The Prognosis, Doc?

July 2, 2008 3:28 PM

Two years since Massachusetts instituted major statewide healthcare reform, the statistics are coming in. 340,000 residents, roughly half the state's previously uninsured, are now insured. The state says that 95% of its population is now covered, based on Department of Revenue estimates. However, a large portion of them are enrolled through state-subsidized insurance programs, and those program's rate of enrollment have far outpaced estimates. This has led lawmakers to forsee a budget shortfall. Premiums and co-pays are going up, cigarette taxes have increased, and a cost control proposal is making its way through the legislature. Assessments have been all over the map.
posted by Weebot (79 comments total)

When I was a kid, I found the idea of states pointless, aside from being arbitrary but convenient boundaries that made identification easy. Something of a Federalist. I did not understand why we would have different laws all over the place. Was justice determined by crossing invisible lines?

I've mellowed to a degree on this. Now each of the fifty states represents a little beaker, bubbling away on top of a Bunsen burner ... fifty experiments in the rules by way of combinatorial chemistry. Or maybe like bacteria, swapping laws and programs instead of genes. We'll see how well this works out; maybe other states will adopt it, maybe not.

Sadly, this is partially necessary because America, as a whole, never seems to look around and say, "Well, how'd that work out elsewhere?" for anything but finding a reason not to do something. Sort of the "OMG, homosexuals? Marriage? Society would surely collapse, for reasons X, Y, and Z!" approach, without looking and seeing countries where this has happened and that the nation in question still stands.

Good luck, Universal Health Care. I don't see how you're going to work with lawyers suing for reasons good and bad, with doctors and nurses who have enormous student loans to repay in the mix, with patented drugs and one-use medical equipment of enormous cost. I wish you well and hope you surprise me.
posted by adipocere at 3:49 PM on July 2, 2008 [1 favorite]

Good luck, Universal Health Care.

Mandatory health insurance is not the same thing as universal health care.
posted by rxrfrx at 3:52 PM on July 2, 2008 [7 favorites]

No, it isn't. It's a nice first step, though. I'd be shocked if anyone thought the plan was to stop there.
posted by adipocere at 4:00 PM on July 2, 2008

Socialism takes time.
posted by pwally at 4:05 PM on July 2, 2008

From my quick reading the assessments all seem to say the same thing; limited success.

Which is, to my mind, better than no success at all, though the Cato Institute seems to think otherwise. Of course I suspect that they wouldn't be happy no matter what.
posted by lekvar at 4:06 PM on July 2, 2008

The fundamental problem with universal healthcare is that demand is infinite, but the resources to supply that demand are not. There comes a point where care has to be denied; human lives aren't of infinite value. But making that call is extremely politically unpopular, so the budget grows and grows and grows.

I don't think the American system is really all that great. In general, I think healthcare based on a profit motive is a bad idea, because it's more profitable to treat disease than to cure it. And the insurance-based approach means that pricing information is not correctly communicated to the consumer, so they can't shop around for reduced rates for services.

But socialized medicine is even worse. There's no room for competition, innovation is stifled, and you end up with a typical bloated bureaucracy whose actual function is growing the bureaucracy, not treating patients. The service will either become very poor, the budget will grow to mammoth proportions, or some combination of the two. We're highly prone to economic wishful thinking, and healthcare is an excellent example.

No, I don't have a clear answer. I wish I did. But I'm morally certain that socializing it, as Massachusetts is doing, will end up being even worse than the messed-up system we have now. The system we have now works most of the time for most folks who use it, and a few people get really, really screwed. If it's socialized, it's gonna suck for everyone.
posted by Malor at 4:06 PM on July 2, 2008 [6 favorites]

But socialized medicine is even worse.

Practical evidence, please.
posted by TheOnlyCoolTim at 4:13 PM on July 2, 2008 [10 favorites]

The problem Malor, is that given the rising inequity of rich and poor, there are more and more people in the "few". I'd say a greater portion of the middle class could be lumped into the screwed category, or at least could possibly be screwed when they fall sick and the insurance companies start to deny coverage.

I'd rather deal with government red tape than getting sucker punched by the cold invisible hand of the market.
posted by zabuni at 4:13 PM on July 2, 2008

... and a few people get really, really screwed.

A few? How many uninsured Americans are there right now? How many americans have bull shit insurance? How many Americans are with insurers that will drop them if they are too unhealthy?

If it's socialized, it's gonna suck for everyone.

I'm enjoying my healthcare in Canada. I guess "suck" and "everyone" are broad terms, just like "a few".
posted by chunking express at 4:14 PM on July 2, 2008 [3 favorites]

Malor, the bloated bureaucracy of socialized medicine is with us here in the US in the form of the bloated bureaucracy of the private, for-profit insurance firms. The difference is that the waste and inefficiency of socialized medicine goes to ensuring that the systems works, whereas the waste and inefficiency of for-profit insurance goes to ensuring profits for CEOs, marketing, and the shareholders. The consumer is an afterthought.
posted by lekvar at 4:14 PM on July 2, 2008 [6 favorites]

Oh, and thanks for the great post, Weebot.
posted by lekvar at 4:15 PM on July 2, 2008

as one of america's 45 million people without health insurance, i think bloated and inefficient healthcare would be a step up from zero healthcare. but that's just me.
posted by sergeant sandwich at 4:22 PM on July 2, 2008 [12 favorites]

But socialized medicine is even worse. ... The service will either become very poor, the budget will grow to mammoth proportions, or some combination of the two.

...with the minor exception of every industrial democracy that has ever tried it.
posted by ROU_Xenophobe at 4:29 PM on July 2, 2008 [16 favorites]

The difference is that the waste and inefficiency of socialized medicine goes to ensuring that the systems works will ensure the profits for the CEOs, marketing, and shareholders of the government contractors who will actually carry out the work.

What, did you think the government actually does anything these days? The government as a collective entity couldn't pour piss out of a boot if the instructions were on the heel; not without putting out an RFP, going through a 12-month competitive bid, and paying a private company a billion dollars to do it for them.

The only way public healthcare won't turn into more of a morass than private healthcare current is, would be if someone actually disassembled the civil service and fixed it from the ground up. But I don't see anyone, anywhere, from any party, with the balls to take that thankless job on.
posted by Kadin2048 at 4:38 PM on July 2, 2008

Sorry, typo:

[...] The only way public healthcare won't turn into more of a morass than private healthcare currently is, would be if someone actually disassembled the civil service and fixed it from the ground up. [...]
posted by Kadin2048 at 4:40 PM on July 2, 2008

adipocere, It isn't just 50 little beakers, it's somewhat different cultures. Indeed state's rights originally meant "the right to repress black people". But progress is sometimes served by centralization and sometimes by decentralization. Today more progress can be achieved through decentralization, like ending the drug war, installing health care, saving social security, etc. You might imagine that decentralization will impede gay rights but even here the conservatives wield considerable national power. It isn't always best to let the states go their own ways, but today it is.

