT gives them very nice Health benefits [both my parents are retired from the US Postal Service along with prior military service so they never had to worry! *wipes brow*] but really the average middle American that works and contribute are the ones that get dicked from the insurance companies...sending these insanely high bills because "insurance won't cover a certain percent" well hell what's the point of being INSURED if you have to still handle a large bulk of the bill?

It shouldn't cost $500 for a emergency room visit or a ambulance trip to the hospital! :(

I look at it like this: for car insurance we have Full coverage or LIABILITY. Liability is just enough coverage to protect you IN THE EVENT OF A ACCIDENT. Imaging having that model for Health care.

two words: Preventitive care [i.e annual check ups, ect...] and having what is what outlined and also no pre existing conditions crap.

If some are lucky today to have good coverage and can afford it, by all means they should have the right to keep their plan.

I can understand some people not wanting the government to have full "control" over health care, but really, SOMEONE needs to step in! Why the hell are we paying taxes if they keep fucking us over on basic health rights! We have the right to be Healthy since they want us to WORK WORK WORK WORK and take no days off or hardly no vacation. We're not ROBOTS [even though the media pushes out the robot themes as to condition people to think they should feel/work this way]. Its really sad but can we at least help out THE PEOPLE instead of bailing out some Auto companies>?! Who the hell is going to buy the cars is no one have any friggin MONEY to buy them because they have to work work work to buy basic nees that have been marked up in prices.

I think we're all running in circles and until Obama really puts his FOOT DOWN, we're not going to get anywhere. Meanwhile, unemployment is over 10% but yet most Americans are STILL mourning over Michael Jackson (R.I.P)

Whos REALLY pondering over the state of America?! What the fuck are they going to do with CALI?

I'm not too "left" or "right" winged because people LOVE to dress their speeches along with labels (Dem or Repub) but forget all of that; what about what our basic necessities that we need?! Do we need at least a Liability coverage or trying to help Chrysler/GM come out with new cars?

Something is very backward.

Sorry I went on a tangent LOL :D

I really liked this post by the way lol

CNu said...

Rather than salivate at the thought of widespread chaos and pain, CNu, why not work out on a heavy bag or go down to the shootin' range?

The latter intentional suffering is rendered all the sweeter in anticipation of the former inevitable suffering.

Whos REALLY pondering over the state of America?! What the fuck are they going to do with CALI?

thehoustongirl ponders truth...,

Undercover Black Man said...

Thanks for the comment, houstongirl. The thing is, before we enact any kind of radical reform, we gotta have a national conversation about what "basic health rights" means.

Is health care a "right"? If so, what does it mean? Free medicine? Free surgery?

If health care is a "right" (or an entitlement), that means all of us are going to have to pay for other people's health care. Not just the richest of the rich will be taxed to pay for it. Believe that.

Obama's not carrying on a national conversation. He's saying it's a given that this overhaul must be done... and done right now.

Michelle Norris made a good point today on "Meet the Press." She said 90 percent of the people who voted in the last election have health insurance. So it's not a crisis as far as they're concerned.

dickster1961 said...

We definitely do not need government controlled health care. It hasn't worked that well in Canada and Britain. A lot of horror stories about rationing,particularly of the elderly and those suffering from cancer.

There are a lot of problems with the costs of health care. I have heard interviews with doctor's where they talk about their 6-figure malpractice insurance premiums. Higher expenses for doctor's gets passed on to everyone else.

The insurance companies are a joke. I had a conversation with my insurance company about a month ago to see if some blood tests would be covered. If it was part of a preventative check up, then it would be covered. If it was because the doctor suspected something was wrong and wanted to check it out to see, I had to pay for it until my deductible was met. Same test, different coverage. Insane.

DRE said...

Normally controlling health care costs would not be as big of a deal, but the current state of our economy makes it a big deal.

The urgency is partly political. The longer this debate goes on, the less likely it will happen.

Anonymous said...

we don't need it now, but we do need it.

read today's NYTimes magazine...we already ration healthcare.

jerkin josh

maria said...

it's not a radical change by any means--that would be single payer. this preserves the existing system of private insurance with a few add-ons.

the goverment thru medicare and medicaid is the biggest payer of healthcare right now. both programs are nearly bankrupt and are unustainable.

the thinking is cover as many people as you can, get preventive care, thwart chronic illnesses (like diabetes) and the cost comes down for everyone.

i'm curious how you as a self-employed person get health insurance, david...can you afford it? do you have it?

when i got divorced i had to find insurance--and it wasn't easy. i was uninsured for two months EVEN THO i had a job....

the biggest reason for bankruptcies is single moms with medical bills.

maria said...

also, this is not his signature thing. he was not that strongly identified with this in the campaign.

and how is jason linkins a class warrior? he just covers the press.

Sam said...

Dickster, health care works a lot better in Canada and Britain than it does in the states. It's the one thing the Canadian government actually manages to do right.

UBM, change "Why should health care be a right" to "Why shouldn't health care be a right," and try to make the argument for denying people basic health care. There is simply no case to be made. I'd accept the "keep Uncle Sam's hand out of my pocket" argument for a lot of things but not for health care.

If the government is content to spring to appoint lawyer, why not an appointed physician?

I realize that American universal health care is probably a pipe dream, but some sort of two-tier system, with free or cheap clinics, subsidized prescriptions, etc., has to be do-able. And the government might be corrupt and incompetent, but if it controlled the health care mandate it would undoubtedly act more ethical than insurance companies. There's stress enough dealing with the injury itself, let alone haggling over the fine points of an overpriced insurance policy with a fleet of corporate lawyers.

