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March 6, 2009 7:43 AM   Subscribe

The diagnosis was only the first shock. The second came a few weeks later, in an Aug. 5 letter from Pat's health-insurance company. For six years — since losing the last job he had that provided medical coverage — Pat had been faithfully paying premiums to Assurant Health, buying a series of six-month medical policies, one after the other, always hoping he would soon find a job that would include health coverage. Until that happened, "unexpected illnesses and accidents happen every day, and the resulting medical bills can be disastrous," Assurant's website warned. "Safeguard your financial future with Short Term Medical temporary insurance. It provides the peace of mind and health care access you need at a price you can afford." [But] diagnosing and treating an illness may not fall neatly into six-month increments. While Pat had been continuously covered since 2002 by the same company, Assurant Health, each successive policy treated him as a brand-new customer. In looking back over Pat's medical records, the company noticed test results from December, eight months earlier. Though Pat's doctors didn't determine the precise cause of the problem until the following July, his kidney disease was nonetheless judged a "pre-existing condition" — meaning his insurance wouldn't cover it, since he was now under a different six-month policy from the one he had when he got those first tests..... I tried to talk to Assurant for this story. Its only response was a written statement from Scott Krienke, senior vice president for product lines: "Due to privacy regulations, we cannot discuss the specifics of any of our customers' coverage."
posted by orthogonality (243 comments total) 12 users marked this as a favorite

 
It's a dodge, certainly, but he's correct in not discussing the specifics of the patient's coverage. This is a great example of what's wrong with our health care system, but is not terribly surprising, unfortunately. 20:1, had they discovered and diagnosed within the same term, the insurance would not have renewed at the next six month cycle.
posted by Pantengliopoli at 7:50 AM on March 6, 2009


What was it that one guy said... oh yeah. God damn America.
posted by showbiz_liz at 7:50 AM on March 6, 2009 [2 favorites]


let's go single payer and kick the parasites like assurant health out of our health care system for good
posted by pyramid termite at 7:51 AM on March 6, 2009 [24 favorites]


if Pat gets sick enough to need dialysis, as he well may, the Federal Government will pick up those staggering costs under the Medicare program for end-stage renal disease.

The whole problem with American healthcare in a sentence. It would be hilarious if it weren't so tragic.
posted by game warden to the events rhino at 7:52 AM on March 6, 2009 [5 favorites]


I see why Americans don't bother paying for insurance.
posted by chunking express at 7:53 AM on March 6, 2009 [4 favorites]



Sorry to hear that. Sounds like he has been using a short term policy as a long term solution. Each contract is a new contract. IANAHMO, so get a lawyer.
posted by lothar at 7:54 AM on March 6, 2009


As a proud Soviet Canuckistan, it is hard to relate to the fear and uncertainty of a life without access to health care. Although I work in the Canadian healthcare system and see some of its flaws up close, I still cannot see how anyone might prefer a system not based on universal coverage, especially as it consistently produces instances of banal evil like the one cited above. I'm sure that ten, twenty, fifty years from now, our descendants will look upon this situation as we look upon denying women the vote or dressing in pantaloons -- ridiculous and indefensible products of a lesser time.
posted by docgonzo at 7:56 AM on March 6, 2009 [31 favorites]


I thought single payer, the only real solution, was off the table. I'd be delighted to be proven wrong, though.
posted by DU at 7:58 AM on March 6, 2009


America has the third largest population in the world. Can it support a single payer system?
posted by Brandon Blatcher at 8:01 AM on March 6, 2009


America has the third largest population in the world. Can it support a single payer system?

Can we afford to not have a single payer system? We're already spending 17 percent of gross domestic product on healthcare in our incredibly inefficient and inequitable system.
posted by grouse at 8:05 AM on March 6, 2009 [1 favorite]


America has the third largest population in the world. Can it support a single payer system?

