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December 19, 2007 8:15 AM Subscribe

The Prepaid Healthcare Visa® Gift Card,for that special someone without insurance on your holiday list. Rejoice! Terry Gilliam's dystopian future is now! [via]
posted by blendor (146 comments total) 9 users marked this as a favorite

Wow, that's grim.
posted by Happy Dave at 8:22 AM on December 19, 2007

I think you are going to get sick. Merry annual gift day.
posted by Mr_Zero at 8:28 AM on December 19, 2007 [1 favorite has favorites]

Look! It's the Romney health care plan!
posted by TrialByMedia at 8:29 AM on December 19, 2007 [12 favorites has favorites]

Well, more proof that the American healthcare system is unfixably fucked up.
posted by cmonkey at 8:29 AM on December 19, 2007 [1 favorite has favorites]

Never have I been so glad to get out of the US. Holy jesus on a stick.
posted by the dief at 8:31 AM on December 19, 2007

Good, this gives me a chance to link to the Bill Maher rant that a friend just emailed me. Also, it gives me a chance to quietly weep; it's either that or shake with silent, endless, inexpressible fury again. Terrific. I love being an American.
posted by mygothlaundry at 8:32 AM on December 19, 2007

So it is just a prepaid Visa card right? I read through the site and it appears you can use it for anything anywhere that accepts Visa.
posted by Mr_Zero at 8:32 AM on December 19, 2007

Why not just give cash? This is like giving cash but saying "I don't trust you to manage your money responsibly and put aside some for healthcare." Maybe this is something you give to a student as they go away to college for emergencies, but it doesn't seem very "gifty" to me. Plus, they'll take back $1.50 every month, so be sure to get sick quickly for maximum value.
posted by mikepop at 8:34 AM on December 19, 2007

It's a good thing you don't have communist health care in America, otherwise how would Visa make any money?
posted by chunking express at 8:37 AM on December 19, 2007

But it "promotes" health!
posted by hermitosis at 8:38 AM on December 19, 2007

Sick, sick, sick. There was a lengthy, but great post written on this about two weeks back on my friend's site, 'Cure This.' Take a look.
posted by junebug at 8:39 AM on December 19, 2007

This reminds me I have to spend my 'flex account' and buy some new contacts or something. Great.

It also reminds me of this this Onion radio news bit I heard on the radio a couple days ago (apparently originally broadcast in September)

Look! It's the Romney health care plan!

Or the Guiliani plan, which is I think even more radical in terms of 'freeing' the health care market.
posted by delmoi at 8:39 AM on December 19, 2007

It's funny, you never hear conservatives fulminating about "socialized" national security. Not funny ha-ha, though. Not at all.
posted by DU at 8:40 AM on December 19, 2007 [5 favorites has favorites]

"You choose the amount you want to place on the card, anything from as little as $25 up to as much as $5,000, and the recipient chooses the health related expenses he or she wants to use it for — however there’s no rule that says you can’t make suggestions!

Dear new neighbor,

Your kids keep trampling my wife's' flowerbed. Enjoy a vasectomy, on us.

Merry Christmas!
posted by hermitosis at 8:43 AM on December 19, 2007 [6 favorites has favorites]

This is no too far removed from the Health Savings Account.

How it works is you have a ridiculously high deductible (mine is $2500, for example.) But, that's ok, because you can get the magic of a HSA! You open one at your bank, and then you can funnel your money into it, tax free, so that you can pay your out-of-pocket expenses until you reach $2500.

Or until your insurance company drops you because you have cancer.
posted by plexi at 8:44 AM on December 19, 2007

Holy Christ, the flash animation on that site is crushingly depressing.

Can someone please explain the Patent Pending statement on the bottom of the site? What could possibly be patented here?
posted by cog_nate at 8:46 AM on December 19, 2007

If someone gets this for me, I will shoot him or her in the face, then recommend that he or she use the card to get a new nose.

Also, yes, that animation is the pits.
posted by Mister_A at 8:51 AM on December 19, 2007

"The Prepaid Healthcare Visa® Gift Card is issued by MetaBank"

So this is mathowie's idea?
posted by randomination at 8:54 AM on December 19, 2007 [1 favorite has favorites]

Can someone please explain the Patent Pending statement on the bottom of the site? What could possibly be patented here?

A new way to cause despair?
posted by Happy Dave at 8:57 AM on December 19, 2007 [2 favorites has favorites]

Holy Christ, the flash animation on that site is crushingly depressing.

I know. It's not like the healthcare "gift card" isn't depressing enough without her giving it to her dad while standing in a cemetary over his burial plot. That's just cold.
posted by loquacious at 8:57 AM on December 19, 2007

Hey, people - whoa. Just hang on a second.

I don't have healthcare, won't somebody please think of me? And...uh...send me some magic medicine cards? For my humors?
posted by Baby_Balrog at 9:07 AM on December 19, 2007

Beginning in the ninth month after the Gift Card is purchased; there is a monthly maintenance fee of $1.50 per month, as long as the card retains funds.
posted by spikeleemajortomdickandharryconnickjrmints at 9:08 AM on December 19, 2007

Guys,
Let's just concentrate on one thing that's fucked up about America to fix in 2008, it'll make us feel better, like just cleaning one corner of your room, maybe we'll get some momentum. Now, we're going to need to start small so we don't get ahead of ourselves and then get all disappointed and quit halfway through. So, no resolving the Iraq situation, no overhauling the crippled greedy healthcare corporate kleptocracy, no trial and firing squads for the war-criminal corrupt to the core federal government, no care for environmental issues, no addressing the mortgage crisis, no fixing the shredded constitution, no dealing with the widening gap between the rich and the poor, no look at the sub-par public education system, no drug war stuff, no attempt to deal with our crumbling infrastructure.

Here is my plan: We take one year and the best and the brightest America can import from other countries and we make sure we hunt down and destroy every single can of Diet Fudge Soda in America. We can do it if we all pull together and sacrifice.
posted by Divine_Wino at 9:10 AM on December 19, 2007 [2 favorites has favorites]

True story. My American wife joined me here in the UK this year. She's been in the group of Americans watching all the social security getting spent by Baby Boomers, working two jobs and barely getting health insurance policies worth the paper they're written on, yet paying a quarter or a third of their salaries for them.

She didn't have a very good idea of what the NHS was like before she came here, but has said the broad impression was of 'Soviet-style hospitals, hours of waiting for anything and low quality care'. The moment she landed in the country on a fiance visa, she was entitled to free-at-the-point-of-delivery care, but she was so conditioned by years of scraping by in the US that she waited nearly two weeks before admitting that she had a gum infection that was causing her quite a lot of pain. She'd been dabbing on clove oil and 'toughing it out', because, as a newly married couple with diddly squat in the bank 'she couldn't afford to get sick'.

I marched her to the GP the next morning (called and got her an appointment and a rapid registration within an hour). She saw a nurse (also a US expat, funnily enough), and after starting into the litany of reasons why she needed antibiotics, was stopped dead in her tracks with

"Honey, you'll get the medicine you need, you don't have to pitch me for it."

She walked out of the clean, well lit GP's office, picked up her prescriptions and left, with no-one chasing after her with a clipboard for her insurance details.

She walked down the hill with me and we went to the pharmacy across the road, where she paid £6.85 for a two week course of antiobiotics. That's about $16.

As we were walking home, she burst into tears and told me it was the first time in twenty years she hadn't been made to feel as if she was somehow a huge inconvenience, or weak, or useless for being sick.

I was born into this system, so I'm at a loss as to why you Americans put up with this. The only people winning here are the HMOs. I pay 22% tax, and I never have to pay for healthcare. Sure, it can be a bit slow occasionally, and I'm lucky in that if I wanted to, I could opt to go private. But private here means you pay £40 (roughly $80ish) a month and that covers pretty much anything. No co-pays, no deductibles, nothing.

If you vote anyone in who's not committed to universal health care, you're doing yourselves and the people around you an enormous injustice.
posted by Happy Dave at 9:15 AM on December 19, 2007 [205 favorites has favorites]

It also costs 4.95 plus shipping and handling. This gift card is a slightly better deal than the bullet. Slightly
posted by gagglezoomer at 9:16 AM on December 19, 2007 [1 favorite has favorites]

I would favorite that comment twice if I could.
posted by blendor at 9:19 AM on December 19, 2007

Delmoi,

If you need to spend flex account dollars, here is a recent trick from a lawyer friend:

a) Go to local pharmacy and buy all the Claritin etc that you need to cover the amount in the account
b) Get a receipt and submit it under your flex account
c) Return the Claritin
d) er....Profit!

/derail
posted by sfts2 at 9:23 AM on December 19, 2007

Yes, the U.S. health care system is awful, and yes, this gift card is a little grim and carries the baggage that dealing with credit card companies entails. But if it motivates a few people to help out friends or relatives with their health care expenses rather than buy them crap they don't really need, that is a good thing.
posted by brain_drain at 9:24 AM on December 19, 2007

Thanks blendor.

Any time me and the wife run up against something like this (her encounter with UK employment laws and our minimum holiday allowances was a similar eye-opener) we joke about how she's seen the light of our socialist paradise.

Thing being, it's not actually all that much of joke, with the way the US is right now.. We get a lot of things wrong here, granted (don't get me started about ID cards), but the healthcare alone is a very good reason why we won't be moving back to the US any time soon.
posted by Happy Dave at 9:28 AM on December 19, 2007

It's fake, uh ?
posted by nicolin at 9:38 AM on December 19, 2007

I was born into this system, so I'm at a loss as to why you Americans put up with this.

Just an underscoring/italicizing/boldfacing of this point from one of your northern neighbours. My family lived in the US for three years in the early '80s, and not long after we settled in - this was in suburban St. Louis - my brother needed an appendectomy. My father was Canadian Air Force, so all his expenses would eventually be covered, but because we were outside the country the bill came first to us.