Undercover Black Man said...

we already ration healthcare.

There's a difference between the state rationing health care and the market rationing health care.

The market rations food and clothing too. People don't have a "right" to eat sushi.

Undercover Black Man said...

The urgency is partly political. The longer this debate goes on, the less likely it will happen.

You right, DRE. But that doesn't mean the debate is unnecessary. And for Obama to pretend it's unnecessary puts him in a messed-up place intellectually.

I'm like, "Back-da-fuck-up, chief. Before we do something we can't undo, let's make sure we have a national consensus that it needs to be done."

But saying "The status quo cannot stand" as if that were a rational argument unto itself, Obama is basically saying: "Trust me. It's for the best."

Well, Prez... we trusted you on the stimulus spending, we trusted you on the bailouts. Let's see how those puppies work out before we ring up another trillion-dollar purchase.

Undercover Black Man said...

the goverment thru medicare and medicaid is the biggest payer of healthcare right now. both programs are nearly bankrupt and are unustainable.

Exactly. So why should we believe that more massive public spending, in the form of a new entitlement, would be "sustainable"?

i'm curious how you as a self-employed person get health insurance, david...can you afford it? do you have it?

As a member of the Writers Guild of America, I pay 1.5 percent of my gross earnings in union dues. That covers my participation in the Guild health plan.

I've never gone uninsured, thankfully. That's why I need a clearer sense of the scope of the "crisis."

Undercover Black Man said...

The insurance companies are a joke. ... Same test, different coverage. Insane.

So what should be done about that, Dick?

Undercover Black Man said...

also, this is not his signature thing. he was not that strongly identified with this in the campaign.

Well, maria... he's sure as shit betting the ranch now.

maria said...

"Exactly. So why should we believe that more massive public spending, in the form of a new entitlement, would be "sustainable"?"

there's no massive government spending planned other than trying to cover the uninsured. that's spin.

you do realize that this has issue has been swift-boated, right?

Undercover Black Man said...

there's no massive government spending planned other than trying to cover the uninsured. that's spin.

That's like saying, "Medicare? There's no massive government spending planned other than trying to cover the elderly."

maria, we're talking about creative a massive new publicly funded entitlement. Can it even be undone if it's implement and turns out to be more costly and world-changing than the Democrats are projecting?

you do realize that this has issue has been swift-boated, right?

Talk about "spin."

The crux of the biscuit is ideological. Is it the taxpayer's responsibility to pay for health insurance for everybody? And how would such a system change health-care delivery as we know it?

This is an issue that demands a deep and serious national conversation... not a politically driven rush job.

maria said...

there is no massive public funding.

even the so-called public option is funded by people and employers' premiums. very few people would get this "for free."

it totally has been spun, if this is the stuff that you believe--it just ain't true. have you read any of the bills?

maria said...

please take a look here:

http://www.kff.org/healthreform/sidebyside.cfm

bklyn6 said...

I'm a bit clueless about the subject, but I'm curious to hear what Gov. Howard Dean has to say about healthcare reform. He's a medical doctor. He was on Democracy Now. link.

Undercover Black Man said...

there is no massive public funding.

Have you read the Congressional Budget Office analysis of the Senate proposal?

The CBO estimates that the coverage provisions would add $645 billion to the federal deficit over the next 10 years... not including government administrative costs.

maria, how can you even suggest that health-care reform won't cost the taxpayers anything?

mint_tea said...

Regarding costs, The Daily Howler brings up a key point, almost never discussed in the media:

It’s very important that voters know the facts about the way that system works. After all, here are two nations’ per capita health care costs from the year 2003:

United States $5711
Canada $2998

Good lord! Per person, we spent twice as much! If Canada’s health care is halfway decent, they’re doing something we should copy!



Private insurance companies make money by covering as little as possible. That's their goal. How many of the currently "insured" will receive an unpleasant shock when push comes to shove, like Karen Tumulty's brother?

CNu said...

Current U.S. per capita healthcare costs - sans universal coverage - are at around $7900/year. Far more costly than either Canada or the UK Trusts - due for the most part from supporting the parasitic and utterly unproductive and care rationing insurers.

But here's what really shocks me about ethics in the House of Love;

The CBO estimates that the coverage provisions would add $645 billion to the federal deficit over the next 10 years... not including government administrative costs.

maria, how can you even suggest that health-care reform won't cost the taxpayers anything?


Why UCBM, you madcap! Your howl of tax protest indignation could be heard all the way from LA to DC.

However, when presented with data showing current U.S. military expenditures to be running close to $700 Billion/year (and much higher than that ($1.2 trillion) with the deficit spending associated with the operational failure in Iraq) - you didn't even pause to bat an eyelash.

Is it just me, or are you rocking some really arcane ethics that we mere mortals just can't comprehend?

Undercover Black Man said...

... here are two nations’ per capita health care costs from the year 2003:

United States $5711
Canada $2998


According to Wikipedia, Canadian health-care spending for 2008 is $5,170 per person.

That's a 58 percent increase over five years.

How does this bolster the argument that government-run health care keeps costs down?

maria said...

maria, how can you even suggest that health-care reform won't cost the taxpayers anything?

i didn't say that.

Undercover Black Man said...

However, when presented with data showing current U.S. military expenditures to be running close to $700 Billion/year... you didn't even pause to bat an eyelash.

It is universally acknowledged that it's the government's duty to "provide for the common defense."

Is it the government's duty to provide health insurance for all?

If so, then President Obama ought to say that. But that's not what he's saying. He's arguing that inserting the government into the health-care market will control "spiraling" costs. (Again I ask: How???)