Malor, You don't have the foggiest clue. Insurance plus doctors handling insurance is like 30% of U.S. health care costs. Sure U.K. socialized health care sucks ass. But France has "single payer" while doctors are private practice, i.e. France says how much it will pay, if the doctor wants to charge more, he will tell you, and you must pay the difference. In the end, France has very powerful leverage on health care costs, may refuse to fund stupid care, etc. but people still have freedoms, unlike the U.K.

Fully socialized medicine is U.K. style 1984, yes. But no one is proposing that in the U.S. Single payer with consumers paying the difference is a good model for mathematical reasons, period. It also leaves people with considerable options and freedoms.
posted by jeffburdges at 4:41 PM on July 2, 2008

I think it is important to distinguish this from socialized medicine; we're not going to get anything like Canada's system anytime soon. The profit-motive is going to be a part of American health insurance for the forseeable future. What we need to pay attention to here is how subsidies and regulations can curtail the problematic aspects of the health insurance market, and whether we would need extend regulation into other areas of health care.

This is why these particular set of reforms are important: any federal healthcare proposal under President Obama — and maybe even President McCain, if Romney gets on the ticket — will draw from the lessons learned here.
posted by Weebot at 4:43 PM on July 2, 2008

Kadin2048, when you say, "will ensure the profits for the CEOs, marketing, and shareholders of the government contractors who will actually carry out the work," are you referring to the Massachusetts model or the Canadian, Japanese and European models? I know that the Mass. program in place now is feeding money into the same pockets that the overall US system does. I was contrasting the current US system against established, truly socialized medical systems that other countries employ.
posted by lekvar at 4:57 PM on July 2, 2008

There's no room for competition, innovation is stifled...
What competition do you speak of? Between hospitals? Between doctors? Between manufacturers? If you think manufacturers are spurred on to compete and innovate under the private healthcare system, you're wrong. HMOs are absolute shit to deal with and nearly impossible to navigate. My firm gets paid huge amounts of money by medical manufacturers and startups just to figure out where they can sell their product, how to label it, and how to get insurance to pay for it. We have people on staff where 50% of their job consists solely of checking insurer websites to see if they've changed their policies on various products.

...you end up with a typical bloated bureaucracy whose actual function is growing the bureaucracy, not treating patients
No, that bloated bureacracy is what we have NOW that makes it impossible for doctors to treat patients. Under private healthcare, your doctor has to have staff to manage contracts, check drug formularies, and check coverage and eligibility with literally hundreds of different insurers. Universal healthcare would take that all away and replace it with 1. That means your doctor wouldn't need an office since he wouldn't need to check if you're covered and billing would simply consist of sending all your bills to one place. Imagine that - medicine with minimal overhead. Oh right, we used to have that!

The service will either become very poor...
I don't know where you get the evidence that service will become poor. But overall health will be better because there won't be an economic advantage for treatment over prevention. That's the key! Under the current system, the doctor and the hospital only get paid when performing procedures and prescribing treatment. They get virtually nothing for dispensing advice, checking your health, and other preventative measures. With universal healthcare, doctors can do what they got into medicine for - to prevent first, treat second. In fact, we already have proof that universal healthcare has better outcomes and is more effective because it already exists in the US except it only kicks in when you turn 65. There have been plenty of studies that show elderly care through Medicare produces better outcomes, higher satisfaction, and at lower cost than employer/private insurance.

...the budget will grow to mammoth proportions
Got any studies to back it up?

---
My job consists of examining every level of the system to figure out how it works and explaining it to manufacturers and hospital administrators. Believe me when I say this system sucks and if tomorrow we had universal healthcare and I was put out of a job, I would be dancing in the streets. Ask any primary care physician what they think of universal healthcare and they'll tell you it's not perfect but it's still a hundred times better than what we have now.
posted by junesix at 5:01 PM on July 2, 2008 [15 favorites]

Another consequence of this Massachusetts reform is that the state appears close to full-scale taxpayer revolt. This November voters will be presented with a ballot measure which would abolish the state income tax.

If it passes, it could force the state to end programs like this one, because as a practical matter there's no way the state could raise property taxes and sales taxes enough to fully replace the lost revenue.
posted by Class Goat at 5:01 PM on July 2, 2008

But socialized medicine is even worse. There's no room for competition, innovation is stifled, and you end up with a typical bloated bureaucracy whose actual function is growing the bureaucracy, not treating patients.

Even though don't think it's fair to take it as an absolute that a state/social program has no room for competition or innovation, I'm not sure we have the cultural knowledge to make that work yet, so I'm willing to take it as a likely proposition that nationalizing health care providers is a bad idea.

However universal care is not necessarily socialized medicine. Even pinko socialist single payer in particular should in theory allow for competition between providers and financial incentives for innovation, because individual providers still compete for healthcare dollars.
posted by weston at 5:04 PM on July 2, 2008

I wish ikkyu2 was around to chime in on this... I'm curious about his thoughts.
posted by crapmatic at 5:17 PM on July 2, 2008

What, did you think the government actually does anything these days? The government as a collective entity couldn't pour piss out of a boot if the instructions were on the heel; not without putting out an RFP, going through a 12-month competitive bid, and paying a private company a billion dollars to do it for them.

Six days a week, the government delivers mail to my home. For a tiny fee, they take things I want to be somewhere else and put them there. Seems to work very well.

Then there's the military, which - when it's not being directed by utter pinheads - seems very capable, if very expensive.

There haven't been any major failures of the air-traffic-control system recently, which is actually kind of surprising, but I'm not complaining.

I could go on, but I guess you're not interested in the government's being able to do things. Enjoy your cave.
posted by Kirth Gerson at 5:21 PM on July 2, 2008 [3 favorites]

But socialized medicine is even worse.

Yes, all those longer lifespans and higher quality of life, lower mortality rates, etc. etc...boy would THAT suck.

Oh wait.
posted by emjaybee at 5:25 PM on July 2, 2008 [2 favorites]

As a resident, I haven't personally noticed much of a change (except for the cig tax, but I'll get to that). I was already insured, and I still am. It was tough on some of my friends who are in between college and a "real job", but if anything it forced them to get insurance that they really should have anyway. I was really hoping that this very fact (enrolling lots of healthy young people who are a smaller burden on healthcare services) would cause the premiums to stop rising at such a torrid pace. That doesn't seem to have happened, though...My premium increased 13% this year.

On balance, I really don't think it's a great program, but it's not a terrible one either. I do think that the burden on employers who elect not to insure their employees should be higher. If it hasn't changed, this is $295 per employee per year. My company is very generous with their contibution to healthcare, and they're paying more than $300 per employee per month to insure us just for individual coverage. Increasing this penalty steeply would be, in my opinion, a much more equitable and effective way of either reducing the state's burden or the state's revenue collection than this cigarette tax increase.

