Despite the many (true) stories of incompetence, excessive bureacracy and foot-dragging by the NHS, my fiance, an American, considers it close to one of the modern wonders of the world compared to what she dealt with as a student in the States.

Any system which incentivized her NOT to have a serious condition diagnosed when problems occurred, since there was no way she would be able to get affordable coverage with the pre-existing condition diagnosed - or even DISCUSSED - strikes me as encouraging its citizens to take rather cavalier risks with their own health. Talk about a broken market . . .

Gotta disagree here - and since I've spent the last 10 years working for an info systems and software provider specifically in the Medicare area, it's an area I know a fair bit about. There is an absolute ton of inefficiency to be eliminated... to say nothing of the constantly rebranded Medicare Plus/Medicare Choice/now Medicare Advantage boondoggle. The plans on the able are light in dealing with the former, but do have provisions on the latter. That said, though, CMS can cut plenty of costs in program administration sans any new legislation.

Zonk, the claim that there's plenty of inefficiency is obviously true (*); the claim that there's plenty of inefficiency to be eliminated is not obviously true. Inefficiency is endemic in any large complex system, and given the (lack of) incentives in government -- i.e., no profit motive -- worse in a public system.



(*) Notwithstanding the left-wing talking point about how Medicare has no overhead and magic unicorns deliver health care to people for free.

Andy, a single-payer or socialized medicine advocate can make a lot of strong points in this debate. In the second paragraph of 186, you're not doing it. Obviously, you're entitled - but...

If you believe this, then as an alternative, how would you deal with the fact that two thirds of personal bankruptcies in 2007 were caused by medical bills? (A rate that went up by 50% from 2001.) Is that to be considered some sort of collateral damage, the acceptable price that we pay for the wondrous benefits of our existing health care system?

These aren't mutually exclusive - there are other responses that may do a better job with cost controls + limit people from that kind of extreme exposure. (For example, under snapper's "plan" you either wouldn't have or would have far less of those kinds of bankruptcies.)

This is not to deny, by any means, that this isn't a serious mark against status quo.

Look, I'd much rather we have a variant of the French system here, based on not only everything I've read, but on my wife's comparative experiences between the two countries. She's a dual citizen who grew up there and spends much of her time there, and she's said for years that it's like night and day, both in terms of cost and bureaucracy. And I don't mean in our favor. She's 49 and in general is in superb health and physical condition (she looks 35), but she's had Crohn's since she was 30, and unless she's forced to by circumstance, she never goes to doctors here, and even more, never would dream of buying her prescriptions here, which are many times as expensive for the identical brand name (Asacol).

And she's not exactly the only one is this state. My only prescriptions are two glaucoma eyedrops, but thank God for Canadian pharmacy---they cost 30% to 50% more here than in Canada, again for the same brand.

But as it's clear that we're not going to get any sort of French system here, of course I'd welcome any serious proposals that dealt with the problem of medical bankruptcies---if they really eliminated them, and not just waved a few token subsidies at them.

Sorry to drag all this "anecdotal" personal experience into this, but neither me nor my wife are exactly unique when it comes to our experiences with our health care system. And since we're in better shape than the great majority of people our age, we're certainly among the relatively lucky ones.

"as for socialist medicine being this wonderful thing, you should just go ask john brattain about the fantastic medical treatment he got. oh wait - you can't"

Still waiting for an explanation of this, Lisa.

and given the (lack of) incentives in government -- i.e., no profit motive -- worse in a public system.
That's overly reductive, David - the private system has a myriad of actors with conflicting motivations, some of which run counter to "the public good" - there's no guarantee that that's going to be more efficient than a well-designed* public one.

As for 'plenty of inefficiency' - there is and will continue to be (US system has huge overhead relative to many others). Question is how much can we get rid of...

* - Feel free to consider that an oxymoron, depending on your bent.

Still waiting for an explanation of this, Lisa.

So am I.

Zonk- if Medicare implements the type of programs necessary to reduce the waste and fraud that will largely finance health care reform- which I believe is the current plan- will the administrative costs remain as they are now? Won't providing the tools necessary to wipe out that volume of poorly directed resources necessarily foster a large increase in admin costs?

Well, that's probably the sticky wicket... Where Medicare's fraud prevention works well -- heavy fines and a cut of those fines going to whistleblowers -- aren't really areas that an expanded public option of some sort handles. The complexity, heavy penalties, and whistleblower rewards keep hospitals well in line.

Most of the fraud in Medicare does come from primary care docs and simpler reimbursements (like equipment).

These aren't insurmountable problems - and ideally, this where a strong technical upgrade to our system would help, as detecting patterns in the data is something best left to a computer.

I think it probably would cut into those administrative savings...

Anecdotes: share away, sorry! They aren't meaningless, I just wouldn't base policy on them.

No part of your 205, Andy, strains belief in any way (nor, I hope, would appear to be contradicted by my past remarks).

I've lost the thread and will have to catch up later. But:

Because you don't believe racism exists?

I believe racism exists.

But I don't believe that McCoy's home room teacher confided to him that she saw blacks as "no good black people." Even if she felt it, it would be self preservation for her not to say it. Especially not casually, to a student, in 1994. What the hell.

Or if she did go around saying these things to students, she didn't last long as a teacher.

as detecting patterns in the data is something best left to a computer.
Or my friend Evelyn. She likes her work and is quite clever - so, good on you America!

Doesn't a single-payer system have a built-in stick to help control costs? I worked in an insurance company that administered Medicare for 10 states, and if Medicare said that XYZ procedure would cost $150 for any Medicare patient, then by God, a doctor performing that procedure for a Medicare patient got $150, no more, no less. And the doctor couldn't charge $300 and go after the patient for the remaining $150, like they do with private insurance.

And doctors went along with this because they knew that if they had their documentation done properly, they would get their $150 in a timely manner. With private insurance companies, they were always getting ###### around for their money. Doctors I talked to LOVED working with Medicare because the billing rules were clear, straightforward, and didn't change arbitrarily like they did with insurance companies.

Anecdotes: share away, sorry! They aren't meaningless, I just wouldn't base policy on them.

No part of your 205, Andy, strains belief in any way (nor, I hope, would appear to be contradicted by my past remarks).

I wouldn't base policy on a handful of selective anecdotes, either, but it's not as if those anecdotes haven't collectively reached flood proportions. Do a bit of googling on "medical bankruptcies" if you doubt this.

179. Ron Johnson Posted: September 14, 2009 at 03:53 PM (#3321527)

#174, apparently nobody in the US has ever died in surgery.

BBC, do you think John would be alive today if he'd lived in (say) Houston? If so, why?

- why would he be alive?

because he didn't just "die in surgery." he would be alive because here in houston, he would have had the option of going to the ER at one of the medical schools. he told me he did not have that option up there.

i would tell you the entire story i swear i would, but john made me promise to not say anything about him or what happened. i wish i could. oh god i wish i could. you have NO idea how bad i want to tell the story. but i promised john i wouldn't never tell a single soul. and if there is one person on this earth who i owe, it is john and i can't break that promise.

you can be mad at me all you want. help your self. but as for me it has been almost 6 months since he's gone and the unbelieveable grief and rage/fury has not gone down one little bitty bit. all i can say is that i hate the health "care" people he dealt with so much i didn't know it was possible for one person to have that much hate in her. may God forgive those people because i don't have it in me to do that

BBC, you don't have the foggiest clue whether John would be alive today if he'd lived in Houston. Please with this.