You mean with all that extra tax revenue we might end up with a surplus of money? Hmmm....that could be a real problem.
posted by DU at 8:06 AM on March 6, 2009


If the system is paid by taxes, why in hell not *couldn't* it be supported? Irreducible complexity? I mean, spreading cheese on a personal pizza isn't all that different than spreading it on an Extra Large.
posted by notsnot at 8:06 AM on March 6, 2009


It's time to start shaming people.

It's time to start shaming people who take money under what is manifestly false circumstances -- like those six-month insurance policies.

It's time to start shaming people who make money by cheating people of their money and then consigning them to poverty and death.

The Scott Krienke who is the number two guy at Assurant Health is also a Member of the Board of The Counseling Center of Milwaukee. That's an ostensible charity. It takes Unites Way contributions, and claims a "mission to help, adults, and families in need take charge of their lives, connect to others, and contribute to the community, our programs are designed to protect children, strengthen individuals and families, and improve the emotional and mental health of people at risk in our community."

So let's ask what Scott Krienke, a guy who has made a fortune by selling people worthless useless "insurance", is doing on the board of a non-profit. Hell, let's ask why Scott's not in prison.

By it's long past the time when we can afford to do anything but snub and ostracize people like Scott Krienke. But I'm sure he's treated like a great guy because he's got money. That's got to stop. We wouldn't (I hope) treat Charles Manson like a hero if he got rich off his murders. Why should we treat Scott Krienke any better than we treat Manson?
posted by orthogonality at 8:07 AM on March 6, 2009 [52 favorites]


America has the third largest population in the world. Can it support a single payer system?

Sure, if it stops spending more of its wealth on its military than the rest of the world combined.
posted by Kirth Gerson at 8:08 AM on March 6, 2009 [4 favorites]


Can it support a single payer system?

In the United States, administrative costs for private healthcare — billing people for healthcare — are so high that those costs alone would pay for publicly-provided, single-payer insurance. America could easily support a single-payer system.
posted by Blazecock Pileon at 8:12 AM on March 6, 2009 [30 favorites]


Here is the New Yorker's excellent medicine writer Atul Gawande's take on funding reform: "Getting there from here."
posted by docgonzo at 8:16 AM on March 6, 2009 [7 favorites]


We could take this one example as a reason to fundamentally change our healthcare system.

Other option would be for this guy to get a lawyer and pursue a claim that will, if the facts are as straight-forward as presented, remedy the situation.

That's what great about our legal system. Lawsuits fix these kinds of situations. Wrongs can be remedied in courts; they do not require massive change in a foolish attempt to eliminate wrongs though policy.
posted by dios at 8:16 AM on March 6, 2009 [2 favorites]


I wonder how many people stay in shitty jobs, with shitty working conditions, shitty bosses, possibly questionable labor practices, at least in part because they need to maintain continuous health insurance coverage. I'm not saying single-payer healthcare would revolutionize labor, but it would certainly change the scene.
posted by uncleozzy at 8:17 AM on March 6, 2009 [13 favorites]


Estimated amount the U.S. would save each year on paperwork if it adopted single-payer health care: $161,000,000,000
posted by Staggering Jack at 8:17 AM on March 6, 2009 [5 favorites]


Sorry to hear that. Sounds like he has been using a short term policy as a long term solution.

See? It's always the insured's fault. We don't need commie health care.
posted by dirigibleman at 8:18 AM on March 6, 2009 [2 favorites]


America has the third largest population in the world. Can it support a single payer system?
posted by Brandon Blatcher at 8:01 AM on March 6


are you fucking kidding me
posted by Optimus Chyme at 8:21 AM on March 6, 2009 [8 favorites]


a foolish attempt to eliminate wrongs though policy.

I agree with this guy. The last thing we need to do is fix the underlying problems. Let's just keep patching the symptoms.
posted by DU at 8:22 AM on March 6, 2009 [6 favorites]


I wonder how many people stay in shitty jobs, with shitty working conditions, shitty bosses, possibly questionable labor practices, at least in part because they need to maintain continuous health insurance coverage. I'm not saying single-payer healthcare would revolutionize labor, but it would certainly change the scene.