The increase in the cigarette tax irks me for two reasons: First, it's an unfair tax in that it collects from a portion of the citizenry (often a poorer portion) to pay for programs which benefit others besides said segment. I know that smoking likely increases the healthcare burden, but so do many other unhealthy choices like eating poorly, not excercising, etc. Unless we're going to tax cheeseburgers, or anyone without a gym membership, or those who come from a family with history of health issues, it's just an easy out. Also, this sets up a situation where the revenue from smoking is relied upon, to paraphrase one of our legislators using this mode of funding essentially means that the Commonwealth needs people like me to keep smoking in order to fund the health connector.

Tangent to Class Goat:

Another consequence of this Massachusetts reform is that the state appears close to full-scale taxpayer revolt. This November voters will be presented with a ballot measure which would abolish the state income tax.

If it passes, it could force the state to end programs like this one, because as a practical matter there's no way the state could raise property taxes and sales taxes enough to fully replace the lost revenue.

This simply isn't true. Ballot initiatives in MA are still subject to approval by the General Court, and there's just no way that legislators are going to let this happen. An identical initiative was passed some years back, and the Legislature killed it right quick. We have an incredibly high rate of incumbency in MA, so people obviously weren't upset enough to vote out their reps over it. Ain't gonna happen, for better or worse and regardless of what the voters say. (For the record, I am against the initiative)
posted by rollbiz at 5:36 PM on July 2, 2008 [1 favorite]

>There's no room for competition, innovation is stifled, and you end up with a typical bloated bureaucracy whose actual function is growing the bureaucracy, not treating patients. The service will either become very poor, the budget will grow to mammoth proportions, or some combination of the two.

But what is the function of a healthcare company? The purpose of any traditional company, first and foremost, is profit. As you mentioned, it is more profitable to treat diseases than to cure them. To that end, companies also prefer to become monopolies (towards bottom of page) wherever possible.* When I hear about the way some of the larger companies handle customer service, I can't help but wonder whether it's really so different from the bureaucracy people fear from universal healthcare. Sure, competition is great for innovation and prices, etc., but will that really be where private healthcare will take us? I feel like a lot of government programs end up not working out because we're spending the money elsewhere.**

Is there a way to keep a leash on the invisible hand so that we stay at the high-competition-low-prices-high-innovation stage? Can we do that and improve availability?

Maybe this doesn't have to be an all-or-nothing approach. Can every state have its own universal healthcare instead of the country as a whole? Can we have several, smaller, parallel state-run healthcare companies that are somehow forced to compete in order to exist? I'm just throwing out ideas.

*The link notes that monopolies need government help to force otherwise competitive companies out of the market. With the power lobbyists have today, It's not difficult to imagine.
**But see the amount spent on Medicaid, SCHIP, etc. How badly are these struggling and is it because of "bureaucracy"? Does the fact that these are monolithic mean universal healthcare has to be?
posted by Grimp0teuthis at 5:38 PM on July 2, 2008

But socialized medicine is even worse.

Canadian health care has many well-publicized limitations. Nevertheless, it produces health benefits similar, or perhaps superior, to those of the US health system, but at a much lower cost. Canada’s single-payer system for physician and hospital care yields large administrative efficiencies in comparison with the American multi-payer model.60 Not-for-profit hospital funding results in appreciably lower payments to third-party payers in comparison to for-profit hospitals61 while achieving lower mortality rates.62 Policy debates and decisions regarding the direction of health care in both Canada and the United States should consider the results of our systematic review: Canada’s single-payer system, which relies on not-for-profit delivery, achieves health outcomes that are at least equal to those in the United States at two-thirds the cost.

Subsequent discussion on Metafilter.
posted by Blazecock Pileon at 5:39 PM on July 2, 2008

Premiums and co-pays are going up

That statement in the FPP (while well intentioned and accurate as far as the link goes) might be misleading in general. For your average Massachusettsan, the premiums available since the new law went into effect are far, far lower than comparable plans in the past.
posted by moxiedoll at 5:47 PM on July 2, 2008

not without putting out an RFP, going through a 12-month competitive bid, and paying a private company a billion dollars to do it for them.

Funny, this is exactly how my company seems to do business. And most of the other companies I worked for. Maybe it's BUREAUCRACY that sucks and not government, hmm?


Also, isn't this thread supposed to be about the experiment in MA? How about some commentary about that instead of this insipid socialism vs. private b.s.?
posted by spicynuts at 5:48 PM on July 2, 2008

I must have missed the memo where they socialized all medicine in the UK. Last time I checked you most assuredly could buy insurance there (and most middle class people do) or have private care if you so desire.

I had arthroscopic knee surgery there, entirely private out of pocket with excellent care and results for less the then cost of the deductible on my US health insurance. The hospital gave me an all in one price up front, I paid it, they paid the surgeon and anesthesiologist, nurse etc and had I surgery the following week.
posted by fshgrl at 6:07 PM on July 2, 2008

I think it is important to distinguish this from socialized medicine; we're not going to get anything like Canada's system anytime soon.

Canada doesn't have socialized medicine. They just have the government give everyone health insurance. Not the same thing by a long shot. Socialized medicine = British NHS, not OHIP etc.
posted by ROU_Xenophobe at 6:20 PM on July 2, 2008

junesix et al, People fear the stupidities of U.K. socialized medicine where your visit a doctor, he says your'll be dead in 2 months, I can get you in in 6, or I can get you in next week if you go private. I don't feel this fear is unreasonable, but the solution is single payer without other restrictions. So the government say the payout for doing x on a patient of age y and gender z, while patents pay the rest. Such a system could provide reasonable health care to all, without restricting choice or creating a separate system for rich and poor (as happened in the U.K).
posted by jeffburdges at 6:33 PM on July 2, 2008

fshgrl writes "The hospital gave me an all in one price up front, I paid it, they paid the surgeon and anesthesiologist, nurse etc and had I surgery the following week."

And this is key. Half of the problem in the US is lack of insurance. But the other half, and maybe worse part, is lack of assurance.

Even with insurance, no one knows if their policy will be canceled if they actually need coverage, because they omitted a bout of mono twenty years ago, and that's a pre-existing condition that -- in some insurance compnay cost-cutter's opinion -- may have had some effect on your current condition.

No one knows if they'll "keep" coverage, but be denied care because it's "experimental", or get coverage too late, or think they're covered until a multi-thosand dollar bill arrives.

No one knows if they'll be covered, but only for "usual and customary" costs which just happen to be a fraction of what they've been billed.

No one -- not the doctor, not the hospital, least of all the patient -- knows what care will cost, what will billed, and whether the rate will be the rate the insurance company gets or the much higher rate that the hospital screws out of people who lack coverage.

No one knows, in the ER or the hospital bed, if accepting an aspirin means $154.23 added to the bill, or if refusing the aspirin is pointless because the mere act of offering it costs $145.12.

No one knows if their prescription is covered, or if they'll have to accept some not so equivalent drug from the insurance company's mysterios formulary.


No one fucking knows, and so even people with insurance are afraid to get care.

And so people get worse off, until they die -- and the insurance company keeps all their premiums without dispensing any money for care -- or they end up in an ER billing it to the public purse, or they get caught in the middle between insured and indigent, and just go bankrupt.

We need a plan that says, if you pay into the system, the system will be there for you when you need it.