211: I believe it (well, I believe it's potentially true, which is close enough). Not nearly the same thing, but I had someone make a similar comment to me in 2006 (at a Chick-Fil-A in my town's old mall, in the Chris Rock sense). I was flabbergasted at the lack of regard in which they held their continued employment, if nothing else.

What's "free emergency care?" I'm poor, I cut my finger off, I go to the Emergency Room, they sew it back on. I don't have any money, so does the hospital just write that $9000 off? ########, they do. They charge me for it, they keep sending me bills I can't pay, and they send me to a collection agency which ##### my credit for the next seven years.

Well, you could call them up -- hopefully the hospital, but if not the collection agency -- and negotiate with them. As an attorney whose office space is being shared by an attorney who works for debt collection firms, I can tell you that they don't expect to see more than a tiny fraction of this money, and they're happy to work out a payment plan that gets them anything at all, on the theory that 10% of something is better than 100% of nothing.

Of all the places I thought this thread might go, this was not it.

My feeling is that it's in very poor taste to use John Brattain as a debating point, regardless of the story that can't be told, and we can move on from there. It's also in poor taste to inquire about the story, so it's best to let it all go.

why not be seen by a nurse practitioner who can do the exact same thing as a doctor? "Doctor" is just a word.

This is quite an ignorant statement. Perhaps some ER care, or 'routine office visits' but this is total nonsense for most specialties.

#196

andy,

i'm afraid.

you see, i believe that in the end, money talks and they are not simply going to get rid of insurance companies and have every person under a medicare system (and you also have got medicare supplemental insurance too because medicare does not pay for everything). and what i am really afraid of is that the new rules will force us to buy the insurance under my husbands policy which will go up in price and i just don't know where we are gonna get that money and i don't know what we are going to do

and i don't believe for a minute that there will be no increased cost to put everyone on the govt system. and i am afraid of what is going to happen to us.

i don't know what to do i really don't.

Well, you could call them up -- hopefully the hospital, but if not the collection agency -- and negotiate with them. As an attorney whose office space is being shared by an attorney who works for debt collection firms, I can tell you that they don't expect to see more than a tiny fraction of this money, and they're happy to work out a payment plan that gets them anything at all, on the theory that 10% of something is better than 100% of nothing.

Correct me if I'm mistaken - but by the time a collection agency gets the debt, hasn't the provider already washed their hands of it? As I understand it - the collections agency buys the debt (for pennies on the dollar) from the biller, so anything the agency collects it keeps.

As such, the sunk costs to the hospital have already worked their way into the health care cost equation (i.e., a $9K procedure produced $900 or whatever in revenue the hospital got when it sold the debt).

Here are three models for national health care, exaggerated to fit the style of an Internet forum, but not too much:

1) The Ayn Rand Health Plan, where there is no health insurance. Being beautiful and steely-willed, you simply don't get sick – but if you do, you bid in an open market for medical services and get better if you have more gold coins stashed in your mattress than your weaker neighbors.

2) The Status Quo Plan, where those with more gold coins in the mattress can buy good care, some workers have crappy insurance because they are low-risk to begin with, the elderly have crappy insurance because they vote and strike terror into the hearts of Congress, and veterans have notably crappy insurance because they inflict at least minimal shame on Congress, and some poor have extremely crappy insurance because they're poor, and other poor have no insurance at all because they are poor and life has kicked them in the ###.

3) The Single Payer Utopian Plan, where everyone has at least the same insurance because the entire nation is the risk pool, and those with more gold coins in the mattress can still buy good care.

I've already expressed my preference for #3. But frankly, #1 looks rather pure and terrible, and is intellectually, economically, and morally tenable.

It's #2 that's the problem. No rational market (#1) and no rational government (#3) would create it. It's based on various profiteers seeing vulnerable spots in a system and moving energetically to bleed it, while various legislators struggle half-heartedly to appease furious constituencies in a series of half-###ed compromises.

Why is #2 a good deal? If it's not, do you want things to move toward #1 or #3?

Do a bit of googling on "medical bankruptcies" if you doubt this.
I don't need to - I previously agreed with you on the scope of that problem. Again, other systems can remedy this as well (including snapper's quasi-proposal).
******
With private insurance companies, they were always getting ###### around for their money. Doctors I talked to LOVED working with Medicare because the billing rules were clear, straightforward, and didn't change arbitrarily like they did with insurance companies.
1) Many docs / practices don't like dealing with Medicare because they think they are then underpaid - often opting out entirely (thus, you wouldn't deal with them).
2) I'm gonna have to redact most of my comments on the billing rules. They are byzantine and both agencies (insurer and hospital/clinic/med assoc/whatever) make them that way, sometimes for good reason. I'm sure they're a pain for individual docs (moreso those who do the billing work for those docs).

This system would have a more general problem - the provision of health care depends, at a basic level, on deep trust between medical practitioner and patient. This is because patients cannot be expected to have sufficient medical knowledge about their situation to determine their own course of treatment, because medicine is some complicated ####. It's the information assymetry again. Then, the more we incentivize doctors to be salespeople and patients customers, the more we damage that trust.

Have you heard of a "second opinion"? Before you get major treatment, you ought to be getting one of those anyway.

veterans have notably crappy insurance because they inflict at least minimal shame on Congress

Actually, VA medical care is now widely regarded as some of the highest quality and most cost-effective in the country. Seriously. We would be in great shape if we modelled our health-care after most of the VA.

"i would tell you the entire story i swear i would, but john made me promise to not say anything about him or what happened. i wish i could. oh god i wish i could. you have NO idea how bad i want to tell the story. but i promised john i wouldn't never tell a single soul. and if there is one person on this earth who i owe, it is john and i can't break that promise."

It's certainly convenient that John swore you to secrecy in a way that allowed you to provide anecdotal evidence in support of a political position, but not elaborate on it in any way when challenged.

Did he happen to tell you where to find all those missing WMD, too?

#196

andy,

i'm afraid.

you see, i believe that in the end, money talks and they are not simply going to get rid of insurance companies and have every person under a medicare system (and you also have got medicare supplemental insurance too because medicare does not pay for everything). and what i am really afraid of is that the new rules will force us to buy the insurance under my husbands policy which will go up in price and i just don't know where we are gonna get that money and i don't know what we are going to do

Point taken. But then you're not really arguing against the French system (or a single payer system), so much as you're afraid of trading the devil you know for the devil you don't know---other than you fear that it will leave people like you and your husband holding the bag. What's coming from you is more of a distrust of the American inclination to let money game the game.

Can't say that I blame you for that, but before jumping to conclusions, I'd wait and see what emerges from the catfight that's taking place now up my way in DC. We've heard plenty from the bloviated teabaggers, but there are plenty of other POVs that have yet to make their push, and I wouldn't write it all off just yet.

223: Heh. May I offer a mini-response (as I won't / can't offer my complete and total preference - which is probably plan #7 or something and would be disliked by all).

You can make a modified #1 work, I think (cost less, better collective health outcomes), but not without pain.
You can make a modified #3 work, I think (cost less, better collective health outcomes), but not without pain.