We marvelled at it. I was six, but I still remember the incredulous dinner-table dissection of the thing, like it was a relic from some inexplicable alternate universe. Some sad and borderline-inhumane universe. Kleenex use was itemized; I remember my mother pointing out that it'd have cost a tenth as much if we'd brought our own box in. In a tone that said: What kind of allegedly civilized society charges you for the Kleenex you use in its hospitals?

The terrifying absurdity of my brother's appendectomy bill was a frequent talking point in my family for years and years afterward, one of the best examples we could provide to our fellow Canadians when they made the error of suggesting in our presence that there were no significant differences between the two countries.
posted by gompa at 10:01 AM on December 19, 2007 [15 favorites has favorites]

I am amazed that no sees the irony here. Christmas, that time when we are supposed to focus on the things that are beyond material in value, but the time that most of America is focused on buying lots of crap...

Into this, a company offers to let you buy medical insurance (of a kind) instead of crap. Then, everyone goes ballistic and claims the apocalypse is nigh.

I tell you, if the millions of uninsured Americans stopped buying alcohol and started buying medical gift cards, then we could figure out how to fix our system. As it is, we are spending all our time wondering how to fix Americans.

Maybe they don't like the free market over there in Britain. Maybe they like free medical care more. Sure sounds good! Free! What could be better than bigger more expensive government! What could be better than bureaucracies spending our money for us! Wait... free socialized beer! Hooray!
posted by ewkpates at 10:05 AM on December 19, 2007

Ewkpates - medical care shouldn't be a 'product' to be charged for. It should be a fundamental basic provision of a society that gives two shits about the people that make it up. Sure, the NHS eats up a lot of tax money. So what? I'd rather they spent my tax money on making sure everyone gets the medical care they need than on pretty much anything else.

And 'bigger, more expensive government'? Bureacracies spending your money for you? What do you call the multi-layered Federal, State, County and Town bureacracies in the US? Here we've got the national government, a couple of devolved national assemblies and county councils, and that's pretty much it. The National Health Service is exactly that. We all pay for it, we all get the benefit of it.

You know... the definition of a society?
posted by Happy Dave at 10:13 AM on December 19, 2007 [6 favorites has favorites]

The US doesn't have a very civilized society and it makes me sad and givewell.com fucking proves it.
posted by aerotive at 10:14 AM on December 19, 2007

I love how the WCBS TV (NYC) report on these cards has the wonderful holiday spin.
posted by wfc123 at 10:22 AM on December 19, 2007

ewkpates,

I'm guessing you have health coverage, probably through your job.

I struggle with my position on the whole healthcare thing and used to come out your way as I'm a libertarian and believe in small government and personal responsibility. I worked hard for my job and I have very good health coverage -- why should someone else who sits on their ass all day get something I have pay for and have me pay for it? There are two reasons I suppose: (1) It is a basic human right, like education or food and (2) It costs us more not to provide health care anyway.

Policy-wise, I would push a plan that provided free government health care to anyone who wanted it. It would be bare-bones, providing basic treatment for real illnesses. The fact of the matter is, if you can afford it, health care in America is the best in the world. Unlike what the Clinton camp would have us believe, you can't just flip a switch and give everyone in the country the type of care that the rich currently receive. I think providing free, basic service would allow for a fair, two-tiered system, giving those who have earned it the opportunity to take advantage of the cutting-edge (and expensive) procedures that simply are not feasible to deploy on a socialized basis, while keeping costs at a minimum. I know this sounds cold, but health care ain't free folks, and the decision on whether to give X that 50,000 a dose cancer medicine to improve his odds of surviving by 3% can be left up to the free market or some government bean counter.
posted by gagglezoomer at 10:25 AM on December 19, 2007

ewkpates, don't choke on all the propaganda there. The Canadian government spends less per captia on healthcare than the US for better service.

Anyway, If you think you should pay to see a doctor, go nuts. That sounds fucking awesome.
posted by chunking express at 10:27 AM on December 19, 2007

Oh sure like I got 5000 bucks on my solstice budget.

This is why they need to free up the drugs.
posted by nervousfritz at 10:29 AM on December 19, 2007

'she couldn't afford to get sick'.

It's sad that people from the richest country on earth are conditioned to say things like that in the 21st century.
posted by ersatz at 10:30 AM on December 19, 2007 [3 favorites has favorites]

The fact of the matter is, if you can afford it, health care in America is the best in the world.

The deal with the devil in American health care has traditionally been that if you were middle-class or above, you had access to the brightest, shiniest system in the world, but because your resources weren't being pooled into a universal system, the poor were pretty much fucked.

While the rest of the western world eventually decided that deal was unacceptably callous and even morally reprehensible, it could be shoehorned into the American culture of individual responsibility and small government enough for most people to live with it.

The problem now is that when it comes to health care, the middle class have become the poor. Oops.
posted by Armitage Shanks at 10:34 AM on December 19, 2007 [11 favorites has favorites]

My point here is what Happy Dave, god love him (or her), put a finger on: Is health care a right?

Well, I don't view meat eating, pot smoking, liquor shotting, couch potato sitting, fried food eating, and high fructose corn syrup consuming a matter for government regulation. Likewise, I don't think the consequences of said ridiculousness to be the proper subject of government funds.

I am increasingly frustrated that Americans don't see health care as something they should make a personal sacrifice in order to obtain. People should get subsidized emergency care if they live below the poverty line. Sure. But all of America?

Aren't we just subsidizing really poor lifestyle choices at the end of the day? And then claiming it's a "right" that the government pick up the tab?

No. Uh-uh. Not in my constitution. As a nation, look what we spend our disposable income on. That's what you get instead of health care. The Right To Consume.
posted by ewkpates at 10:38 AM on December 19, 2007 [1 favorite has favorites]

ewkpates: Maybe they don't like the free market over there in Britain.

Speaking personally, I don't like the free market operating on decisions that are about whether people live or die, no. Frankly, if you think ooh, it's socialised medicine and therefore awful, take a look at the mortality stats, where there's little or no difference between the UK or US. And if you think that the taxes are too high, well, the difference in tax take as a percentage of GDP between the US and UK is something like ten percent. But hey - you can have your ten percent of income back, if that's more important to you than lots of dead poor people. That's fine.

I used to work for the UK Department of Health, and was working there on 5 July 1998, the 50th anniversary of "the appointed day" - the day on which the National Health Service Act came into force. It's sometimes said that the British don't have a religion other than the NHS, and the celebrations around that day really left an impression on me. Not just of the strong support that Brits usually show for the concept of the NHS (if not always the reality), but also of a lost era where collective action was seen as a positive moral force, not something evil to be sneered at and fought against.

Socialised medicine: yes, please. Your insult is my badge of pride.
posted by athenian at 10:39 AM on December 19, 2007 [11 favorites has favorites]

Just because everybody gets free medical care doesn't mean that the rich aren't free to pay extra for solo rooms and all the extra special care they think they won't get with socialized medicine.
posted by Megafly at 10:40 AM on December 19, 2007

I am increasingly frustrated that Americans don't see health care as something they should make a personal sacrifice in order to obtain.

Reagan-era brainwashing goes deep, doesn't it?
posted by wfc123 at 10:43 AM on December 19, 2007 [2 favorites has favorites]

That's what you get instead of health care. The Right To Consume.

American's totally deserve the country they have.
posted by chunking express at 10:43 AM on December 19, 2007 [1 favorite has favorites]

Of all the preposterous things said so far in this thread, that's gotta be the best.

Are you really proposing that Americans would fleece the system to avoid lifestyle changes, despite the inevitable health consequences?

I don't care how good your care is, after the first heart attack most people change their ways despitet he quality of care.

Dick Cheney being the exception proving this rule.
posted by butterstick at 10:43 AM on December 19, 2007

Aren't we just subsidizing really poor lifestyle choices at the end of the day?

Yes, that's exactly it. That's why America, which has the least extensive public healthcare system in the industrialized world, is also blessed with its lowest rates of obseity and other "lifestyle"-related health problems. Because leaving the private sector to inform people on how to make healthy lifestyle choices and how to seek correctives for unhealthy ones has done the job so magnificently well. Right?
posted by gompa at 10:44 AM on December 19, 2007 [18 favorites has favorites]

I don't care how good your care is, after the first heart attack most people change their ways despitet he quality of care.

I work in a grocery store pharmacy. This is totally not true. You know what goes well with Lipitor and Metformin? Pizza Rolls and Edy's Dibs.
posted by pieoverdone at 10:47 AM on December 19, 2007 [1 favorite has favorites]

When I was pregnant, I had excellent care from my GP (I've had the same doctor for twenty years now), ultrasounds as necessary, glucose tolerance test, etc. When I suffered bleeding at twenty weeks (placenta praevia) I was rushed to Emergency, seen immediately, stayed in a private room with constant care, and was released to go on bed rest for the rest of the pregnancy (which I could afford thanks to state benefits). I went back into the hospital for two weeks before having an induced labour at 37 weeks; everything went well. I wanted a private room after my son was born, and for that I paid five dollars a day.

The total cost of my health care to me during that year, in other words, was about 25 bucks.

My son's father, on the other hand, had to live through his father dying of emphysema while having to pay cash for every tank of oxygen. They were forced to sell half their assets, including things like an extensive coin collection for face value. They nearly lost the house. When his mother went into a nursing home, I couldn't believe the stack of forms and paperwork that arrived every month, and, like gompa, read over the invoices with incredulity ("They charged three bucks for a sleeping bill?").

So yeah. I can't believe the stories I hear from down South. It just seems inhumane and, dare I say it, barbaric. A friend in Detroit who had to suture her own wound, others who pay hundreds of dollars a month for health care which they have to fight with in order to get their expenses approved. Seeing a different doctor every time they go to the HMO. I just don't get it.
posted by jokeefe at 10:48 AM on December 19, 2007

I don't understand why socialized health care pisses so many people off. You hardly ever hear anyone object to America's socialized roads, police departments, fire departments, military, or food and drug regulation. Some folks object to education, but even there, hardly anyone proposes total privatization. So why is health care so objectionable? What line does it cross?