The intellectually honest thing would be to say: "It doesn't matter how much it costs. Fuck a free market, and quit yer bitchin' about higher taxes. Every citizen is entitled to publicly funded health insurance."

Then we can debate that.

Undercover Black Man said...

i didn't say that.

You said: "there is no massive public funding."

Why do you say that?

Undercover Black Man said...

Far more costly than either Canada or the UK Trusts - due for the most part from supporting the parasitic and utterly unproductive and care rationing insurers.

I thought it was due to the fact that in Canada and the U.K., the state sets the price for doctors' services, and the state sets the price for pharmaceuticals.

Is that what the U.S. government should do? If President Obama believes that, he should say that.

Then we could debate it.

CNu said...

It is universally acknowledged that it's the government's duty to "provide for the common defense."

Well, it's constitutionally acknowledged. That said, very little of that $1.2 trillion annual debacle is actually going to "defense".

If China, Russia, U.K., France, Japan, Germany, South Korea, and India combined can defend themselves for less than $500 Billion - then there's either a massive amount of wasted pork in that U.S. "defense" budget, or, it's being spent on something entirely other than defense.

It's also constitutionally acknowledged that it's government's role to "promote the general welfare".

Standardizing, universalizing, and regulating healthcare would fall under that rubric rather nicely.

mint_tea said...

I don't think universal healthcare is a right. I understand the argument that "I pay for my healthcare, why should I have to pay for someone else's?" That being said, I do think universal healthcare would be a tremendous social good.

As jobs become more insecure, universal healthcare would provide a stronger social safety net. Uwe Reinhardt said "People in Germany and Canada don't go bankrupt over medical bills, why should we?" In an interview with Fresh Air, he noted how he grew up dirt poor in Germany, but still had access to excellent healthcare as a child. He never forgot this and wishes Americans could enjoy the same.

And preventive care is *far* cheaper than emergency room visits, or no care at all. In the long term, healthy citizens with limbs and organs are more productive than the amputees, chronically ill, and the deceased who could not afford care until it was too late.

Reducing the power of private insurers will make healthcare cheaper. Isn't the statistic that 1/3 of all healthcare costs are just paper-pushing, wrangling back and forth over costs?

Another thing to remember - even with universal healthcare, the wealthy will still be able opt out and utilize boutique, higher-end services.

Undercover Black Man said...

Standardizing, universalizing, and regulating healthcare would fall under that rubric rather nicely.

So, Craig... does this mean you believe the government should set the price for doctor's fees, the government should set the price for hospital services, the government should set the price for surgical procedures, and the government should set the price for prescription drugs?

Anonymous said...

The House Health Care Bill, 1,018-page document, released this week (July 14th, 2009) reveals some concerns as noted by http://www.healthinsurancetexas.biz and http://www.selecthealth.biz Mike Oliphant serves as health care consultant with these two popular websites in Utah. He also is a serving board member with Utah Association of Health Underwriters. A provision within this bill would indeed outlaw individual private coverage. Under the Orwellian header of "Protecting The Choice To Keep Current Coverage," the "Limitation On New Enrollment" section of the bill clearly states:

"Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day" of the year the legislation becomes law.
This translates into those who currently have private individual coverage won't be able to change it. It is likely that those same people will suffer abnormally high rate increases over time which would force them out of coverage. Nor will those who leave a company to work for themselves be free to buy individual plans from private carriers.
From the beginning, www.benefitsmanager.net and www.dentalinsuranceutah.net warned that if the government gets into the business of offering subsidized health insurance coverage, the private insurance market will wither. Drawn by a public option that will be 30% to 40% cheaper than their current premiums because taxpayers will be funding it, employers will gladly scrap their private plans and go with Washington's coverage. The nonpartisan Lewin Group estimated in April that 120 million or more Americans could lose their group coverage at work and end up in such a program. That would leave private carriers with 50 million or fewer customers. This could cause the market to, as Lewin Vice President John Sheils put it, "fizzle out altogether."
What wasn't known until now is that the bill itself will kill the market for private individual coverage by not letting any new policies be written after the public option becomes law. The legislation is also likely to finish off health savings accounts, a goal that Democrats have had for years. They want to crush that alternative because nothing gives individuals more control over their medical care, and the government less, than HSAs. With HSAs out of the way, a key obstacle to the left's expansion of the welfare state will be removed.
SelectHealth.biz states that the public option won't be an option for many, but rather a mandate for buying government care. A free people should be outraged at this advance of soft tyranny. Washington does not have the constitutional or moral authority to outlaw private markets in which parties voluntarily participate. It shouldn't be killing business opportunities, or limiting choices, or legislating major changes in Americans' lives.

Anonymous said...

"This translates into those who currently have private individual coverage won't be able to change it."

that is a completely FALSE conclusion.

Undercover Black Man said...

That being said, I do think universal healthcare would be a tremendous social good.

Theoretically, public education is a social good, and public housing is a social good.

In practice? Well... let me ask you: Are public schools of superior quality to private schools? Is public housing of superior quality to private housing?

Why should we believe that the state would do a better job in the health-care business than it does running the Los Angeles Unified School District... or than it did running the Robert Taylor Homes?

CNu said...

So, Craig... does this mean you believe the government should set the price for doctor's fees, the government should set the price for hospital services, the government should set the price for surgical procedures, and the government should set the price for prescription drugs?

It already does that on a MASSIVE scale. And vastly more efficiently than the private sector. Not only has it implemented massive single-payer, it's also had a longitudinal electronic medical records system in place for some time now. The gross inefficiencies in the private health sector are inexcusable and trivially remediable.

