Monday, October 08, 2007

How to Get What the Doctor Ordered

Raise your hand if you love your insurance company.

That’s what I thought.

We have a healthcare crisis in America, and to fix it requires a simple step: eliminate the for-profit insurance industry.

It sounds terrifying, at first, to say that the government has to dismantle an entire industry, but that industry is the very cause of our nation’s crisis; it’s an industry that grows fat off of figuring out how not to provide the services its customers pay for. The success of their business depends on pulling in as much money as they can and then letting go as little of it as possible.

Politicians in Washington like to talk about how people should have choice in healthcare. But the choices people want to make are not about which insurance company to use; they’ll use the one that provides the most coverage at the lowest cost. That’s assuming they have a choice, in the first place. Most Americans get their coverage through their employer. Many that don’t have employer-paid coverage can’t afford their own. (And tax credits won’t help.) The choices that matter to people are which doctors and facilities to go to and which treatments to have. Those are the very choices that are imperiled by the insurance industry. Why should it cost you to go to an “out of network” doctor? If your doctor feels you should have a particular medicine, why should some corporation say, “We won’t pay for that one, but we’ll pay for this one”? If consumer choice is what really mattered to politicians, the insurance industry would have been overhauled years ago.

It’s common knowledge that Americans spend more – much more – on healthcare than any other nation, yet by every measurable standard receive worse care than our industrialized neighbors. Why? Because so many healthcare decisions are made with regard to “the bottom line”: how to get the patient to pay the most for the least care. The bottom line in healthcare should never be profit, but the patient’s best interests. The only way to achieve this is to establish a separate government agency that does one thing: pay your medical bills.

Opponents of this glaring necessity like to call it “government run healthcare” or “socialized medicine.” They like to conjure images of trips to the doctor looking more like trips to the DMV, where your healthcare decisions will be made by bureaucrats. But that’s not the model at all. That’s not what healthcare looks like in Europe. Without the for-profit insurance industry, healthcare decisions will actually be made by the medical professionals. Bureaucrats won’t have a say in it one way or another, they’ll just send the doctor the check. You’ll never see the bill.

Yes, it will require a tax increase. But that increase will be more than offset by savings in current healthcare spending. The current employer-paid coverage model is a disaster. Businesses are crumbling under the weight of paying for insurance executives’ salaries. One of the leading causes of personal bankruptcy in the U.S. is medical debt. A modest tax increase – far less than what businesses and the average American currently pay annually for healthcare – will fund a pool that can pay for the whole program.

Universal healthcare is better care for less money. Anyone who says different is selling something. Probably insurance.


Jade said...

Many that don’t have employer-paid coverage can’t afford their own.

It's not just about not being able to afford their own health care, by the way... if you want to buy an individual policy (at least in the state of Washington) you have to fill out a 40+ page "health questionnaire" describing any and all health items you have received treatment for over the past year. Then you mail it in, and they score you. If you score over 300 points, you are considered "high risk" (read: high health care cost) and health insurance companies will not take you. The only option is to go with the state health insurance program, which is significantly higher in cost (unless you go with the low-premium/high deductible plan, which means big out-of-pocket costs)

Even corporate policies are being systematically broken down.

When I was shopping for health insurance for our company we were told we are lucky to be in Washington, where we are a "0% increase" state. What this means, she explained... is that in our state if we have a corporate policy, and an employee actually has to use it (say for something like cancer, or a car accident) then our health insurance company cannot raise our rates. In other states (California and Arizona are pretty bad, I guess) they can be raised up to 400%. So... one person in the company gets sick, the health rates for the entire corporation can skyrocket, then the company can't afford to offer health insurance to their employees anymore.

Jade said...

Oop... I mis-typed. The questionnaire doesn't just cover the past year, it covers the past decade.

Gino said...

the free market solves all ills.

i kinda like the idea where the govt gets out of the health business altogether, and the people buy their own coverage.

just like with groceries, and shelter.

Andy said...

Gino, I completely disagree. Access to healthcare is a fundamental right. No one should be denied access to the best possible medical treatment simply for inability to pay. It's monstrous.

