Great quote for the Executive Director of the California Nurses Association: "Rose Ann DeMoro, Executive Director of CNA/NNOC, who attended a private screening in New York, notes that SiCKO is 'not just an indictment of an indefensible healthcare industry in the U.S. It's a rejoinder for those who think we can fix the soulless monster by tinkering with an unconscionable system that puts us further in thrall to those who created the crisis.'" Web Link
There will be a CNA-hosted screening of SiCKO at 3:30pm at the Crest Theatre. See the links above for details.
Great quote from the Executive Director of the California Nurses Association: "Rose Ann DeMoro, Executive Director of CNA/NNOC, who attended a private screening in New York, notes that SiCKO is 'not just an indictment of an indefensible healthcare industry in the U.S. It's a rejoinder for those who think we can fix the soulless monster by tinkering with an unconscionable system that puts us further in thrall to those who created the crisis.'" Web Link
There will be a CNA-hosted screening of SiCKO at 3:30pm at the Crest Theatre. See the links above for details.
Posted by Resident, a resident of Another Palo Alto neighborhood, on Jun 12, 2007 at 4:28 pm
After 25 years working as a professional in health care, in all segments of health care, I can confidently state that our health care system is the best in the world. There is no wait for services when you are in pain ( unlike socialized medicine countries, where you can be in severe pain and still wait for surgery because it isn't prioritized as medically necessary), you have the choice of any provider you are willing to pay for, you can choose to pay for health care plans that are from the Cadillac end or the scooter end of providers, you have choice, choice, choice in how and what you pay for.
If you choose to not have health care ( and i treated a LOT of people who had decided they would rather not buy health insurance, and then something happened), then you are in trouble..but that is a different story, and not an indictment of our health care system, but of people making foolish choices.
There are definitely problems with our system, but the fact that Moore claims that Cuba's health care is so superior to our own tells me that he is going to approach this just like he did Farhenheit 911...with a political agenda, not as a documentary.
Examine this movie critically, research, before you believe it.
Question: If Cuba's is great, why did Fidel go to Spain for health care? If Canada's was so great, why did they finally change their law to allow private health care insurance plans? Why did people from Canada come to the USA to pay privately for health care they couldn't get in Canada?
Without even seeing this movie ( and I will), I can guarantee you that the solution you are going to come away believing is the right one is...national health care. There are much better solutions. This isn't one of them.
Research countries that have "national health care" and the problems they have and ask yourself if you really want your choices removed.
Posted by Another resident, a resident of Another Palo Alto neighborhood, on Jun 12, 2007 at 10:09 pm
Surveys of patient in France, which ranks much higher than the US in health care, show consistently that people are very satisfied with their system, have access to specialists without waits, etc. etc. Why should we aim for the Canadian system when we can aim higher?
My own experience in the health care system has been vastly different than yours. I do not think financing health care in a more intelligent way has to result in declining choice. We once had city and county hospitals that were the envy of the world, and I don't recall any complaints about lack of choice of waits from that era. I know more than one person in this country who has died because they could not get the care they needed (because of waits at the HMO, for example) or couldn't pay for the care they needed because insurance delayed. I know more people still who are living compromised lives because they cannot get or pay for the care they need -- and these are people WITH insurance.
Generally family in different European countries are getting vastly better care than I am here, don't have to pay for it (certainly don't end up bankrupt or losing their homes because of an illness), don't suffer the kinds of waits those benefitting the most from our system like to scare everyone else with, don't have to deal with the backbreaking paperwork or the nasty, fraudulent insurance and provider schemes that make patients like me and millions of others feel as if we are being shaken down for everything we've got.
So you know people who've gone from Canada to here for care. Guess what? I know many, many people who go to Canada to get drugs they can't afford here. I know people who have gone to Canada for medical procedures not available here, probably because keeping them around is primarily a medical decision and not a financial one. I have myself been prescribed medications I could only get in Canada, legal here but discontinued just in this country, coincidentally when patents ran out. I also saved a ton of money.
I don't expect to learn anything from Michael Moore's movie that I don't already know from having lived this nightmare. Just a caveat for you, since you think your experience puts you in the know: I saw an interesting article in Time Magazine not so long ago which was all about just how surprised doctors are by how bad are system is when they need care themselves. That was the whole focus of the article, doctors who thought they knew the flaws in the system got a real awakening when they needed care themselves. (There have always been books and articles by doctors in this situation, this article was about just how common this is now and just how incredibly surprised doctors are even when they think they know our system has flaws.)
Insurance is a racket, functioning more like organized crime now than legitimate business. Good for you if you've been lucky enough to be oblivious to that. Milllions of us haven't been so lucky. Go Mike for having the courage and intelligence to take on the insurance mafia in an effective way!
Posted by anonymous, a resident of Another Palo Alto neighborhood, on Jun 12, 2007 at 10:15 pm
You can always find individual cases to support an argument, but statistically speaking, the U.S. has lost the vast majority of its once booming foreign "medical tourist" business in the last decade. This used to be big business for us and it has all but dried up. People are choosing to go to other places like Switzerland and Singapore where procedures are just as advanced, care is better, and way cheaper. Frankly, for every story of a Canadian who came here for some procedure, I could probably tell you ten of people who were visiting here from foreign countries (even third world countries) and horrified and shocked by what happened to them when they needed medical care here. The term "medical tourism" now seems to apply to U.S. citizens traveling overseas to get healthcare they can afford.
Posted by Disgusted, a resident of the Downtown North neighborhood, on Jun 12, 2007 at 10:32 pm
Resident: "There is no wait for services when you are in pain"
Guess you haven't visited an emergency room recently!
The worst thing we've ever invented is the HMO - they should be abolished immediately. Let doctors go back to being doctors - not being told what to do and how fast to do it (when's the last time you actually got more than 10 minutes with a doc?).
And also tell the pharma companies to back off their aggressive advertising to consumers and hounding of doctors - doctors are not supposed to be drug dealers, but the pharmas have turned many of them into such dealers.
Posted by Fed Up and Not Going to Take it Anymore, a resident of Another Palo Alto neighborhood, on Jun 13, 2007 at 11:57 am
Actually, our problems began when the government deregulated insurance during the Carter Administration. State governments do not have the resources or the will to properly regulate insurance companies.
Public Citizen published a report in 2003 noting that at the time, administrative costs in our system were about $400 billion annually, largely because of private insurance. When they compared the cost of administering ANY LARGE GOVERNMENT PROGRAM or any health care system in other countries that provides universal care for everyone, they determined that nearly $300 billion of that is utter waste. Waste from our country's standpoint, but for insurers, it's their investment in even greater profits. This is born out in the numbers, as now less than half of money spent in our over $2 trillion health care economy go towards actual care, the rest according to Public Citizen, is mainly administrative costs and insurance industry profits. Insurers are tighter with money than anyone, anyone who thinks they just need an incentive to get the paperwork under control doesn't get it. Insurers make more money by delaying and denying care, the excessive paperwork is the means, their investment in greater profits.
At some point, our businesses need to get the idea that insurance companies are not one of them, they are shaking everyone down for "protection" and not providing it when the time comes. Some businesses are already realizing this, and offering direct reimbursement for health care without insurance.
I've personally been through a complicated audit with the IRS and a difficult health problem. Based on that experience, hands down I would rather the IRS administered our health system than insurance companies. That was not a compliment of the IRS, either.
Posted by R Wray, a resident of the Palo Verde neighborhood, on Jun 13, 2007 at 4:24 pm
The insurance business is one of the most regulated (state and federal)--just Google on "insurance regulations".
One main thread of the health insurance problems began around the time of WWII. The government froze wages. To get the employees they needed, companies began to offer health insurance as a perk. This led to more government regulations. The individual was removed from most of the responsibility for monitoring and paying for his medical costs. This is a prescription for runaway costs.
Posted by Fed up and Not Going to Take it Anymore, a resident of Another Palo Alto neighborhood, on Jun 13, 2007 at 5:29 pm
[Portion removed by Palo Alto Online staff.]
Insurance regulations are mainly toothless and/or unenforced. This began when insurance was deregulated on the federal level. The states lack the resources and the will to properly regulate insurance companies.
You can say there are a lot of laws on the books against organized crime, it's not the same as having good enforcement action that cleans up and gets rid of the "mafia" as the poster above put it.
Posted by Fed up and Not Going to Take it Anymore, a resident of Another Palo Alto neighborhood, on Jun 13, 2007 at 10:42 pm
What does Medicare have to do with regulation of the private insurance industry? The Carter administration got the deregulation ball going on a lot of industries, insurance was one of them.
You're not making your case with that argument, either. I'm not holding up Medicare as the paragon of medical quality, but they operate with considerably smaller administrative "waste" than private insurance. Prices in our system are artificially inflated because of private insurance (compare the actual cost of care to other first-world countries who objectively provide better care, like France), the operation of Medicare is negatively affected by those circumstances.
My insurance company tells my doctors and hospital what they can do for me (nothing, if the insurer can get away with it) and how much they will be paid (nothing, if the insurer can get away with it). Often, they can get away with it, because insurance companies pretty much get away with whatever they want these days. I have been treated more fairly by Medicare than my insurer and I have more accessible and fair recourse with Medicare with coverage problems.
If Medicare is so lousy, why do you even bother with it? Wouldn't you be helping the system by paying out of your own pocket or using private insurance? (No excuses about rates now, you can join large groups -- ) Why not join an HMO?
Here's an interesting discussion about insurance regulation (from an insurance industry publisher, someone supporting your idealogical side of the fence over mine): Web Link
The reason for the article: "From the Wards of New Orleans to the hearing rooms of the U.S. Capitol, a consensus is building that the states are unable or unwilling to regulate insurance. Now, influential members of Congress have proposed a different kind of deregulation: recall the states’ borrowed authority to regulate insurance and in return apply federal antitrust law and Federal Trade Commission oversight."
Whether you agree or not with the author's bent (as I said, I am not on the same side of the ideological fence), I'm not the only one who has noticed that states aren't doing a good job of reining in egregious conduct by insurers. Let's see, when insurers complained about excessive payouts in malpractice cases, reforms (mostly hurting consumers) were enacted, payouts declined or remained steady, yet premiums continued to rise out of control.