Change it back to the way it was before the Glorious Reagan Revolution? When practically nobody stayed with or chose an employer because of the healthcare plan, and one good job was enough to support a family? I suppose you think all the *progress* we've made since then was just accidental!
posted by Kirth Gerson at 8:22 AM on March 6, 2009 [5 favorites]


Estimated amount the U.S. would save each year on paperwork if it adopted single-payer health care: $161,000,000,000

Imagine how much better and faster we could fix our economy with both a healthier population and more money in the bank to spend on repairing the schools, services and infrastructure neglected by the right-wing.
posted by Blazecock Pileon at 8:24 AM on March 6, 2009 [4 favorites]


That's what great about our legal system. Lawsuits fix these kinds of situations. Wrongs can be remedied in courts; they do not require massive change in a foolish attempt to eliminate wrongs though policy.

I was going to snark but, honestly, don't you think that in situations involving critical medical treatment that people should have a little more security than the knowledge that they can always fall back on a lengthy legal process to fight their insurance company, a process that may last longer than their prognosis without treatment?
posted by anifinder at 8:25 AM on March 6, 2009 [39 favorites]


America has the third largest population in the world. Can it support a single payer system?

Every system of healthcare is cheaper than yours. Even the raving Socialist ones. Every other one is cheaper. Your healthcare system is the most expensive in the world. Per head, total, percentage of GDP. Your healthcare is the most expensive system in the world.

The most expensive component of health care is old people. Old people cost the most for healthcare. One spends most health money on old people.

The US government already pays for healthcare for old people. Old people, the most expensive people, already live in a world of "socialized medicine". You have introduced a national tax-paid healthcare system already for only the most expensive and least productive people*. You have a socialized national healthcare system, but only for the most expensive section of your community. Taxpaying adults generating all your income and doing all your work? No.

Clearly you should switch healthcare systems to one that costs less money and does a better job. To reiterate, this is any other healthcare system.

I've got my British head round your gun ownership, and your high levels of religiousity, but your refusal to have a sane healthcare system? Still staggers me.

* Not to say that old and retired people have any more or less moral right to healthcare, but I'm trying to make a very pragmatic, economic argument. I'm also ignoring kids, but kids turn into taxpayers and old people don't. Apologies in advance for any offence taken.
posted by alasdair at 8:26 AM on March 6, 2009 [79 favorites]


are you fucking kidding me

It's good to ask questions if you don't know something. Sure, you may sound ignorant, but as times passes you learn more things.
posted by Brandon Blatcher at 8:26 AM on March 6, 2009 [9 favorites]


...fifty years from now, our descendants will look upon this situation as we look upon denying women the vote or dressing in pantaloons -- ridiculous and indefensible products of a lesser time.

You can have my pantaloons when you pry them from my cold, dead legs.
posted by DU at 8:27 AM on March 6, 2009 [4 favorites]


Other option would be for this guy to get a lawyer and pursue a claim that will, if the facts are as straight-forward as presented, remedy the situation.

Until he gets buried in a mountain of motions and shit from the insurance company's lawyers and can't afford his attorney's bills.

That's what great about our legal system. Lawsuits fix these kinds of situations. Wrongs can be remedied in courts; they do not require massive change in a foolish attempt to eliminate wrongs though policy.
posted by dios at 8:16 AM on March 6


That is demonstrably false and you know it. The judicial system is set up for the benefit of corporations, the people who run them, and the lawyers who sell their souls to do their bidding.
posted by Optimus Chyme at 8:28 AM on March 6, 2009 [5 favorites]


It's good to ask questions if you don't know something. Sure, you may sound ignorant, but as times passes you learn more things.
posted by Brandon Blatcher at 8:26 AM on March 6


I understand that BB; it's just that I see how much we spend on gold-plated tanks and research programs to see how to more effectively vaporize brown-skinned orphans and it's clear that paying more health care would be trivial if we had anything approaching rational priorities.
posted by Optimus Chyme at 8:31 AM on March 6, 2009


Estimated amount the U.S. would save each year on paperwork if it adopted single-payer health care: $161,000,000,000

That's without even beginning to factor in the savings from more preventative care and the economic advantages of having a healthier population.