Whichever direction we move in, I worry that special interests will cause us to adopt policies that eat up much of the savings/benefits that are possible - and that depresses me.

The Ayn Rand Health Plan, where there is no health insurance.

What does libertarianism have to do with banning health insurance?

Anyone who thinks Lisa was trying to make a cheap point off of John is on crack; she was much closer to John than pretty much anyone else on the site.

Doesn't a single-payer system have a built-in stick to help control costs? I worked in an insurance company that administered Medicare for 10 states, and if Medicare said that XYZ procedure would cost $150 for any Medicare patient, then by God, a doctor performing that procedure for a Medicare patient got $150, no more, no less. And the doctor couldn't charge $300 and go after the patient for the remaining $150, like they do with private insurance.

And doctors went along with this because they knew that if they had their documentation done properly, they would get their $150 in a timely manner. With private insurance companies, they were always getting ###### around for their money. Doctors I talked to LOVED working with Medicare because the billing rules were clear, straightforward, and didn't change arbitrarily like they did with insurance companies.

Specialists, I'm guessing...

The biggest problem with 'Medicare for all' from a provider perspective is that the segment of the health care world that most dislikes Medicare's rates are the primary care docs most needed under a broad public plan. That's really going to be the biggest problem with a public plan -- I haven't seen anyone suggesting mandated participation by providers of any sort, and right now, primary care/family doc participation in Medicare is a real problem in some areas.

I'm not switching sides mid-thread... just getting to why I'm not a public option absolutist.

Really, though, that's sort of moot since the option in HR3200 is pretty severely restricted and really isn't going to be a true option for the vast majority of people.

In fact, I could even get behind a plan with 'triggers' - not because I think we should give private insurance "one last chance" but because we really do need to see what happens to rates under a universal coverage mandate.

I honestly do think that people - and even the CBO - underestimate what will happen with private and public reimbursement rates once health care is more efficiently allocated, and emergency rooms return to handling true emergency care only.

So I hear Len Dykstra is selling his World Series ring.

john/bbc: Drop it, everybody.

and emergency rooms return to handling true emergency care only.
Big 'if'. A glorious 'if', but still an 'if' (many single payer systems have wide ER overuse, incl. France).

There is really no dispute over this point. The spread is not 30% to 3%, as folks on the left would like to claim -- but a significantly higher percent of dollars paid under Medicare/Medicaid go directly towards care vs. overhead than in the private system.

Even if you exclude things private insurance has to cover in their administrative overhead -- profit, commission, taxes -- Medicare still comes out ahead. (5.2% overhead for Medicare, 8.9% for private insurers excluding tax/profit/et al -- 16.7% if you include them).

No one familiar with the numbers seriously contends that public programs - Medicare/Medicaid/SCHIP/etc - don't have lower administrative costs than private insurers... even the industry itself does not deny this.

I don't dispute their calculations, but I dispute the conclusion you're drawing. The formula "administrative costs/administrative costs + benefits" doesn't tell you anything unless the populations covered are the same, and they're not. Note that all you have to do to lower overhead, using that formula, is increase the benefits paid out. Even setting aside the fraud issue, Medicare covers older people. Older people have much higher health care expenditures than younger people. So the benefits paid out go up, so that ratio shrinks, since administrative costs are proportionate to the number of people covered more than the size of their benefits. But so what? The correct measure of efficiency is not "overhead / overhead + benefits," but per capita overhead.

(Of course, for an accurate comparison you need to properly account for overhead that has been offloaded from the Medicare budget to a different government agency's buget.)

The Ayn Rand Health Plan, where there is no health insurance.

What does libertarianism have to do with banning health insurance?

This is correct, there would still be insurance companies run by steely-eyed virtuous rapists*, and the intelligent elite would purchase such insurance.

Everything else works out pretty precisely, though - the existence of insurance companies in no way means that the uninsured and underinsured wouldn't die in the street under this system.

*I know there's sensitivity here, so I'll say that obviously libertarians are not pro-rape. Ayn Rand's collected works, though, stand a truly disturbing distance away from the anti- side.

Actually, VA medical care is now widely regarded as some of the highest quality and most cost-effective in the country. Seriously. We would be in great shape if we modelled our health-care after most of the VA.

Yes, anecdotal coverage of problems not withstanding, on a pure outcome basis, the VA does quite well for itself.

In fact, the VA is actually the only true 'socialistic' health care system in the US. Medicare doesn't technically own any hospitals or providers -- but all VA facilities truly are like Britain's NHS in that the doctors, nurses, etc are employed directly by uncle sam.

The correct measure of efficiency is not "overhead / overhead + benefits," but per capita overhead.
That would understate Medicare's advantage - people that use more benefits require more work.

(Of course, for an accurate comparison you need to properly account for overhead that has been offloaded from the Medicare budget to a different government agency's buget.)
Again, heh.

You can make a modified #1 work, I think (cost less, better collective health outcomes), but not without pain.

I'll freely admit that #1 would come with a lot of pain and would not make everyone happy and healthy.

I'll deal with whatever system we end up with, but my main complaint is, like with The War in Iraq, we're getting negatives shooed away by the proponents because the underpants gnomes will magically take care of it.

Amusingly enough, I'd probably be less annoyed with the health system overhaul if what Sarah Palin said about rationing and death panels were true - government services, where they exist, should be rationed.

If you believe this, then as an alternative, how would you deal with the fact that two thirds of personal bankruptcies in 2007 were caused by medical bills? (A rate that went up by 50% from 2001.) Is that to be considered some sort of collateral damage, the acceptable price that we pay for the wondrous benefits of our existing health care system?

Easy: Elizabeth Warren is an intellectual fraud, and her numbers are cooked. Two thirds of personal bankruptcies in 2007 were not caused by medical bills, and it's not up 50% since 2001.

When one asks people whether they have a problem, and X% of people say yes, and then one's study says that 3X people actually have that problem, it's usually a sign that one's study is garbage. Nowhere close to 2/3 of debtors claim that their bankruptcies were caused by medical bills; the number of people who make that claim is closer to 1/5th. (And keep in mind that, given the lack of stigma attached to medical bills, survey respondents would have an incentive to falsely blame medical bills rather than some causal factor which might have more moral opprobrium attached to it, like being an irresponsible spendthrift.)

What she does is redefine "medical" to include things that aren't medical, and then redefine "caused" to include bankruptcies that aren't caused by even her expanded definition of medical.

1) Many docs / practices don't like dealing with Medicare because they think they are then underpaid - often opting out entirely (thus, you wouldn't deal with them).

My own doctor doesn't take Medicare patients per se, but he bills us geezers directly at the Medicare rates, submits the paperwork to your (supplemental) insurance company, and if you have the right kind of supplemental insurance, they make up the difference to him, under an optional clause that adds only a few extra dollars to your monthly premium. Without that supplemental coverage, you still have to pay out of pocket, but at a fraction of what you would have paid before you turned 65, something like 25% of his standard rate. And of course many other doctors simply refuse to accept the geezer crowd unless they're willing to pay the full going rate. Again, I was lucky in that I had no previous idea how he was going to handle this.

Needless to say, this was all new to me until a few months ago. The extra $135 a month is worth it both for the savings and the sense of certainty that you're not going to be hit with a financial sledgehammer if something really went wrong. And again, why should you have to wait till you're 65 to obtain that sort of peace of mind? Why should any of this be dependent on your income or your age?