While we're on this topic, I'd also very much like to see the U.S. armed services wield it's market determinative might to manipulate energy and construction best practices in the U.S., as well. As the buyer of fully one percent of all transportation fuels used by the U.S. economy, it has the heft and leverage to trivially determine directions and outcomes in the energy development and energy security sectors.

CNu said...

Theoretically, public education is a social good, and public housing is a social good.

In practice? Well... let me ask you: Are public schools of superior quality to private schools? Is public housing of superior quality to private housing?


umm..., since health-care reform is not likely to stimulate white flight, and there won't be any ghetto-ized healthcare services, and I believe you know this fact - why you spawning specious strawmen arguments?

Is that what your defense of parasitic insurers and health rationing based on wealth is now reduced to?

CNu said...

Is the national "defense" fir which you're eager to spend $1.2 trillion intrinsically inferior?

Is the Tricare healthcare system intrinsically inferior?

Undercover Black Man said...

Not only has [Tricare] implemented massive single-payer, it's also had a longitudinal electronic medical records system in place for some time now.

And it's going broke anyway.

A 2007 Defense Department task force report says:

"[T]he system cannot be sustained at the current level without some degree of... contribution from military retirees. ...

"While military retirees deserve a more generous benefit because of their sacrifices and years of service, relatively modest increases in out-of-pocket costs will not only help stabilize the system and make it more accountable, but will also be looked upon as being appropriate by the American taxpayer. ...

"The Task Force recognizes that its proposals, if accepted, will not be able to resolve the future budgetary problems that the Department of Defense will face as a result of rapid, future increasing costs of the Military Health System."

So what were you saying, Craig, about how "vastly more efficient" Tricare is?

CNu said...

So what were you saying, Craig, about how "vastly more efficient" Tricare is?

Why not reference the report in question?

If you call yourself making an argument against the comparative efficiency of Tricare to the private care sector, surely you're going to offer a little more than that?

I mean, efficiency is measured in definite terms. The fact that the Tricare system is serving a vastly enlarged span of customers (this is not the VA mind you) - means that it has to change processes designed for the smaller client base if formerly served.

If you've got a specific argument to make about inefficiencies, then by all means - make it.

Outcomes?

Unnecessary procedures?

Per Capita costs to participants?

Accidents?

(you realize that a LEMR would serve to prevent unintended drug mixups - this is something the private sector -by-and-large doesn't have)

We can go on, and on here, but the point is very simply that you're not arguing from facts David, you're arguing from partisan ideology and as a propagandist rather than a seeker of objective information.

Undercover Black Man said...

^ So, Craig... does this mean you believe the government should set the price for doctor's fees, the government should set the price for hospital services, the government should set the price for surgical procedures, and the government should set the price for prescription drugs?

mint_tea said...

Why should we believe that the state would do a better job in the health-care business than it does running the Los Angeles Unified School District... or than it did running the Robert Taylor Homes?

We have the examples of Taiwan, Germany, Canada, France, Japan, UK, etc to draw on. No system is perfect, but in general they do it
better and cheaper than
we do.

CNu said...

does this mean you believe the government should set the price for doctor's fees, the government should set the price for hospital services, the government should set the price for surgical procedures, and the government should set the price for prescription drugs?

means the government does so already and on a massive scale about which I've heard scant few complaints.

Let me see your contrast and comparison of the rate of medical errors between Tricare and a comparably sized private vendor like say...., sisters of mercy or kaiser permanente.

Let's get down to performance based specifics.

(mint_tea brangin truth....,)

Undercover Black Man said...

^ CNu: Since you brought up Tricare in the first place, and proclaimed it to be "vastly" more efficient than private care, the burden is on you to provide evidence for the shit you poppin'.

Regardless of that, nobody -- and I mean noooobody -- is talking about medical errors in the context of the current debate. Prez has never mentioned medical errors as an element of what's wrong with our health-care system.

Let me repeat, with crystalline clarity:

Obama's push for reform has two prongs... and those prongs don't seem to be consonant.

1. We must, as a matter of social justice, insure the uninsured.

2. We must bring down the overall cost of medical care.

I'm waiting for an explanation of how 1. leads to 2. ... particularly in a way that doesn't devastate the American principle of free-market economics.

DeAngelo Starnes said...

Dave, I was trying to sit this one out, but the problem with opponents of the current effort to reform health care reform is (a) lot of criticism without a viable alternative and (b) a lot of criticism without a viable alternative. To work backwards, you were doing a decent job of espousing the insurance companies' arguments until you espoused that "free market" bullshit. There is no such thing as a free market anywhere in the world.

I noticed the arguments, like they are in public, are all over the place. Let's start with a fundamental - there's health care and there's health insurance. Health care is what we get when we got a medical provider. When discussing controlling those costs, that's more a market problem but could be controlled when the persons providing payment for the health care decide they won't pay those costs.

Then there's health insurance, which is the vehicle used to pay for health care. This is really where the fight to control health care costs lies. Because insurance companies have decided they won't pay for certain procedures for various conditional reasons or that the price is too high. Who's in the middle? The Patient.

So who has a bigger dick? The insurance companies or the federal government? In winning the war against reform, the insurance companies right now. But they fear the Government's porno-sized dick coming into the game. And if they thought the Government was so poor at performing, why are they crying so much and spending all the money they're spending? It ain't because they're so concerned about your and my health's well-being. It's a Wall Street thang.

Frankly, fuck cost. It's a better investment in America's health than fighting these asinine wars against people you and I will never come into contact with only to line the pockets of the military-industrial complex.

Holla! Ding!