Of course, can we really afford to lose all those jobs at the insurance companies right now? Think of our current system as a makework stimulus package for claims agents and insurance CEOs.
posted by Vectorcon Systems at 8:32 AM on March 6, 2009 [1 favorite]


Other option would be for this guy to get a lawyer and pursue a claim that will, if the facts are as straight-forward as presented, remedy the situation.

Get a lawyer and litigate, huh? I thought that the litigation industry and the heinous "trial lawyer lobby" were one of the other massive banes of American existence today, at least according to some of the same policymaking folks who oppose universal health care, and some of those same policymaking folks want dearly to make it much harder to "get lawyers" and file lawsuits against corporate entities and gain much in the way of reasonable damages from said lawsuits, but maybe I'm mistaken.
posted by blucevalo at 8:32 AM on March 6, 2009 [6 favorites]


I wonder how many people stay in shitty jobs, with shitty working conditions, shitty bosses, possibly questionable labor practices, at least in part because they need to maintain continuous health insurance coverage. I'm not saying single-payer healthcare would revolutionize labor, but it would certainly change the scene.

I just want to chime in and say this is certainly the case in my family. I make the bulk of our money; if it weren't for the great (and I mean insanely great) health care coverage my husband makes at his job, he'd be able to quit and stay at home full time with our son. But we can't afford to lose the coverage.
posted by anastasiav at 8:33 AM on March 6, 2009 [1 favorite]


I'm hearing that there are clinical trials that are approaching signoff that are derived from orphan vapor.
posted by Lipstick Thespian at 8:37 AM on March 6, 2009 [1 favorite]


"That's what great about our legal system. Lawsuits fix these kinds of situations. Wrongs can be remedied in courts; they do not require massive change in a foolish attempt to eliminate wrongs though policy."

dios, you need to read the article. After Pat's sister -- journalist Karen Tumulty, the author of the linked article -- talked to state regulators, Assurant Health came up with some money.

Assurant was alsoo assesses "a record $2.1 million in penalties" by Connecticut regulators.

But none of that has stopped Assurant Health from selling useless "insurance" to new victims. And that's the problem your "solution" ignores. Lawsuits, after years of lawyers' fees and suffering, help out the few people with the resources to carry a case through the courts -- and mostly help out the lawyers' bank accounts. Lawsuits are not an answer to systemic fraud.

So frankly, dios, when you propose that, it really gives me the impression you just don't care about justice at all. I hate to say it, because but I think you've gone from being a contrarian minority voice, to almost reflexively defending the indefensible, blasely waving your hands and muttering platitudes about "the legal system" while real people literally bleed to death.

I don't know whether that's trolling or pride or willful blindness, but honestly, I begin to wonder what's in your heart, that for all your stony pronouncements from on high, you seemingly can't feel their -- our -- pain.
posted by orthogonality at 8:40 AM on March 6, 2009 [12 favorites]


The last thing we need to do is fix the underlying problems. Let's just keep patching the symptoms.
posted by DU at 10:22 AM on March 6


I know you care about being snarky and you don't give a fuck-all about actually engaging in a discussion like a mature individual, but you missed my point: there will always be problems. You think that the single payer system will be problem free? Have you ever seen a nationally-run program that has no problems? And guess what: when the federal government is running it, you sometimes don't get to complain or seek a legal remedy. Sovereign immunity, baby.

It is the height of foolishness to think that we can create a perfectly functioning system.