We would be in great shape if we modelled our health-care after most of the VA

If so, my apologies to the VA.

And my best to libertarian health-insurance entrepreneurs, too, though it seems to me that pooling risks is rather the thin edge of the communitarian wedge, isn't it? What if some low-life gets their nose in the tent and starts to die, involving a protracted, hideously expensive procedure, thus raising the rates of the supermanly few? :)

Edit for clarity

Because you don't believe racism exists?

I believe racism exists. But McCoy's own posts show that he sees racism where none exists. (See, e.g., post 65.) I don't believe that racism would be expressed in the situation McCoy described. If the teacher got drunk at a bar, perhaps. But that's not what McCoy portrayed.

To be clear, I interpreted #1 to be the everybody gets money toward purchasing mandatory insurance + gets catastrophic coverage with a reasonable threshold type deal. Not actually wild wild west.

IMO, a mandate / universality has to be part of the deal.

If you believe this, then as an alternative, how would you deal with the fact that two thirds of personal bankruptcies in 2007 were caused by medical bills? (A rate that went up by 50% from 2001.) Is that to be considered some sort of collateral damage, the acceptable price that we pay for the wondrous benefits of our existing health care system?

Easy: Elizabeth Warren is an intellectual fraud, and her numbers are cooked. Two thirds of personal bankruptcies in 2007 were not caused by medical bills, and it's not up 50% since 2001.

When one asks people whether they have a problem, and X% of people say yes, and then one's study says that 3X people actually have that problem, it's usually a sign that one's study is garbage. Nowhere close to 2/3 of debtors claim that their bankruptcies were caused by medical bills; the number of people who make that claim is closer to 1/5th. (And keep in mind that, given the lack of stigma attached to medical bills, survey respondents would have an incentive to falsely blame medical bills rather than some causal factor which might have more moral opprobrium attached to it, like being an irresponsible spendthrift.)

What she does is redefine "medical" to include things that aren't medical, and then redefine "caused" to include bankruptcies that aren't caused by even her expanded definition of medical.

I think we might let Ms. Warren and her colleagues speak for themselves. This is the full text of the article in the American Journal of Medicine, a notorious pinko publication, and Ms. Warren is but the third of four listed authors, who include among them two MDs and a Harvard Law Professor (Warren).

What does libertarianism have to do with banning health insurance?

I don't want to put words in BDC's mouth, but I suspect what he meant by his #1 was no government or employer health insurance. Anyone who wanted insurance would simply by an individual or family policy on the open market, and those who couldn't afford it or didn't want it would pay cash for medical services as necessary. IOW, we'd get rid of the jury-rigged employer-based health insurance system that we've had since WWII.

EDIT: And, while I prefer a single payer system, I agree with him that #1 isn't a crazy idea. What's crazy is staying with our current system.

Ray Ray, since you are all into asking the personal questions in this thread, let me ask you a couple. Do you have health insurance? How good is it? How much do you pay? Would you settle for less? Would you give up your insurance and pay out of pocket?

The biggest problem with 'Medicare for all' from a provider perspective is that the segment of the health care world that most dislikes Medicare's rates are the primary care docs most needed under a broad public plan. That's really going to be the biggest problem with a public plan -- I haven't seen anyone suggesting mandated participation by providers of any sort, and right now, primary care/family doc participation in Medicare is a real problem in some areas.

You can add anesthesiologists to this list of aggrieved. Their reimbursement rates, trail their peers substantially, and any broad public plan will see a number of those providers, such as an outpatient surgery center, further limit Medicare patients, or simply close their doors. That is a lose-lose situation for patients and physicians.

63. Traderdave Posted: September 14, 2009 at 12:42 PM (#3321280)
I'll second that Atlantic piece, and go so far as to say all in this thread should stop posting and read it, then come back to the discussion.

Thanks for the suggestion. I read that and it was outstanding.

Yes, Yeaarrgghhhh, I was thinking of a purely market-driven system in #1, inspired by snapper's notion that health care really would work as a pure market.

Though hell if I want to start shopping for surgery like one shops for cars. "I think I'll skip the Optional Anaesthesia Package."

I don't think that's what snapper wants (purely market driven, zero gov't involvement) either.

"I think I'll skip the Optional Anaesthesia Package."
Nice line. So... what constitutes undercoating?

"Anyone who thinks Lisa was trying to make a cheap point off of John is on crack; she was much closer to John than pretty much anyone else on the site."

Maybe so. But if she was genuinely sworn to secrecy on it, whatever "it" is, she shouldn't have brought it up at all.

What does libertarianism have to do with banning health insurance?

Not much I guess, but I wouldn't want to see how health insurance of any sort would work without substantial state oversight, and I've seen some gosh-darn awful state oversight. It's laughable that the average individual can evaluate the claims-paying ability (and willingness) of an insurance company.

I think we might let Ms. Warren and her colleagues speak for themselves. This is the full text of the article in the American Journal of Medicine, a notorious pinko publication, and Ms. Warren is but the third of four listed authors, who include among them two MDs and a Harvard Law Professor (Warren).

Indeed. Read their study, read the way they defined terms, and then see if it makes any sense on its face. After that, we can discuss the flaws that have been identified. Or, we can play your silly games about "pinko publications," your usual m.o. of substituting strawmen mockery for actual analysis.

Ray Ray, since you are all into asking the personal questions in this thread, let me ask you a couple. Do you have health insurance? How good is it? How much do you pay? Would you settle for less? Would you give up your insurance and pay out of pocket?

I'm not RayRay, but I think something that some in the debate don't do is listen to the reasons why some of us don't support a 'public option.' It isn't that we want to keep the status quo, we simply do not want to hand over the keys to 1/6 of our economy to the government.

I have private insurance via my employer provided plan (which I think is a ridiculous model, employer sponsored plans that is), I pay for 'family coverage', as my wife is self employed as a physician, and ironically her health insurance options would be triple the cost of what they are under my employer's coverage. The 'care' is fine, but that's the problem, compared to what? I have no idea how much anything costs, I just consume care for myself, my spouse and my newborn, and pay my premiums, which seem reasonable compared to my two other options, my wife's plan, or no insurance. We have zero incentive to manage our consumption, I couldn't even tell you how much a 'physical' would be out of pocket and I'm married to a physician.

A problem is I can't adequately shop around to other state's for coverage so I don't know if the care I receive is good, bad or indifferent, and I'm just one of millions of employees in the same situation. Why can't I shop my care and have more options. More transparency would go a long way towards at least understanding health care costs.

Bring Me the Head of Shooty (Vlad) Posted: September 14, 2009 at 04:57 PM (#3321622)

"i would tell you the entire story i swear i would, but john made me promise to not say anything about him or what happened. i wish i could. oh god i wish i could. you have NO idea how bad i want to tell the story. but i promised john i wouldn't never tell a single soul. and if there is one person on this earth who i owe, it is john and i can't break that promise."

It's certainly convenient that John swore you to secrecy in a way that allowed you to provide anecdotal evidence in support of a political position, but not elaborate on it in any way when challenged.