No "pre-existing", no "experimental", no "usual and customary", no bullshit. Just straightforward coverage, the same as the CEO of Heartless Insurance Inc. or Senator So-and-so gets.

I guarantee that'll cut health costs (and increase productivity) simply because people won't be stressing their hearts and nervous systems, day in and day out, wondering, "do I have coverage?", "will I continue to be covered if I seek treatment?", "can I afford to take preventive care?"
posted by orthogonality at 7:05 PM on July 2, 2008 [13 favorites]

Yeah, if one could snap a finger and jump ahead a generation or two to some system, any system, that guarantees a minimum level of care to all people, those kids would look at our system with the same horror and embarrassment as we do with Jim Crow laws. Any new paradigm for health care is going to look like a disaster in the making to some people and not others, but something will give. Just a matter of time. I can tell you, though, that waiting times are going to get horrendous. Currently, physicians who work harder to be more accessible do so by having more available slots in their day and do so to some degree to be paid more. Once pay scales level off or drop there will cease to be enough incentive to see those extra folks and you'll see wait times go from bad to worse. That's not meant as a reason not to go to a different system, but more a perspective that you won't hear from most analysts or physicians in an interview.
posted by docpops at 7:33 PM on July 2, 2008 [2 favorites]

December 2005: The Republican [Mitt Romney] Who Thinks Big on Health Care .

March 2008: "Mitt Romney [aka Flip Romney] signed a Massachusetts law creating [mandatory health care] that he now distances himself from."

"As governor of Massachusetts, Republican presidential candidate Romney, 60, championed and signed a law mandating that everyone have health insurance by July 2007.

Some of the Massachusetts funding will come from a $295-a- worker assessment on businesses that don't provide health benefits and have more than 10 workers. Now Romney is distancing himself from the plan, the Boston Globe reported last month. This reflects a reluctance among Republicans to make health insurance mandatory and tax businesses to pay for it, the newspaper said."

posted by ericb at 8:17 PM on July 2, 2008

February 2007: Romney distancing himself from state health plan

"With signs emerging that his signature health-care plan faces hurdles, former Gov. Mitt Romney has begun to distance himself from the new law and is suggesting that Democrats will be to blame if the plan falters.

... At recent political appearances, Romney has subtly lowered expectations for the law he championed as governor.

... The plan for statewide, near-universal health coverage was the centerpiece of Romney's administration, and it has become a key part of his presidential resume.

... Romney has long said that the plan would suffer hiccups. But he now appears ready to blame Democrats for any of the plan's shortcomings...

... Romney's recent comments underscore how sensitive an issue the plan is with to conservative audiences, whose support is crucial to his presidential aspirations. Many conservatives view the concept of requiring individuals to purchase health insurance - and penalizing some businesses that don't offer it - as anathema to their principles.

posted by ericb at 8:24 PM on July 2, 2008

Six days a week, the government delivers mail to my home...Then there's the military...There haven't been any major failures of the air-traffic-control system...I could go on...

As will I.

Our children receive free, tax-subsidized education (K through 12) and low-cost state public college education.

We have access to free libraries.

We subsidize our fire and police forces -- who operate and respond to emergencies without cost.

Our roadways are maintained ... and in certain areas plowed when covered by snow; cleared when landslides occur.

Many municipalities pick-up garbage and recyclables for "free" (albeit tax-supported).

I suggest watching Michael Moore's documentary 'Sicko' for more examples. The film's Prescription for Change. [previous MeFi thread].
posted by ericb at 8:36 PM on July 2, 2008

I think the point about the demand for health care being nearly infinite is a good one. Think about the kind of massive health care that, say, Ted Kennedy could command. Think about everyone wanting a new heart.

Basically, unless they're brave souls, willing to face down the Reaper, or taken suddenly by accident, massive stroke, and so forth, the dying can request some awesome levels of expense to get even another day of life. And once treatment becomes established as a "right," then the lawyers come. Hey, if you didn't like insurance companies making medical decisions for you now, just imagine how much doctors will love lawyers making medical decisions for them. And the costs rise yet again.

Until we track down the costs that go into medical care, both obvious and subtle, and decide how we can lower them (or if we will at all), this sort of thing looks just like another budget problem. Sure, we'd all like cheap medications, but then you realize that the limited patent we grant to Big Pharma funds the research - some estimate that it can take half a billion dollars to get a new drug to market. Some of that is due to stringent testing required. We may be faced with some ugly choices: do we want to take that way, taking the incentive with it, and leaving Big Pharma with little reason to make new drugs, since they would have a hard time recouping their losses? Or do we want to relax the testing? "Crap, Ted, it worked in a batch of thirty mice. We gave it to this old homeless dude with a bottle of Thunderbird, and he didn't croak by the next day. Good enough, let's issue a press release!" We face that choice, and similar choices for our medical professionals (If we pay them less, can we get away with it by making med school free? If so, who pays the professors to teach?), for medical equipment, etc.

Until all of that rah-rah Singularity stuff happens and we have genetically engineered cattle squirting out gallons of AZT, with quadrillions of assemblers busy cranking out crash carts built out of the plasma-sorted elements and simple compounds mined from landfills, while machine-minds (glowing white hot from their processing despite continual circulation of liquid helium through their cores) just do all of the protein-folding and metabolic interaction in their shiny metal heads, it seems that all of the resources that go into medical care (time, education, smarts, research, rare compounds, legal liability, etc.) will be in short supply.
posted by adipocere at 8:39 PM on July 2, 2008

But socialized medicine is even worse. There's no room for competition, innovation is stifled

Really? I suggest you tell that to Canadian Nobel winners, as well as the incredible doctors at Sick Kids (the Hospital for Sick Children, in Toronto).

But socialized medicine is even worse. ... The service will either become very poor, the budget will grow to mammoth proportions, or some combination of the two.

...with the minor exception of every industrial democracy that has ever tried it.

But what works everywhere else on the goddamn planet that does it couldn't possibly work in 'merika.

But what is the function of a healthcare company?

To provide healthcare. Duh.. Profit should be a secondary motive.
posted by dirtynumbangelboy at 8:52 PM on July 2, 2008

We need a plan that says, if you pay into the system, the system will be there for you when you need it....No "pre-existing", no "experimental", no "usual and customary", no bullshit. Just straightforward coverage, the same as the CEO of Heartless Insurance Inc. or Senator So-and-so gets.

One of the primary points of Michael Moore's 'Sicko' documentary which focuses on those who are insured and have been denied health care and/or made to "jump through hoops" for basic response when faced with health issues. From the start the documentary mentions that its focus is on the insured and not the uninsured in the U.S.
posted by ericb at 8:55 PM on July 2, 2008

Here's the thing. If I pay you for a service, I expect that service to be rendered unto the terms of the contract.

Unfortunately, most HMO contracts in the USA are so full of weasel words and slippery language that it's possible for insurance companies to get out of damn near anythign. That needs to change.