Undercover Black Man said...

^ Seems like old times, DeAng.

Frankly, fuck cost.

That, at least, is an intellectually honest liberal argument.

But politically, it will not float in America. Imagine if Obama uttered such a thing.

Shoot... I don't even think Obama has used the term "social justice" in regard to insuring the uninsured. He knows that if he seems motivated by leftist, statist ideology, not only will health-care reform go down in flames... but he'd validate all that "socialist" name-calling from the right.

You're not the only one saying the Republicans "don't have an alternative." Whaaa? An alternative is only required if you accept the premise that "something must be done NOW. The status quo is UNACCEPTABLE."

But all that do-it-now, unacceptable-status-quo woofin' is coming from Obama and the left purely as a tactic. Get it done now... while Obama's popularity is still high. Get it done now... while the Dems hold a supermajority in the Senate. Etc.

Can somebody explain to me, objectively, and in some detail, why health-care costs are rising so fast? This is the sort of thing that should be part of a public debate on the issue.

But on this one, Obama's "bully pulpit" is all bully and no pulpit.

DeAngelo Starnes said...

Dave, health care costs are rising because of the elephant in the room whose name is not an insurance company: doctors taking advantage of the market. I mean supply and demand have overcome the Hippocratic Oath. Don't get me wrong - I don't think medical providers have no interest in our collective well-being (unless you're Michael Jackson or Rush Limbaugh's doctors). I'm saying that treating unhealthy people is a booming ass market - especially with the advances in medicine that keep us ostensibly alive.

There is some merit to the slow down aspect of the debate. But not the way these opponents mean it. Slow down because like I said there's health care and there's health insurance. The debate is skewed on health insurance. Let's talk about health care - what's covered, what's not, why for either, and how much is covered. Then why is the price fixed at the point it is? Doctors, like the banks, have set their price and there isn't much you can do about it if you want to live your life the way you want to. Concentrated power like that isn't right.

Now, the insurance companies have their own racket, but they might have a point when it comes to "rationing" as it pertains to medical costs.

Bottom-line: everyone should be covered and it might not be a bad idea if the system was socialized so as to control costs. The proposals as have been submitted are nowhere near "socialized medicine." Nowhere near it. Socialize medicine isn't when the government pays for the services only. It's when the government employs ALL the medical providers and owns ALL the medical facilities. Only the VA fits that definition.

But if the Republicans are truly concerned about controlling costs if Government pays for it, they need to stop playing the "socialism" boogieman card because without heavy regulations, that's the answer.

Free market dictates lower prices? Will the insurance company willing to lower its prices cast the first stone. I'll stand inches away and offer my forehead.

This is like old times. Feels good.

DMG said...

How are you all going to be having a health care conversation and neither CNulan nor UBM invited me? I'm offended brothers, offended.

Anyway, I will say yes we do need comprehensive health care reform, because the state is going to pay for the care for many folks eventually anyway. I'd prefer to spend hundreds rather than millions of dollars on people...don't you agree?

What happens when that person who is too poor to afford insurance and too "wealthy" to qualify for medicaid has a bellyache? They ignore it, take some Pepto Bismol and move on...that is until they are brought in on a stretcher with a gangrenous gallbladder or pancreatitis or whatever. Then they stay in my ICU for 2 or 3 weeks (which is probably more expensive than a suite at the Ritz-Carleton). We ration health care irrationally. We don't provide primary care or preventive medicine. People wander into the Emergency Dept. after waiting until they are REALLY sick before seeking care...which is just economics.

We spend the MOST per person on healthcare than ANY other country in the world, and still have shitty outcomes because our population doesn't have comprehensive coverage. I see diseases in county hospitals that should only be seen in war ravaged third world countries.

DeAngelo, sorry, but you aren't correct here. We aren't starving but the vast majority of us aren't getting filthy rich off of treating sick people. They are a drain. I get paid the same if my gallbladder patient stays in the hospital overnight or 2-weeks. It's in my best interest to get people well and home, rather than sick and in the ICU. But here's a nice article that shows some doctors ARE taking advantage, and some of the reasons behind it. http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande

The price we charge for a procedure isn't going into my pocket alone. There is overhead, nurse, equipment, etc. that needs to be paid for. We are in the hole for that until (or if) we are reimbursed by insurance or the patient. I could save your life, but I'll be the last person you'll think about paying. Strange.

We have some of the lowest taxes in the world, but still complain. There are places where the people pay greater than 51% tax, but don't complain. Why? Because their tax money isn't' going to build aircraft carriers and fighter jets we'll never use. It goes to fund university education and cradle to grave health care. And because they don't have such huge military there is incentive to keep OUT of world conflicts and rely on diplomacy.

Yes, we need health care reform. I think Obama's plan is going to be watered down by the naysayers and cowards in congress.

Undercover Black Man said...

... and neither CNulan nor UBM invited me? I'm offended brothers, offended.

Hey, doc. I thought you were on Martha's Vineyard or some shit. Ain't seen you at DV's place for a while.

Anyway, thanks for your insights.

We have some of the lowest taxes in the world, but still complain.

If your notion of health-care reform is predicated on the argument that the American people are under-taxed... good luck getting it done.

You won't be hearing any Democratic senators or congressmen -- let alone Prez -- making that argument in public. Quicker than you can say "tsunami," the Republicans would be back in power.

You provide food for thought, DMG. But I still can't get my head around the built-in contradiction of the Democrats' stated arguments.

The "social good" argument is predicated on economic strength. To wit: "How can we, the richest nation on Earth, have 47 million uninsured. That's unacceptable!"