The trouble is, a real market system is as loathsome to insurance monopolies as single-payer. Consumers who actually require delivery of the insurance product -- the coverage, not just the promise of coverage -- they actually have virtually no impact on the insurer's bottom line. It's really impossible to get that kind of balancing influence because insurers have the power to thwart any proposals and do. When people suffer a major loss, it's really essentially a hostage situation -- some will be treated well, many will not.
Posted by Resident, a resident of Another Palo Alto neighborhood, on Jun 14, 2007 at 6:44 am
re: Insurance regulation: In fact, I think that is one of the problems with our health care prices, too much insurance regulation. This has resulted in a lack of competitive market prices for insurance, and at the same time a decrease in the availability of typically necessary services because the payment/hour to physicians has decreased for time consuming procedures, like actually examining and talking to a person, and increased to pay for specialty tests. Hence, more money on tests than on day-to-day physicians like pediatricians, family practitioners, internal medicine etc.
In states such as ours, Blue Shield costs much more than in other states, because our state mandates that all insurances cover such things as chiropractors, more psychiatric counseling than other states, accupressure,etc. The result? Those of us who would rather not pay the extra monthly premium this coverage demands are forced to pay. Hence, fewer people choose to spend their money on insurance, since even the cheapest is not cheap. Or, conversely, if I would rather pay the same premium I am paying now, but it all goes to paying only physicians and ancillary traditional medecine, I can't choose that. If I could,there would be an increase in the availability of these services because more money would go toward paying for them.
I am completely for "deregulating" insurance at the state level, so that an insurance company in Nevada, say, which lets me pay half my monthly premium for health care here than I pay now, but I give up my "right" to get chiropractic ( not knocking it, by the way, just making the point) or accupressure in response to something that may happen.
I am also for individual incentive and competition. Insurances that can offer high deductibles and high individual co-payments have much lower monthly premiums, because they know that when the 25$ per officr visit comes out of someone's pocket for a doctor's visit, but a non-emergency ER visit ( like for a chronic back ache or a cold) takes $200, then people are incentivize to use the less expensive, more planned approach of scheduling and appt and using the better option. The waits in ERS are from, frankly, non-"emergency" visits, usually, often by people who either have no insurance and know they will at least be triaged through the ER, or who have no incentive to use the less expensive day-time option.
I agree, we have real problems in our health care system. But, to the person who thinks France's health care system is so great. Here, we can buy insurance to pay for our nursing home placement when it becomes necessary. There, you can't, and you must wait until there is an opening in a state-run facility..sometimes 5 years beyond when you need it, by which time you have spent all your money on in-home help. They have switched to high per-office visit payments because of the severe overuse of "something free" has strained the system to the breaking point ( lots of complaining about this!!). They couldn't attract physicians to the field because they couldn't "compete" for salaries. Family practitioners there became quite scarce because who wanted to go through all those years of extreme hard work, then work 60 hours per week for the rest of your life, when all you could afford was the same as your neighbor who was an engineer, went to school half as long, and worked only 40 ( at that time) or 35 hours per week? Or as a nurse here in the USA?
As for long wait when in pain, I was referring to such things as a hip replacement for someone in so much pain they can barely walk. In France, you wait until you are so disabled you can barely walk before you get your hip. Here, even if you are on Medicaid, you get your hip much faster.
Posted by anonymous, a resident of Another Palo Alto neighborhood, on Jun 14, 2007 at 8:40 am
I know someone here with a severely infected limb who was put on a waiting list for a week to get a hospital space for adequate treatment. A dear friend with a neurological disorder was put through a tiring mill to get a communication device -- never materialized -- when I tried to follow up, I found out that this is par for the course: the hope is patients will die before they get the expensive equipment (she did). A friend with Kaiser waited nearly a year for her knee replacement. She was unable to work the whole time. Another friend with Kaiser was "observed" for a heart problem - he died without the benefit of standard follow up that would have saved his life.
For every anecdote you can come up with, there are millions in this country as well. We need to stop ignoring them. Our system is seriously broken. France is #1 on the World Health Organization health ranking, we are #37. Surveys of people in France are actually uniformly rosy compared with here. People in France are happier with their system, for good reason.
As for Blue Shield, I'm beyond caring what the premium is, I would just like to actually be reimbursed for major medical care that I need. All this talk of premiums is ridiculous when they just take money and don't keep their end of the contract, and get away with it with it so often. If you are laboring under the delusion that they are an ethical business that just needs a little better incentive, Google "Blue Shield" and "qui tam". Or go see Michael Moore's movie.
Posted by Resident, a resident of Another Palo Alto neighborhood, on Jun 15, 2007 at 9:08 am
Re; Happiness ratings of health care in other countries.
If you don't know anything else, you are happy with what you have.
Of course France generally thinks well of its healthcare. They know only what they have, they have nothing to compare it to.
Comparing all of healthcare in US to Kaiser is silly. I left Kaiser years ago for the reasons you have stated. If that is all we had, we wouldn't know better and be fine with it. I was tired of waiting for a necessary procedure also, got better insurance, and got much better care. My choice.
If you think that any socialized medecine system is better than Kaiser, think again. Kaiser IS what all socialized medecine plans have to become at some point, or worse. The incentive in such programs is to NOT give services, because services cost money. In private pay, the incentive is to give services, because there is money to be made. Think about it.
At least here I have a CHOICE about which kind of system I pay for.. I want to keep it that way. Those who want socialized medecine should pay for it and live under the consequence. I don't want it forced on me.
Make informed choices, and choose by your priorities with your pocketbook.
Here is a link to an article in BBC about the WHO ranking of nations in healthcare.
Note the CRITERIA for ranking, classic ranking style of an organization which fundamentally believes in socialism as an "ideal". 3 of the 4 criteria mentioned are about health inequities, overall health, and distribution of cost burden. These criteria completely ignore the effects of such a highly diverse population as ours with full ability to make choices in how we live ( we retain the right to make stupid choices, and the responsibility to pay the price for these choices, like getting fat, smoking, eating badly, not buying health insurance etc), and does nothing to compare the poorest amongst us and their healthcare access to the poorest in France and their health care access. The poorest citizen here has all the health care access that the poorest in France does. What the WHO did was get bummed that here our insurance is not COMPULSORY, and in France it is. What that means is socialized.
I prefer to leave people the choice. Once we make it "compulsory" through taxes, the whole system simply grows and grows.
Think about England which recently introduced a bill to not give health care to smokers. Since theirs is a socialized medecine also, ( and they rank "higher" than ours, too), they are forced to give equal results to people who make poor choices. In other words, here if you are a healthy, non-smoker, non-alcoholic person who buys insurance, you pay less in premiums and aren't forced to supplement ( as much) an insurance for those who have chosen poor lifestyles.
There, the people are getting fed up, subsidizing bad choices, and rather than simply stratifying their risks and taking more taxes from those who are making bad choices, they are starting to think of simply stopping their health care.
Says it better here than I did about England and smokers and incentives etc.
I am NOT saying we don't have problems! We do! We have problems of..insurance companies being allowed to completely deny health insurance to individuals on the basis of health or prior issues, instead of simply setting up a separate price structure for them, or even being ( dare I say it), subsidized through taxes for the health care costs of the higher risk populations.
We also have gaps in our health care insurance options for the lower middle class self-employed, and the older, but not yet 65, person who has income that used to cover health premiums, but whose premiums have gotten huge from aging relative to their income. And from people who go from employed to self-employed, and can't buy insurance, even if they make a million per year, because no insurance company will cover their pre-existing condition once their COBRAS run out. We have people stuck in jobs they can't stand because to go into their own business means losing their insurance. We have kids born disabled which force the mother stay employed because the baby was born on the health insurance of the mother's employment, even if they could otherwise afford to stay home with the baby to care for him, just to keep the insurance up on him, cuz he is uninsurable otherwise.
We have lots of problems. I prefer to fix each individual problem (like was begun under Clinton with the portable insurance law), then go socialized and create new problems. Once you go socialized, you have opened pandora's box.
Posted by Citizen, a resident of Another Palo Alto neighborhood, on Jun 15, 2007 at 4:23 pm
There's where you're wrong. Once we get rid of the racket, the insurance mafia, we are free to improve the system as we need. Right now, insurance companies do an end run around incremental reforms, making it seem as if we are powerless to solve our problems.
And I think we would improve the system if we were free to do so.
You aren't going to make much headway with me on those theoretical comparisons of our systems with others' - I have plenty of family in countries with better medical care. Surveys' of satisfaction with the care in England are not uniformly as good as France, because the system in France is objectively better.
Right now, I'm paying for health care coverage that is a mirage. I'm paperworked to death. My annual copays exceed what I would be paying for the entire cost of this care in Switzerland or Austria or Australia, (and just about everywhere else), never mind being reimbursed for it there. I'd frankly be willing to pay a little more just to be free of the horrendous paperwork. But I wouldn't have to pay more, because just saving the paperwork and excessive profit alone would put the care you consider unnecessary in the noise.
When paradigms end, solving problems becomes more and more difficult and more and more expensive to solve less. We need a new paradigm -- one we will have the ability to improve. Right now, offering more "protection" by the racket to those who don't have it will only fuel the racket. We have to get rid of the racket or we will never be able to truly fix the system.
Posted by resident, a resident of another community, on Jun 16, 2007 at 5:16 pm
you are paying more in co-pays than you would be paying in the countries mentioned..AND you earn a lot more, AND you pay a much lower percent in taxes.
I, too, have lots of family in other countries ( 3 others)...
every system has its problems. every system can be improved. I prefer to improve our choices. for example..don't want to do paperwork? go HMO. Less paperwork, less choice, less hassle. Don't want co-pays? Want less of a deductible? Pay more monthly insurance premiums for less co-pay, less deductible. Prefer to do the paperwork and pay the co-pays because you aren't much of a medical user? Buy PPOs.
Insurance is all about the kind of bet you want to make about your future health, and kinds of consequences you are willing to accept.
The problem with it is that most folks don't take the time to become truly informed about their options, so just throw the die and take what shows up. And, once a medical issue arises, it is too late to "switch".
Posted by Citizen, a resident of Another Palo Alto neighborhood, on Jun 16, 2007 at 9:08 pm
Oh brother. Let's see, HMO's do a great job at caring for people with certain health conditions and an abysmal job with others. Your plan supposes that I'm able to predict that I'm going to need major medical care and for which condition.