Gino said...

a fundemental right(whatever that is) is not the same as a entitlement.

the constitution says i have a fundemental right to free speech and to bear arms. does that mean the govt must provide guns,ammo, and a blog account?

and isnt food more basic than healthcare?

kr said...

Andy, dude!, you totally tripped over the food and shelter are more basic "rights" than healthcare bit, there ...

What makes me f-ing crazy is that the system is goddamn socialized already, and the people who are most business-oriented should see that and want the cheaper-to-them option! Right now, it's socialized, plus profit: why are insurance claims so exorbitant? Oh, well, a big chunk of that is because so many uninsureds use the emergency departments (where they are by law required to receive care), oftentimes when things have reached a crisis (so the ED will actually have to DO something for them), and the (very expensive) emergency departments need to get money to stay open, so charges for insured services get jacked up ... corporations and private citizens and medicare and medicaid are paying for (incredibly shitty) universal healthcare.

The government has defined that people are entitled to (emergency) care.

Execs are profitting. Patients, doctors, and communities (especially small communities) are all suffering. People are dying from lack of decent care.

Government run health care is not something I "want" (the government as-it-exists and I agree on very little about life-management). But the current monster should certainly have its guts ripped out. If we can transistion to some free-market model, fine. Not seeing that anytime soon; too many people have been raised to believe in entitlements for too many generations. Free-market only REALLY works if people step up and take responsibility.

Myself, I will keep on paying out of pocket for regular care (finding a medical practicioner who is useful to me is a nightmare I don't care to repeat regularly) and maintaining a crisis-care insurance with a deductible no higher than my credit card limit (which card is generally kept at a zero balance).

And, on behalf of insurance companies ... I am a very light user, and with several companies in the past, they have approved things that weren't necessarily "they had to approve it" items ... I think because they know they had had so much payin and so little payout. People in general aren't evil, and most will do the right thing if they feel they can.

Gino said...

kr: thats what i think the solution is.
office visites are paid out of pocket.
anything major: you buy a policy to cover it.

auto ins works much the same way.
you pay daily to maintain your car, and fix broken windows/flat tires etc... out of pocket. and ins kicks in when you have something major.

kr said...

gino--yes ... but we have a couple of generations of people who have been taught that money grows on trees (credit cards) and the government is supposed to take care of them ... responsibility and self control seem a bit challenging for most Americans : P.

Andy said...

Well, I have no problem saying that people are ENTITLED to healthcare. In this day and age, when we have so much power to cure and heal and eliminate or reduce suffering, I find it a grave moral error to say that we will only help those who have the ability to pay. What did Jesus charge for His services? Who did He turn away?

It sounds lovely to say people would just pay for office visits and would have insurance for anything major. But the reality -- right here in the United States -- is that so many people live paycheck to paycheck (if they HAVE paychecks -- and not all people are unemployed because they're lazy, hello corporate downsizing, outsourcing and manufacturing decline) and struggle even then, that they truly do not have the funds to cover even an office visit. That's one of the giant problems with the current system; people don't get regular checkups because they just can't afford it. They don't go to the doctor when they start to feel ill because they just CAN'T afford it. Suddenly they get REALLY sick and have to go to an emergency room, and now they need much more expensive care (assuming it's not too late) to treat a condition that could have been headed off for less money had the condition been discovered earlier, say, during a routine checkup. You know, the one these people can't afford to go to.

The system DOES NOT WORK. It is NOT a question of merely teaching people to be more financially responsible (though of course that would help the economy in general, though it would be strongly discouraged by large banks and credit card companies). The simple fact is that we have millions - MILLIONS! - of Americans who can't afford basic healthcare.

Gino said...

define 'basic healthcare'.

besides, isnt food an even more basic need?
should we be entitled to that, as well?

Andy said...

Aren't we?

Or is your proposal that we just let people starve to death? Sorry pal, if you don't have any food, it couldn't possibly be that you are a victim of circumstance, it's clearly that you are irresponsible. You made your bed, now sleep in it. Or starve to death, whatever, see if I care. If your children are hungry, well, you should have gone to college and gotten an MBA and a six-figure salary. Is that honestly your attitude?