The cost-containment argument is predicated on economic weakness. "We can't afford to do nothing. Skyrocketing health-care costs could destroy the economy. The status quo is unacceptable!"

And yet Obama is making both arguments at once!

Michael W. Tucker II said...

UBM, I don't think the Obama Administration has been unresponsive to meaningful criticisms. There was a response to the CBO report and there have been responses to some of the other criticisms put forth.

But the Obama Administration isn't going to go out and act like they need to convince people of healthcare reform when people already that we should have it. People are convinced that SOMETHING has to be done about rising costs. SOMETHING has to be done about the 50 million uninsured. That doesn't need to be sold.

Are you not sold that SOMETHING has to be done? Or is it the HOW that has you concerned?

NY Article About Widespread Support for Reform: http://www.nytimes.com/2009/06/21/health/policy/21poll.html

Michael W. Tucker II said...

http://www.nytimes.com/2009/06/21/health/policy/21poll.html

Undercover Black Man said...

Michael Tucker, welcome to my spot.

Are you not sold that SOMETHING has to be done? Or is it the HOW that has you concerned?

It's the WHY and the HOW. It's the WHY because I don't understanding WHY health-care costs are rising so steeply.

As far as I can tell, the reason Obama's not addressing the WHY is not because the public overwhelmingly agrees with the WHY.

If the public overwhelmingly agreed on the need for radical restructuring of the health-care market, then the Republicans would be committing political suicide by obstructing.

Whereas, in reality, moderate Democratic legislators (presumably put in office by right-of-center constituencies) are fearing the political repercussions of supporting comprehensive reform.

The reason I think Obama and the Dems aren't addressing the WHY is because of political salesmanship. The old-fashioned hard sell. "Everybody knows your vacuum cleaner's not getting the job done. You know it, your neighbors know. The question is: What are you gonna do about it?"

Undercover Black Man said...

Also, Michael... if there were overwhelming public support for radical health-care reform, then why has Obama whipped out the "fear card" to get it over?

HuffPost reports tonight that Obama told a conference call of bloggers:

"It is important just to keep the pressure on members of Congress because what happens is there is a default position of inertia here in Washington.

"And pushing against that, making sure that people feel that the desperation that ordinary families are feeling all across the country, every single day, when they are worrying about whether they can pay their premiums or not... People have to feel that in a visceral way."

Notice how the whole deal went from insuring the uninsured as social good... to the middle-class populist scare tactic of: "You could end up uninsured too!"

Like that old bullshit about people being "one paycheck away" from homeless.

But thanks for those links, Michael. I'll read them.

elcectique916 said...

You never know how crapped up the current health care system is until you really need health care. Or when you get that $575 dollar bill for testing the wee-wee sample you left in the plastic shot glass. I'm not lying.

Good op-ed in the Post today from a cancer patient - for a little perspective: http://tinyurl.com/mmeyl9

I hold my breath every year for my annual breast cancer screening. I've been going through this since the age of 29. Technically you shouldn't lose your property to pay health care bill if you're still paying a mortgage - that's liability. But they will come get your house if it's an asset or force you to sell. However, right now, that may not be in the best interest of "the market."

On the Canada thing, I also had a friend who was here on a work visa and for some reason, something told him not to give up his Canadian citizenship. He was opening a restaurant. Well, what do you know, his kidneys crashed and he had to go on dialysis. So dude's back in Canada now where he can afford treatment.

In America health care costs go up no matter what your income or lack there of in good and bad times especially for self-employed folk like me. I don't think anyone's against paying a little something, but having more options to fit your budget ("option" is the key word; public option is not gov. take-over) with no penalties on you for your age, sex, pre-existing conditions, or geography would be sweet.

Michael Murray said...

I think a point that is being missed here is that this country currently pays a higher percentage of GDP to healthcare than almost every other country. Without thinking in terms of the welfare of others, it puts this country at an economic disadvantage. Keeping costs under control is in the national interest as much as controlling the boarders.

I keep hearing folks say what is being proposed is a radical approach but really the big difference will be that folks CAN buy insurance from the government. We keep hearing about how we don't want the government in between us and our doctors, but I would prefer that to an insurance company who's job it is NOT to pay against my claim. Most folks like their current healthcare because they don't really use it.

And what's up with all this "Leftist" stuff. All modern countries have a mix of safety net programs. Thinking about this in terms of left and right is pretty useless.

DMG said...

Hey UBM,

Had to take a break from the insanity over at DV's spot, consuming that much stupid is bad for anyone's health. My research sabbatical is over so I don't have as much time anyway. Am I a big fan of the current health care reform? No. But I'm happy they are trying to do something, because the current system isn't sustainable. The nation spends too many health care dollars and man hours on medical billing, fighting with insurance companies to get costs covered. I was just pointing out the fact that as much as we complain about taxes that we aren't paying the highest in the world, and that we aren't getting that much back for our return other than a kick ass military.

I was backing a plan offered by a physician group that suggested a 3-tier plan, which covered everyone, while relieving employers of footing the bill for employee coverage. The plan also actually HELPED and regulated insurance companies so they had NO impact on basic, preventive, necessary care. This relieved them of the group that cost them the most, which would lower premiums. Politicians didn't want to hear it, unfortunately.

Whatever happens, we need to get primary care patients OUT of the ER, attack the epidemic of obesity and smoking like they are terrorist organizations (because it's costing everyone alot of money), and make sure every U.S. Citizen is covered so they don't have to make the choice of going bankrupt or dying.

Lack of health care has also made us a less productive country, as we miss more work because of health related problems than many other countries (out sick longer, obesity related illness, etc.).