- convenient???
CONVENIENT???

do you know anything about grief counseling? you are supposed to talk about everything. and i can't. i can't. because if i hadn't promised he wouldn't have told me and i had to know. and he needed to tell someone too. i had to stand by for years and keep mouth shut and now that he's gone i still have to stand by and keedp it all inside. it is a huge poisonous painful growth i can't cut out and i can't make better

you don't get this. i loved john - he was like an uncle to me - he did so much for me and then for so long and i had to just stand by and do nothing. you do NOT get this. if he was here in houston i would have took him STRAIGHT to baylor. he didn't have to be dead. he didn't he didn't.



Did he happen to tell you where to find all those missing WMD, too?

- i don't give a shtt about stupid weapons and stupid lying politicians and their stupid lying lies they all tell so they can get more money for them and all their stupid greedy lying friends/cronies/campaigh donors. i give a shtt about john. he didn't have to be dead. and i can't even talk about it. and i regret that i didn't tell him how much he meant to me me and how i loved him and thank you that night before he went in because i knew it was the end but i was afraid that would jinx him and i still couldn't face it. and i couldn't even go to his funeral to say goodbye. and now even if i got the money i can't even go to his grave to say goodbye and i miss him because he got cremated and he doesn't even have a grave

i shouldnt have said nothing at all. it wont bring john back and it made me feel even worse

Believe or not, I agree with you Yeaarrrggghhh.

Obviously, we disagree on our ideal system, but given the alternative of some slapdash mix of both the worst aspects of the free market and the worst aspects of a state-run market, I'd rather just go single-payer now and try to get the most rational single-payer system we can get.

The comment threads on 538 are quite entertaining on the subject. There are actually people who are simultaneously excited that a plan with a public option would lead the way to a single-payer health system and angry that Republicans claim that a plan with a public option would lead the way to a single-payer health system. Too bad that site can't just be Silver and Gelman - the other writers are generally pretty terrible and/or partisan hacks and the discussion sections are worthless.

You dickheads need to leave Lisa be and drop it regarding the Brattain comment.

Why? Your auto or home insurance doesn't cover routine care. We have no problem laying out $100 or $500 for auto repairs, but blanch at doing that for our own health.

Speak for yourself. I had to get rid of my car as I couldn't afford to pay the $500 repair bill. (Of course, I could only learn about the problem after I paid the $150 registration renewal fee, since mechanics won't do an inspection until the registration was paid for.

The comment threads on 538 are quite entertaining on the subject. There are actually people who are simultaneously excited that a plan with a public option would lead the way to a single-payer health system and angry that Republicans claim that a plan with a public option would lead the way to a single-payer health system. Too bad that site can't just be Silver and Gelman - the other writers are generally pretty terrible and/or partisan hacks and the discussion sections are worthless.

Generally agreed. Many of the articles on that site are original, perceptive, and stimulating, but the comment threads are reliably garbage.

There are actually people who are simultaneously excited that a plan with a public option would lead the way to a single-payer health system and angry that Republicans claim that a plan with a public option would lead the way to a single-payer health system

I do agree that centrist Democrats, including the President, are entangled in their own spin. Not wanting to say an unpopular word, they present a picture that doesn't convince doubters, or energize their base, or inspire altruism and sacrifice, or promote community, or basically give anyone a reason to support them except that they're proposing a tepid overhaul of some aspects of the status quo.

It happens with every President: I begin to appreciate aspects of the last one. W. would come out and say something like: "We need to put people's Social Security money back into their own hands, so they can invest it with wizards of the marketplace like Lenny Dykstra." Whereupon you at least knew where you stood, and could phone your Congressperson in horror to instruct him/her to vote the proposal down. Whereas Obama's health care proposal does have the rhetorical trimmings that Ray discusses (though I doubt they are factual lies except in the sense that all politicians always spin drastically). "It won't raise taxes, it won't ration care." Well, we need to raise taxes because the savings elsewhere will outbalance the taxes. And we must ration care because (as several above have said) care is currently rationed: I get 100% and meatwad gets zero. We just need to ration that differently.

And we must ration care because (as several above have said) care is currently rationed: I get 100% and meatwad gets zero.

But Meatwad doesn't get zero. (Even though he pays zero.)

I don't think that's what snapper wants (purely market driven, zero gov't involvement) either.

No. I want government to provide a minimum safety net of care through county hospitals and free clinics. Anyone can use it, but if your income is above a certain threshhold, you get billed according to your ability to pay. The care should be good quality, but nothing fancy. No really high-tech stuff is covered (heart transplants, $100,000 per year drugs, etc.). A free governemnt benefit has to have limits.

Everyone else buys their insurance through voluntary groups (churches, clubs, etc.) or through randomly assigned pools. The only kind of insurance that gets a tax deduction is high deductible/medical savings account plan. Premiums will be much lower, and a lot more medical spending will come out of pocket. This will hopefully discipline the market and drive down prices. No one will be bankrupted by medical bills.

Medicare needs to be driven to more managed care to reduce the incentive for doctors to do unecessary procedures. As it is now, the elderly are a cash cow for doctors and hospitals. The "last 6-months of life" spending issue is real.

I thought that by the time he was driven into debt peonage and hounded by the collectors meatwad got less than zero. No matter. He's a lucky ducky.

Medicare needs to be driven to more managed care

"Managed care" is a euphemism for putting more money into insurers' hands and less into both doctors' and patients'. Managed-care companies have no incentive to improve care unless they are managed in turn by vigilant state insurance commissions.

Ray, the argument is that while the uninsured poor get some health care in ER visits, that care comes tied to conditions that always drag down their quality of life while simultaneously preventing them from pulling themselves out of their hole. So you're right, Meatwad doesn't get zero, and saying that he does is simplistic sloganizing, but while what he does get is better than no health care, neither of those situations are acceptable.

There's plenty of places in that argument to disagree, but 261 and the post it's responding to are both preventing actual discussion from taking place.

Edit: Bob in 263 says something similar, but I guess I don't want to say that meatwad got less than zero, because that depends on the details. If he made a bad decision and got treatment that didn't significantly make his life better by making him healthier, then he got less than zero. If he got health care that really mattered, in return for peonage he got health. Not a trade I would want to be forced to make, but not less than nothing either.

"Managed care" is a euphemism for putting more money into insurers' hands and less into both doctors' and patients'. Managed-care companies have no incentive to improve care unless they are managed in turn by vigilant state insurance commissions.

Doesn't need to involve insurance companies. What I mean is paying for outcomes, not treatments. Base the incentives/payments on keeping people out of the hospital, not in the hospital.

I have a 97 year old grandfather who is in great health, and I see the ######## treatments he gets talked into by his doctors (one of whom is his grand-son-in-law). He got dehydrated and they had him is for an angiogram. WTF does an angiogram on a 97 year-old until you're sure it a heart proble. You know who? The doctor who's getting $5000 from Medicare to do it.

Fair enough, snapper. The term "managed care" just has specific resonances within the industry. If you'd rather see direct state oversight, I'm all for that. In fact our views are much closer than I would have imagined.

But Meatwad doesn't get zero. (Even though he pays zero.)

No, he pays whatever money he has, and then after he goes bankrupt the hospital eventually stops trying to collect.

You dickheads need to leave Lisa be and drop it regarding the Brattain comment.