And even if someone isn't a pure victim of circumstance but rather someone who's made a series of bad choices: does our Christian faith allow us to cross to the other side of the road and pretend we don't see them? We're just going to let someone starve to death because to do otherwise would interfere with the invisible hand of the free market and would weaken democracy or something? That's not democracy, that's economic darwinism.

Yeah, forget I said "basic" healthcare. I mean "healthcare." If more people went to the doctor regularly for checkups, more serious ailments would be caught earlier in manageable or preventable stages. Instead what we have now is nearly 50 million Americans who rely on the emergency room. But whether we're talking about a routine checkup or a liver transplant, no one should be turned away.

kr said...

Andy, Gino is not saying we should ignore hunger

He's asking if it is the _Government's_ job to provide food

That's a real question ... and it applies to healthcare as well.

As soon as government becomes the responsible party, people let go of being responsible for themselves AND OTHERS (this is the part that bugs me, personally--because so many people seem to have the "well, I've paid my taxes, why should I ...?" attitude). As soon as the government gets involved, everything gets standardized (I hope that as a gay male you can see the damages that would have caused, oh, say, even 20 years ago, but certainly 50 years ago). As soon as the government starts providing services, the services will be run by the highest bidder/best lobbyist, and consumers, entrepreneurs, and "little" people with original ideas will be left out in the cold.

The government has shit credibility in the healthcare department (big pharma, VA hospitals, condemnable nursing homes, years of pussyfooting for tobacco, etc.).

Food, shelter, healthcare ... all basic rights of every human. The delivery of those things to the indigent or otherwise disadvantaged among us?

I'd rather trust charities and local communities.

But that's maybe the Catholic in me. (Private Socialism. I tell you, it's the only answer ;)! )

Andy said...

Well, the current system doesn't work. And the current system IS the free-market system. There are no options.

Gino's trying to bait me into a typical BS conservative slippery slope argument, that if we socialize healthcare, we'll end up socializing everything else. Why? That's not what's happening in Europe and other places in the industrialized world where the government pays for healthcare. (These countries also offer better, cheaper education and have less poverty.) I don't think anyone is saying that the government will eventually just have to pay for our food simply because they pay for our healthcare. Food is a daily -- but manageable -- expense. Healthcare is usually not a daily expense, and depending on circumstances, can be a catastrophic one.

It's a bogus question that Gino poses. People aren't clamoring for "socialized food" because they don't want it, the present system works okay for us.

Andy said...

I'd rather trust charities and local communities.

But here you are overlooking one of the best things that the free market has to offer: the economy of scale. A centralized agency with the sole function of paying for healthcare can do so far more efficiently and LESS EXPENSIVELY (and, importantly for healthcare, consistently) than a hodgepodge network of charities trying to keep up. If the charity system were working okay, we wouldn't have the healthcare crisis we do.

kr said...

Nah--if people didn't expect the gvt to do stuff for them, they would be better about charities/helping their neighbors

it is happeneing around here, people are waking up to the fact that we have to consciously choose to be community

and the current system ISN'T a free market, it's a protectionist game with the cards stacked for big business

and we DO have choices--witness my not-well-off self prioritizing healthcare (naturopathy, chiropractic, midwifery--you know, the stuff that WORKS without KILLING me or my children in the process) and paying out of pocket

example of why standardized medicine sux: you know that "autism epidemic" we are experiecing here in America? it is statistically WORSE (can you imagine??) in direct proportion to the amount of the population that receives technological prenatal care (ultrasounds) ... Japan and Britain for instance are SCREWED on this one, I hear. Their mothers go in early and often for ultrasounds. And again: The amount of pressure to have kids immunized (for anything pharma can invent, with or without decent testing, growl) in Britain is farking RIDICULOUS; doctors who don't immunize like 85% of the kids they see lose gvt payments ... so they dump patients to meet the gvt imposed quota for fucking up children's immune systems so they can't learn to fight regular diseases properly. (And here you thought, I bet, kids in Britain were "covered"--uh uh, being part of the alternative health care population, I can tell you that lots of families are paying out of pocket there and some of their practicioners have to do some fancy dances to not get shut down for non-compliance.)