My two cents. Let me know what you think of that New Yorker Article.

CNu said...

Thinking about this in terms of left and right is pretty useless.

Unless you're a partisan ideologue whose objective isn't to make the situation better, but to ensure the continuation of the incredibly broken status quo.

Undercover Black Man said...

Thinking about this in terms of left and right is pretty useless.

That's an ahistorical point of view, Mr. Murray.

England's socialized health-care system didn't happen out of nowhere. It grew from the writings of Liberal Party politician William Beveridge, who called for a "cradle-to-the-grave" welfare state.

The American health-care debate is, at core, an ideological one.

As for CNu's bear-baiting... I state the obvious fact that a "partisan ideologue" is one who suggests that the government should set the price for doctor's fees, the government should set the price for hospital services, and the government should set the price for prescription drugs.

CNu said...

The American health-care debate is, at core, an ideological one.

Wrong.

The AMA signed onto the bill today because like me, a well-informed senior IT professional who has worked in and around the healthcare industry for nearly a decade, it recognizes that unnecessary variation in care, reduction in unnecessary costs, improvements in safety, and scientific adoption of best practices - is the key to better medicine.

McAllan is the poster child for what you've been "popping shit" about on this thread David, and there's just no graceful way for you to skirt that unfortunate fact.

Any industry consuming in excess of 15% of the GDP and not delivering better and more consistent outcomes than this one does - and in a declining economy - is very obviously on its way to the political and economic slaughterhouse.

KST said...

Like that old bullshit about people being "one paycheck away" from homeless.

Curious UBM,^ why do you consider that statement b.s.?

Undercover Black Man said...

^ Because ever since homelessness emerged as a media issue in the 1980s, it was obvious to me that the problem of people living on the streets was largely a problem of mental illness.

All that bit about people being "one paycheck away" from living on the streets always struck me as a media meme to trick the middle class into giving a damn.

InsuranceInsider said...

Wow, I'm so glad this question was posted even though it seems out of place. This issue is like racism: if you've never experienced a problem with it, you're less likely to see what the big deal is. The people that are fighting this have never had a major illness and seen accountants make life or death decisions about their treatment OR they are profiting from the current system. If you really want to learn why we need reform, read "The Great Risk Shift."

PLEASE let me explain how a stronger government play in health care will DEFINITELY lower cost.

First, remember that private insurance is not even adding value to the process. It's just a mechanism for financing health care. Insurers are middlemen who aren't treating patients at all but have control over life and death by paying or denying coverage with no restraints. They are eating most of the profits from the system (not doctors and hospitals).

Now, what's the difference if corporations or the government is the middleman serving as the mechanism for financing health care?

It's this: The government will ALWAYS be the lowest cost provider of insurance because they can mandate that more people be covered. This is not including improvements to information systems and other economies of scale. That's why insurers are having nightmares about a public option. The cost of ANY kind of insurance is decreased when you increase the pool of covered insureds.

If you have more people paying premium, you have more people paying a small share of the cost when claims are paid.

The only time this gets tricky is for catastrophic type claims. That's why property insurers tend to exclude the big stuff (flood, earthquake, etc.). If you want insurance for that, you pay a LOT extra and as people in the Gulf Coast know, insurers still may or may not pay.

Likewise, health insurers make money as long as you're healthy and pay your premiums. But if you have a catastrophic or chronic illness (cancer, lupus, diabetes), their profits on you are shot. So they impose restrictions on pre-existing conditions and seek to deny claims or only pay for cheaper less effective treatment. They will even drop entire employer accounts if they have a handful of employees they have to pay out "too much" for.

Should we blindly assume that a free market WITHOUT public players is always the most efficient option to solve every problem? Or can we consider that a free market WITH a public player can be a better solution?

We have public schools (basic education as a right) with the option to attend public school. Why shouldn't we have public insurance as an option (basic health care as a right) with the option to purchase public coverage?

Insurers know that over time, everyone would see public options as the most cost effective and sound the death knell to their industry.

InsuranceInsider said...

OOPS, correction:

We have public schools (basic education as a right) with the option to attend PRIVATE school.

Why shouldn't we have public insurance (basic health care as a right) with the option to purchase PRIVATE coverage?

CNu said...

BOO-YAA!!!

InsuranceInsider is truth!!!

accept no substitutes...,

(II, can I have your permission to post your comment in its entirety on my blog?)

Undercover Black Man said...

^ Cool your jets, Craig. I'm about to dismantle II's argument.

CNu said...

are you going to dismantle II with the same quality of "issues-focused" engagement you've previously demonstrated on this thread?

if so, I'll have to hold my breath, cause, that promises to be some total.muffled.devastation.on.stage.,

NOT!!!!

Undercover Black Man said...

InsuranceInsider: Thank you for contributing to this discussion... be it "out of place" or not. (And just because I write about music a lot doesn’t mean I ain’t deep!)

First, remember that private insurance is not even adding value to the process. It's just a mechanism for financing health care.

Exactly. Who cares whether or not insurance "adds value"? That’s not the purpose of insurance... to "add value." That hasn’t been the purpose of insurance ever since insurance was invented... way back when slave-ship owners sought a way to minimize their losses due to storms at sea.

There’s a market for health insurance because the cost of treating illness and injury is huge. And private insurance is the way a person minimizes the risk of a medical "storm at sea."

The fundamental principle of health insurance is: The well share the cost of treating the sick. So, naturally, an insurer wants to maximize the number of well customers... and minimize the number of sick customers.

This isn’t just a matter of filthy profit. It’s a matter of keeping the cost of premiums down so that customers are willing to pay for the service.