There will always be problems.

You can't change the system every single time there is a problem. But you can certainly remedy them the courts.

This does not mean that we shouldn't look to a single payer system. The only point I made is that to fix THIS, there is another solution: let the legal system fix the problem. That doesn't foreclose fixing the system, too.
posted by dios at 8:40 AM on March 6, 2009 [1 favorite]


it's just that I see how much we spend on gold-plated tanks and research programs to see how to more effectively vaporize brown-skinned orphans and it's clear that paying more health care would be trivial if we had anything approaching rational priorities.

I hear ya and I'm all for a single payer system in America (O Canada, how tempting you look), but it would mean a major change in how America spends money, especially for the military. Such a change has implications for the world, since we have our military all over the place. Yes, some of this would be good, but would all of it?
posted by Brandon Blatcher at 8:40 AM on March 6, 2009


Get a lawyer and litigate, huh? I thought that the litigation industry and the heinous "trial lawyer lobby" were one of the other massive banes of American existence today, at least according to some of the same policymaking folks who oppose universal health care, and some of those same policymaking folks want dearly to make it much harder to "get lawyers" and file lawsuits against corporate entities and gain much in the way of reasonable damages from said lawsuits, but maybe I'm mistaken.
posted by blucevalo at 10:32 AM on March 6


I'm not sure what your little rant has to do with my point. This guy can get help. I hope he does.
posted by dios at 8:42 AM on March 6, 2009 [1 favorite]


.fifty years from now, our descendants will look upon this situation as we look upon denying women the vote or dressing in pantaloons -- ridiculous and indefensible products of a lesser time.

What? We still wear pantaloons. We just call them pants.
posted by Astro Zombie at 8:44 AM on March 6, 2009


It is the height of foolishness to think that we can create a perfectly functioning system.

OK, seriously. SERIOUSLY. "Humans are imperfect" is not a reason to stop trying to build stuff. Hoover dam? Sorry, we can't build that--no structure can hold back ALL the water. The moon? Sorry, we can't go there--no capsule is PERFECTLY airtight. Democracy? Sorry, we can't do that--many humans make flawed decisions. Single payer healthcare? Sorry, there could well be some flaws, better to stick with the insane system you have now.
posted by DU at 8:47 AM on March 6, 2009 [7 favorites]


We could take this one example as a reason to fundamentally change our healthcare system.

Yes, because this is the only example of American stupidness when it comes to Healthcare. Really, you should be looking for examples where it isn't fucking ass backwards.
posted by chunking express at 8:48 AM on March 6, 2009 [1 favorite]


I was going to have my car fixed, but because it will never run perfectly, I decided to stick with tying one end of a steel cable to my dick and the other end to the Mythbusters' JATO car and hoping I wind up where I want to go.
posted by Optimus Chyme at 8:50 AM on March 6, 2009 [13 favorites]


As someone living with a chronic non-curable (but also, thankfully, non-fatal) condition, I have to say that this story is really only a few steps removed from my actual life. I will never be able to buy insurance on my own because of my pre-existing condition.

To have to choose jobs based on providing insurance is difficult enough when the economy is good. It's also rough to know that in the future, if I want to stay insured, there's a good chance I'll have to at least temporarily take a side-track from a career in childcare and work in a cubicle somewhere. (No offense to the cubicles, honestly, I just prefer being knee deep in toddler poo, apparently.)

The American system totally, totally sucks. To constantly hear that we've got the best research and the best care available for blah blah blah blah conditions, and to know that the care that I got in a socialized country (Iceland) was indeed BEYOND sub-par, as in, they don't even use the medications that I get over here, and at the same time be forced into organizing my ENTIRE LIFE so that I get my health care paid for is maddening.

Currently, I live in MA where health insurance is mandatory. I send my tax forms to the state, they decide what my options are in terms of buying insurance from a private company. I pick a plan, I pay a monthly premium.