No.. fuck that. The concept that keeping everyone at a basic level of health is anything other than the government's--that is, the people's--responsibility is what needs to change. Period. There is no argument on this; all arguments to the contrary boil down to "but waaaahhh I don't wanna pay for someone else."

Suck it up. We're all in this together, and keeping each other healthy makes us all better. Most of the rest of the world has already learned this lesson. Why is the USA stuck in the 19th century?
posted by dirtynumbangelboy at 9:00 PM on July 2, 2008 [2 favorites]

But socialized medicine is even worse. There's no room for competition, innovation is stifled...Really? I suggest you tell that to Canadian Nobel winners...

And to the late Tommy Douglas (Premier of Saskatchewan) who introduced universal public healthcare to Canada.
posted by ericb at 9:06 PM on July 2, 2008

*One of the primary points of Michael Moore's 'Sicko' documentary which focuses on those who...*
posted by ericb at 9:10 PM on July 2, 2008

Consistently interesting insider blog on Chapter 58, the Massachusetts health care law. Make sure to read the comments, where people consistently complain about the mandate, demand real cost control, &etc.
posted by alms at 9:11 PM on July 2, 2008

Just wanted to point out that, as far as innovation-through-competition goes, the Federal government, through the NIH, is by far the largest single source of R&D funding in the United States. So it's not like medical innovation will grind to a halt if we were suddenly without an unfettered health market.
posted by Weebot at 9:25 PM on July 2, 2008

juffburdges: Not sure why that was directed at me. I'm all for a hybrid system (single payer without restrictions on additional private care). In fact, I think that's as close to ideal as well.

spicynuts: Fair enough. So here's my take on Massachusetts.

I applaud Massachusetts for experimenting with a new system and getting the state involved with offering affordable coverage. But I don't think what they've done is going to help one bit.
1. Establishing a swap meet for healthcare is not doing anyone any good. Forcing everyone to buy healthcare from a marketplace assumes that the core problem was simply an inefficient market for healthcare. I don't buy that at all - the problems with healthcare are obviously much deeper than having more provider and plan choices. People need care that makes sense and is cost-effective, not more choices about how to get it.
2. Providing tax credits to low-income families as a form of assistance is just plain dumb. If I'm living from paycheck to paycheck, I'm much more concerned about making my monthly expenses than what I'm going to be paying at tax time. The last thing I need is a couple hundred dollars in monthly expenses tacked on with the promise of tax credits in April. Only rich politicians could have dreamed up this part. Completely idiotic.

So at the end of the day, Massachusetts' plan consists of a convoluted health insurance stock market and tax breaks for the super-poor. There isn't a single measure to improve some of the core problems in healthcare, namely, over-utilization of services, misalignment of the payment structure, lack of a global electronic medical record system, and lack of performance and quality metrics.

With all that said, I think Massachusetts could use the marketplace as a short-term measure to transition to universal healthcare in the long-term. The marketplace is already there, now the state just needs to set itself up as a payer/insurer. Implement the lessons that helped the VHA to succeed: pay-for-performance metrics and rates, VistA electronic medical records, research and invest in long-term patient relationships and care. Then go parade it to the employers to drop the private insurers and get lower cost insurance with the state. The long-term economics of universal healthcare makes sense, the state just needs to make the time and investment to do it.
posted by junesix at 10:21 PM on July 2, 2008

I can tell you, though, that waiting times are going to get horrendous.

To expand upon docpops' point, there is some evidence that Massachusetts doesn't have enough doctors to see all those people who suddenly have access.

Remember that doctor shortage everyone was talking about 15 years ago? Kinda funny how we forgot all about that once people stopped being able to afford health care.

Assuming we have a magical sea change and we pass a "perfect" health care reform package the day after Obama is elected, it's going to take a *minimum* of 10 years for all the other elements that need to correct to do so. That's 10 years of things being a little worse before they get better. That's a lot of time for the Kadin2048s of the world and the "Government-always-fucks-everything-up" Brigade to vote those of us who are trying to fix things out of office. I'm not sure how we're going to get around this fact and it depresses me quite a bit.
posted by Slarty Bartfast at 10:36 PM on July 2, 2008

The only excuse to make comments like Malor's is... well, there really is no excuse. The salubrious and money-saving effects of single-payer are well-enough known and broadly-enough broadcast that the only explanation is that Malor, like millions of Americans, simply doesn't want to know, or doesn't want you to know. It's time to start attributing to malice when incompetence is inexplicable.

I mean really, the only reason to oppose it at this point is an ideological opposition to collective solutions for collective problems. Enough with the "but their systems suck!" lies.
posted by Pope Guilty at 11:25 PM on July 2, 2008 [1 favorite]

Just wanted to point out that, as far as innovation-through-competition goes, the Federal government, through the NIH, is by far the largest single source of R&D funding in the United States. So it's not like medical innovation will grind to a halt if we were suddenly without an unfettered health market.

Yeah, the people who claim that socialising medicine would kill medical innovation somehow ignore the fact that our military is the sole customer of a lot of companies, and somehow that situation hasn't killed off competition and innovation in blowing lots of people to kingdom come.
posted by Pope Guilty at 11:27 PM on July 2, 2008

I don't want commie, pinko, socialized medicine, I just want the same level of health insurance my representatives get. You know, those health plans payed for by my commie, pinko, socialized taxes.
posted by ryoshu at 11:46 PM on July 2, 2008 [2 favorites]

I just want the same level of health insurance my representatives get.

Exavtly. Federal Employees Health Benefits Program.

"Every member of Congress should be covered by a private health care plan just like the rest of us. Members of the house pay $300 a month and Senators about $600 a month for their own pharmacy, nurses and doctors, and can get a physical, x-ray or electrocardiogram without ever missing work. Taxpayers contribute about $2 million toward the congressional health-care system. Still wonder why we can't get health care reform?"^*
posted by ericb at 12:04 AM on July 3, 2008 [1 favorite]

Exavtly...

Exactly -- excuse the vodka. ; )
posted by ericb at 12:12 AM on July 3, 2008

But socialized medicine is even worse. There's no room for competition, innovation is stifled, and you end up with a typical bloated bureaucracy whose actual function is growing the bureaucracy, not treating patients. The service will either become very poor, the budget will grow to mammoth proportions, or some combination of the two. We're highly prone to economic wishful thinking, and healthcare is an excellent example.

Heh. What is managed healh care if not bloated with inefficient "cost controlling" bureaucracy? A government run system would be outsourced to exactly the same people so this is a zero-sum argument.

Socialized medicine would never work in America (cause America is different), but it works wonderfully in lots of other places. The "socialized" health care here in Sweden, for example, is pretty goddamned good. Expensive as a hell (but less so than in America), but effective and universal.

I see what may tax money goes to and it's going to to a good thing, so I don't get so worked up about "socialism" aspect of it.
posted by three blind mice at 1:32 AM on July 3, 2008

The only excuse to make comments like Malor's is... well, there really is no excuse. The salubrious and money-saving effects of single-payer are well-enough known and broadly-enough broadcast that the only explanation is that Malor, like millions of Americans, simply doesn't want to know, or doesn't want you to know. It's time to start attributing to malice when incompetence is inexplicable.