You also seem oblivious to the real problem, which is that regardless of what it says in the pamphlet, the insurance companies and HMO's have schemes to figure out how to avoid paying and/ or avoid providing the care.
In sectors of the economy where the consumer can be held hostage, where the a SICK consumer can be held hostage, government and non-profits typically do a better job.
Here's a link to an article about how large studies of for-profit and non-profit hospitals in the U.S. show a higher mortality rate in for-profit hospitals:
Let's not forget the $400 billion we spend every year on administering health care, mostly because of private insurance. The overhead in private insurance industry is 30%; in Medicare the overhead is 3%. In Canada the overhead is 1.8%. We could afford to lavish a lot of wasted care on the people of this country for that $300 billion every year. Think of the gains in having less disability and improved productivity, too. Or perhaps you would just rather pay for the War in Iraq without running up a deficit or raising taxes....
The profit motive in our system is actually driving inefficiency and poorer outcomes.
Posted by Resident, a resident of Another Palo Alto neighborhood, on Jun 17, 2007 at 7:36 am
You do not understand the differences in hospitals per this report.
For profit hospitals are those that are driven to contain costs...get it? Like the Kaisers. In others words, those with motive to undertreat. If you go socialized health care, that will be the result for ALL of us.
I have worked in both. This is a study which, frankly, proves my point. I prefer my choice of which hospitals I frequent. I don't want some central fed agency regulating all the hospitals to bring them down to the same level.
Do you know what happened in Oregon with their "general" health insurance? Are you paying attention to what is happening even in France with their healthcare? Co-pays going up, care being "rationed", taxes maxed out so that people bring home 30% of their pay check, economy the worst in Europe..why do you think they just elected Sarkozy? Like all socialized anything, it looks and feels so good at first, but within a generation or two it collapses under its own weight.
As for you thinking I said HMOs do a great job for some diseases and not others? Not me..never said it. Don't know what you are reading. What HMOs tend to be better at is prevention. It pays off to prevent.
I am not asking you to predict what illness you will have. I am asking you to take responsibility and choose what kind of coverage you want. We all make bets every day. This is a free country ( so far), and you have the right to choose which kind of bet you want to make with your life. Shall we fedrealize your house insurance, your car insurance? What about the area you live in? Some are more dangerous than others, but I have lived in very dangerous areas in order to save money, though I could have easily afforded elsewhere. Should I have been forced to live somewhere that someone else decided was better for me because I could afford it? My choice.
I wouldn't argue that, like car insurance, we should make it mandatory that all people purchase a minimal amount of insurance through a more deregulated insurance market, so that I can choose to forgo some kinds of professional care in my future, or not, but i want to pay as I wish. For example, I would rather pay less for insurance that doesn't pay for certain life extending procedures after a certain age, because I have no intention of doing most of what I see 80 and 90 year olds doing to prolong their lives. Or for certain reproductive procedures I know I will never use. ( Why should I pay the premiums for an insurance that covers in vitro fert, for example, if I know for a fact that I would never, ever choose this?).
There are all kinds of choices I prefer I make for myself, not others make for me. If we allowed insurances to compete on different levels of coverage across the nation, I would support it, and I would even go along with regulating a minimal level of insurance such as at a Medicaid level that must be the minimum everyone buys. THAT would pretty much wipe out the "uninsured" dilemma. Just like mandatory car insurance makes uninsured car accidents rare.
Precisely which sector of our economy is the sick consumer held hostage? This sounds like a rhetorical phrase you heard somewhere. I have worked primarily with the poorest in our state, where I presume you are talking "hostages" reside. Frankly, over the last 25 years, Medicare has become the best insurance there is, especially over the last 4 years. AND, it has doubled it's share of our national budget. Federally funded programs tend to grow exponentially because the costs are coming out of "someone else's" pocket. Even Medicaid, the program for the poor in our state, provides vaccines and doctor's visits and medicine and surgeries etc. It looks a lot like the universal health care in some countries, and who knows where the health care of France will end up now that the bull is taken by the horns there. It is going to be a long, messy battle.
If you think that 600 billion per year, increasing 8-9% annually,( when inflation is 3%) of federal spending for just Medicare and Medicaid is "good", then go ahead and keep pushing for "universal" health care and watch what happens to our federal deficit and your pocketbook now, and your kids style of living when they are grown.
Posted by resident, a resident of Another Palo Alto neighborhood, on Jun 17, 2007 at 9:19 am
PS again - I am sorry, your belief that private "overhead" is EVER more than "government" overhead is cute. Govt has no incentive whatsoever to keep overhead low. Anything that tries to compare overhead as you have stated is either lying in the interest of an ideological cause, or is naively completely ignoring the true "overhead" costs of govt programs. Why do you think that whenever a govt program "contracts out" to private companies, costs go down? Why do "nationalized" companies lose money?
If you have read this somewhere, it is by a wolf in sheep's clothing.
Read some basic economics books for the lay person..Thomas Sowell comes to mind
Posted by Anonymous, a resident of Another Palo Alto neighborhood, on Jun 18, 2007 at 8:44 am
I used to think in ideological terms the way resident does, with much the same arguments, until I actually experienced a disaster loss and a serious health problem. The trouble is that insurance companies compete only to sell a promise, not the product (the expensive coverage in the event of a major loss). When a consumer requires delivery of the product, there is no leverage or power to make the big insurance company deliver in most cases. They would only be too glad if you "chose" to go away, and they do their best to encourage you to do that without your coverage. They spend money on that, via the paperwork, whhich is an investment in the greater profits they make by not delivering on their contract/promise.
It's interesting that you bring up the issues of "federalizing" car or house insurance. Actually, whenever some big loss comes up which forces insurance companies to pay out large claims, they find a way to make the federal government take over the riskier insurance -- so they're guaranteed to make money and the government pays out anytime there is a real loss (so the government ends up fulfilling the purpose of insurance without getting the big money in). Think of flood insurance, for example. And before you go off on some unrealistic ideological tangent about consumers making choices to rebuild in flood prone areas, you should first talk to some disaster victims and find out about how the contracts often require people to rebuild or they essentially recover nothing. The last thing you have is "choice" when you have a huge loss -- you are a hostage, I've seen this over and over again.
When we went through our disaster loss -- this was before Bush gutted FEMA, it was a good agency back then -- we would have been BY FAR better off if we'd had NO insurance on that day than we were with "coverage" by the major insurer we had. Because we had coverage, we were ineligible for low-interest loans and disaster grants which, while sparer, were given in quickly and in good faith without years of trying to wear already vulnerable people down as insurers did. It would have allowed us to move on, where the insurance was a bigger nightmare than the disaster and ultimately cost us years of our lives without letting us dig out of the hole of having a mortgage and no house. We will suffer considerably financially for it for the rest of our lives; I would have vastly prefered if I'd had a government sponsored insurance instead!
The studies on overhead of health insurance -- paperwork -- are done by reputable sources like Public Citizen's Dr. Sydney Wolf. Insurance companies have such high paperwork and administrative costs, because they use it to make even greater profits, they use it to delay and deny care. That is why the government has such smaller overhead. Resident even admits that Medicare has become the best insurance there is! The administrative costs of running Medicare are around 3%, the rest is going to things like medical care, not paperwork to try to cheat people out of their coverage.
We could afford to be pretty wasteful and still get better results than having this private insurance racket taking all of the money and not fulfilling it's end of the contract. That's the essential problem here, what resident doesn't see is that end of it -- insurance companies of all stripes pretty much don't fulfill their end of the contracts when it comes to MAJOR losses anymore. (Don't tell me about minor losses, they often pay those to keep people paying those premiums.) There are some good insurance companies in the casualty sector, but I don't see the same in the health insurance market.
Resident and I would probably have been great buddies ideologically when we were younger. Unfortunately, he or she is not able to see the facts that don't fit the ideology, such as that private insurance is so wasteful. The point is, it's not wasteful from THEIR standpoint, it's only wasteful from our standpoint.
We cannot incrementally fix a system with rackets/monopolies. If resident wants competition, the only way to fix the system is to do away with the rackets and monopolies. If we have a more fiscally sound administrative system, there will always be the opportunity for private enterprise to improve it. That's why I am not as hopeless about fixing our system as resident is.
Posted by Anonymous, a resident of Another Palo Alto neighborhood, on Jun 18, 2007 at 11:43 am
Right you are, R Wray, and it's important for the ideology to be informed by facts.
Note how resident above cannot even process the fact that private insurance has such an enormous overhead cost associated with it compared to Medicare. If he were able to let facts inform his ideology, then true to his ideology, he would then say, rackets and monopolies are anti-competitive, and we can't have the benefits of the marketplace until we end the rackets that are controlling the system and creating such bloated costs. Insurance companies as they are operating now are anti-competitive and destroying our medical system.
Residen'ts problem is that he is not letting facts, even very overt and incontrovertible facts, affect his ideology.
It's not a secret that our system is overburdened by outrageous administrative costs, largely because of private insurance. The administrative costs of Medicare are a tiny fraction, as are the administrative costs of virtually any other well-run (and no-so-well-run) universal health care system in the world. We could be using that money in such better ways.
Posted by yet another resident, a resident of Another Palo Alto neighborhood, on Jun 18, 2007 at 1:46 pm
let me guess, anonymous...I would guess you also believe that oil companies are making incredible profits from their monopoly, right?
And you would insist on that is true because of the cost of gas, even if I told you that they ( they being the shareholders, which you could be if you bought stock) make 8 cents per gallon profit, and the rest is regulation compliance and taxes and research?
you really do not understand how govt costs are factored into "overhead" in any agency, let alone into govt agencies.
Posted by Anonymous, a resident of Another Palo Alto neighborhood, on Jun 18, 2007 at 2:35 pm
If you want to start an unrelated thread about oil profits, be my guest. I don't have strong opinions about the oil industry as you do, and I don't think it has anything to do with this discussion. Have at it.
I think you really do not understand how insurance works in the real world. I know what that's like to think that way, I used to be there myself.
I know an extremely sucessful businessman who told me he was always self-insured because if anything happened, he "didn't want to have to deal with those bastards." I know more than one very successful person who self-insures, it seems to be happening more especially with health care. Unfortunately, most people can't afford to self-insure, and can't easily pick up their lives if they have a major casualty or health loss, they need insurance for that, that's why we have insurance.