People always reach for the moral hazard argument, but there are moral hazards in many of those other things, too--some people have more kids to educate, some people place more of a burden on the police, some people don't drive, etc. What makes health care different?
posted by equalpants at 10:50 AM on December 19, 2007 [7 favorites has favorites]

Aren't we just subsidizing really poor lifestyle choices at the end of the day? And then claiming it's a "right" that the government pick up the tab?

But what about the people who do make "good" lifestyle choices and then have the misfortune to get hit by a bus? Or get a brain tumor? Should they be penalized because they had bad luck? Sorry, you got that brain tumor and your insurance has run out, sucks for you!

There's always going to be people who game the system, but does that mean that everybody else should lose out because there are some grifters out there?

I think that is so mean. I would gladly pay as much in taxes as I am right now for health insurance so that I wouldn't have to worry about it if I lost my job, and that the guy next door doesn't have to go into debt if he has the bad luck to get hit by a car.

Not just of the strong support that Brits usually show for the concept of the NHS (if not always the reality), but also of a lost era where collective action was seen as a positive moral force, not something evil to be sneered at and fought against.

Amen.
posted by sutel at 10:52 AM on December 19, 2007

ewkpates - Fuck that mindset in eye with a big dirty stick, seriously. Happy Dave took the words out of my mouth. It goes far beyond the question of personal responsibility which people of that mindset like to drum up as the answer to such a larger problem. Don't get me wrong, I don't discount the need for people to to take care of themselves but that is such an infinitesimal speck of fly shit in the big picture. Face it - your life is a commodity that is brokered every time you check into an ER. That is why people chase you around with clipboards and make sure you have the $$$ before they get around to figuring out your medical condition. That is why when you go see your doctor/therapist/specialist, there are signs like "All Service Must Be Paid....." The focus is on cash flow - not your personal well being. Why do I say this? Because I used to be in a position of making those types of decisions and the directive was simply "cut at all costs." If I could charge someone $75 for a pair of foam rubber slip-ons, I'd do it. If I could charge someone $15 for a package of Kleenex, I'd do it. Why? Because my job depended on it and if I didn't have a job I couldn't afford MY health insurance. See how that works?

I personally would like to see anyone in a position of power to change things, lined up and shot in the fucking head on Pay-Per-View for the way they've raped your and my dignity and caused us to live in constant fear of financial and physical ruin. I voted last year based on a candidates stand on health care and will again this year. I am so glad that I do remember a time when getting health care wasn't like this. It gives me something to hope for; that it will change if enough of us get sick and fucking tired of it.
posted by KevinSkomsvold at 10:55 AM on December 19, 2007 [10 favorites has favorites]

/soapbox
posted by KevinSkomsvold at 10:56 AM on December 19, 2007

In the interests of anecdote, I just got a bill from the county health department. My son went to see the nurse-practitioner at his public high school. It turns out that going to see the school nurse now costs $92.

That's really all I have to say.
posted by mygothlaundry at 10:57 AM on December 19, 2007 [5 favorites has favorites]

Whenever free marketers get on their high-horse about healthcare and the "evils" of universal coverage, I like to remind myself that it's the free market that put us in this position in the first place.

Corporations and their investors built this broken system for their own profit. And now they've pushed their profit-taking to the point where Americans are fed-up. Well...too fucking bad for the corporations. They had their chance to build an equitable, fair and affordable system and they elected not to. They made their choice, and now they have to live with the results. Evolve or die, right?
posted by Thorzdad at 10:58 AM on December 19, 2007 [2 favorites has favorites]

How bad does the situation in this country have to get before people decide to start organizing unions in order to get adequate health care? I have to wonder which option big business would prefer--workers with bargaining rights or a universal health care system?
posted by TrialByMedia at 11:00 AM on December 19, 2007

You know why Republicans had to invent the canard of "compassionate conservatism"? Because the party line "if you're poor or sick, it's entirely your own fault", being demonstrably false, doesn't win elections. I guess some folks didn't get the memo.
posted by edverb at 11:01 AM on December 19, 2007

In order for this gift card to be actually have some meaning, they'd have to let you buy them pre-tax, like you can with Health Savings Accounts. If they don't offer that, then it's just a normal Visa gift card with a different bow on the box.
posted by Vorteks at 11:02 AM on December 19, 2007

"Pay up, or drop dead" in 08!
posted by edverb at 11:04 AM on December 19, 2007

sfts2 writes "Go to local pharmacy and buy all the Claritin etc that you need to cover the amount in the account"

Just not the good stuff lest unmarked vans start being parked in front of your house.
posted by Mitheral at 11:05 AM on December 19, 2007

God I wish this was a hoax.
posted by Afroblanco at 11:16 AM on December 19, 2007

ewkpates, please explain your position on socialized defense, as mentioned above.
posted by maxwelton at 11:18 AM on December 19, 2007

Sure sounds good! Free! What could be better than bigger more expensive government! What could be better than bureaucracies spending our money for us! Wait... free socialized beer! Hooray!

Well, right now everyone has big bureaucracies spending their healthcare money for 'em. And most people don't have a choice, I certainly don't. My employer offers a handful of plans, only two of which apply to me as a single person. Yet, each year thousands of dollars come out of my "total compensation." And few bureaucracies outrank the private healthcare providers of the United States. However, government bureaucracy, in a democracy, is accountable to the voters. Private companies are accountable to their shareholders, and their customers, none of whom are me. The customer is my employer, not myself. But I pay for it.

"Smaller Government" is great. But it's not when the alternative is ceding government functions to gigantic, unaccountable for-profit corporations.

I am increasingly frustrated that Americans don't see health care as something they should make a personal sacrifice in order to obtain.

I'm not. So at least it's clear where we disagree. That's much better then all the dishonesty that gets thrown around all the time, so thanks.

No. Uh-uh. Not in my constitution.

Well it's right in the preamble of the U.S. constitution to: "promote the general Welfare," So I'm not quite sure what constitution you're reading.
posted by delmoi at 11:28 AM on December 19, 2007 [4 favorites has favorites]

It is sobering to think how the money going down the drain in Iraq could otherwise have been spent. "For this amount of money, we could have provided health insurance for the uninsured of this country," Bilmes tells me. "We could have made social security solvent for the next three generations, and implemented all the 9/11 Commission's recommendations [to tighten domestic security]."

That kind of list goes on: the annual cost of treating all heart disease and diabetes in the United States would amount to a quarter of what the Iraq war is costing. Pre-school for every child in America would take just $35bn a year. In their main paper, Bilmes and Stiglitz come up with an even more intriguing possibility: "We could have had a Marshall Plan for the Middle East, or the developing countries, that might have succeeded in winning hearts and minds." (source)
posted by blue_beetle at 11:33 AM on December 19, 2007 [3 favorites has favorites]

(sorry for the derail)
posted by blue_beetle at 11:33 AM on December 19, 2007

I was born into this system, so I'm at a loss as to why you Americans put up with this.

Empirical answer:

Most Americans have perfectly good coverage right now, and many but not most have the cost largely hidden from them, and don't know what they'd get under any universal system or how much it would cost. For example, I, along with about a quarter-million other people, work for the State of New York. I pay $90 every two weeks for health insurance for me and my wife (and family, if we had kids). I have no clue what it actually costs to provide this to me. Not a bit. I'm sure it's a whole goddam bunch more than $180/month, though. And the coverage is quite good.

What most Americans have now is better than a pig in a poke, than a draw from a highly random lottery with some terrible outcomes in it, so they don't much agitate for change. Again using me as an example, I stand some nontrivial chance of being made worse off if we switch to single-payer health care, so it wouldn't be surprising to not see me at the health-care-related marches. (I'd still prefer single-payer health care, FWIW, because it would be far better for the uninsured)

This shit will sort itself out when GM, IBM, GE, Citicorp, etc, start agitating for single-payer health care since it's cheaper than continuing to fuck around with their own insurance plans (and it probably means they can fire a whacking great chunk of their HR departments). I'd bet that it happens sometime in the next 25 years.
posted by ROU_Xenophobe at 11:35 AM on December 19, 2007

Happy Dave wrote: As we were walking home, she burst into tears and told me it was the first time in twenty years she hadn't been made to feel as if she was somehow a huge inconvenience, or weak, or useless for being sick.

There's something terribly wrong when a healthcare system makes so many people weep, not because they are sick and in pain, but because they are terrified of being denied healthcare.
posted by hurdy gurdy girl at 11:38 AM on December 19, 2007 [4 favorites has favorites]

a draw from a highly random lottery with some terrible outcomes in it

Not quite sure what this means... do you mean that universal health care systems are like a giant game of Russian Roulette to see who gets care and who doesn't. Because they aren't, they really, really aren't.
posted by Happy Dave at 11:46 AM on December 19, 2007

All this talk of libertarianism reminds me of that recent article about Lagos. Surely, the Free State Project should just buy every member a plane ticket to Nigeria.

Maybe I digress, but I believe that threats to life and liberty can come from systems of oppression other than the government. To be sure, these systems usually leverage the government, but they are independent actors none-the-less.

Ever talked to someone who works in medical billing and claims? Holy shit. It is inhuman and a clusterfuck of inefficiency. Why is the current bureaucratic nightmare of the HMO system somehow magically preferable to a theoretical government-run bureaucratic nightmare? Why do US healthcare consumers pay more for drugs, especially drugs that are researched and produced in the US? We're paying coming and going.

Happy Dave's story actually clearly demonstrates the internalized oppression of the current system. The ideas that are propagated and then absorbed by individuals are: "I don't deserve good care." "If I were a good person, I wouldn't get sick." "My illness burdens other people." And, reflexively: "Other peoples' illnesses burden me." "Only bad people get sick."

Here's a hint: Everyone gets sick. We are all temporarily-abled people. We will someday grow old and feeble (if we're lucky enough to live that long). Do we choose to honor our elders?