That was pretty harsh Pope Guilty. And unfairly so.

The very basis of a single payer system is a sense of community and shared responsibility. This exists in a tiny country like Sweden with a more or less homogenous population, close borders, and a well-defined cultural identity. People do not mind so much paying taxes to support other people. The whole Swedish welfare model would not exist otherwise.

Even in the UK where these is a larger, more diverse population, the NHS is a matter of national pride (or shame depending on the state of it.)

The situation in America is entirely different. America is a country of individuals. The idea that a single payer system would work in America - without strong-arming half the population into unwilling submission - is lunacy. America needs to come up with an American solution however distasteful that may be to you as an individual. Malor's comments - agree with them or not - accurately reflect the core beliefs of a significant number of Americans which must be part of any "American" solution.

Malice, if there is any to be attributed, lies with those whose ideological purity would impose a single payer system without compromise on an unwilling population.
posted by three blind mice at 1:46 AM on July 3, 2008 [2 favorites]

The fundamental problem with universal healthcare is that demand is infinite, but the resources to supply that demand are not.

How's that? I live in a country with "socialized" healthcare. I don't go to the doctor or dentist unless I need to. It's not because it's free (or almost free) that I enjoy sitting in a waiting room. Medical demand is probably one of the best documented phenomena around. X percent of the population gets cancer each year, X percent gets pregnant, X percent will need heart surgery. I don't think you'll find drastic changes from year to year, unless a nuclear reactor blows up somewhere.

To dispel a few USian myths about "socialized" healthcare.

In most European countries, healthcare is seen as an insurance (Bismarckian model) as opposed to a welfare program (Beveridge). This has profound impact on the philosophy of the model, because as an insured person, you have rights, whereas in a Beveridge model of welfare, you are granted a favour that can be suspended at any time.

This means:
- anyone can visit any doctor he or she wants to visit. There are no suits deciding where and when I can find medical help (this is quite contrary to the notion that most Americans have of the vilified "socialized medicine"). If I'm not happy with the care I receive in a certain hospital or from a certain doctor, I can go elsewhere. The only thing my insurer does, is pick up the bill. In fact, this situation is a lot better than in the US, where an insurer can often tell you to which doctor you can or cannot go under the terms of your contract.

- there actually is competition between individual hospitals/doctors. The fact that they get paid by the health insurance doesn't mean that they work for the (bureaucrats of the) health insurance. They get paid because they have patients. More patients = more pay.

- no one can ever be uninsured because of a pre-existing condition.

- the only thing "socialized" about 'socialized healthcare' is that the premiums are calculated based on income (I believe employees pay about 18 % of their wages toward social security in general, which covers pension, unemployment, healthcare, vacation money and child support). So yes, people who make more money pay more for health care. Of course, it's this basic form of solidarity that irks most Americans: "I ain't gonna pay for no welfare queen's doctor's visits, goddammit".

- the overall cost of healthcare in most EU countries with socialized healthcare is lower than in the US, because people can actually go to a doctor with banal medical conditions before they develop numerous complications that require expensive care. Prevention is the cheapest form of healthcare available.
posted by NekulturnY at 3:42 AM on July 3, 2008 [1 favorite]

• Link to this week's NPR series of stories on healthcare in Europe.
• Interactive chart comparing US healthcare with European plans.
posted by Thorzdad at 5:04 AM on July 3, 2008

Just to counter some of the FUD on this thread about the NHS (the British system):

1: One of its major benefits is that it's cheap. The British government spends less per head (and a lower percentage of GDP) on healthcare than the American one (combining Federal and State). And for fellow Brits, this is true even with New Labour's increases in spending.

2: The bureaucracy cost is low. 5% of spending. Which compares to the very best the private sector has ever done (and is pretty good by public sector standards).

3: In terms of research we more than hold our own with the US per capita and oustrip them in terms of return for spending. And most of the US research that isn't pharmaceutical companies trying to brute-force all possible drugs comes from the NIH (i.e. public funding).

4: Private health insurance in the UK is both available and pretty cheap. Largely because if the private sector really screws up you end up back in the hands of the NHS. For that matter the NHS is good enough that the percentage of the population that bothers with private insurance is in single figures. (I seem to recall it's about 4% but don't quote me on that one).

5: Find me a single patient in the last 10 years who has been told he'll be dead in two months but needs to wait six for surgery. I'll find you either a doctor who was lying or a Hospital Chief Executive who has been sacked for incompetence. Yes, we have waiting lists (currently hospitals get rapped across the knuckles for a more than 18 week from GP referral to treatment - and that includes all diagnostic testing. And there are much tighter limits for anything that's immediately life-threatening). Yes, they are still longer than I would like - but I'd like to see any evidence at all that jeffburges isn't simply making things up.

6: As for choice, that's been one of NuLabour's great goals. Three weeks ago I needed to see a consultant for something. So I picked one by name who was not from one of the normal hospitals the GP refers to. My sister has a serious and complex problem with her heart. In the US unless you had the money (and we don't), you wouldn't even get the chance to be treated in one of the best hospitals in the world for paediatric care. My sister was referred there and consequently is still alive and thriving.

Healthcare in most countries works under the normal rules: Good, fast, cheap - pick two. France, Germany, Sweden, and others have thrown out cheap. Britain has thrown out fast (which impacts good due to time-critical issues) and prioritised cheap. The US is neither cheap nor good. And fast is debatable - it's fast when you can get it at all.
posted by Francis at 5:07 AM on July 3, 2008

I've just realized that the US suffers from a common character flaw typical of addicts: terminal uniqueness. We'd rather die or destroy the world than acknowledge that anyone has something to teach us, that methods used elsewhere might work here.
posted by anotherpanacea at 5:21 AM on July 3, 2008 [6 favorites]

I live in Australia which has a public medical system along with a parallel private system. I'll give you a brief rundown of some recent events from a car crash I had:

* Hobbled into the emergency room around 11:15pm
* Triage took my case history
* Got ushered through to the ED about 11:45pm
* Nurse came around shortly after
* Doctor took a look at the wounds, ordered an x-ray for my pelvis, knees and femurs
* Transferred to radiology about an hour later
* Doctor found nothing wrong with the bones after getting back the shots a few hours later
* Doctor cleaned and sutured my wounds
* Nurse dressed them a short while later
* Discharged at about 5:45am and was taken home

I didn't pay a penny at the hospital. No co-pays. No worries about whether I'm covered by insurance. No hidden costs. The worst thing I've been hit with financially is a $30 bill for the crutches I hired. I pay 1% of my income (~US$400/year) in Medicare.

So about six and a half hours from admitting to going home.

I have private health insurance but it's specifically there if I need to have an elective procedure without having to wait (i.e. if I'm in pain but it's not life threatening I won't have to spend 6-18 months doped up waiting for an op) which is the only thing Medicare won't do and to help pay for my optical and dental requirements. I pay about A$720 a year into that.