If you must know, I'm very fiscally conservative, I just look at the big picture, I don't subscribe to some limited ideology divorced from facts. The insurance racket is hurting our country and our economy in so many ways, our businesses really need to wake up to this fact. Some big ones are now starting to provide health coverage themselves so they don't have to deal with insurers, but they still cannot escape the excessive costs that insurance foists on our system throughout.
The trouble is, people go on and on about competition and marketplace benefits, but they don't really have the balls to ensure that rackets are kept out and competition and marketplace pressures improve our system. I used to believe it was possible, and I could talk at length about the kinds of changes we'd need, but at this point I can see that it's easier to introduce positive market pressures after ridding the system of the bigtime rackets -- it's been really impossible over the last decade especially. Almost anything else can be improved later. We are not moving to a communist form of government, only trying to find a more intelligent, effective, and efficient way to finance and deliver health care. That's fiscally conservative. It's not fiscally conservative to keep paying "protection" money that doesn't really offer the protection when it's needed and that is burdening our economy and the productivity of our citizenry.
If we get rid of the racket, the environment for private enterprise will actually be more positive to improve the system -- and that means, improve it for the goal that remains, i.e., quality health care for less cost, not denying and delaying care to avoid paying.
I have a more complex understanding of overhead in government and private enterprise than you are expressing, and I've seen many situations over the years where government subcontracting out to private businesses actually caused more waste and expense than if government had just handled it. I'm not saying I want government to handle everything, quite the contrary. But let's deal with the real world.
If you cannot see how the insurance industry is no longer functioning in the way it was intended in our economy, if you cannot see the very obvious and overt ways that it has become really a racket that is hurting business and citizens, then we really will be talking past each other. Fortunately (unfortunately), millions of other people agree with me because of first-hand experience that blows away their preconceived ideas.
Posted by resident, a resident of Another Palo Alto neighborhood, on Jun 18, 2007 at 4:56 pm
it is absolutely impossible for you to be simultaneously a governmental fiscal conservative and a universal health care advocate.
so, maybe you guys have been simply both saying that there are problems that need fixing, ( which you both acknowledge), and somehow got off on the philosophy of which way to fix it.
I have had a horrific thing happen to my family also. I see many problems. I have horrible paperwork. I was stuck in a job for awhile because of health insurance problems.
lots of problems. lots of ways to fix them.
even so, i do not want universal health care to "fix' the problems.
you are right, if you fundamentally ideologically believe that the fix is best through govt in spite of the consequences to the future, then you will go for universal health care. and, if not, you will go for fixing the problems directly, and keep fixing each problem as it arises.
Posted by Anonymous, a resident of Another Palo Alto neighborhood, on Jun 18, 2007 at 5:54 pm
What you fail to realize, resident, is that the incremental fixes that have been proposed, even legislated, end up going nowhere because we do not have a healthy functioning system. Insurance does an end run around even legislation that would OSTENSIBLY save the insurance industry money -- the trouble is that they don't want things to change, they're gaming the system too well already.
If you want a system that has good incentives that create efficiency and high quality care, it won't happen incrementally through what we have, anymore than suggesting to the chief of police in a mob-dominated town that incremental improvements in the laws should solve problems with organized crime. First we need to end the racket, which will be a very tough business so long as people who claim to value competition and market forces defend the racket at the expense of legitimate business, at the expense of fiscal responsibility.
I'm being pragmatic when I suggest that we go to a single-payer. I'd much rather fix the marketplace, but it ain't gonna happen, at least not while insurers are around. If you keep up the rhetoric that ignores the problems eventually there will be a breaking point, and there will be a kind of revolution that brings in single-payer. At that point, suggesting market-based improvements will be far tougher if not impossible.
Get rid of the insurance companies. Fix the bloated system. Start introducing improvements (even private insurance supplements), but from scratch with proper rules in place so that they have proper INCENTIVES (and sticks if necessary) to honor their contracts.
You're right if you think I am not a Bush conservative, I think frankly that that's an oxymoron (the phrase). I'm a fiscal conservative, and I think Bush is a big talker but poor fiscal manager.
Please get out of the rut of thinking of this as government solving all problems, or any other narrow ideological saw. This is about ending a racket that has a stranglehold on our country and moving on from there. Nothing will be solved until we end the racket.
Posted by Anonymous, a resident of Another Palo Alto neighborhood, on Jun 18, 2007 at 10:53 pm
Nowhere have I suggested that bigger government is the answer, that's an ideological saw that I wish you could see around.
Conservatives don't like big bloated government because of the infringement on freedom, I am squarely in that camp. I am against feeding all large bloated entities that don't have to respond to the market or the populace, and that restrict freedoms. Rackets that benefit from compromising and hurting people and wearing them down, that grow to bloated, Big-Brotherish proportions, that wield such unchecked political power, that suck such a huge percentage of our economy relative to other rich nations which provide great health care for every citizen -- these are keeping out a healthy marketplace and oppressing our citizens in much the same way that a big, unresponsive and bloated government would, with one notable difference: the insurance companies aren't just unresponsive, they develop and refine strategies that actively harm people when they are most vulnerable. If it were government doing exactly this, we would be up in arms, real arms, over it. But because it is labeled "private", they get a free pass no matter what they do, no matter how much they become what we hate about bloated government.
Putting the same label on insurance companies now as on all legitimate private business that respond to normal market pressures and benefit from competition is kind of like calling mobsters "just businessmen like everyone else." They aren't, they are hurting business.
Try to step outside of old, tired rhetoric and arguments that just don't apply. See the movie Sicko. Check the facts about our system, the overhead, what it's doing to people and business and our ability to compete worldwide (and not just on sites where people have made up their minds on ideology before seeing the movie).
Have you read Upton Sinclair's The Jungle? Okay, yes, there is a lot of communist drivel at the end, which never happened and wouldn't have happened (no offense to communists, but his ideas for how to solve things through communist revolution were just reactionary, unrealistic idealism, and dumb). But highlighting the insularity and corruption of the food industry spurred a revolution that was good for the country. Being forced to clean up ended up being the best thing for that industry as well. And yes, government was a means to that end. I would maintain that once the food industry saw the benefits of cleaning up, were forced to do it, their whole paradigm shifted. Regulations and government are not what drive our superior food system today, but strong intervention very much like sweeping up serious rackets was necessary to get the industry onto the right track.
The analogy end there, though. Insurance companies are far more powerful and corrupt than the food industry described in Sinclair's The Jungle. I have watched them defeat reform after reform that would have improved their incentives. Unfortunately, that kind of racket is a one way street.
Posted by Resident, a resident of Another Palo Alto neighborhood, on Jun 19, 2007 at 8:16 am
Ok Anon: Don't ask me why I am spending time on this on vacation, but I just hooked up and saw someone tried to "carry on" while I am gone, so I just want to make a quick comment ( then back to a vacuum for a brain)
The basic difference between your solution and mine is this. You want more regulation, to the point where there is no more "private" insurance and we all are part of an insurance run by our govt for 300,000,000 people. I want less regulation to the point where there is a REAL choice in insurances in every state, so that I can choose which type of insurance I pick, like my car insurance, based on what level of risk I am willing to assume and what level of coverage I want. Deregulate health insurance, and the vast majority of what you see ( and I agree with most of it) will disappear. The problems you see are from legislators trying to muck about with a system they do not understand, taking away choices from people they think are too stupid to figure out their own desires.
I believe more "privatizing" through less regulation about what each insurance company will provide will work much better, leaving people with true choices in what they are willing to pay for, and result in much better coverage than we have now ( with the only caveat that every person be required to purchase a minimal amount of insurance, like with cars, and every insurance company be required to insure some percentage of "pre-existing" so that every person has the chance to buy insurance).
For example, I would pay a lot less for the same because I would choose a health insurance that would still provide me with what I use now..one that doesn't cover elective abortions, IVFs, cancer treatment or daily dialysis after the age of 80, accupuncture, more than minimal "counseling", etc. There are a lot of services I pay for that I will never use, or don't want to ever use.
Did you know half of all Medicare dollars are spent on the last 6 months of life? That is insane, and a result of people not actively choosing how to spend THEIR dollars, just choosing to spend dollars that "someone else" is spending. Sounds heartless, but honestly, if you knew that you were going to spend every last dime of your money on taking chemo at the age of 80, and have a 10% chance of living another 5 years, would you do it? No, but that is the type of decision people make every single day in hospitals because there are no checks at all in this very emotional decision tree.
I want us each to know the value of our own health care, by having some personal connection to the dollars that go out on our behalf. That is the only way to contain costs and still provide everyone with care they actually value.
Where do all the greatest new medicines come from? The USA. Where are most of the best medical advances made? The USA. Where do the new life saving or quality of life improving machines come from? The USA. These things happen here, not because our hearts are bigger ( though I also think that is true in general), but because of the PROFIT MOTIVE to pharmaceutical companies, medical tech companies, etc. Doctors are motivated to devote energies, and their teaching hospitals to allow them the freedom to do so, not just crank out patients, to creating new and better surgeries because if they do, they become "famous", they make a lot more money, the teaching hospital gains grants and high paying patients, etc.
If you take away profit motive through a single payer system, you take away more than just profits, you take away the willingness to take the financial, personal and time resource risks to create and invent the very life-saving drugs and devices and techniques we all want to use.
This is not "ideology", this is simply fact. You are an unhappy consumer. I understand that. I sympathize. We have problems in our system. Absolutely agree. Let's fix them, not through more "regulation" (which has been the reason prior "fixes" for the most part of failed, and only made things worse), but by opening up insurances to more free-market reforms.
1) More freedom for people to buy what they want
2) Require every person to buy insurance at a minimal level.
3) Require every insurance company to "absorb" a certain percentage of "pre-existings".
4) Assure full info for all people choosing insurances so that they know what risks they are assuming for themselves.
Posted by Anonymous, a resident of Another Palo Alto neighborhood, on Jun 19, 2007 at 11:00 am
I would love to have a face to face discussion with you, because I can see we have a lot of common ground, you think a lot about this topic as I do, and you have a lot of intelligent points to make. I would also love the chance to talk to you about where we don't see eye to eye, because I think we could.