Moral, non-oppressive free market systems sure as hell don't try to maintain their hegemony by imposing guilt on their consumers. Happy Dave, that is the system we're fighting. That's why just voting isn't enough. It's an internal, cultural struggle as much as it is an external, legal one. It's also related and intertwined with almost every other major social struggle going on in America right now.
posted by Skwirl at 11:46 AM on December 19, 2007 [10 favorites has favorites]

My health insurance is an HSA with the 2k deductible. Since I take expensive daily asthma and allergy medications, I'll meet the deductible in June or July.

Unfortunately, that means they'll only cover one of my two expensive medications.

After all that, due to increasing costs, our insurance contributions are going up 7%. Which coupled with the fact that we're a small company that couldn't really afford raises this year effectively means I will be making less next year.

This is on top of last year, where an asthma attack lead to an Urgent Care visit. Between the doctor fee and the hospital fee, half of the money my wife received for our wedding was gone.

Fuck the insurance industry in the eye, indeed.
posted by drezdn at 11:52 AM on December 19, 2007 [1 favorite has favorites]

Most Americans have perfectly good coverage right now

BullFuckingShit

Most Americans YOU know perhaps have good coverage, most Americans in reality do not.
posted by edgeways at 12:06 PM on December 19, 2007 [6 favorites has favorites]

Also, it pisses me off to no end that if you buy prescription medicine at a place like Walgreen's it's cheaper if you have certain insurance plans.
posted by drezdn at 12:12 PM on December 19, 2007

Just because everybody gets free medical care doesn't mean that the rich aren't free to pay extra for solo rooms and all the extra special care they think they won't get with socialized medicine.

The Phillips House -- "The Phillips House offers patients the privacy and comfort of a fine hotel, combined with the excellent medical care for which Massachusetts General Hospital is well known."
posted by ericb at 12:16 PM on December 19, 2007

Most Americans have perfectly good coverage right now

The Number of Uninsured Americans Is at an All-Time High

"Data released today by the Census Bureau show that the number of uninsured Americans stood at a record 46.6 million in 2005, with 15.9 percent of Americans lacking health coverage. 'The number of uninsured Americans reached an all-time high in 2005,' said Robert Greenstein, executive director of the Center on Budget and Policy Priorities. 'It is sobering that 5.4 million more people lacked health insurance in 2005 than in the recession year of 2001, primarily because of the erosion of employer-based insurance.'

Census data show that 46.6 million Americans were uninsured in 2005, an increase of 1.3 million from the number of uninsured in 2004 (45.3 million). The percentage who are uninsured rose from 15.6 percent in 2004 to 15.9 percent in 2005. The number of children who are uninsured rose from 7.9 million in 2004 to 8.3 million in 2005."

posted by ericb at 12:20 PM on December 19, 2007 [1 favorite has favorites]

Also, it pisses me off to no end that if you buy prescription medicine at a place like Walgreen's it's cheaper if you have certain insurance plans.

That's the way prescription coverage works. Every insurer can add whatever drugs they want to their formulary and assign them to whatever tier they want. Each tier has a different copay which is of course different for every plan.

So say you come in to the pharmacy with a prescription for Nexium. It's brand only right now and very expensive if you were to pay cash price for it. Depending on your plan, your copay could be a flat amount like 20.00 or a percentage like 30%. If it's the former, then it makes no sense to switch pharmacies. If it's the latter, the 30% is based on the cash price of the prescription after the pharmacy markup. Then it makes sense to shop around pharmacies. However, let's say your insurance carrier does not cover Nexium. When a prescription is filled, the insurance carrier is billed on the spot. Some carriers will reject with a generic 'NDC not covered' which means the drug is not covered at all. Some will reject with 'Not in formulary, prefer Protonix or Prevacid' which means if you don't want to pay cash money for your Nexium, you have to call your doctor and have him switch you to one that is covered. Others require a prior authorization meaning that this drug is too expensive and they need to hear directly from the MD himself justifying why you need that costly medication.
posted by pieoverdone at 12:20 PM on December 19, 2007

Or they think they have good coverage.

Until they get really sick.

Or get a chronic illness.

Or get hit by a car

Or get fired.

The freemarket answer to drezdn's story (used as an example because i've heard it so many times) would be "use your social mobility and work capital to get a job at a firm that will pay more and give you better health care. Oh, no other jobs where you live, move to a bigger city." All of this of course, ignoring the social and monetary struggles of moving / getting a new job / looking for a new job / having a soul.

Everyone I have heard espousing these systems have never actually had to do such things. They say they made it on their own, so others can too. But they never acknowledge the work and support of their social networks and connections that they had access to that others didn't. That summer internship they got while in college, because they had connections via friends, family, professors that could get them in the door? They change careers because they have a social network and connections to other people, so they end up on the first call list when a business is looking to hire someone.

And along with privatizing healthcare entirely, and social welfare, the spout about lets get rid of that FDA (who are not exactly doing a bang up job). Then I like to remind them that Lysol was advertising itself as a mouthwash, a home disinfectant, and a DOUCHE wash, all on the same bottle.

Excuse me, I'm going to be in my Angry Dome™.
posted by mrzarquon at 12:24 PM on December 19, 2007 [9 favorites has favorites]

Reading this wants to make me start cutting myself, but I won't because the cost of an emergency room visit would only kill me slowly.
posted by MiltonRandKalman at 12:25 PM on December 19, 2007 [2 favorites has favorites]

Most Americans have perfectly good coverage right now

Most Americans are one major illness away from bankruptcy.

About half cited medical causes, which indicates that 1.9–2.2 million Americans (filers plus dependents) experienced medical bankruptcy. Among those whose illnesses led to bankruptcy, out-of-pocket costs averaged $11,854 since the start of illness; 75.7 percent had insurance at the onset of illness.

Most folks don't understand there is a limit to your coverage, once you hit your ceiling you pay out of pocket, and you don't have the buying power might of the insurance company marking down the hospital's sticker price for service.
posted by MiltonRandKalman at 12:30 PM on December 19, 2007 [2 favorites has favorites]

Whilst like Happy Dave I'm a born and bred UK resident who will (like most of the rest of the UK population who know a good thing when they've got their hands on one) let the politicians drag the NHS away from us over our dead bodies, I would point out that Happy Dave pays a whole lot more than 22% in income taxes. The tax system is needlessly complex (surprise!) but the upshot is that the UK marginal tax rate for paid employment is 42% or so — the exact figure varies with income of course, but not by much. Notionally, the NHS is paid for by a hypothecated income tax (called 'National Insurance'), but the overlap is not exact.

The UK spent 83 billion UKP on the NHS in 2005/6 (source: The King's Fund), whilst the total government tax take for that financial year was 486 billion UKP and total government expenditure was 524 billion UKP (source: HM Treasury) so the NHS costs us about 15% of total government expenditure, if I have my figures right.
posted by pharm at 12:31 PM on December 19, 2007

Most Americans have perfectly good coverage right now. . . I, along with about a quarter-million other people, work for the State of New York

See the combination there? That would be why you and those other 224,999 people have good coverage. I worked for the government once myself; it was amazing. I haven't had coverage for anyone in my family since then; in the outside world, it turns out that your job won't pay for that, not any of it. My portion of my insurance alone costs me what it's costing you to pay for yourself and your wife - and I have a huge deduction I never meet and anyway, every time I go to the doctor I hit this insurance shortfall thing where there's an ever increasing chasm between what they will pay and what the doctor demands, whereby each procedure ends up costing me a couple hundred dollars out of pocket no matter what.

And, you know, health care becoming the province of the employer is only about 50 years old. What if, instead of doing that, we'd gotten actual "socialized medicine oh horrors" in the late 40s? What if you could actually quit your job if you wanted to without worrying about health care? Why is a job and insurance such a natural link? Why should your employer be paying vast sums in health care? What makes that intrinsically more moral than the government kicking in? I keep thinking that business will finally see the light and recognize that getting out of the health care nightmare completely is by far the best for them. They'd be doing better in every way even if they could just escape the morass that is navigating health insurance for their current employees - I'm not even going to get into the companies that are still paying for people a generation or so before me, who got to retire with full health benefits forever.
posted by mygothlaundry at 12:33 PM on December 19, 2007 [1 favorite has favorites]

Not only that, mrzarquon, but the reason that drugs now have to be certified as safe stems from a very specific incident.

Sulfa drugs were the antibiotic of choice back in the early part of the 20th century (they don't work now on any but a few specific things). Problem was, you couldn't give them to children because they wouldn't dissolve into a syrup like most drugs do.

Finally, a chemist figured out that he could make one of them dissolve.

In diethylene glycol. Also known as antifreeze.

Hundreds of children died of kidney failure, the chemist commited suicide, and the company that did it? Oh, it got fined. But not for killing children, no. For labeling its product an "elixir," when an "elixir" was defined as an alcohol based liquid. It said it had done nothing illegal as far as the children's lives were concerned -- and before federal regulation, the bitch of it is, they were RIGHT.

That's the libertarian paradise folks like Ron Paul want to return us to in the name of getting the government out of our lives. Thanks, but I'll take my drugs antifreeze-free.
posted by InnocentBystander at 12:35 PM on December 19, 2007 [11 favorites has favorites]

Also:
Do you find it more than a little ironic, as I do, that the person claiming that most Americans have good health coverage is getting covered courtesy of none other than the government? If the government is good enough for these people, why isn't it good enough for everyone else?
posted by InnocentBystander at 12:37 PM on December 19, 2007 [5 favorites has favorites]

Canada here, eh!

Just because everybody gets free medical care doesn't mean that the rich aren't free to pay extra for solo rooms and all the extra special care they think they won't get with socialized medicine.

Exactly - a "n-tier" system. Basic coverage free, but perks and extra's cost if you want them. For example, when we were expecting our first child we had to wait 3 weeks for an ultrasound. When child number two came around, it was the same - or we could pay to go to a third-party provider (next day) and get a nifty DVD. For the first child, my wife had to share a hospital room with a family who had no less than 20 visitors at a time trooping in and out. For the 2nd, we paid 12/night extra for a private room.