Even if I do have a procedure performed under my private health insurance there's still a chance (albeit a small one) there might be a gap between how much the specialist charges and how much my fund will pay towards it.

Where do you think I've received more value from?

Anyone who doesn't think that a public health system in some form is a good idea needs to be slapped upside the head.
posted by Talez at 5:33 AM on July 3, 2008

A faculty union of which one must be a member in order to work in the state, working without a contract for three years getting a temporary "agreement" for one year that gave us back pay increases which we may lose because of no new contract in the works, all in order to have health benefits in a state that now requires universal coverage and is talking about increasing the costs of those benefits to those who are working for those benefits without a contract and a chance of actual reduction in pay ...

Only a little bitter this morning reading this ...
posted by aldus_manutius at 5:47 AM on July 3, 2008

Malor's comments - agree with them or not - accurately reflect the core beliefs of a significant number of Americans which must be part of any "American" solution.

Key word: beliefs. Malor's comments do not match reality.

Malice, if there is any to be attributed, lies with those whose ideological purity would impose a single payer system without compromise on an unwilling population.

Mm, yes, the same way that ideological purity imposed desegregation without compromise on an unwilling (large segment of the) population. Proper healthcare is a human rights issue.

The problem, of course, with a 'hybrid' (two-tier) system is that the upper tier (privately paid) will naturally attract the doctors who can command the higher salaries. These often tend to be the better doctors. We already see this in Canada; doctors and nurses leave here to go work privately in the USA for scads more money than they can make here. Where this leaves the government-paid tier of healthcare is tolerably obvious.
posted by dirtynumbangelboy at 6:32 AM on July 3, 2008 [1 favorite]

But socialized medicine is even worse.

The socialized medicine/healthcare I receive in Germany has markedly improved the quality of my life. Seriously, it works. It isn't perfect, but it is much better that the complete cluster-fuck of a system that is in place in the US. I've had many conversations with other American expats living in Germany, the UK, France and Scandinavia who have come to the same conclusion, especially those who have needed it. I can only speak from my own experience, but I am very very grateful for socialized medicine. It is probably the main reason why I may never move back to the US.
posted by chillmost at 6:39 AM on July 3, 2008

I am always grateful for the NHS, especially when compared with (from what I have heard) the fiasco which is US medical insurance. However, it is suffering from some of the problems that Malor has identified. Demand is increasing, as is cost. This is an unsolvable problem, as the better we are at keeping people alive, the longer they live and the more healthcare they require. It will take a long time (and perhaps divine inspiration) to work out a solution to this fundamental problem.

New Labour have decided to 'fix' the NHS by repeatedly spending (wasting) huge amounts of money on it, setting ridiculous (sometimes damaging) targets, destroying the education of young doctors, introducing the pointless and expensive patient choice initiative, and then attempting to blame the doctors when it all goes wrong. Lets not forget the mismanagement of GP contracts, where the doctors are first offered extra money if they hit targets, then get criticised for being "greedy" when they hit them and claim the rewards! New Labour have also been criticised for closing hospitals and maternity wards all over the country.

And to think I've got this far without mentioning the complete disaster of the NPfIT (more).

Whoops, that turned into something of a rant. My apologies, please get back on topic.
posted by iso_bars at 7:22 AM on July 3, 2008

Assuming we have a magical sea change and we pass a "perfect" health care reform package the day after Obama is elected, it's going to take a *minimum* of 10 years for all the other elements that need to correct to do so.

Not necessarily.

Dear Canadian physicians,

You may have noticed that we put in that single-payer thing a few months ago, so there's no more dealing with a bunch of nasty insurance companies. But we find we're a bit short on docs.

Wanna come down here for a bit? We'll send up some people to give you our standard licensing exam, which you shouldn't have any problem with. When you pass, we'll hand you a green card and arrange contacts with several practices and/or hospitals that pay pretty good. Or, if you want, we can arrange for you to have a half-time position for three or four years so you can travel around at your leisure.

(repeat beyond Canada)
posted by ROU_Xenophobe at 8:12 AM on July 3, 2008

This is very interesting, particularly coming as it does so close to the standoff in Congress over physician pay cuts in Medicare. For those who don't nerd out on the wonky details of state and federal health care reform, both the Massachusetts experiment and the current Medicare physician cuts illustrate two competing policy positions in the U.S. around reforming the system. One on hand, you have a bunch of reformers who say, The primary issue plaguing the markets is access; we need to get everyone in a position to have access to medical care, and the rest will take care of itself--whether that's Medicare-for-all, expanding Medicaid and SCHIP to cover more of the middle class, or reforming insurance markets. On the other hand, you have a bunch of health economists jumping up and down, pointing to the steep line that is the escalating per-capita health care costs over the past 50 years in this country, and saying, Look, the fundamental issue is that costs are rising too fast, and the access issue is a direct result of being priced out of health care. Increasing access won't help [or will, but only in the very-short-term], because it'll just bankrupt the system if we don't get our arms around how to slow this cost growth. These people tend to agitate for things like pay-for-performance, or global caps on spending, or nifty new disease management programs, and so on. They definitely don't get much press or attention, though, as most things they advocate are the unpleasant realities that neither politicians nor voters want to really think about. The Sustainable Growth Rate (SGR)--an automatic cut in physician rates every time that utilization rose too far, to force the Medicare program to only grow its physician costs at a "sustainable" rate every year--has thus for been politically totally unworkable.

I think both the initial findings coming out of Massachusetts (which tried to implement UHC through the private market and insurance companies) and the continuing struggle over the SGR in Medicare (which is the model of single-payer that most Americans point to as a model) lend some pretty strong support to the faction of health care reformers who insist that you can't fix health care in this country without grappling with how to slow costs. How to do so is obviously the $10 billion dollar question, but any intellectually honest attempt to fix the system is going to have to figure out how to do it.
posted by iminurmefi at 8:20 AM on July 3, 2008 [1 favorite]

Dear Canadian physicians,

[snip]

Wanna come down here for a bit?

Please don't. We have enough difficulty keeping our own physicians as it is. How about you take those nifty licencing exams, and make it simpler for overseas doctors who have already moved to the USA to practice medicine? (And yes, believe me, I'm aware that we need to do that here to. Shit you not, I had a cab driver the other day who was a cardiologist back home, but the hoops he had to jump through here to even get close to writing an exam were ridiculous.)
posted by dirtynumbangelboy at 8:33 AM on July 3, 2008

Oops.

lend some pretty strong support to the faction of health care reformers who insist that you can't fix health care in this country without grappling with how to slow costs.

Easy-peasy. Stop making healthcare a profit-driven business.
posted by dirtynumbangelboy at 8:34 AM on July 3, 2008 [1 favorite]

DNAB, would you consider Medicare a profit-driven business? It doesn't involve insurance companies at all; in fact, it's as close as the U.S. can get to the Canadian model.

Which is exactly my point in bringing it up: both the MA Connector and Medicare do seem to be showing that merely covering people with some amount of guaranteed care isn't enough to fix everything.
posted by iminurmefi at 9:41 AM on July 3, 2008

The very basis of a single payer system is a sense of community and shared responsibility.