I'll go one step further and suggest that the powers that be perform one of their patented thread-scrubbings and delete all posts that refer to Brattain in this thread.

I really hate the idea of any of his family members coming across this. Good god almighty.

The term "managed care" just has specific resonances within the industry. If you'd rather see direct state oversight, I'm all for that.

"Death panels" also has its connotations, but it's a somewhat valid description of how we'll ultimately address the "last six months" issue.

FWIW, "managed care" means/t to me more or less what snapper described.

I like agreeing with Dan S when I can.

Tom Schaller is a moron, and it's really too bad he's wasting space on 538.

Why do I not believe you?

Because it would be convenient to not?

I've mentioned it before when Eraser-X was challenging on my experiences with racism.

Tom Schaller is a moron, and it's really too bad he's wasting space on 538.

That overstates it. Schaller's the weak link among the regular column-posters there, but he's no moron.

The moronic element of that site is plainly evident in the comment threads.

I would just like to point out that 143 is my favorite Keefe ever.

Yes, that was a good Keefe.

I would just like to point out that 143 is my favorite Keefe ever.

Yes, that was a good Keefe.

Thirded. The bit about "not wanting to Tom Goodwin a perfectly good thread" caps it off wonderfully.

I'll chime in with my list of "bad decisions" that led to my being uninsured.

1.My father was a well-paid engineer when I was born, but made a succession of bad decisions that has resulted in his being mostly unemployed for the past 20 years.

2. But miraculously, I was able to get through college with only a small debt, because he actually was employed during my four undergraduate years--and unemployed ever since! So unlike many Americans my age, I have no financial backup of any kind from the parents. While at college, I made the horrible decision of following my passion and talent, and becoming a composer and musical scholar instead of the CPA or whatever that I could just as easily have become.

3. In fact, I decided very quickly that I would go to graduate school and become a professor. I got a MA, and am now in the position indicated by my handle. For parts of that time, I've been under assistantships, and during those periods, I've had insurance, since insurance subsidy was a benefit of the job. For other parts of the time--during my whole master's degree, and also this academic year--I've not had insurance, because I've not been able to get a job that has benefits. It goes without saying that I can't afford to buy a plan on my own.

In Ray's world, I very clearly chose not to have health insurance, and if I wanted to have health insurance, I'd have gone into a field of study that allows one to more quickly and easily get jobs with benefits.

I'm lucky in a lot of ways. I was able to go to college, and I've not paid a cent for my graduate studies (though that's changing this year). Now, if I had it to do all over again, I probably would go into a field more conducive to building a life without any financial backup from family members. I've seen that liberal arts academia is a game for the upper classes. But it shouldn't be that way. And it's sad that I should have to feel this way. I don't whine, either, about not having fancy stuff; I did make a choice to forgo that, in order to do what I wanted to do. But the health insurance thing gets my goat. Why should the people who love me have to say goodbye to me if I needed a liver or heart transplant, when the people who love Ray wouldn't? Because I love beautiful music more than I love slide-rules and ticker tape?

"Illegal immigrants won't be covered." [No mention that Democrats refused to accept the amendments requiring citizenship checks.

So let's all remember to bring our birth certificates or our green cards with us, so if we're hurt in a tragic out-of-nowhere horrific car accident or something, we don't have to scramble around proving we 'deserve' healthcare, okay everyone? That way we can always easily lose it too, so that makes things even more fun!

That overstates it. Schaller's the weak link among the regular column-posters there, but he's no moron.


If he still counts as regular, that's gotta be Quinn. Schaller can be kind of weak, but at least he never wrote Obama fan-fiction.

Sorry to Dial the thread here, but this was directed to me:

Emergency care is not health care. It is a part of it, sure. But when I worked for the real-estate development firm and they gave me an extra $200 per month and said "Buy your own, find your own" and I was limited to catastrophic, I did not remotely feel covered. And I never get sick. This thing with my dead wrist the last 4 months has been the first doctor's visits since my age was counted in months.

Why? Your auto or home insurance doesn't cover routine care. We have no problem laying out $100 or $500 for auto repairs, but blanch at doing that for our own health. I was self-employed, and had GHI, which excludes most routine visits/tests. I knew that was coming out of my pocket, but since the expenditure is capped, it didn't worry me in the least.

Amongst many reasons why is that you are continually (up to this point in the thread and a good ways past) focusing on the primary and ignoring the notion of family units. If I have catastrophic, and I have a kid with Down's Syndrome, or dialabetes, or my wife contracts some manner of long-term-care-necessitating but not typically fatal illness or injury, I am straight ###### in the ass. And the moment that kid is born, or my wife is diagnosed, I'm never going to be able to have true full coverage again.

Why should the people who love me have to say goodbye to me if I needed a liver or heart transplant, when the people who love Ray wouldn't? Because I love beautiful music more than I love slide-rules and ticker tape?

The counter-argument to that is why random strangers should be more responsible for your continued well-being than you are. Or why strangers should have to subsidize what you love to do.

When it comes down to it, there are some philosophical disagreements that can't be bridged. And unfortunately, since we live in a world of finite resources, any health system will have a lot of people who don't receive treatment and who will die.

And unfortunately, since we live in a world of finite resources, any health system will have a lot of people who don't receive treatment and who will die.

Not if you pay the man his ####### $5 AND LET HIM GUIDE YOU ACROSS THE RIVER

So let's all remember to bring our birth certificates or our green cards with us, so if we're hurt in a tragic out-of-nowhere horrific car accident or something, we don't have to scramble around proving we 'deserve' healthcare, okay everyone?

That's quite a strawman you've got going there. As has been mentioned, no one is discussing repealing EMTALA which mandates care for anyone who shows up to the hospital with an acute medical issue. The question of whether it makes sense to provide universal coverage to illegal immigrants while essentially maintaining an open border is a legitimate one. If you answer that we should- that's fair enough, but at least be honest about the costs of your proposal.

From the GQ article:

up top he sports a tan baseball cap bearing the logo of Maybach—the German brand that sells the $400,000 sedan, I’ll later learn, that Lenny likes to drive around his gated community just outside L.A.

Appropriate given that he seems almost as delusional as Rick Ross.

Amongst many reasons why is that you are continually (up to this point in the thread and a good ways past) focusing on the primary and ignoring the notion of family units. If I have catastrophic, and I have a kid with Down's Syndrome, or dialabetes, or my wife contracts some manner of long-term-care-necessitating but not typically fatal illness or injury, I am straight ###### in the ass. And the moment that kid is born, or my wife is diagnosed, I'm never going to be able to have true full coverage again.

And if we followed my plan, see #262, you'd never have to change insurance, so it wouldn't be an issue. If insurance wasn't linked to employment, this sort of thing would never be an issue.

No one is saying an insurer should be able to drop you if you get sick, just that it screws up the insurance market to let you buy insurance when sick, at the same price as the healthy. If you have insurance and get sick, that's the risk the insurance company signed up for. If you're already sick, that's not risk, that's pure wealth transfer. It can't be handled well by insurance.

That's quite a strawman you've got going there. As has been mentioned, no one is discussing repealing EMTALA which mandates care for anyone who shows up to the hospital with an acute medical issue. The question of whether it makes sense to provide universal coverage to illegal immigrants while essentially maintaining an open border is a legitimate one. If you answer that we should- that's fair enough, but at least be honest about the costs of your proposal.