And - lest everyone decry the horrible waiting times & service in Canada (particularly Alberta) - never in my experience. If your condition is serious, it will be treated quickly. If your condition is rare and serious - boom, you will be seen rapidly.

Neither myself, or my family or our friends have never had to wait more than 45minutes in emergency before being triaged and assigned a bed. Sure - at times the staff is swamped and it may be a couple hours before seeing the doctor - but you are being looked after by a nursing/emerg staff during the wait.

Conversely - I have to travel extensively through work (which provides an AMAZING international medical plan) and the times I've had to visit hospitals in the US were a complete nightmare - 10-14 hour waits, rude staff and INCOMPETENT billing/administrative staff.

And for those talking about how inefficient "big government" is - what about the inefficiencies of multiple HMO's? You are paying one way - or another.

Well - I guess spending your money on military and invasions is a far better use of funds - but the bizarre thing is, according to your press - your wounder soldiers get the shaft after they return, guess they shoulda had better insurance, eh?
posted by jkaczor at 12:40 PM on December 19, 2007 [1 favorite has favorites]

a draw from a highly random lottery with some terrible outcomes in it

Happy Dave wrote: Not quite sure what this means... do you mean that universal health care systems are like a giant game of Russian Roulette to see who gets care and who doesn't. Because they aren't, they really, really aren't.

I cannot emphasize this enough. If there's one difference I see between the US healthcare system and universal health care systems, it's that those of us who have universal health care don't wonder just how sick/injured we can get before we are bankrupted by hospital bills. We don't sit around thinking, "I can afford to get a finger reattached, but not an arm. I can afford to get hit by a car, but not to have a heart attack."

Now THAT seems more like a random lottery to me.
posted by hurdy gurdy girl at 12:42 PM on December 19, 2007

I would point out that Happy Dave pays a whole lot more than 22% in income taxes. The tax system is needlessly complex (surprise!) but the upshot is that the UK marginal tax rate for paid employment is 42% or so — the exact figure varies with income of course, but not by much. Notionally, the NHS is paid for by a hypothecated income tax (called 'National Insurance'), but the overlap is not exact.

See, I get that, I really do. I know a big old chunk of my money gets taken from me. I don't own a car, so I don't pay road tax, but I do pay council tax, direct PAYE income tax, and 17.5 VAT on everything I buy, pretty much. But for me, it's pretty damn simple. I get X amount, I pay Y amount, and the rest of the money is mine to spend. And everyone around me, including me, is 'lucky'. We all have 'good coverage', effectively. And the people who aren't satisfied with what's provided with the state are free to take their money and go and get private healthcare, which has to offer value for money, because it's competing with free-at-the-point-of-delivery, which each and every one of us has already paid for.

I watch my wife's family and friends in the US struggling to make ends meet, constantly stressed and paying medical bills they're going to be paying for twenty years, and I'm so bloody glad I don't have to live within that system. Hell, I even watch my very well off and very highly paid friends and acquaintances who have 'good coverage', and I worry about them, and what sacrifices they'll have to make to keep that coverage, and what might happen if they actually have to make a claim and begin the soul-sucking process of getting health insurance companies to pay for their treatment.
posted by Happy Dave at 12:46 PM on December 19, 2007

Happy Dave: I'm on your side, honest! But I did think that the 22% figure you quoted needed correcting. That 42% figure is the income tax rate you (and I) really pay. Tot up the basic tax rate, national insurance and employer's national insurance and you get to 46% on income between ~5k and ~36k.

VAT and so on are consumption taxes which we get to pay on top.
posted by pharm at 12:57 PM on December 19, 2007

drezdn: Also, it pisses me off to no end that if you buy prescription medicine at a place like Walgreen's it's cheaper if you have certain insurance plans.

I was pretty surprised to learn of the (sometimes big) differences in cost between corporate chain drugstores and local pharmacies. I would have thought the big chains would have lower rates, just based on economies of scale. Indie drug stores may be worth shopping around, if you have any in your area.
posted by blendor at 1:02 PM on December 19, 2007

InnocentBystander- I remember the Sulfa incident also. And anti-freeze is back in public eye again (thanks to outsourcing production of source materials to countries with no testing and labeling).

But the lysol story strikes a cord because it is so strange and has struck other people as such. Not just horrible keeping people from dieing stuff, but a sanitation product, which most people have worked with or experienced, being used as a mouthwash? or more horribly, a douche rinse?

One of the original fliers.

Unless there is an active and unbiased third party meant to reflect the interests of the people, not their wallets, along with an open channel of communication for journalists to disseminate information, there would be literally no way to ensure businesses wont start pulling this crap again. Because in most cases the first thing they will jettison when profits start to slump is their quality control staff, who are just taking objects which have already been paid for, out of the possible pool of sellable assets.

Why is High Fructose Corn Syrup everywhere? because people like it? no, because one of the reasons it is liquid at room temperature so it is easy to put in an assembly line of food production to add sugar / calories / flavors. It is also cheap, so it is in the cheap food, which is what people who can't afford health insurance or a car to drive to a local farmers market (if there even is one where they live). Fun fact: poor people are fatter than rich people, for the first time in history. Because calories from sugar are cheaper than healthy calories.
posted by mrzarquon at 1:10 PM on December 19, 2007 [1 favorite has favorites]

I'm an American who had spent maybe a total of five days in my entire life outside the country (and that was in the artificial bubble world of trade shows) before moving to Canada a little over three years ago.

I'm not going back. Not only is the health care system obviously, like smack you in the face with a trout inescapably superior, I'll also make a more controversial argument. Despite America's supposedly brilliantly self-righting system of checks and balances, I'll argue that by and large Canadians are more "free" than Americans, and have more input into the governance of their country than Americans do.

Canada hasn't freaked out and turned itself into a police state in the wake of 9/11, and we have a working multi-party system up here rather than a two-party monoculture. It does wonders for allowing smaller constituencies to at least influence policies even if they don't hold the actual reins of power. And scandals that topple governments up here wouldn't even make the news in the states. Bush would literally not bother to deny something like the sponsorship thing. He'd just bulldoze through and insist that it's actually okay for him to do stuff like that and nobody would call him on it. Indeed the darkest shadows I see looming over Canada come from them trying to imitate the Americans and, thankfully, doing a piss poor job of it because it's just not in their nature to be like that.

At the end of the day, Canadians seem to understand that they're individuals within a community and that, like it or not, problems in the community are their problem because they're going to affect them sooner or later, one way or another.

The American ethic seems to be "I've got mine. I'll just separate myself from those other bastards and then their problems are their problems." A generation ago Americans moved out to the suburbs so they wouldn't have to spend tax dollars subsidizing "urban" people and their "urban" kids. Now the cities are wasted and collapsing, there's a whole gangster subculture (which of course the corporations have commoditized and sold to your alienated suburban teenage sons and daughters) and a generation that's got no education and no opportunity and really doesn't have anything better to do than come out to the burbs and see if you've got anything worth taking. So now you're literally walling yourselves up in compounds with guards at the gate and you can't build prisons as fast as the people outside them are having kids. How's that working out for you?

I'll take Canada, thanks. Even without the Constitution.
posted by Naberius at 1:11 PM on December 19, 2007 [16 favorites has favorites]

Happy Dave, I think the "Russian roulette" aspect consists of wondering what sort of universal health care we USians would get stuck with. I've noticed our Feddle bureacracy tends to vary in quality of service across departments and at different times -- kinda like how FEMA was dealing with Katrina back in the day (vs. some alleged improvement with housing sitch in LA and MS now). I'd like to believe the US Health Corps nationalizing all the hospitals, or whatever, would result in cheerful, efficient, brisk, comprehensive and competent service, but I'm a "don't trust those folks just because you're paying for them" crowd.
posted by pax digita at 1:11 PM on December 19, 2007

(that will teach me to walk away from my machine mid post: HFCS is cheap, so people who already can't afford insurance end up also being the ones buying the goods which are laden with it, thus suffering more since they don't have the resources for alternatives or to find out why they are feeling so crappy in the first place).
posted by mrzarquon at 1:24 PM on December 19, 2007 [1 favorite has favorites]

but I'm a "don't trust those folks just because you're paying for them" crowd.

But the question is: Why trust the private health providers? You're not their customer is, your employer is. Do you think your employer gives a damn about your health? Well mine probably does, but there are a lot of shitty employers out there.

You're never going to have the government swoop down and nationalize the hospitals. All anyone is talking about here is having the government provide insurance. Sadly, most of the democratic "universal" health care plans take the same crappy system we have now and force the currently unemployed and self-employed to pay huge premiums in a new, private, 'flat tax.' (Obama's plan doesn't force people to do anything, and therefore isn't universal')
posted by delmoi at 1:36 PM on December 19, 2007

...but I'm a "don't trust those folks just because you're paying for them" crowd.

Which might mean that, for once in what seems like an eternity, Americans might actually have to get involved in the governance of their country, if they want to have any influence in what the future of healthcare is going to be in the US. This really is too important to just sit back and hope it'll turn-out fine. Unless citizens get involved and truly agitate and influence for the sort of change they want, we'll probably end up with a wolf-in-sheep's-clothing...a Massachusetts-lite scheme...nothing more than a guaranteed pay-day for the insurance companies.
posted by Thorzdad at 1:36 PM on December 19, 2007

And everyone around me, including me, is 'lucky'. We all have 'good coverage', effectively.

Absolutely - I love this! I make fairly basic clerical money, but every month I take home about £1100 (US$2200) after all taxes* and I don't have to pay a single penny of that out for my (fairly considerable) medical expenses. Recently I've been to see a specialist in London for my first of two referrals for specialist surgery (free), had an operation on my ingrowing toenail (free) and four follow-up sessions with nurses (all free), seen my GP for prescriptions (free) and paid for three months' supply of a drug I take (£6.75). Tomorrow I go in for an injection (free) and I will have follow-up on that, with blood tests, in the new year (free). Yes, I've paid out National Insurance for this, but I'd be getting exactly the same excellent coverage if I was unemployed, or too disabled to get out of the house, or a company CEO. I cannot see how anyone could have a problem with the concept behind this system.