I don't disagree with much of what you said in the first half of your message. However, for what you suggest to work assumes that insurance companies function in good faith as legitimate businesses. This was the case 50 years ago, but is absolutely not the case now. Choice in insurance matters not a whit when insurance companies simply don't pay to honor their contracts, when they are rewarded financially for running schemes that not only get them out of their contracts, but that actively hurt their policyholders. We're not talking about exceptions, we're talking about what the "business" of insurance is today.
I do not think regulation of the insurance industry is the answer. I think getting rid of the insurance industry so that the major corrupting and enormously expensive influence on our system is gone is a necessary step.
I don't want to be required to buy more insurance or to provide at taxpayer expense more "protection" for people who are even less prepared to deal with insurance malfeasance than I am. All of your points assume that insurance is acting in a certain way to market pressures, and it's just missing what is happening, which is why we are not solving this problem. If insurance is a racket, none of your points will make a bit of difference, except to continue raising the cost of our health system to the breaking point. Insurance is functioning as a racket.
Posted by R Wray, a resident of the Palo Verde neighborhood, on Jun 19, 2007 at 1:56 pm
There is a legitimate function for health insurance. A group of people can get together and contract through an insurance company to share the risk of catastrophic medical expenses. This is a responsible and rational approach.
To declare this practice a racket and outlaw it would be a violation of our constitutional rights.
Posted by resident, a member of the Gunn High School community, on Jun 19, 2007 at 3:14 pm
Anon: I don't see anyone but you saying they want more regulation, as you seem to think the others are saying. I see them saying...less micromanaging regulation, more requirements of all people to buy health insurance, with more insurance options for people through deregulation.
This is an interesting idea, and leads to me to want to research what Massachusetts just did with its health insurance laws a few months ago. I think I remember something about requiring everyone to buy private health insurance, and getting rid of the "govt" insurance for the poor and instead buying private insurance for "the poor" with tax dollars.
Posted by Anonymous, a resident of Another Palo Alto neighborhood, on Jun 19, 2007 at 9:52 pm
"There is a legitimate function for health insurance. A group of people can get together and contract through an insurance company to share the risk of catastrophic medical expenses. This is a responsible and rational approach.
To declare this practice a racket and outlaw it would be a violation of our constitutional rights."
R Wray -- Absolutely agree with you 100%. Please read what I wrote a little more carefully and don't just argue the usual old saws. I too think there is a place for insurance. I believe I said above that most people could not afford to self-insure. I believe I also pointed out that insurance companies have behaved legitimately in our system in the past.
However, the way they are behaving now is as a racket. I am not saying the concept of insurance itself is a racket, I am saying health insurance companies are currently essentially operating rackets. You can't make incremental improvements, they have done a fabulous job thwarting all attempts for a very long time, which is why we are in this predicament.
It's the difference between needing to improve the business environment and turning powerful mob bosses from their ways and submitting themselves to good faith business practices. You can do the former with incremental changes; unfortunately, it's just not possible with the latter, I hope you see why.
I believe I also pointed out that once the rackets are removed, it would be possible then to improve any system we put in place.
Posted by resident, a resident of Another Palo Alto neighborhood, on Jun 19, 2007 at 10:44 pm
ok, I am an ideologue, too..freedom of choice, free market blah blah.
But, these guys are telling me WHY I intuitively like this way in insurance. if somebody finds an equally compelling and scholarly treatise on why we should go universal health insurance, please post it. I want to read both sides. This one has me convinced.
Very long article by about 5 guys from different countries, including France, talking about the problems with their systems.
Posted by Anonymous, a resident of Another Palo Alto neighborhood, on Jun 20, 2007 at 1:02 am
Good article. I had to laugh when I read the part about giving up personal freedoms. Right now, it's 'your money or your life' in our system. When I have needed expensive medical care, my insurance company has presented me AFTERWARDS with the choice of my money or my life. My time and energy are overwhelmed by paperwork and nasty interchanges, all with the intent of wearing me down so that I give up and lose my money, which I can ill afford for such major care. If I give up my life to the paperwork, I **might** get my money back. Choosing not to doesn't divest me of the paperwork, as just figuring out what I owe under contracts is usually a horrendous paperwork nightmare in itself, again, all intended to confuse and overwhelm me so that providers and insurers can shake me down for more.
Half of all personal bankrupties in this country are for medical expenses; the majority of those people had insurance at the start of the illness that bankrupted them. And believe me, those people didn't just opt out of the paperwork.
Speaking of freedom and personal choice, I would rather have the choice of a system free of this racket. I would rather have the choice to pay, out-of-pocket for realitically priced care rather than paying the same amount in copays in a system with 30% administrative overhead, overhead that drains my life in order to get more profit. (That overhead exists in order to garner even more profit, so that costs are at least twice what they would be without the racket -- borne out by the statistic that we currently spend lest than half of all health care dollars spent on actual care, the rest is insurance industry profit and paperwork.)
I have compared the actual full cost of the care in other countries where I would get the same or better care, and it's less than my copays and non-covered expenses here. (I'm talking about what my insurer ends up sticking me with, not what they put in the manual.)
So that's one important distinction: we should have health insurance for major catastrophic protection. Health insurance should not be for most routine health care. We don't have car insurance to pay for our gas and upkeep.
But again, this is all apart from the fact that all of my ideas about how we could improve the system with more effective market forces are all nothing if we don't get the racket out of the system. If it means we go single-payer to do it, I'm all for it. Get the graft out of it, and get the room to start improving from there.
(I'm always amazed that people claim they are for positive market forces, yet when I suggest that perhaps health care providers should have to give most patients an idea of what to expect for what cost and let the patient judge and pay based on whether the expected results were delivered, they balk. At that point, consumers get talked about like they are commodities with no brains. Bah! Insurers should be subject to the same feedback; consumers who require delivery of the insurance should have a more direct impact on insurers bottom lines. That has been tried, however, proposals never get anywhere, insurers simply won't allow it. If we get rid of the rackets and start from scratch, however, we can design a system with those appropriate checks and balances in it. It's about as likely to happen as my insurance company coming through on my last major medical. It's not my first choice, but I'd much rather have single payer.)
The other important point about the article is that going to a more efficient way of financing health care does not mean we are necessarily going to a European model of living. That's a stretch. The article doesn't distinguish between health care financing and health care administration, which are really two different balls of wax. In some countries, government handles both. I don't see that happening here even if we go for single payer. And of course, I doubt the government would actually handle the administration, I'm guessing they would send the work out to bid, a way to get control of what is done for less money. Single payer on our own terms.
Posted by anonymous, a resident of Another Palo Alto neighborhood, on Jun 20, 2007 at 1:13 pm
To clarify that 2nd to last paragraph: I meant to say, single payer is not my first choice, getting rid of the rackets and instituting real market reforms that create efficiencies and better quality would be, however that's about as likely to happen as my insurer actually paying for my major medical care. People talk a lot about market place, blah blah blah, but when push comes to shove, they don't REALLY want to submit to a balancing act with consumers that would be healthiest for the system.
Posted by Resident, a resident of the Adobe-Meadows neighborhood, on Jun 21, 2007 at 2:10 pm
"I'm always amazed that people claim they are for positive market forces, yet when I suggest that perhaps health care providers should have to give most patients an idea of what to expect for what cost and let the patient judge and pay based on whether the expected results were delivered, they balk."
I might be willing to go along with the "pay if it works" scenario if there were a way to trust people to tell the truth about their pain or function!
I definitely go along with everything up to then..each person should have a "stake" in the outcome and the cost for it, so that each person decides if the cost is worth the outcome. For example, your doctor orders a hearing test. You ask why. She says "because you said you are having troubles hearing your wife"...you find out it costs $600 dollars for the test, and you have to pay $100 of it. You decide to research other causes of hearing loss, go to an ENT and for $200, your share $35, get your ears cleaned and Bob's your Uncle! ( and you get another doctor).
If you pay nothing, you do whatever the doctor says and costs soar.
In our era of letigious behavior, our MDs are very test bound, and are afraid to do the "simplest" thing first, for fear of that 1/1,000 time they should have gone for the CAT Scan first. So, I am not blaming the "testing" mentality. The whole thing needs to be overhaused, AND we need to be responsible for our decisions.
Posted by Dewey, a resident of the College Terrace neighborhood, on Jun 21, 2007 at 2:19 pm
We need socialized medicine now. Our health should not be held hostage to greedy corporate insurance companies, health care conglomerates and Mercedes driving doctors.
"People's" health care as every citizen is entitlted to in Cuba, (and before the US overthrow of the peaceful revelolutionary republics in the USSR and eastern Europe) gives equality in health care to all...not just the few capitalist overlords.
Stop the Republican Oligarchy. Vote Democratic now.
Posted by R Wray, a resident of the Palo Verde neighborhood, on Jun 21, 2007 at 2:43 pm
If I needed an operation I would choose a freely acting, high-achieving, Mercedes-driving doctor any day over a nine-to-five, mediocre, government bureaucrat who got his job at a government hospital by meeting minimum government regulations.
Posted by Anonymous, a resident of Another Palo Alto neighborhood, on Jun 22, 2007 at 12:33 am
Financing health care in a more intelligent and fiscally sound way will not divest doctors of their mercedeses. You are confusing health care, health care administration, and health care financing. I'm thinking my doctor could afford to get a new mercedes every year after firing the five or six people she won't need anymore to push paperwork if the insurance mafia were elimated. Oh, and she might actually get to practice medicine again with her time, instead of arguing with insurance companies.
I'd take any good doctor at any good city or county hospital from the '40's or '50's any day (there were many), I don't know where you've been, but they delivered pretty damned good medicine for the most part.
Posted by Dewey, a resident of the College Terrace neighborhood, on Jun 22, 2007 at 12:49 pm
If we had an intelligent socialized medicine scheme, and appropriately progressive taxes, we could insure that all citizens receive equally good care AND take away the Mercedeses of doctors and other rich fat cats who have more than their fair shares of income.
Posted by Anonymous, a resident of Another Palo Alto neighborhood, on Jun 23, 2007 at 9:30 am
""I'm always amazed that people claim they are for positive market forces, yet when I suggest that perhaps health care providers should have to give most patients an idea of what to expect for what cost and let the patient judge and pay based on whether the expected results were delivered, they balk."
I might be willing to go along with the "pay if it works" scenario if there were a way to trust people to tell the truth about their pain or function!"