But that's the thing... and it's why I just don't understand why the current provision in HR3200 isn't enough. It prevents any subsidization, but if an illegal immigrant ends up buying a policy, at full price, via the exchange or any other method - why is that not a good thing? They'll be paying into the system. Immigration isn't going to be solved in this bill, and if nothing else - this bill does nothing but at worst, maintain the status quo...

No no, you're ignoring the part before I change insurance. Where I start with only catastrophic, and I'm boned if my kid has dialabetes (I don't know why this tickles me, but it does.)

By the way, as someone who knows exactly what to look for, I very slowly become more convinced that Szym is Keefe.

Also, don't think I haven't noticed you don't even try to defend your poor mountaineering skills anymore. A sad end to a pathetic career, man.

and I'm boned if my kid has dialabetes (I don't know why this tickles me, but it does.)

I actually have Type I diabetes, and this sounds WAY ####### scarier.


And unfortunately, since we live in a world of finite resources, any health system will have a lot of people who don't receive treatment and who will die.

This hearkens back to a lot of African starvation arguments. People aren't dying because there isn't enough food, and people aren't dying from finite resources - they're dying more from general inhumanity and philosophical arguments that won't be bridged. Not can't - WON'T.

This hearkens back to a lot of African starvation arguments. People aren't dying because there isn't enough food, and people aren't dying from finite resources - they're dying more from general inhumanity and philosophical arguments that won't be bridged. Not can't - WON'T.
Lassus, this is going to be true in any model (short of ones I haven't heard anyone discuss because they'd be cost-prohibitive/insane). [Witness the death panel hyperbole.]

No one is saying an insurer should be able to drop you if you get sick, just that it screws up the insurance market to let you buy insurance when sick, at the same price as the healthy.

So you're saying that that a person with a pre-existing condition should have to pay more than a healthy person of the same age, if (for instance) both had been laid off from work at the same time and had to buy insurance on their own? Or was that merely a statement of fact? The wording is ambiguous.

Obviously as a point of fact, it's an indisputable statement, given the way our system is organized. But as a moral assertion, it's tenable only to a cold blooded Randian. Which is why I tend to think you meant it only as a statement of fact.

-----------------

People aren't dying because there isn't enough food, and people aren't dying from finite resources - they're dying more from general inhumanity and philosophical arguments that won't be bridged. Not can't - WON'T.

Well, in many cases lifestyle choices (diet, exercise, etc.) do play a big part. (If I were a health insurance company screener I wouldn't insure too many of those SABR guys myself, he says while ducking.) But in the mass, and especially when you take the Third World into account, your point is absolutely correct. We are forever remembering only the first part of that Rabbi Hillel quote.

For readers of this thread who aren't familiar with the individuals involved in the discussion, the thing I "love to do" is also something that Dan Szymborski loves. To add nuance to the proceedings, I point out that I've volunteered, with my eyes open, to live in relative poverty in order to do it (which I stated in the original post also).

I frequently call my profession "useless" to both those inside and outside it, and not always semi-jokingly, either (and I'm pretty sure I've done so here in the past). I don't for one moment think that the government should subsidize it in any sort of moral sense; rather, I merely wish that a majority of American citizens would want it to do so. I know they don't, and won't.

Medical treatment, it seems to me, is separate from the rest of liberal economics. I don't disagree with the notion of an economy that pays CPAs more than musicologists, because of market forces that place the former in more demand than the latter. Such a thing saddens me, because it speaks negatively of human nature, but I logically understand it and know it's the way things are. Medicine, on the other hand, is life and death. If human beings can't rise above their competitive, animal nature to work as hard as possible--at this late date of supposed advancement--for the equal opportunity of their fellows to breathe for one more day, then all our work and sacrifice through the centuries has so far amounted to nothing.

Some human societies, of course, have done this. And their "solutions" have flaws; vast flaws at times. But many of these societies have worked harder, and done better, than ours.

No no, you're ignoring the part before I change insurance. Where I start with only catastrophic, and I'm boned if my kid has dialabetes (I don't know why this tickles me, but it does.)

No. Under catastrophic, your out of pocket is going to be capped at $5000 or $7500 per year, as long as you don't change insurers (and you never have to if insurance is not employment linked) your expense is capped, and your premium will only go up at the general rate. It may be a financial hardship, but you're not screwed.

So you're saying that that a person with a pre-existing condition should have to pay more than a healthy person of the same age, if (for instance) both had been laid off from work at the same time and had to buy insurance on their own? Or was that merely a statement of fact? The wording is ambiguous.

No. I'm saying insurance should not be linked to employment. If you bought your insurance individually through a voluntary (church, club, etc.) or randomly assigned group you'd never need to change insurance. If your health deteriorates, you just stay will your original carrier, and your premiums go up at the general rate.

Again, health deterioration isn't a problem with insurance you signed up for while healthy. That's the risk the insurer took, and priced for.

Under my system, everyone has and maintains insurance from when they are young. If they choose not to, then the county hospital/free clinic system is there as a backup.

Wow, I come back less than 12 hours later and see this confragulation and it makes my heart warm. This, however, doesn't.

Data reported by the insurers to the California Department of Managed Care from 2002 through June 30, 2009 revealed that six of the largest insurers operating in California rejected 47.7 million claims for care or 22 percent of all claims.

The top 18 insurance giants racked up $15.9 billion in profits
Read more: http://www.sfgate.com/cgi-bin/blogs/ybenjamin/index#ixzz0R8IPLaS4

These two memes have been taking off like wildfire on the internet, almost all without attribution, but apparently because the California Nurses Association, is spreading them in a fervent attempt to lobby for a single payer system.

In the first case, insurers claim as much as half the claims they reject are rejected because of capitation, they were improperly submitted to the insurance company when a doctors group has been already paid for the care. If that's true, they are still rejecting a little over 10% of their claims. Does that mean they are uncaring, greedy, bastards, or that people and doctors occasionally submit claims that they know are invalid, or even fraudulant?

The second meme is even less well supported. $15.9B is about $50 per every person in the U.S, and if you assume only half of the country is covered by private insurance, about $100 per year in profit per person. According to the Oregon Insurance Commission site that I cited,

http://insurance.oregon.gov/health_report/3458-health_report-2009.pdf

in Oregon the average person is paying (or his company is) about $4,000 per year for health insurance. So $100 per year would be a 2.5% profit margin. This matches up well with what the report says. "From 2003-2007, Oregon’s eight largest insurers showed an average profit margin of 3 percent; through the third quarter of 2008, the average profit margin is 1 percent."

So get rid of the profits, and we'll save as much as 2.5% a year, i.e. nearly nothing. And that's assuming the elimination of choice, competition and selection are good things, and that government employees work as hard as private sector employees do, all very dubious assumptions. Of course administrative costs are high, but you can't believe that insurance company execs are evil greedy bastards on one hand, and on the other believe they could slash administration costs if they wanted to make more money but just choose not to. Administrative costs are high in part because they are heavily regulated, which is another reason they work so hard to reject claims because they are often FORCED to accept customers they might not want at rates that don't make sense.