There are problems in the implementation, of course - particularly for "edge cases" like me - but I just can't understand how someone could object to this on principle.

*I pay around £2500/year in income tax, national insurance, and student loan repayments.
posted by ArmyOfKittens at 1:53 PM on December 19, 2007

Big Table Fantasies
posted by homunculus at 2:10 PM on December 19, 2007

Well, I don't view meat eating, pot smoking, liquor shotting, couch potato sitting, fried food eating, and high fructose corn syrup consuming a matter for government regulation. Likewise, I don't think the consequences of said ridiculousness to be the proper subject of government funds.

Wow. This is one of the most ignorant, sanctimonious and just plain wrongheaded things I've read here in a long time. Do you honestly believe that all illness is caused by the actions you listed above? Do you honestly believe that those people who commit the "sin" of eating french fries deserves to die in the gutter? How many french fries must one eat to be condemned to a pointless, painful death?

What about sunlight? It can cause cancer, along with air and water pollution and a myriad other conditions that no person has control over.

What about the "blameless?" Children with health problems? What about accident victims?

Your mindless moralizing makes me sick. I pray to God you never have to decide between paying rent and going to the doctor - although - if it happens to anyone, you might be the most deserving.
posted by The Light Fantastic at 2:19 PM on December 19, 2007 [2 favorites has favorites]

Wow. This is one of the most ignorant, sanctimonious and just plain wrongheaded things I've read here in a long time. Do you honestly believe that all illness is caused by the actions you listed above?

One of the tenants of the authoritarian mindset is that when people have problems, it's their fault. But that doesn't work with healthcare. I mean, obviously some people live sedentary lives, but many more do not and still get cancer or sick or whatever.
posted by delmoi at 2:51 PM on December 19, 2007

This is all bringing back horrible memories of the time I had to go to the ER and answer questions about insurance and fill out forms while I was sobbing and bleeding from both ears. Then I had to wait another 2 hours before getting help. All I remember is sitting in the waiting room as everyone stared at me rocking back and forth like a crazy person. If I could easily and quickly move to a country with national healthcare, I'd be like Lot and never effing look back. Great post, great discussion, but I'm gonna go weep in a corner now.
posted by wowbobwow at 3:07 PM on December 19, 2007 [2 favorites has favorites]

"Well, I don't view meat eating, pot smoking, liquor shotting, couch potato sitting, fried food eating, and high fructose corn syrup consuming a matter for government regulation. Likewise, I don't think the consequences of said ridiculousness to be the proper subject of government funds."

This sounds uncannily like a healthy 20-year old who thinks he's immortal. One day, you will die, as will I. I may go a bit sooner, as I'm a 34-year old office worker who eats more sausages than he should, but one day you will be that person in the hospital bed, and then you'll be glad that there are self-righteous 20-year olds out there to take their share of your burden.
posted by athenian at 3:13 PM on December 19, 2007 [1 favorite has favorites]

Can I just say I love "Brazil"? Such a prescient movie, in more ways than one.
posted by fungible at 3:30 PM on December 19, 2007 [1 favorite has favorites]

Not quite sure what this means... do you mean that universal health care systems are like a giant game of Russian Roulette to see who gets care and who doesn't.

Only that one of the possible, if unlikely, outcomes of shifting to a single-payer system is:

The system is a colossal fuckup run by cynical, greedy jerks and their idiot tools in a manner similar to the Iraq occupation, and is so bad that we have to go out and get private health insurance again, anyway, to get reasonable coverage on top of whatever taxes we have to pay to line the pockets of the companies who benefit from the program.

Most Americans YOU know perhaps have good coverage, most Americans in reality do not

Maybe. I don't have any statistics handy and can't be bothered to go look it up. I already said that I'd prefer a single-payer health care system, so don't mistake this for advocacy.

But "most" doesn't mean "almost everyone." It only means 50%+1. And I do suspect that 50%+1 of Americans have pretty decent health insurance, but this is just an empirical question.

In any case, even if it's not at least 50%+1, at the very least a very sizeable minority of Americans have pretty decent health care coverage. Which is to say that they have something on the table that they'll have to give up in order to get universal health care, and they're probably going to be pretty risk-averse about it.

A dude asked a question -- why do you put up with this? I offered an answer, which might be wrong -- because enough people are doing well enough under the current system that they don't want to take their chances with an entirely new and unknown one. Maybe it's wrong, but it seems at least reasonable.
posted by ROU_Xenophobe at 3:56 PM on December 19, 2007

ROU_Xenophobe wrote: A dude asked a question -- why do you put up with this? I offered an answer, which might be wrong -- because enough people are doing well enough under the current system that they don't want to take their chances with an entirely new and unknown one.

It may be more accurate to say that enough people think they are doing well enough under the current system, because they've never known anything different. It's easy for people to fear the unknown and therefore choose what they think of as the lesser of two evils. If Americans believe that socialized medicine entails horrible, grim, third-rate healthcare, why the hell would they want that? But this is the reason for all the proclamations of "I would NEVER go back" from ex-pats who move to the UK or Canada. Their eyes have been opened.
posted by hurdy gurdy girl at 4:10 PM on December 19, 2007 [1 favorite has favorites]

What are some countries that are relatively easy to get permanent residency for AND that have a humane medical system?? I find that more and more I am wondering about packing my bags and leaving the US. Fortunately my work travels with me, but I definitely don't have enough cash lying around to pay something like Canada's 6-figure Entrepreneur residency program.
posted by chips ahoy at 4:31 PM on December 19, 2007

ROU_Xenophobe: at the very least a very sizeable minority of Americans have pretty decent health care coverage. Which is to say that they have something on the table that they'll have to give up in order to get universal health care

I think you're looking at this somewhat back to front. The health care that Americans (or at least those who actually have health care) already have – that is, the health care that is already on the table – is not something that they would suddenly have to "give up" under a system of universal health care. In fact, under a system of universal health care, they might, in fact, pay less for what they've already got.

Currently, health care for Americans costs anywhere between 16 to 28% of their income depending on whether you're talking about single person or family cover. And that's before you factor in such charges that come from co-pays and deductibles and the like. (Which add how much? When it costs anywhere from $40 to $100 to visit the doctor and you're ill/sick three times in the space of one year, you could be talking anywhere from $120 to, oh, thousands, if you require multiple trips to your GP.)

In the UK, National Insurance payments, which cover the cost of NHS care, are, if I remember correctly, 9% of your salary/wages, and that means free at the point of delivery health care for everyone in the country. Should you wish to go private on top of that, it may cost you more. But much of the time, you don't need to go private on top of that.

So on top of the taxes Americans pay, they're already spending 16% to 28% of their income on health insurance. Meanwhile, people in the UK are paying 9% on top of their income tax. And under the UK system, every single person – be they homeless, toothless and destitute, or Bentley-driving millionaires who eat nothing but foie gras and freshly-shot venison – get free health care, regardless of whether they've got a bit of a cold (which requires nothing more than some cheap antibiotics) or leukaemia (which might require chemotherapy, a bone marrow transplant, and anything up to two or three years of post-care supervision).

Oh, and as an afterthought: the fact that a "very sizable majority" of Americans have decent healthcare isn't something to be trumpeted as a success; the fact that this somehow counts as a positive is an indication of how fucked the system is.
posted by Len at 4:44 PM on December 19, 2007 [1 favorite has favorites]

Oops. that should of course read "a very sizeable minority"
posted by Len at 4:47 PM on December 19, 2007

The health care that Americans (or at least those who actually have health care) already have – that is, the health care that is already on the table – is not something that they would suddenly have to "give up" under a system of universal health care.

No, it really is, unless you mean a universal system sitting on top of the current mess of private insurances, which would probably be the worst of all possible worlds.

Look at it this way:

I (or someone else) currently have health insurance with certain characteristics -- major stuff is covered, there's some coverage for physical therapy, there's some coverage for mental health stuff, some coverage for allergies, coverage for diagnostics, whatever.

When we switch to a universal system, I suddenly don't have that health insurance any more. Instead, I have the universal health care. Which might have better coverage for physical therapy, and might have worse. Which might have better mental health coverage, or worse. Which might have better allergy coverage, or worse. Which might have better coverage for diagnostics, or worse.

And lots of Americans who already have good coverage probably worry about those various "or worse"es, so switching to a universal system isn't the instant victory that it might seem like it should be.

Again, let me note that I do not favor the current system, which is immoral. I am only trying to explain why someone -- SOMEONE OTHER THAN ME, WHO IS NOT ROU_XENOPHOBE BUT IN FACT A COMPLETELY DIFFERENT HYPOTHETICAL PERSON -- might be leery of universal health care.

the fact that a "very sizable majority" of Americans have decent healthcare isn't something to be trumpeted as a success

I agree. That's why I didn't do that, as clever readers might notice. Also why I said that I'd prefer a single-payer system, which clever readers also might notice. If I were advocating anything, it would be a single-payer system like OHIP or extending Medicare down the age ladder.
posted by ROU_Xenophobe at 6:21 PM on December 19, 2007

As long as we're sharing stories... My wife and I are currently reside in Sint Maarten. She's pregnant so we have to go see an OBG/YN every month. Our bill is $50 per visit. Ultrasound is free and is done every time. We were planning on her giving birth in the States, so I checked with my insurance company how much its going to cost us. Well, long story short, maternity is not covered. The hospital and doctor fees are going to be around $18k, that's if everything is as straightforward as can be. Preterm visits are $2800 for four of them. If (when) she gives birth in Sint Maarten, a Dutch colony, it's going to be $1600 for the hospital and about as much for the doctor. Oh, and my wife is a citizen of Ukraine, and if she gives birth there, not only won't she have to pay a cent for anything, but the government will pay HER $8000. In fucking Ukraine! But in the best and richest country in the world a woman has to pay an equivalent of college tuition, downpayment for a house or simply half of the national average annual income just to fulfill her most basic biological role.
America, fuck yeah!!
posted by c13 at 6:37 PM on December 19, 2007 [1 favorite has favorites]

Reading this post has really disturbed me, and I felt the need to tell my American in the UK tale.