Nonsense. The basis of single payer is that single payer works; it provides similar or superior care for a fraction of the cost.

The situation in America is entirely different. America is a country of individuals. The idea that a single payer system would work in America - without strong-arming half the population into unwilling submission - is lunacy. America needs to come up with an American solution however distasteful that may be to you as an individual.

American exceptionalism is never quite so irritating as when it's being used to suggest that changing things for the better is unamerican.

Malor's comments - agree with them or not - accurately reflect the core beliefs of a significant number of Americans which must be part of any "American" solution.

Which is irrelevant, because they are wrong. They are factually incorrect. They are not connected to reality. The proper response to such views is education, not consideration. By your logic, we should teach creationism, since most Americans reject evolution.

Malice, if there is any to be attributed, lies with those whose ideological purity would impose a single payer system without compromise on an unwilling population.

That's one of the most disgusting things I've heard recently. Supporting a system which leaves 15% of the population without healthcare is not malicious, but supporting a system that gives those people the healthcare they need is malicious? Your conception of malice is broken beyond repair.
posted by Pope Guilty at 9:58 AM on July 3, 2008 [3 favorites]

Which is exactly my point in bringing it up: both the MA Connector and Medicare do seem to be showing that merely covering people with some amount of guaranteed care isn't enough to fix everything.

Ever dealt with Medicare? It's run like a for-profit insurance company, complete with trying to deny coverage whenever possible. Medicare is not a good model.
posted by Pope Guilty at 10:00 AM on July 3, 2008 [1 favorite]

Pope Guilty, if Medicare isn't a good model, I'm honestly confused about what you're advocating for here. (Are you perhaps thinking of Medicaid instead?) Medicare is exactly what you get when you take the Canadian system and implement it in the US.

If you're pro-single-payer, what exactly is it that you would change from the Medicare model? How would you improve upon it?
posted by iminurmefi at 10:04 AM on July 3, 2008

Because Medicaid is needs-based, while Medicare is for seniors.

The way the rest of the world does it is that the government simply pays for healthcare (with, yes, some exceptions). Done. That's it. There isn't anyone else involved, except--in Canada, at least--to a) provide services not covered by government healthcare (e.g., certain forms of psychotherapy, depending on your province) and b) pay for those services which are not covered (e.g. private insurance paying for elective private rooms in hospitals).

That's it.
posted by dirtynumbangelboy at 11:11 AM on July 3, 2008

The situation in America is entirely different. America is a country of individuals. The idea that a single payer non-segregated education system would work in America - without strong-arming half the population into unwilling submission - is lunacy. America needs to come up with an American solution however distasteful that may be to you as an individual.

Hmm. Reads a little differently there, don't it? Said it before, will say it again: basic decent healthcare is a human right.
posted by dirtynumbangelboy at 11:12 AM on July 3, 2008

Speaking of Canada:

Chrysler, suffering from slow sales of its minivans, decided to close its St. Louis plant, leaving minivan production in Canada only. Why? Canada's national healthcare system makes each vehicle $1,000 cheaper to produce.

posted by Kirth Gerson at 12:00 PM on July 3, 2008

And that is probably the only thing that could ever cause proper healthcare to happen in the USA; when IBM and so on realize the mind-numbing amount of money they will save with a real healthcare system (which they probably alreayd have; now it's time to do something about it), I'm sure that their pet Congresscritters will start agitating pretty damn quick.
posted by dirtynumbangelboy at 12:18 PM on July 3, 2008

Dear Canadian physicians,

You may have noticed that we put in that single-payer thing a few months ago, so there's no more dealing with a bunch of nasty insurance companies. But we find we're a bit short on docs.

Wanna come down here for a bit? We'll send up some people to give you our standard licensing exam, which you shouldn't have any problem with. When you pass, we'll hand you a green card and arrange contacts with several practices and/or hospitals that pay pretty good. Or, if you want, we can arrange for you to have a half-time position for three or four years so you can travel around at your leisure.

This would require rewriting the licensure laws as they exist. Which will probably happen, of course, but it require a couple of legislative sessions, then recruitment, training, moving people down here. And then, this is only one tiny problem we'll face. Hundreds of thousands of out of work insurance company workers. Pharmaceutical companies that will have to adjust to smaller profits and marketing regulations. The "catch-up" health care of 42 million who've been going without care. As I said, 10 years.

Just for the record, I am totally in favor of a big government solution to this problem. As has been illustrated by the Massachusetts experience, I expect that people are going to perceive that things are getting worse until they get better. How do you see real reform all the way through when we have a representative democracy with a history of short-sightedness and an electorate that thinks smaller government is better and who get to a vote an entirely new administration in every 4 years?
posted by Slarty Bartfast at 1:44 PM on July 3, 2008 [1 favorite]

From the inside, the Massachusetts healthcare system is amazing: fair, reasonable, affordable, and very much worth paying and fighting for. It's *real* health insurance that covers preventative care, specialists, prescriptions, mental health appointments, and dental/vision care. When you're sick, you can get the treatment you need without forgoing groceries for the week.

Full time employees with traditional companies and the destitute have always been fine-- employer sponsored plans and Medicaid pretty much covered it. But working individuals and families who fell outside of this range were really screwed. In 2002, similar individual insurance coverage for a 20-something MA nonsmoker in good health cost $300 a month. An individual plan with a $1500 deductible and a coverage limit under $10000 was $100 a month. If you're a freelancer, if you're working at a small business, if you're temping, what do you do? You starve, you gamble, or you go without. You have a little bit of means, but if something goes wrong, you lose your house. This is how health-related bankruptcies skyrocketed.

It's disappointing that Mitt Romney has been distancing himself from the greatest accomplishments of his political career here in Massachusetts. I, in my naivete, still believe the *true* Romney is the frugal, libertarian-minded, live-and-let-live attitude he showed here. Spend money on our most important priority: health, cut government waste, support a woman's right to choose, defend stem cell research, support gay marriage, and leave the wacko religious right hatespeech out of the Republican party.
posted by Gable Oak at 10:34 AM on July 4, 2008 [1 favorite]

Mitt was here? Actually in the Commonwealth? I thought he spent his whole term elsewhere, gathering support for his next campaign and badmouthing Massachusetts.

I hope that's the last time we elect a hairdo Governor.
posted by Kirth Gerson at 4:21 PM on July 4, 2008

I left this page in despair. And then I came across a description of System Justification Theory, and the heartless indifference seemed more understandable. From Wikipedia, my emphasis added:

System justification refers to a social psychological tendency to defend and bolster the status quo, that is, to see it as good, fair, legitimate, and desirable. A consequence of this tendency is that existing social, economic, and political arrangements tend to be preferred, and alternatives to the status quo are disparaged. System justification refers, therefore, to an inherently conservative tendency to defend and justify the status quo simply because it exists, and sometimes even at the expense of individual and collective self-interest.
posted by Idcoytco at 11:19 AM on July 5, 2008