Look, if you want to fight for a single payer system, do it right and don't fool yourself. Don't allow others to misrepresent facts to attack it, but also don't misrepresent facts to promote it. Insurance companies simply aren't that profitable, they operate under heavy regulatory burden, and most of their executives weren't spawned, or recruited yet, by Satan. I'm not saying they are saints either, just regular business people trying compete in a complex market.

My father in law once started a small health insurance company that made their mark competing with Blue Cross by offering better prices in rural areas. One day the state insurance commission decided his company was undercapitalized and would have to be shut down if it wasn't addressed. He had to put his remaining life savings, including his and his new wife's retirement funds, into the business and hit up his investors for more money to save it, and it was barely enough. He had to endure 6 brutal months not knowing if one bad month of losses would cause him everything forever. Then one day the state examiners came back, and said "oops, we were wrong, you were correctly capitalized all along" just like he had told them. Being able to be put out of business by regulator fiat is a risk most businesses don't have, and that I think he was foolish for accepting.

I hate to use the "no free lunch" analogy, but it's exactly apt here. You have to pay for your medical costs. No insurance company, employer, or government entity can pay them for you. You have to pay in premiums, or by having part of the income you earn go to "benefits", or in your taxes. What is being argued about is what segment of our population needs help paying their medical costs, and what segments need to pay for that help.

Insurance only works if, in aggregate, everyone pays for what they use. If insurers have to give people with pre-existing conditions the same coverage at the same cost as people without, then the healthy have to pay more. That's one of the reasons why health insurance has grown so expensive, regulations keep limiting what insurance companies can do to charge based on risk, so they have to charge more assuming a higher average costs and higher potential risks. I have no problem with helping pay so the sicker among us can afford good care. I'm just not excited about the current system that tries to hide those extra costs by forcing insurance rates higher and higher to, instead of explicitly taxing for them. And I'm not excited about a system that doesn't require those in need to contribute as much as they can first, before taxpayers take care of the difference. And frankly, I'm dreading any kind of single payer system simply because I think choice is important.

I believe racism exists.

But I don't believe that McCoy's home room teacher confided to him that she saw blacks as "no good black people." Even if she felt it, it would be self preservation for her not to say it. Especially not casually, to a student, in 1994. What the hell.

Or if she did go around saying these things to students, she didn't last long as a teacher.

Yes, for the last 15 years I have been making this story up and retelling it at times when it doesn't suit some liberal vs conservative agenda.

The truth of the matter is she did say it and yes it was a shocker for a teacher to say it so casually to me. At the time I didn't view teachers as humans since then I have seen my fair share of teachers in non teacher roles and what she said would no longer shock me if a teacher said that to me.

At the time I didn't view teachers as humans

Crap. He's onto us.

But McCoy's own posts show that he sees racism where none exists. (See, e.g., post 65.)

What? Were you the drunk Okie spouting off about the muslim waitress on Saturday? I thought that was you. Oh wait, you have no idea what you are talking about.

He's probably looking to nationalize the lucrative neck-stabbing industry under a soon-to-be-named Neck-Stabbing Czar.

Hutcheson's dream job.

By the way Empire Total War takes forever to install. Somebody should look into that.

You dickheads need to leave Lisa be and drop it regarding the Brattain comment.

I'm a little late on this, but this comment was really uncalled for.

Wow, I come back less than 12 hours later and see this confragulation and it makes my heart warm. This, however, doesn't.

Data reported by the insurers to the California Department of Managed Care from 2002 through June 30, 2009 revealed that six of the largest insurers operating in California rejected 47.7 million claims for care or 22 percent of all claims.

The top 18 insurance giants racked up $15.9 billion in profits
Read more: http://www.sfgate.com/cgi-bin/blogs/ybenjamin/index#ixzz0R8IPLaS4



These two memes have been taking off like wildfire on the internet, almost all without attribution, but apparently because the California Nurses Association, is spreading them in a fervent attempt to lobby for a single payer system.

In the first case, insurers claim as much as half the claims they reject are rejected because of capitation, they were improperly submitted to the insurance company when a doctors group has been already paid for the care. If that's true, they are still rejecting a little over 10% of their claims. Does that mean they are uncaring, greedy, bastards, or that people and doctors occasionally submit claims that they know are invalid, or even fraudulant?

The second meme is even less well supported. $15.9B is about $50 per every person in the U.S, and if you assume only half of the country is covered by private insurance, about $100 per year in profit per person. According to the Oregon Insurance Commission site that I cited,

http://insurance.oregon.gov/health_report/3458-health_report-2009.pdf

in Oregon the average person is paying (or his company is) about $4,000 per year for health insurance. So $100 per year would be a 2.5% profit margin. This matches up well with what the report says. "From 2003-2007, Oregon’s eight largest insurers showed an average profit margin of 3 percent; through the third quarter of 2008, the average profit margin is 1 percent."

So get rid of the profits, and we'll save as much as 2.5% a year, i.e. nearly nothing. And that's assuming the elimination of choice, competition and selection are good things, and that government employees work as hard as private sector employees do, all very dubious assumptions. Of course administrative costs are high, but you can't believe that insurance company execs are evil greedy bastards on one hand, and on the other believe they could slash administration costs if they wanted to make more money but just choose not to. Administrative costs are high in part because they are heavily regulated, which is another reason they work so hard to reject claims because they are often FORCED to accept customers they might not want at rates that don't make sense.

Look, if you want to fight for a single payer system, do it right and don't fool yourself. Don't allow others to misrepresent facts to attack it, but also don't misrepresent facts to promote it. Insurance companies simply aren't that profitable, they operate under heavy regulatory burden, and most of their executives weren't spawned, or recruited yet, by Satan. I'm not saying they are saints either, just regular business people trying compete in a complex market.

My father in law once started a small health insurance company that made their mark competing with Blue Cross by offering better prices in rural areas. One day the state insurance commission decided his company was undercapitalized and would have to be shut down if it wasn't addressed. He had to put his remaining life savings, including his and his new wife's retirement funds, into the business and hit up his investors for more money to save it, and it was barely enough. He had to endure 6 brutal months not knowing if one bad month of losses would cause him everything forever. Then one day the state examiners came back, and said "oops, we were wrong, you were correctly capitalized all along" just like he had told them. Being able to be put out of business by regulator fiat is a risk most businesses don't have, and that I think he was foolish for accepting.

I hate to use the "no free lunch" analogy, but it's exactly apt here. You have to pay for your medical costs. No insurance company, employer, or government entity can pay them for you. You have to pay in premiums, or by having part of the income you earn go to "benefits", or in your taxes. What is being argued about is what segment of our population needs help paying their medical costs, and what segments need to pay for that help.

Insurance only works if, in aggregate, everyone pays for what they use. If insurers have to give people with pre-existing conditions the same coverage at the same cost as people without, then the healthy have to pay more. That's one of the reasons why health insurance has grown so expensive, regulations keep limiting what insurance companies can do to charge based on risk, so they have to charge more assuming a higher average costs and higher potential risks. I have no problem with helping pay so the sicker among us can afford good care. I'm just not excited about the current system that tries to hide those extra costs by forcing insurance rates higher and higher to, instead of explicitly taxing for them. And I'm not excited about a system that doesn't require those in need to contribute as much as they can first, before taxpayers take care of the difference. And frankly, I'm dreading any kind of single payer system simply because I think choice is important.

Quoted for truth. All of it.