Due to said pre-existing condition, I can't be denied insurance, but since I can't really afford a plan that only covers me if I get hit by a bus - I pay FULLY HALF of my month's salary toward health insurance. And it's still cheaper than buying my medication out of pocket.

Honestly, if a cow ran for President and promised a single-payer system with guaranteed insurance for everybody, I would campaign for that cow as hard as I possibly could. I don't care if the cow also wanted to blow up Iran. Fine with me. Healthcare is absolutely the single most important political issue for me.
posted by grapefruitmoon at 8:51 AM on March 6, 2009 [17 favorites]


I begin to wonder what's in your heart, that for all your stony pronouncements from on high, you seemingly can't feel their -- our -- pain.
posted by orthogonality at 10:40 AM on March 6


I'm sorry that I don't let my empathy for such people--which I do have--cloud my understanding of how the system works. I've seen our legal system work wonders. I've seen problems be fixed.

Perhaps it is a déformation professionnelle. But I believe in the legal system's ability to help people. When people do wrong, the legal system--if triggered--fixes it. I have trust in it.

We aren't going to be eliminate all problems. We are not angels, and things are messy. But when something bad happens, we can try our best to fix them. It doesn't mean it is the only approach we take. But it is one that we should not ignore when it comes to fixing problems.

Lawsuits are not an answer to systemic fraud.

This is completely incorrect. It would be correct if you had said "the only answer." But they certainly are an answer. Practices are consistently changed through the legal system. There are literally thousands of lawsuits every year which result in systemic changes to what are system problems. And they are not just for the rich. Lawyers work for free ("contingency") in most such cases.
posted by dios at 8:52 AM on March 6, 2009 [1 favorite]


I'm not sure what your little rant has to do with my point. This guy can get help.

You assert that "this guy can get help." So be it. And if he should get so far as finding a lawyer who'd be willing to spend the time and money to litigate his claim, a boatload of well-paid lawyers from the insurer's side will file counterclaim after counterclaim stating that the plaintiff has filed a "frivolous lawsuit." Saying that "this guy can get help" is akin to saying that a drowning man in the middle of the ocean can eventually reach shore if he swims hard and long enough.
posted by blucevalo at 8:52 AM on March 6, 2009 [10 favorites]


I had a discussion w/ my parents about changing the system. I basically explained why I felt it was in our best interest to switch over to a single payer system. Their argument? "It can always be worse". That was it. It can always be worse, so don't try to change it b/c you'll just end up making it worse.
posted by ShadowCrash at 8:52 AM on March 6, 2009


In the United States, administrative costs for private healthcare — billing people for healthcare — are so high that those costs alone would pay for publicly-provided, single-payer insurance.

Blazecock Pileon, did you even read that article? That's not what it says in the slightest. (Granted, Uwe Reinhardt is a bit cagey in the way he's phrasing things there, but that's still a serious misinterpretation of what it says.) If you click through to the underlying Health Affairs article he links to, it's clear from even just the abstract that they're talking about what it would cost to bring the 16% of the uninsured population into our current system--not what it would cost to cover 100% of the population under a single-payer system.
posted by iminurmefi at 8:55 AM on March 6, 2009


"It can always be worse". That was it. It can always be worse, so don't try to change it b/c you'll just end up making it worse.

And this is the game plan of the Republicans, starting with the infamous "I'm from the government and I'm here to help" line of Reagan's. Government doesn't work. CAN'T work. So just cut taxes, deregulate and hunker down.

That's why they are afraid of Obama. Not because he might tax them but because it might work.
posted by DU at 8:56 AM on March 6, 2009 [4 favorites]


It is the height of foolishness to think that we can create a perfectly functioning system.