I'm a dual citizen of the US and the UK, though I've lived in Virginia my whole life. When I arrived in England after being hit by a car as a pedestrian in Rome, I was in a wheelchair with a fractured pelvis and jaw and my arm had a massive, otherworldly external fixation device.

I went to the ER and was dealt with right away, given the paperwork to apply for a NHS number. I was assigned a nurse, who came to my home to tend to my wounds twice weekly. I was given highly subsidized dental care for my three fractured teeth. And all this care for someone who had arrived that day to live in England for the first time in her life.

To put it in perspective, I was told that if I had been hit by a car in the U.S. I would be in about $50,000 of medical debt, despite the fact that I had the right of way and the accident was a hit and run.

I feel dizzy with gratitude for my privilege, and ill considering how many others would have had different luck.
posted by quelindo at 6:38 PM on December 19, 2007

When we switch to a universal system, I suddenly don't have that health insurance any more.

With our current system, people lose their health insurance and never get any again. As someone that has great coverage courtesy of the Mrs., it amazes me how often the terms of our insurance changes. It could be better, it could be worse, but given the state of the US health insurance industry, I seriously doubt the terms ever get better.
posted by ryoshu at 6:53 PM on December 19, 2007 [1 favorite has favorites]

delmoi writes "Private companies are accountable to their shareholders, and their customers, none of whom are me. The customer is my employer, not myself. But I pay for it."

Actually, the medical practitioner's customer is the insurance company, whose customer is your employer. Because the hospital/doctor is being paid by the insurance company, their first duty is to them, not the patient.
posted by krinklyfig at 7:18 PM on December 19, 2007

And, ftr, no, that's not a great way to work it.
posted by krinklyfig at 7:18 PM on December 19, 2007

ROU_Xenophobe writes "In any case, even if it's not at least 50%+1, at the very least a very sizeable minority of Americans have pretty decent health care coverage. Which is to say that they have something on the table that they'll have to give up in order to get universal health care, and they're probably going to be pretty risk-averse about it."

It seems that way, until you need to use your insurance to pay for something serious and/or chronic, like cancer treatments, diabetes, heart surgery, most anything requiring a regular regimen of pharmaceuticals, etc. Then the number of people who have "good" insurance drops dramatically.
posted by krinklyfig at 7:22 PM on December 19, 2007 [1 favorite has favorites]

I wonder if this works overseas, because I could most definitely use this should I end up moving to Denmark.

In Malaysia, the poor get healthcare covered by the Government, and any treatment in Government hospitals is subsidized. Middle class and above have to pay, and most of them have insurance (insurance is a BIG industry here). There is a bit of controversy about Government hospitals not being good, but also about private hospitals waiting for money before they'd think of treating a person.

I'm covered by life and health insurance, mainly through my dad. My dad likes top-tier service, so whenever I fall sick (which is sadly fairly often - I was recently admitted to hospital a few weeks ago for a stomach bug) my dad would insist on me getting a nice private room and top care. He's able to do this with our regular hospitals here as they are a sister company to his and he's the MD of his company, so they're familiar with him and treat him as something of a VIP. But even overseas, where his status doesn't matter so much, my dad makes sure we are properly insured in case anything happens.

One time in Germany I fell down the stairs in the middle of the night and sprained my ankle. When I returned home I got the bills - treatment, emergency, ambulance - and had to file insurance claims. The insurance company at first didn't want to pay the (hefty) ambulance fees, as they said that because I didn't call them first before calling the ambulance, I shouldn't qualify! Myself, my dad, and my dad's secretary all went at them saying look, I was in SHOCK at the time, it was my first night in Germany, I was in pain and hardly knew where I was, my first priority is to make sure I didn't break my spine! Only after that did they repay me - though I don't think it was the full amount.

Despite all the issues and paperwork headaches, I'm still very very lucky that I am covered by insurance and that my dad's job allows me to not have to worry about affording medication or IV. Goodness knows what will happen to me if I had to rely on the (rather disorganized) Government to make my health decisions for me!

That said, socialized healthcare is definitely a great idea - no one should have to worry about affording proper healthcare.

I'm thinking of going to Denmark for 3 years for school, and the healthcare there is puzzling me. Denmark apparently has great healthcare, but I have no idea if I'm covered for it. The Foreign Ministry says I am a no-go no matter what, while universities and other places say I can be if I get registered first (so the question now is whether I can get registered as a resident in the first place). Registration takes 6-8 weeks so I have to get covered privately for that amount of time before the Danish public healthcare takes over.

NO ONE is willing to sell me 8 weeks worth of health insurance. My friend's cousin sells insurance and told me off for "wasting everyone's time" just because I wasn't interested in a full life insurance plan (which wouldn't work in Denmark anyway!). And I don't know if I can get travel insurance if I'm still remaining in the country. This VISA card would be helpful just so I can avoid all the insurance hassles.
posted by divabat at 7:27 PM on December 19, 2007

...at the very least a very sizeable minority of Americans have pretty decent health care coverage. Which is to say that they have something on the table that they'll have to give up in order to get universal health care...

Ummm...are you saying they would have to give up the quality of their coverage in order to get universal coverage? That's a fairy specious argument. Certainly not one born-out by any supportive facts.
posted by Thorzdad at 7:30 PM on December 19, 2007

With our current system, people lose their health insurance and never get any again.

Yes, I know. This is one reason among many why, really, any reasonable, knowledgeable person would favor a single-payer system. I favor a single-payer system. I do not favor the current system. I was not offering an argument in favor of the current system, I was offering a possible reason why many Americans are surprisingly inactive or indifferent to the health care system and its myriad of problems.

Is there some way I could be clearer about this? I dislike how testy I'm being, but for God's sake it's right there in plain English written in good old fashioned Roman letters. It's not even ROT-13d or anything.

are you saying they would have to give up the quality of their coverage in order to get universal coverage?

No. I am saying that they are concerned that they might have to give up some quality of coverage, and might prefer maintaining their current coverage to the unknown coverages they would have under some universal scheme.

That's a fairy specious argument.

I agree. This is, again, one of many reasons why I do not favor the current system and would prefer a single-payer system.
posted by ROU_Xenophobe at 8:29 PM on December 19, 2007

I'm pretty impressed the word "care" is still used to describe this.
posted by mattoxic at 8:35 PM on December 19, 2007

Democracy is a failure.
posted by muppetboy at 10:37 PM on December 19, 2007

Hey, in light of Happy Dave's early comment, I am hereby putting out the call for a lovely new UK-residing husband. Mefi users have declared me "totally cute" (note: they may have thought I was TPS) and I am not even sick! Yet.

Please?
posted by lauranesson at 11:02 PM on December 19, 2007

equalpants

Actually, in many parts of the U.S., fire departments are now privatized.

In fact, there've been numerous stories of companies that provide fire protection refusing to service certain areas because it would cost too much.
posted by Target Practice at 1:39 AM on December 20, 2007 [1 favorite has favorites]

I'm unable to find the WHO classification of states in the last report.. but in 2000, the US system was 37th.
posted by nicolin at 2:11 AM on December 20, 2007

About the firemen : as long as they do not set fires themselves...
posted by nicolin at 2:13 AM on December 20, 2007

I am hereby putting out the call for a lovely new UK-residing husband

Wouldn't it be better to put out the call for a lovely new UK-residing bachelor. Unless you wanted one already broken in, I suppose. And how vengeful is your grotty old US-residing husband like to be? I ask because I might, you know, possibly know one of them. Friend of a friend. Quite lovely. Mefilmail me and I'll send you myhis details.
posted by Sparx at 3:48 AM on December 20, 2007

Democracy is a failure.
No.
The problem is that the citizens of this country gave up participating in Democracy, allowing it to be twisted into the corporate greed-fest that we have now. Democracy can still work. It just takes citizens pulling their asses away from Survivor:Low-Earth-Orbit and Ow! My Balls! and actually get involved to turn things around.

Democracy can still work.
posted by Thorzdad at 4:12 AM on December 20, 2007

I was involved in a minor traffic incident in the US a few months back (collided with a kid who ran a stop sign). Bit of a jolt but I felt fine. It was suggested I went to the local hospital to get checked out, just to be on the safe side, so I did. Half an hour in a waiting room and 5 minutes with a doctor who prescribed nothing and used no consumables, far as I could tell, and who confirmed there was nothing wrong. Total bill: $400.

A few years ago the NHS in the UK rebuilt my knee successfully, involving a three-day hospital stay and the skills of a very expert orthopedic surgeon and several months of physiotherapy. Total bill: Zero.

I'm very thankful to have a job, insurance, a support network. I'm left wondering how the uninsured can survive. It terrifies me. What if I had been uninsured and got injured in a car smash through no fault of my own? Turned out the kid who hit me had no vehicle insurance. The health care system in the US is a brutal lottery and I'm stunned whenever anyone attempts to defend it on principle.
posted by normy at 7:25 AM on December 20, 2007

My DH has health insurance. We're still getting stuck with a $13,000 cholecystectomy bill (gallbladder operation). In case you missed it the first time: he HAS insurance and we STILL have to pay $13,000!!!!!!!! The insurance claims he met his amount of coverage for the year. That's almost the full amount of the operation.

He's never been sick in his life. He's paid in faithfully for the five years he's been employed at his current place of employment. It's total BS that we have to pay the full amount, especially since we called the insurance co., and they said it would be 80/20. Someone's making a bundle off of us.

Not to mention, a couple of days ago, I was in the pharmacy and an older lady was getting her monthly prescriptions, only to discover she fell into the so-called gap, where she had used up all her prescription $ for the year under her Medicare plan. She was now going to have to pay $78 for the prescription. However, the pharmacist called someone (dunno who that was) to find out if she could get the cost reduced if she paid cash. And the pharmacist was able to get the amount reduced to $38! I was thinking to myself, WTF? How can they bill the insurance $78 and if you pay cash, reduce to $38?