I DON'T EVEN WANT TO BEGIN TO CONSIDER WHAT THE AMERICAN GVT WOULD DECIDE WAS "CORRECT" CARE. I worked in a private haelth system that was trying to figure out "best practices." I have watched the gvt repeatedly try to vacate organic standards. I have watched the gvt decide it has no (actual functioning) responsibility for watchdogging things like food imports, non-big-pharma medicines (this is so ironic to me), bioengineered food, animals, plants, animals that have eaten bioengineered plants ... I often think the only reason anything gets caught at all is because some competing agency wants to get the theoretically responsible agency in trouble. like fractious siblings or something! In any case, the health of the populace? Not something our gvt has a good track record on. For God's sake, the USDA SUED a farm in the midwest that decided to test every cow they killed for BSE so they could export to Japan ... to SUE them for trying to keep people safe!! From a health problem that is ever so Inconvenient, you know, to admit or deal with ...

And you know what, I don't think Gino is trying to lure you into a slippery slope argument. Gino respects you and is probably trying to ENGAGE YOU ON THE TOPIC with HIS REAL THOUGHTS. I am not impressed that you are throwing the Easy Wrtie-Off at him--talk about knee-jerk reactions!

On the other hand, maybe Gino was bullshitting, and I'm sure he'll set me straight if not.

The revolution is up to you and me ... people have to CARE again, and make help happen, hands on and money in. Not the gvt.

Economies of scale were an interesting mathematical model that SUCKED when applied to the real world with real people and plants and animals. Outsourcing, environmental degradation, etc etc -- a "utopian" ideal from back when utopianism was still in vogue, and I wish this one would die. Local, sustainable, in-your-community consumerism ... it's not exactly utopian, but at least it engenders awareness and involvement.

Jeff said...

If health care were as cheap as food, maybe we could expect everyone to pay for their own health care out of pocket.

Seriously, food is cheaper than ever - even though it's crappy food. Meanwhile, health care gets more and more expensive every year.

The free market does not solve all ills. If there were a private-sector solution to our nation's health care problem, the private sector would have found it already.

An unstinting belief in the power of the free market is just a form of ideology. Ideology is neat, but it doesn't feed you or perform preventive exams for cancer.

What's more important: a nice theory, or a healthy populace?

kr said...

The medical market isn't free

it is subsidized

that changes everything

and I don't buy cheap (poisonmongering) food either

the entire expectations system that things "should be" cheap is why we all live with so much crap in our homes and streets and dumps, and why many human rights abuses happen

what would really happen if every consumer in America prioritized--really truly prioritized--food, then shelter, then additional healthcare (both of the first items being types of healthcare)? fewer people would by new cars, too many clothes, bigger closets to store too many clothes ...

yes, "things" can be nice. Not having to experience chemotherapy? Nicer. Maybe priceless.

Gino said...
This comment has been removed by the author.
Gino said...

"Gino's trying to bait me into a typical BS conservative slippery slope argument, that if we socialize healthcare, we'll end up socializing everything else. Why?

no andy, i was trying to lead you into an economic discussion, since this whole this is economic after all.

"That's not what's happening in Europe and other places in the industrialized world where the government pays for healthcare. "

there is nothing left in europe to socialize, and with the loss of markets, you have chronic double digit unemployment, and rapidly disappearing cultures. western values will be gone before we know it, as well.

i just saw a story last nite about thousands of canadian women yearly being sent across the 49th to spawn due to shortage of facilities in their socialized welfare state.
tell me again how well it works?

or would you want a govt of neocons and/or marxists deciding who gets treatment, and how much?
>>sorry, no treatment for those who had sinful lifestyles<<
>>smokers and fat folk need not apply<<
>>white folks to the end of the line. affirmative action,ya know<<

i support the right to choose as only a free market can allow. and i dont mean killing babies.

we dont as of yet, have socialized groceries. but countries that do (europe) pay more for food than we do here.
the free market makes food cheap. so much so, that we are the most affordably fed nation on earth.

kr is right.
i've always respected to you.
and have said so publically at my own page.
when have i ever dissed you? here, or anywhere?