This is the crux of why we don't have positive market forces in the system, this unreasonable distrust of individuals. Right now, I can call my credit card and get my money back if I have an unreasonable hotel stay or other bad hospitality industry experience, yet the hotel and hospitality business in this country has not collapsed because of this, in fact it thrives nevertheless (I would submit it is thriving BECAUSE it has to be responsible to each customer for results). This is so even though there isn't some set-in-stone standard by which to judge reasonable service.
Let's face it, health care providers and insurers have no equivalent feedback. Doctors who get it wrong often don't ever know what the right answer was for most patients. Think of how fast our system and the practice of medicine would improve if everyone had to face this reality, no matter how imperfect. Medicine is an art -- even the ART of medicine would have to improve with this kind of direct feedback.
The threat of lawsuits is very real, but let's put it in perspective. The landmark Harvard Medical Practice Studies took a very detailed look at this issue, and the rate of lawsuits that come from even very blatant malpractice that definitely resulted in injury or death was only something like 0.2%, not even 1% of those cases deemed very obvious malpractice. Which means, in a way, your chances of being injured or killed by your doctor vastly outstrip his likelihood of being sued by you (or your family) if he does. Another major study published in the Lancet found that by far the majority of lawsuits that are filed could have been avoided if patients had felt that the mistakes had been properly investigated and appropriate apologies made, etc. Often suits were filed in the event that a child was injured and future medical costs and disability costs loomed for the child and family.
Reasonable negotiations dealing with these issues have vastly reduced costs of dealing with medical mistakes in pilot programs, yet we cling to this unwieldy system of lawsuits because of this unwillingness to regard individuals with the respect we would want accorded to us in those situations. Capping awards has resulted in stable or declining payouts, yet malpractice premiums have continued to rise. Anyone who truly understands the value of real market forces would have seen this coming a mile away (I did).
Lawsuits are horrendous, they hurt plaintiffs and defendants, largely because of insurance involvement. There really must be more intermediate and accessible levels of recourse -- every individual should have the same level of recourse that they would have with a bad hotel stay -- it would not only thwart escalation to lawsuits, it would also provided immediate and direct feedback (positive market forces) the lack of which our system is greatly suffering from now.
I value choice as a consumer, but right now, the ONLY control I have over quality is through that choice. (And let's face it, with insurance, they would only be too glad to have me "choose" to go elsewhere if I have a major loss.) My insurer can act like mobsters, and nothing happens. If there were more intermediate levels of redress, where every policyholder with a major loss had more direct impact (even ANY impact) on the insurer's bottom line if they don't deliver, we wouldn't be in this mess.
But we are in this mess. Insurers are essentially running a racket. If we don't get rid of the racket, there is no way to fix the system. I am personally not afraid of doing this by going to single-payer, because I know single-payer won't be as hard to improve (or remove) than the racket is.
Positive market forces work best if they are direct and not so remotely removed from every consumer interaction as lawsuits. The vast majority of people cannot sue and will not sue. Many negative and unsatisfactory consumer interactions don't meet the level of a lawsuit, anyway, yet recourse to provide feedback in every instance (market forces) would keep our system efficient. That recourse doesn't exist in the medical arena.
A lot of conservatives claim to be for market forces, yet I would submit that the majority of those who claim this aren't willing to walk the walk. My hope is that going to single-payer would galvanize other conservatives to finally accept the need for real market forces -- and that would mean empowering the consumer. I just don't understand conservatives who claim to be for market forces, yet they act as if promoting monopolies is the same thing.
Medicine is a tough and important profession, and I think doctors should make a good living at it. Doctors are presently more unhappy than they've ever been, but not because they can't make a living at it (though we could argue that point), it's mainly because they can't practice in the way they think is best. Both the income and the practice constraints have come about because of insurance companies, and that's because of this enormous insurance administration that is USED by insurers to essentially cheat their policyholders. The only practical way to end this stranglehold is to end the rein of insurers.
We are not instituting a communist form of government -- no one has to be afraid of single payer. Let's get the benefit of it, and improve on it from there. But we won't do better unless conservatives face up to what real positive market forces are required to make an efficient and effective medical delivery system. We can't keep treating patients like brainless, untrustworthy commodities, you can't get positive feedback in the market that way.
Posted by Living in the present, a resident of Another Palo Alto neighborhood, on Jun 23, 2007 at 6:15 pm
RWray, you are confusing health care financing and health care delivery. The government will not be taking over health care delivery, only consolidating health care financing so that we are no longer spending more than half of our health care dollars on insurance paperwork and profit, and less than half on care. In case you haven't noticed, we HAVE huge monopolies running our health care system, and they are milking our system at the expense of care and the health of our citizens (not to mention the health of our businesses). Probably the biggest difference health care providers will notice if we go to single-payer is the lightening of their payrolls when they no longer need an army to do the paperwork for insurance.
You also said, "If I needed an operation I would choose a freely acting, high-achieving, Mercedes-driving doctor any day over a nine-to-five, mediocre, government bureaucrat who got his job at a government hospital by meeting minimum government regulations."
That's interesting, because a lot of the world is now choosing doctors in the socialized health system in Switzerland over ours for things like heart and other advanced surgery. They are getting better outcomes for less money. You almost can't even compare the two systems. Switzerland spends 2/3 as much as we do to deliver high-quality, advanced care to all of its citizens. There are no waits to see specialists, no backbreaking paperwork, etc. The hospitals and health facilities are WAY cleaner and nicer. Over there, if you have surgery the health system pays for you to recover in the mountains in some nice resort. Sure, they have higher taxes, but they also have free health care, free college education, such outstanding elder care and nursing home facilities compared to ours it would make you weep if you'd had to care for anyone in a home here, etc. etc. None of my relatives with serious health problems chose to leave Switzerland to come here for care - even though, in my self-absorbed delusion about the quality of care here, I did everything I could to entice them - but several of them RETURNED to Swizerland when they needed care.
Every Swiss relative who has passed away has left an inheritance; none of my once well-to-do relatives here has been able to, between the extreme cost of health care and long-term care at the end of life.
The old, tired ideological arguments from the cold war about politics just do not apply here. You are right about monopolies: it is monopolies, private monopolies, that are destroying our system.
Link to how the Democrat party is now basically the Socialist Party. The NeoCon attitude is the true and original Liberal of my youth..the people who want freedom from tyranny in any dictatorship, including communist, are called "liberals".
Posted by Anonymous, a resident of Another Palo Alto neighborhood, on Jun 24, 2007 at 3:52 pm
You must be a little older than I am. In the '30's, Democrats were the party of the corrupt fat cats, Republicans were the party of the people, who stood up for individual liberty and the oppressed. They were still then the party of Lincoln. People in the South were historically Democrats because Lincoln had been a Republican. That changed only in recent decades.
I don't identify as strongly with a party as you do, because politicians say one thing and do another. I identify with the values of being fiscally conservative and strongly supporting freedom and democracy (whether against government tyrants or private oligarchic and monopolistic tyrants).
By your thinking, our police and fire departments are socialist. I know, Libertarians think police and fire departments should be "free market" entities as well; luckily for our society, the rest of us are realists.
"Socialized" medical systems in the rest of the world are not equivalent to "socialist" government, and many of those medical systems are working far better than ours for lots and lots less money. What is so wrong with us that we can't do better than that? I think we CAN do better than that, but we have to deal with realities. We can't just keep saying we are the best on ideology, divorced from all facts.
I say if you and those like you persist in avoiding the real problem, which is not the marketplace but that the real free market is being thwarted by monopolies and insurance rackets, there will eventually be a backlash against the marketplace and we really will see more people pushing socialist ideals. Is that what you want? Or do you, as you claim, really value free market principles? If you have any great ideas (grounded in reality) about how to trump the rackets and get back a stable free market in our health care system, by all means, lay it out. Because with rackets in place, those reforms are just not happening. Every time they are tried, they are thwarted. It would be easier to go to single payer, get the financial benefits of that, and move on to something better. What, are you afraid that people have gone so long confusing rackets with well-functioning free markets that you think they won't let us improve on single-payer? If you value free markets as I do, the longer that confusion persists (and rackets are only too glad to promote the confusion to their own benefit), the more likely the majority will only be too glad to get rid of the "marketplace" for just about anything government. Is that what you want?
You are stuck in cold war dogma. This is not about that. Our health system more closely resembles the organized crime problem of the '30s. (Ironically, it also kind of resembles the marketplaces of the corrupt Soviet Union before it collapsed.) We needed tough laws and tough enforcement to get rid of the organized crime, the "free market" wasn't free and wasn't able to get rid of the mobsters without help.
Posted by R Wray, a resident of the Palo Verde neighborhood, on Jun 24, 2007 at 4:25 pm
The government is an instrument of force. The police are a valid part of government because they use force to protect us from those who initiate force against us.
Force is NOT a part of the insurance business. The government should not be in the insurance business. The present problem is that it is in the business now with all the insurance regulations--many of them instigated by the insurance lobby. The solution is to get rid of all of these regulations and have a free market. Get rid of the tax and other incentives for employers to buy insurance for their employees. Let individuals buy their own insurance--if they want to. We would undoubtedly see competition with many new innovative insurance products.
If you have a specific problem with your insurance contract, sue. That's what the courts are for--they are a valid part of government to enforce contracts.
Posted by resident, a resident of Another Palo Alto neighborhood, on Jun 24, 2007 at 7:13 pm
I still haven't seen any proof, even in everything posted here and all the links, that universal health care delivers the top quality available to us, AND does it cheaper. I have read only of universal health care initially delivering good quality when first instituted, then gradually slipping into loss of quality, increased rationing,
"equally" bad access, long wait lists and every diminishing quality in procedures/medicines.
It is a quick and good short term fix with long term disastrous consequences. I want my kids to have at least as good as they have now..AND I want everyone to have at least some minimal standard. That is my starting point.
fix the problems, don't go "universal" health care.
Posted by resident, a resident of Another Palo Alto neighborhood, on Jun 24, 2007 at 7:14 pm
By the way, your history is a little off. Republicans fought entering WW 2 in the 30s, it was Dems who wanted to go into it. In my mind, the Dems were on the right side then. They were ALSO in the pockets of union bosses ( still are), but that is another story.