Now... to the crux of the biscuit:

If you have more people paying premium, you have more people paying a small share of the cost when claims are paid.

The only time this gets tricky is for catastrophic type claims.


You see the problem here, II? You say that a "public player" will keep costs down by having more people paying premiums. But you ignore the fact that the public player will be on the hook for all "catastrophic type claims"... because the public player can’t exclude anyone from coverage.

More people means more sick people. Which brings us back to the ideological essence of this debate: Is it the duty of American taxpayers to pay the medical expenses of every citizen... no matter the cost?

The Left says "Of course." That’s the essence of the welfare state.

But the majority of the American people?

That’s the debate we ought to be having.

KST said...

@UBM - I agree. Sorry, going way OT...

My office is located near a homeless shelter. Everyday I see the people milling about talking to themselves, sometimes engaging in arguments with invisible foes. My state's mental health system just took a huge budget hit, so the problem will only grow worse.

Interestingly enough the field(MRDD) that I work in has made a lot of progress with regards to housing. The population went from being warehoused in inhumane conditions into group homes, and now supported living.

Friends who work in the mental health field are angry that the individuals they work with do not receive the same public support and are faced with a stunning lack of resources.

Regarding folks being "one paycheck" away from the homeless shelter: for a lot of people, this is true. Many people make just enough to pay their bills, but have very little left over for savings. One major car repair, illness, an illness that uses up all of your sick/vacation/personal time resulting in a lowered paycheck, resulting in bills being payed late - that's where things can spiral downward fast.

There are millions of people that work 40 hrs. per week, do not qualify for Medicaid, reduced or no cost daycare , food stamps, and have worked damn hard to make sure they don't. These are the people Obama needs to focus on. People talk about the shrinking middle-class - well where the hell does everyone think they're going?

Lord. I could go on and on about the cost of daycare and crappy health insurance...

DMG said...

I didn't know you brothers were still going at it over here.

"More people means more sick people. Which brings us back to the ideological essence of this debate: Is it the duty of American taxpayers to pay the medical expenses of every citizen... no matter the cost?"

Mills, we are paying for this now anyway. The disconnect that the accountants have is that the more uninsured the more REALLY sick people we will have. People with really good insurance are able to get their illness taken care of sooner rather than later. With some diseases, the longer one waits the worse (and more expensive) it gets. Overhead for private insurance companies hovers around 19%, whereas Medicare overhead is closer to 4%. A government plan doesn't have to pay bonuses to CEO's or MD's in their employ who deny claims. Alot of medical billers may be out of work (possibly even my wife's small company) if we get a good public option, but so be it. People excluded from private insurance for pre-existing conditions who can't afford a huge premium will go without care...and that's not good for patient or taxpayer.

wanda loves... said...

It seems to me that people are in love with this health care plan because it makes them feel good.

We constantly hear about how horrible the cost of care is for Americans (and this is true), but before the government goes and takes over the system, maybe they could investigate why care is so expensive in the first place?

And then maybe if they concentrated on and fixed those problems Americans would be able to afford and keep their own private care?

If the Pres was serious about helping people, maybe he should stop subsidizing corn and increase subsidies for fruits and vegetables (since poor people have to usually buy the cheapest food available and suffer in greater numbers from obesity).

Or maybe he could try to get a handle on malpractice lawsuits?

Many of these things would help the cost of healthcare and it also wouldn't cost trillions of dollars.

Undercover Black Man said...

Or maybe he could try to get a handle on malpractice lawsuits?

Thanks for commenting, Wanda. I've noticed that no Democrats are talking about the cost of malpractice insurance as an element of health-care spending.

PHG said...

UBM, change "Why should health care be a right" to "Why shouldn't health care be a right," and try to make the argument for denying people basic health care. There is simply no case to be made.

Actually, Sam, there's a very good case. I'd make it, but Jonah Goldberg already stated it better than I could (http://article.nationalreview.com/?q=Nzk1ZmQ0ZjhmYWZiNmViZWI0NzgyNWU1ZGU5Njg3OTQ=):

Let us for a moment adopt the proposition that health care is in fact a “right,” as pretty much every liberal politician has told us for at least a generation.

Now let us consider how President Obama's proposed health-care bill would work. Under his plan, an official body — staffed with government doctors, actuaries, economists, and other experts — will determine which health-care treatments, procedures, and remedies are cost-effective and which are not. Then it will decide which ones will get paid for and which won’t. Would a 70-year-old woman be able to get a hip replacement, or would that not be considered a wise allocation of resources? Would a 50-year-old man not be permitted an expensive test his doctor wants if the rules say the cheaper, less-thorough one is sufficient? The Democrats call this “cost-controls.” But for the patient and the doctor, it’s plain old rationing.

Now, imagine if the government had a body of experts charged with figuring out what your free-speech rights are, or your right to assemble, or worship. Mr. Jones, you can say X and Y, but not Z. Ms. Smith, you can freely assemble with Aleutians, Freemasons, and carpenters, but you may not meet in public with anyone from Cleveland or of Albanian descent. Mrs. Wilson, you may pray to Vishnu and Crom, but never to Allah or Buddha, and when you do pray, you cannot do so for longer than 20 minutes at a time, unless it is one of several designated holidays. Please see Extended Prayer Form 10–22B.

Of course, all of this would be ludicrous beyond words.

Which is the whole point. Health care cannot be a right, because rights cannot come from government. At best, they can be protected by government. The founders understood this, which is why our Bill of Rights is really a list of restrictions on the government in Washington. “Congress shall make no law . . . ” is how the First Amendment begins.