"does our Christian faith allow us to cross to the other side of the road and pretend we don't see them?"
is this a call for forcing personal morality through govt?
if so, i have a few other moral laws out of the Bible i'd like to add. how bout we put those in as well?

or we could leave morality out of it, and go with individual liberty as our over riding value?

Andy said...


They wouldn't be given the opportunity. That whole flaw in the system is the ENTIRE result of the profit motive by the private industry. With universal healthcare, the medical professionals and the patient decide on the course of treatment. The government just pays for it. There would obviously have to be some mechanism to prevent/police fraud, but it would function like the IRS. The role would not be to "make money" for the government, but to make sure that the right money is collected and appropriately distributed.

kr said...

No, Andy, because there is still certification. Professionals would stll have to qualify for payment by some measure established "by the people and for the people." The only actual way to accurately measure that would be to let people freakin' choose.

(Remember I mentioned that I was in a health system that was trying to establish "best practices"--they were really doing so, too, trying to figure out what treatments were most effective without cost as the deciding factor, although they remained aware of it of course. And while I was working there I stepped out of their own insurance plan and the hospital I had worked at because my own research showed me that non-hospital births were in fact way safer--and cheaper, although of course not for me, since it wasn't covered by my plan. It matters what questions get asked ... and who defines the questions. I can't imagine that the AMA would not be the first and probably the only serious "authority" looked to for the standards-development. I am pretty much anti-AMA-everything at this point. Including cancer treatment, since that always seems to come up.)


Here, I'm an advocate of school vouchers as a bridge between complusory schooling and actually educating children. How about it works this way--the gvt sets up a voucher system. You have to buy crisis-insurance before you can access the other money, and the other money can only go to liscenced practicioners. It's a pot of money the gvt provides for you to shop your preferences, with some reasonable rules.

This would make people responsible for their own care choices but make sure everyone had care, let the wiggy wigs like me still pay out of pocket if we want something not liscenced ... and probably get the neighborly conversations started: "hey, me and three others on this block want chiropractic covered ... let's start a petition, and get the liscencing standards amended!"

One advantage to having it be a federal program is we (the people) would only have to fight one big fight for each issue instead of state-by-state.

Yes, Gino, it's still an entitlement program ... but it's a step in the right direction, and means almost all people would have some sort of crisis insurance and probably some basic healthcare.

kr said...

sorry about that "me and ..."
ouch : P

kr said...

oo! and! if someone walks into an emergency room without having purchased their basic crisis coverage--there is a pot of money from which to pay that!

I suppose there would need to be some budget adjustments by age and stuff, and maybe diagnosed disability, too.

Could this program absorb medicare and medicaid? Logically it could, I think. Check it out, I just took down two moneysinks and made them more consumer-driven than government-driven!

Anonymous said...

Yes, omit the word "industry" when talking about healthcare. It's an inalienable right, not a capitalistic scheme. It should NOT be privatized. Single-payer is the only way that this can work. Kucinich '08!


Anonymous said...

And btw, health "care" is so expensive b/c BigPharma negotiates for the freedom of charging exorbitant rates for drugs they create and then giving doctors incentives for prescribing these drugs.


Anonymous said...

And "Christian faith" has nothing to do with it. It's just about being a human with a social conscience. One needn't believe Jesus is literally the son of God to be a decent human being. Jews, Muslims, Hindus, Atheists, Agnostics, etc. are all capable of caring for their neighbors. It's best to not delineate this humanistic theme with religious terms.

The objective is not so much to have a government agency delivering or deciding upon health care treatments, rather that there be a single-payer system, wherein there is no room for competitors to cover that which is not covered by another (thereby leaving clients of one insurance company w/out treatment possibilities.) As Andy wrote, the government itself isn't deciding on a course of treatment. They simply pay for it (with our tax money).

All people should have access to equally good care. This is what single-payer health care would provide. HR676!

Gino: Marx would have granted all people the right to health care. Haven't you actually studied his writings? And I live in Germany. My bio (organic) food is much cheaper there than it is in the U.S. And my health care is GREAT there. I go to the doctor when I need to. I pay a 10 Euro co-pay, which will be good for the following three months, should I need to make another visit. I have never needed to book an appointment sooner than 3 days in advance. And all prescriptions are only 5 Euro.