I hate insurance companies. It's a load of crap for us working stiffs. They don't cover a damn thing when push comes to shove. They don't cover preventive care, but yet will drop you if you come down with a terminal illness.
posted by cass at 9:31 AM on December 20, 2007

Not to mention, a couple of days ago, I was in the pharmacy and an older lady was getting her monthly prescriptions, only to discover she fell into the so-called gap, where she had used up all her prescription $ for the year under her Medicare plan.

A lot of people just stop taking medication once they hit the Medicare donut hole. Some people hit this in March or April, others are good until December.

The pharmacy I work at has a very elderly population. I can think of at least a dozen people who come in there that are over 90. Some days it's like a scene from Land of the Dead with zombies advancing towards the window 'PIIILLLLZZ PIIIILLLLLLZZ'.

The one I normally work at is in a mostly white blue collar area. A lot of the people come in and are overweight and just flat out look like crap; like they'd given up on themselves once they hit 40 or so. When I work out in the richer suburbs, people age better, obviously give a shit about taking care of themselves, and the medications we hand out are different. Instead of bags of beetus, water, bp, cholesterol, angina, and bladder pills, we give out maybe a bottle of bp or heart meds, propecia, viagra, and estrogen.
posted by pieoverdone at 10:50 AM on December 20, 2007

A lot of the people come in and are overweight and just flat out look like crap; like they'd given up on themselves once they hit 40 or so. When I work out in the richer suburbs, people age better, obviously give a shit about taking care of themselves,

The wealthy can afford to care for themselves. Regular exams, preventative treatments, medication, gym memberships...hell...even eating fresh fruit and vegetables costs more.

The 40's is right around when one suddenly gets a clearer idea whether the future is going to amount to anything, or if life's just going to be a long slog to make ends meet for the next 40 years. Add-in the constant pressure/worry about your family's needs, whether your job is going to be there tomorrow morning, etc....it's no wonder a lot of your customers look like crap.
posted by Thorzdad at 11:28 AM on December 20, 2007

cass writes "We're still getting stuck with a $13,000 cholecystectomy bill (gallbladder operation). In case you missed it the first time: he HAS insurance and we STILL have to pay $13,000!!!!!!!!"

Just as an FYI a friend from the US had that operation last year and because she is not yet a LI she had to pay out of pocket. Costs were about ~$6500 dollars here in Canada. Obviously YCMV but I bet your insurance company wouldn't pay that amount if you were covered because of discounts.

pieoverdone writes "Instead of bags of beetus, water, bp, cholesterol, angina, and bladder pills, we give out maybe a bottle of bp or heart meds, propecia, viagra, and estrogen."

A lot of the former can be side effects of not treating stuff early. High blood pressure especially, well to hear my doc tell it, leads to all sorts of cardio vascular complications if not treated. And because it is essentially symptomless people who can't afford regular care don't get treated because they don't know they have it. Until one of the secondary diseases hits and then they are on a pile of meds.

I'd also guess the working poor generally lead more stressful lives and excess stress isn't good for you.
posted by Mitheral at 11:53 AM on December 20, 2007

People seem to forget that this is still a very real class based society, the sheer quality of life found in medical care is but one example of it. The great triumph of capitalism this past century is the wholesale acceptance and legitimization of the Pandora box belief that everyone has a good chance of living the Horatio Alger story. Then you grow up, and by the time reality sets in most people have lost the fire to make revolution.
posted by edgeways at 11:56 AM on December 20, 2007 [2 favorites has favorites]

In related news: Uninsured more likely to die from cancer -- "Patients with no insurance nearly twice as likely to die within five years as those with private coverage."
posted by ericb at 1:03 PM on December 20, 2007

Remember, too, that beyond the uninsured are the under-insured. Or those who have insurance just in case of a major illness, but can't afford to use it for more common needs, due to lack of co-pays, high out-of-pocket requirements, enormous deductibles and other restrictions or riders.
posted by Thorzdad at 1:12 PM on December 20, 2007 [1 favorite has favorites]

See the combination there? That would be why you and those other 224,999 people have good coverage. I worked for the government once myself; it was amazing. I haven't had coverage for anyone in my family since then; in the outside world, it turns out that your job won't pay for that, not any of it.

But if you're a domestic partner, like me, you'll pay twice as much as you would for your coverage than if you're a spouse, because the anti-same-sex marriage morons have managed to game the way companies are allowed to cover their employee's chosen ones under state law.
posted by bitter-girl.com at 3:02 PM on December 20, 2007

I was not offering an argument in favor of the current system, I was offering a possible reason why many Americans are surprisingly inactive or indifferent to the health care system and its myriad of problems.

I know you weren't offering it as your personal argument in favor of the current system, you've made your position quite clear. It's an argument that I've run into before and will likely run into again. I was merely pointing out a counterargument to the point you brought up.

/meta
posted by ryoshu at 4:46 PM on December 20, 2007

This is all bringing back horrible memories of the time I had to go to the ER and answer questions about insurance and fill out forms while I was sobbing and bleeding from both ears.

I would like to know how much of Americans' insurance premiums go towards clipboards. Because I would sooner die in a ditch than deal with those fucking clipboards. This is not hyperbole. Happy Dave made me very homesick.

What ought to be clear by now is that the US healthcare system treats one patient, and its name is Leviathan.
posted by holgate at 11:55 PM on December 20, 2007 [1 favorite has favorites]

I know I always bring up China, but I'm doing it again: in the PRC, which is known for being just about the shittiest medical system anywhere outside of the 4th world, I get better, more effective, more prompt, and cheaper by 5/6 care for my asthma. That's without insurance. What the fuck, USA?
posted by saysthis at 12:56 AM on December 21, 2007

Teen Dies After CIGNA Denies Funds for Liver Transplant.
posted by ericb at 7:55 AM on December 21, 2007

You so beat me to that one, ericb.

''Our hearts go out to Nataline and her family, as they endure this terrible ordeal,'' the company said. '' ... CIGNA HealthCare has decided to make an exception in this rare and unusual case and we will provide coverage should she proceed * with the requested liver transplant.''

* should she live long enough while we calculate the cost/benefit analysis of paying for potentially life-saving treatment...
posted by wowbobwow at 8:11 AM on December 21, 2007

Just to add my own 2c: I'm an American with a chronic, very expensive, disease (epilepsy). I pay ~$500/mo out of pocket for medication at the moment because I don't have insurance. I can't qualify for job-based insurance because my job... I'm a nanny.

I've lived abroad and couldn't grok the idea that I could just go to the doctor. My second day in Iceland, I had a large piece of wood fall on my head and I didn't go to the hospital because I freaked out about what it would cost. To put this into perspective at how monumentally stupid this was: I have a neurological disorder. I suffered blunt-force trauma to the head. I didn't go to the doctor because I was worried about the cost. Hooray for being conditioned by the American health "care" system!

I'm going to be going to grad school in the near future, a decision sparked by the fact that this is one of the only ways that I can get insurance. Oh yeah, I want to further my career as well, but I'll be honest - the insurance is really the main motivation here. Yeah, thousands of dollars for more education is going to be cheaper in the long run than paying for my disease out of pocket until I find a childcare job with insurance. (There are, I believe, three of those jobs. I've worked in preschools and no, they don't offer insurance very often and when they do it's patchy at best. Think of that! The people who are caring for your kids probably can't afford to go to the doctor! Doesn't that make you feel warm and squishy inside?)

My boyfriend is from Portugal and is a firm believer in the capitalist free-market system. He's all in favor of privatized health care, or at least, he was. After seeing how much I pay for medication per month and having a discussion wherein I explained that he should only call 911 if I'm half-dead because I can't afford the bill, he's changed his mind about the American health care system. Privatization shouldn't mean extortion.
posted by grapefruitmoon at 10:49 AM on December 21, 2007

Maybe the Government is the best way to fix health care in the US. Maybe the current Administration would, were they in change of our health insurance, have made choices we might have been happier with than those they made in other areas.

No one is arguing that the current system isn't broken. I haven't heard even the pigs who made millions in the health insurance business arguing that the system works. As opposed to the oil system, for example.

Some may be arguing that heart disease isn't our single biggest health problem, a problem which can be fixed by diet and exercise but is instead treated with billions in medications and surgeries and ridiculousness.

Fire and military are paid for by government because, like disease control, are threats to the rule of law. The crappy health care system is not yet a threat to rule of law.

I continue to be disturbed by the lack of regulation on the part of the government and the insistence on the part of Americans that the government solve their problems. Plus, and I even more disturbed by this, some of you may have noticed that the government is out of money, and is running out of credit.
posted by ewkpates at 5:27 PM on December 21, 2007

Plus, and I even more disturbed by this, some of you may have noticed that the government is out of money, and is running out of credit.

In which case, I can't think of anything better than a large chunk of the workforce that feels compelled to avoid medical care until limbs start dropping off.

Also: is the absence of libraries a threat to the rule of law?
posted by holgate at 6:00 PM on December 21, 2007

This is all bringing back horrible memories of the time I had to go to the ER and answer questions about insurance and fill out forms while I was sobbing and bleeding from both ears.

Or the time I shattered my elbow, was holding it up with the other hand and had a nurse ask me to fill out a staggering list of paperwork. My then-boyfriend pulled my wallet out of my purse and did it for me, even forging my signature right in front of her. I shudder to think what would've happened if he hadn't been there to do that.

"Nope, sorry, no doctor for you, missy, come back when you can fill out the forms!"
posted by bitter-girl.com at 10:26 AM on December 24, 2007

Can any good come out of the Nataline Sarkisyan tragedy?
posted by homunculus at 9:25 AM on December 25, 2007

Every American Deserves CheneyCare
posted by homunculus at 11:04 AM on January 7, 2008

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