"We the people, in order to form a more perfect union why bother?"
posted by Astro Zombie at 8:56 AM on March 6, 2009 [21 favorites]


Really simple request: in your rush to thrown snarky bombs at me, could you please at least attempt to grasp the fact that I did NOT say we should ignore fixing the healthcare system. These are not mutually exclusive options. Of course the system needs to be fixed. But we cannot forget that there are legal remedies to punish this kind of behavior as well.
posted by dios at 8:56 AM on March 6, 2009 [1 favorite]


Don't you go undermining my awesome strikethrough joke.
posted by Astro Zombie at 8:59 AM on March 6, 2009 [8 favorites]


That's not what it says in the slightest.

I'm not sure you're correct:

The McKinsey Global Institute estimated that excess spending on “health administration and insurance” accounted for as much as 21 percent of the estimated total excess spending ($477 billion in 2003). Brought forward, that 21 percent of excess spending on administration would amount to about $120 billion in 2006 and about $150 billion in 2008. It would have been more than enough to finance universal health insurance this year.

The McKinsey team estimated that about 85 percent of this excess administrative overhead can be attributed to the highly complex private health insurance system in the United States.

posted by Blazecock Pileon at 8:59 AM on March 6, 2009


"We the people, in order to form a more perfect union why bother?"
posted by Astro Zombie at 10:56 AM on March 6

What fucking language am I speaking?

Where did I say that we should not try to fix the system?

My only point, which I thought was relatively clear, was that we will always have problems, and we cannot forget that there are legal solutions that can be pursued. We will not be able to get rid of these kinds of stories by policies alone.
posted by dios at 8:59 AM on March 6, 2009


dios, you're being hugely disingenuous here.

You began your contributions to this thread by suggesting that instead of taking the article in the FPP as an argument for universal healthcare, the guy in the article should just sue. ("Other option...")

Now you seem just to be arguing that lawsuits can sometimes have good results and people should be allowed to bring them. Nobody disagrees with this, and many systems of nationalized healthcare accommodate legal redress.

The problem with your unserious style of argumentation in this specific case is that the issue is... well, about as serious as it's possible to get.
posted by game warden to the events rhino at 9:01 AM on March 6, 2009 [6 favorites]


What fucking language am I speaking?

I SAID DO NOT UNDERMINE MY AWESOME STRIKETHROUGH JOKE!

You're just a jerk, you jerk.
posted by Astro Zombie at 9:02 AM on March 6, 2009 [3 favorites]


The only point I made is that to fix THIS, there is another solution: let the legal system fix the problem.

If I could afford a lawyer at $100/hour (cheap), I wouldn't be worried about paying for health insurance. I can't, so I am.
posted by stet at 9:02 AM on March 6, 2009 [5 favorites]


Lawsuits fix these kinds of situations. Wrongs can be remedied in courts; they do not require massive change in a foolish attempt to eliminate wrongs though policy.

Yeah...by extending the process to the point where the plaintiff either goes bankrupt or dies. That, or, by threatening to extend the process, backing the plaintiff into privately out of court, changing absolutely nothing about the wrongs being perpetrated upon many, many others. Policy strives to eliminate systemic wrongdoing.

The health industry (including insurance, pharma, doctors, etc) is a unique marketplace wherein the suppliers (medical, insurance) have effectively completely cut-out the consumer from the usual market equation. Simply put, the ability of the customer to afford the product doesn't matter. The suppliers know they are supplying a necessity and that the consumer will simply have to pay whatever is demanded or do without, at the risk, potentially of their very lives.
posted by Thorzdad at 9:04 AM on March 6, 2009 [3 favorites]


dios, I'm pretty sure nobody in here is suggesting that Pat's problems will be solved by a move to single payer. For one thing, it would likely take time that Pat doesn't have to spare. What they are saying is that we can prevent this problem for other people. Telling Pat to "get a lawyer" (possibly) solves one problem but doesn't prevent others. You see that, right?
posted by DU at 9:04 AM on March 6, 2009