Posted by Fed Up!, a resident of Another Palo Alto neighborhood, on Jun 24, 2007 at 8:19 pm
RWray - I can see that you have the ideas about insurance of those who have not had major losses. You are assuming that insurance companies would act in good faith. Unfortunately, often they do not. You talk about force, they do cruel and actively harmful acts to vulnerable people as a matter of course. They aren't doing this because of regulations, they are doing this because they CAN to make more money. As I said, having gone through major medical and a year-long audit by the IRS, I would much rather have the IRS running our health care system. Far more humane, far less paperwork, much more fair (and believe me, I am not offering this as a compliment to the IRS so much as a commentary about the reality of insurance).
Lawsuits are not that accessible to ordinary people in practice. People get healthcare to get their lives back. Suing a big insurance company means offering your life to the alter of that suit. Getting a lawyer to take the suit can be difficult unless the case is clear cut, and usually even a contingency fee agreement leaves the plaintiffs paying stiff court and other costs along the way, often out of reach of ordinary people's budgets. And if you think insurers are cruel when you need them to pay under their contracts, try suing them some time. Sure, once in awhile someone wins, but insurers can pretty well count on most people not being able to sue, and of those who do, most will have trouble prevailing against insurance nuclear scorched earth tactics. Do you not get that the racket has been using the courts to their advantage for years? (Of course you don't, I doubt I will get you to see how dangerous powerful rackets are while you obsess about toothless government.)
I want out of this system, but I can't just opt out because the existence of insurance adds to the cost of all care by a factor of 2-4 at least. If I don't have insurance, providers often won't provide the care, then ironically insurance doesn't pay -- only after the fact, when it's too late to return the care.
resident, if you want proof, travel to some other advanced countries with good universal health systems and get care there. You will be shocked at how much cheaper and better things can be.
Look, our system is even hurting our standing in medical research. Fifteen years ago, when I did literature searches, all the best research was from this country. If you read papers from that era still, it's like reading work written by grown ups (as compared to really much more juvenile stuff we publish now). When I do searches now, I come up with the most relevant work from Sweden, Denmark, Australia, Germany, Switzerland, Italy, Japan -- especially clinical papers -- and more and more, they don't feel compelled to publish in English anymore. Mark my words, if we do not tend to this, we will lose our reputation worldwide and once lost, there will be serious economic consequences, serious consequences to our competitiveness.
Insurance rackets are dragging our businesses down in so many ways. Wake up!
Posted by Resident, a resident of Another Palo Alto neighborhood, on Jun 25, 2007 at 6:15 pm
Right, and that is why my cousin the MD in France buys the Journal of American Medical Association, because our research is so bad and English is leaving as the language, and asks me to send him American pharmaceuticals not available in his country and buys the American PDR because it has the latest information and ...you get the idea.
I am sorry you have suffered so much..trust me, if you were in France, you would have gotten less care for your problems. You would have gotten more time in a hospital, true, because old fashioned rest and TLC is still paid for by the govt, yet it is also part of the reason there is such a long wait list for hip replacements etc. And you might have gotten some homeopathy, which our insurances don't pay for, but you would have still had to also fill out paperwork to get teh govt to reimburse you for its "share" of your copays etc.
You have not lived in France. If you have even a Kaiser here, you get better care than you do in France. You get caught sooner, because it pays to catch illnesses sooner, so you are less likely to die from heart disease and cancers here than in a govt controlled health system..because there are no shareholders to account to for "profit". That nasty old profit motive assures that preventative care takes a high seat.
If you have been screwed, get a lawyer on "commission"..he or she will take most of your money, but you will get something out of it and some measure of satisfaction..and maybe help the next person get better care.
Posted by Fed Up!, a resident of Another Palo Alto neighborhood, on Jun 25, 2007 at 10:08 pm
I didn't say that most of the world isn't still in our research thrall, I'm saying the end of that ascendancy is coming if we don't get our house in order. Your argument is specious anyway. My doctors all subscribe to the Lancet, is that proof to you that the British system is better? My doctor has patients buy drugs from Canada and Europe that aren't available here (often because they are so inexpensive and commonly used in the rest of the world that no one is interested in selling them here), is that proof to you that the Canadian system is better?
I happen to know that in France, people with my condition get better treatment. I have lived in Switzerland, where people with my condition get better treatment than in France and far better treatment than here. No one there tries to screw you through outrageous paperwork, either. The costs of the actual care are less than I get stuck with here in copays, never mind that the governments there cover those costs for their citizens.
You really have a simplistic, unrealistic idea about lawsuits. How can you call yourself a conservative and say that lawsuits are the answer to everything? (I am actually not contractually allowed to do what you suggest, but that's a long discussion that doesn't belong on this forum.)
As for Kaiser, I personally have found they are better at absolutely ignoring things until patients die than providing great preventive care except for a few conditions. There is actually plenty of research showing that preventive medicine can be more expensive (has been summarized in Scientific American if you are interested in following up).
The real problem is that the profit motive is not tied to the benefits desired by consumers, the profits are tied more to behaviors that go directly against what consumers want (delaying and denying care, avoiding care whenever possible despite the consequences), thus our messed up system.
As has been said many times above, trying to fix the system by solving that problem goes nowhere because insurance companies thwart every proposal.
I am not the only one getting screwed. Compared to millions of other Americans, I'm actually one of the "lucky" ones. Millions of other Americans are getting screwed, too, and it's life and death. You really have no idea how much I used to think exactly as you do, until I had to face reality.
Posted by Resident, a resident of Another Palo Alto neighborhood, on Jul 2, 2007 at 7:22 am
To Fed Up:
This is the part that messes you up. You say that
"The real problem is that the profit motive is not tied to the benefits desired by consumers, the profits are tied more to behaviors that go directly against what consumers want (delaying and denying care, avoiding care whenever possible despite the consequences), thus our messed up system."
Trust me..if you make money by providing a service, you will provide the service. If you don't make money by providing service, you will try not to provide the service.
If the govt ( us ) is paying for everything - what is the motive? To NOT provide service, because to provide service drains the taxes. Again, research the health care rationing that is starting to happen in every system you mention. ( not to mention the ever increasing rules regarding rationing of every other central socialized benefit, like retirement, college payments etc).
And that is the way of all socialized health medicines, once the honeymoon is over.
It is a quick "cure" in the short-term, but like medical care for some conditions, just delays the inevitable.
No, I am not the naive one here. I am on the provider end, I know what motivates physicians/patients in both systems.
Seeing "Sicko" ( which I will) will only show me a joke of propoganda, like his other movies, not "teach" me anything. A true documentary, which this is probably not any more than his other mockumentaries, would not have a political goal in mind, but would sincerely examine all the factual good/bad of our system, and leave it to us to work out how to improve our system.
Posted by Fed Up!, a resident of Another Palo Alto neighborhood, on Jul 3, 2007 at 11:03 am
If seeing SiCKO won't teach you anything, try spending some time with a group of disaster victims or people with serious chronic medical problems. Or see if you can spend an afternoon with Jackie Speier, she'd straighten you out. The trouble is that you have unrealistic, idealistic ideas about the insurance industry. I think if you understood these issues, you and I would have a lot of common ground.
I don't think we need to think of our system in the way your are suggesting. We have a government run postal system, yet we also have UPS, Fedex, DHL, etc., all competing and adding service and value. But you don't see any of those companies adding letter service, because it just isn't a profitable area and requires a huge infrastructure. I also find that for small packages, the USPS is often more convenient and cheaper. The existence of the private competition improves the USPS.
This is more what we would get than the system in England. We could find ways to improve the incentives for the insurers, but they simply haven't allowed it. They are functioning more like organized crime racket than legitimate business. As said above, if those of us who value market forces persist in labeling what is happening now as free market, there will eventually be such a backlash that will sweep out any hope of real free market benefits. I wish I could get you to see that, because you have intelligent things to say in this debate, and I am otherwise on the same wavelength with you. I don't want the extreme of a bureaucratic government system either, but that's not what we're talking about here. We're talking about sweeping out the racket, seeing the cost savings of that (hundreds of billions), and improving from there in ways that we can't now because of the stranglehold the racket has on the marketplace, frankly.
I know you are a provider, but that doesn't mean you understand the problem of insurance for patients. I have a friend who is a long-time provider who told me he would not have believed it if people had told him, except that a relative died of cancer and he ended up with the insurance paperwork.
Posted by Fed Up!, a resident of Another Palo Alto neighborhood, on Jul 3, 2007 at 11:08 am
P.S. YOU may make money by providing a service. Insurance companies make more money by delaying and denying care, and since they are dealing with a vulnerable population (sick people), they do it quite handily. Hence the burgeoning bureaucracy -- it is the result of incentives for the insurers exactly opposing the wants of consumers, and consumers having no power to impact the bottom line of insurers when they are unhappy with the delivery of the insurance product.
Posted by Fed Up!, a resident of Another Palo Alto neighborhood, on Jul 3, 2007 at 7:27 pm
I wasn't descriptive enough in my first paragraph. I wasn't talking about your experience with medical issues - I believe you - I was talking about the insurance mafia and things you could do to understand it, if you wished. I would very much like to convey this to you, because I think we could really have a productive talk about improving our system. Your work with patients as a provider is vastly different than sitting with them through the paperwork nightmares from their insurers -- I don't share those with my doctor, I don't know anyone else who does. Your work with chronic medical problems is a whole different ball of wax. As I pointed out later in my post, I have seen first-hand how friends who are also providers don't "get" this just from being providers, not even from the paperwork they themselves have to do on their end.
We're just not talking about the same thing. If you have a contract with someone and they regularly commit fraud to avoid honoring it, would you do nothing and call anyone else who did as having "unrealistic expectations"? I doubt it, you're the one who told me to file a lawsuit without even knowing the details.
Everything you have said so far in this discussion shows loud and clear that you think insurers act like legitimate businesses to legitimate market pressures and that's just not true now, especially in health care.
I'm talking about insurance companies that work up schemes to cheat people, full-blown, illegal, fraudulent schemes to avoid fulfilling their contractual obligations to sick people. Not as a little misbehavior here and there, but as their main modus operandi. Companies that run contests to reward whomever can cheat policyholders by the most money, have done so for years. Companies that create paperwork schemes that burgeon and become hundreds of billions of dollars in annual"waste" -- waste to the rest of us, but to them, an investment in even larger profits. It's a racket that is creating the problems in our health care system.
I'll say this again. If those of us who care about the benefits of market forces persist in treating these rackets as legitimate, in refusing to differentiate between rackets and real healthy markets, eventually the pendulum will swing so violently against markets, we will end up with the system that both of us really fear. That eventuality is a lot closer than you probably realize.
I, too, understand limited resources. I also hate flagrant abuse and waste. I would personally prefer to spend a trillion dollars annually on care rather than on insurance company administration and profit. (We currently spend less than half of health care dollars in our over $2 trillion dollar health care economy on actual care, the rest goes to paperwork and profit, mainly because of private insurance.) This is not a system that is benefitting from marketplace efficiencies. We could "waste" a lot of care on people, "waste" a lot of money overpaying providers, and still save a heck of a lot of money if we just got rid of the rackets. Going single payer, for now, is really the only politically viable way to do this. Insurance companies just will not allow the kinds of reforms that would eliminate this great racket. It's been tried for years, ain't gonna happen.
Posted by Another resident, a resident of Another Palo Alto neighborhood, on Jul 5, 2007 at 12:05 am
Fed Up! - You might find this is interesting: Web Link
"The underlying statement I’ve heard is that if this [health care] system collapses then the business community will end up with something they don’t like" ...“You want a seat at the table, because if you’re not at the table you may be on the menu.”
Posted by resident, a resident of Another Palo Alto neighborhood, on Jul 6, 2007 at 11:26 am
this link is hilarious. A summary -Big Business is Bad because it just crassly cares about the bottom line...except Big Business is Good when it wants govt (ie our wallets)to help it with its' bottom line, like in taking over health care.
i want the bottom line of companies to be dealt with by their own shareholders, not my wallet.
Posted by Anonymous, a resident of Another Palo Alto neighborhood, on Jul 6, 2007 at 3:37 pm
I'd really like to get to where we see eye to eye on the insurance issue, because we think alike when it comes to business.
All money-making enterprises are not necessarily healthy for marketplaces, anymore than armed robbery is a normal marketplace consumer interaction. Counterfeiting, for example, is a pretty efficient moneymaking operation - but it's also illegal and bad for legitimate business. Money laundering operations can actually be good for a local community, but they are also illegal for good reason.
Right now, I'm concerned about how business in this country is affected by runaway costs in the health sector (mainly private insurance administration and profit, which are not happening in the context of a healthy marketplace), and by a less healthy workforce. I do not equate my value of legitimate business with insurance companies (as they are now operating in the health sector), it's like equating a bank withdrawal with a bank robbery. Not the same thing.
When banks have a problem with armed robbers, they do typically turn to the government (the municipal police) to help. And then they go on with business. They also pay for their own security systems, guards, etc. Turning to the police to solve a crime problem is not inviting a socialist takeover of our government.
Now, I'm doubtful that the government has the will to break up the rackets and restore a healthy marketplace. Think of any proposal that would level the playing field a bit, for example, give consumers an impact on the insurers bottom line to make them think twice about what they are doing. It's got about a snowball's chance in hell of happening, which is a sight better than my chances of being reimbursed for my healthcare by insurance right now.
How about this? Allow insurers only to deduct administrative costs that do not exceed a flat 3%, dropping to 1% (it's 1.8% in Canada, surely private insurance could do better with proper incentives). Or how about this? If a consumer is unhappy with the delivery of the product when it is needed (the insurance coverage in the event of a major loss), then he could CHOOSE to go to another company, and if he does, he can take with him 50 years worth of premiums at today's prices. And the winning company still can recover the cost to treat that person's pre-existing condition from the losing company. (A much more fair fight, something that would happen in each instance.) Both of those examples would cut hundreds of billions in administrative waste immediately. Insurers would do a far better job honoring their contracts without creating unnecessary costs trying to avoid paying legitimate claims. And if they have costs they don't like paying, they can be up front about it and announce more clearly what they won't cover so that people can be better buyers of the product. Insurers would eventually begin gaming the system again, but it would take awhile.
I know, you could probably argue with those, I'm not necessarily putting them forth as the best ideas, but I hope you will examine your shock at those proposals for how much you really do value market forces. They've got about a snowball's chance in hell of ever happening, which is a sight better than my chances of being reimbursed for my healthcare by insurance right now.
Going single payer for now is kind of like calling in the police. It's not the same as asking for a socialist government. And true to our system, there will be marketplace efficiencies, once we get the "bank robbers" out of the game.
Posted by resident, a resident of Another Palo Alto neighborhood, on Jul 8, 2007 at 4:40 pm
ok, if we stick with fixing private insurances, we can start to talk. You completely lose me the moment you go to single-payer govt health care. Esp. when you compare to the Canadian system which is good only in that everyone has an equal wait for care, and is equally rationed. The people there got so fed up, they just voted in the right ( finally!) to buy private health insurance. ( Which was forbidden before hand).
My business solutions wouldn't be as draconian as yours. Mine would be..open up the insurance market to true competition, so that every state has to accept any insurance carrier from any State into its market, and allow each insurance to decide what "market" it is after. If an insurance wants to go after the "volkswagon" market, and insure just basics, fine..if one wants to offer cadillac insurance, fine. Stop allowing individual states to force insurance companies to cover much more than a lot of us want to pay for, so that basic insurance becomes affordable. Forbid each individual state to force all insurance companies who sell insurance in their state to provide x,y and z. I am forced to pay exhorbitant premiums, even the cheapest I can find, because of state regulations forcing me to pay for stuff I don't want to insure against..like chiropractors adn counseling etc( sorry, nothing against chiros and counselors, just not interested in paying insurance for what I believe is a bet I don't need to make..my problem if I am wrong.
The only regulation I would accept is that every person MUST buy a "minimum" insurance ( to be debated, of course) along the lines of the law that says every Driver MUST carry a minimum insurance. This alone would pull in millions of uninsured, and lower premiums considerably, because most uninsured are young and healthy, which is why they choose not to buy insurance in the first place.
Glad to see you read the article, too, and understood what it was actually saying.
Posted by Anonymous, a resident of Another Palo Alto neighborhood, on Jul 10, 2007 at 11:36 pm
No, I don't think we will ever be able to see eye to eye, because you keep getting back around to ideas that assume the coverage you buy is the coverage you'll get, that insurance companies act in an ideal way that is divorced from all reality at the moment. It really doesn't matter what the issues surrounding the premium are, they have no bearing on what the insurance companies will do. Regulations aren't what make insurance companies honor their contracts, as you and I both agree, it's market forces. But the companies just haven't had those, and as a result, have gotten out of control.
Insurance companies mostly do not honor their contracts, and this is costing our country in far more ways than just the $300billion in annual administrative waste.
Again, we made all the changes everyone wanted around limiting damage awards, and suits and payouts have remained stable or declined, yet malpractice premiums have continued to go up.
Any business solutions that would work would give more direct incentives to insurers to act in good faith with each major loss. Those reforms are less likely to happen than single payer. Think about it -- even you called my suggestions "Draconian," and you claim to be for market control.
I know the insurance industry, and I will fight, fight, fight against any regulation that requires everyone to have private insurance. It's like trying to solve the problems of mob domination by requiring everyone who isn't already to pay the mob. I'm sick of the mob. Millions of other Americans - not coincidentally the ones who have dealt with insurance - are sick of it, too. I am far less afraid of a single-payer system that we could change and improve. I doubt that people will be so attached to it that they'll avoid improving it -- unless people who claim to be for market forces let the insurance companies shake us down for so long that everyone becomes afraid of what "marketplace" means.
Posted by Anonymous, a resident of Another Palo Alto neighborhood, on Jul 11, 2007 at 12:18 am
Your first article makes my point very nicely: it is possible to improve single payer with private sector innovations. In none of these countries are people calling for the end of their free health systems. (I'm sorry, but the very tiny few who are are just that, a very teeny, tiny, vocal few.) They are trying to find ways to improve their systems, not end them. Carrying some supplemental insurance so that you can have first-class care if you want more than the free system offers is very different than dumping the universal health care for our system. And in those countries, the insurance companies operate very differently. (This article is exactly proving my point that we could save money and provide universal care by going single payer, and then private innovations could improve it from there.)
Those scare anecdotes just don't mean anything to me, because I see those exact situations and worse in our system all the time. I had a cancer scare, positive tests, suspicious follow up on ultrasound, strong family history, the works. A cancer that would have needed rapid diagnosis and treatment. Yet it took four months of persistent follow up to schedule the MRI to rule it out just because of administrative screw ups at the for-profit hospital. My copay was a mint, too.
As for the second article, a friend from the UK turned to me just today, dumbfounded about claims like that. The article is old news -- many of the notorious waits have been reduced. People here with agendas use those complainers for their own purposes, but in general, people from those other countries are confused at why their systems are being portrayed so negatively here. I'm getting that all the time now from friends and acquaintances from Canada and the UK, especially.
But again, I'm not going to defend the system in the UK, it's only 18th on the WHO ranking. Why don't we aim for something better? You seem to put a lot of stock into our ability to innovate and tie that to our system, yet look at what the Swiss do in pharmaceuticals and biotech, with their tiny country Web Link . They have universal healthcare, no waits, clean, clean hospitals (oh heck, their public toilets are generally cleaner than many of the hospital areas I've visited here lately). It doesn't seem to hurt their ability to innovate and make money. They have also stolen much of our foreign medical tourism in recent years. Why don't we aim for that? Or better than that? What's the matter, you don't think we could do it? (Well, we definitely can't with insurance companies draining hundreds of billions from our system annually with no value added.)
Why is it that so many people who claim to value the marketplace are so naive about monopolists and rackets?
Posted by Anonymous, a resident of Another Palo Alto neighborhood, on Jul 11, 2007 at 12:32 am
Here's something from a non-partisan news service. Web Link
Look, I know you'd argue it on idealistic grounds, I would too -- that's not why I'm posting it.
The backlash is coming, and you are totally oblivious. Let me say this again: if people who value the marketplace do not wake up and stop defending rackets as if they are the same as healthy markets, the backlash will bring in everything we hate. And besides, we aren't getting the benefits of healthy markets with rackets! As long as we delude ourselves that we are, our system will continue to suffer. If you value the benefits of markets, you should abhor rackets and the burden they place on business and individuals in this country.