Right, Blazecock--and that $120 billion is the same estimate given in the Health Affairs article (linked to in the paragraph above what you pulled out, in the word "needed") to attain universal coverage. However, despite how often they're conflated in popular terminology, in health economics "universal coverage" doesn't imply "single payer" at all--it just means that everyone is covered. As you can see in the Health Affairs article, the authors (both of whom are hugely well-respected in this area) are estimating that the additional cost to the health care system of bringing the 16% of uninsured people into the current system is $120 billion, about. Notably, they point out that it may cost the government more than $120 billion because of crowd-out--that's another clue that they're talking about entire systems costs, not cost to the government.
posted by iminurmefi at 9:07 AM on March 6, 2009


"What fucking language am I speaking?"

If you feel that you're not being treated fairly, dios, one option would be for this guy you to get a lawyer and pursue a claim that will, if the facts are as straight-forward as presented, remedy the situation.

Not that I'm being blase about your suffering. Oh no. I'm just saying, it's one option.
posted by orthogonality at 9:07 AM on March 6, 2009 [9 favorites]


I had to go to the hospital a few years back to get a broken arm fixed. I walked in, filled out some forms, and was told to have a seat and wait. About an hour later, I was brought to the x-ray machine and had a few x-rays. About a half hour after that I was put in a cast. I THEN WALKED OUT THE FRONT DOOR WITHOUT PAYING A CENT OR HAVING ANY SORT OF BILL*.

*'Alberta Health Care' was $44 a month back then but is currently $0.00 a month.
posted by chugg at 9:08 AM on March 6, 2009 [2 favorites]


Here's a quick tip: anybody against universal health care is either:

a) an idiot,
b) a crook,
c) or mad.

It really is as simple as that. The US under a single-payer setup would probably end up with better health care for less money. Get that? More for less! Just like the advertisements on tv promise, only this time its true.

Okay, I'll try hard to be more serious. The problem is that (most) markets have gaps, inasmuch as they can't provide to every single person. That's not a problem for certain goods, but health care is a fundamental human right: people deserve to be looked after when they become ill. The short-term insurance is an attempt to cover a gap caused by the existing application of the market in a particular way to health care. We know people need 'insurance' and we know that some people can't get it cheaply enough. So let's sell them 'insurance plans' which last six months, so for that time they'll be 'insured'. But the superificial nominality of this is exposed by the $2,500 deductible and the low maximum claim ceiling, nevermind that every six months they pretend he just walked in off the street and can refuse to cover him at all. But what did you expect? There's little enough money to be made from insuring poor people anyway, so shouldn't he be thankful he got something?

Neither markets nor chainsaws are inherently bad, but I wouldn't want either being part of my health care.
posted by Sova at 9:09 AM on March 6, 2009 [3 favorites]


I just don't understand this at all. I was paying for healthcare for my family, and after paying bills, I could only afford for 2 out of the 3 (my wife and daughter) of us to go to the doctor this year because I just couldn't afford the deductible for all of us before the copay would kick in. Forget about getting my teeth worked on; it's all out of pocket due to "preexisting conditions". Now that I've been laid off, they've offered COBRA to me, but I can't meet the payments on it, so we've had to go with my wife's even crappier insurance, and it takes half of one her month's pay to cover it. I asked my self-described dittohead stepfather what he thought, and he told me we've got such good healthcare here that pregnant Canadians are streaming across the border to have their babies here; they can't get an appointment before their due date. I have no idea where he got this. Are only the people that can afford to fling gobs of money at their insurance companies American enough to have real medical care?
posted by Bernt Pancreas at 9:09 AM on March 6, 2009 [3 favorites]


If I could afford a lawyer at $100/hour (cheap), I wouldn't be worried about paying for health insurance. I can't, so I am.
posted by stet at 11:02 AM on March 6


Contingency fee.

You began your contributions to this thread by suggesting that instead of taking the article in the FPP as an argument for universal healthcare, the guy in the article should just sue. ("Other option...")

You italicized "instead." Where did I say "instead"? Options are not mutually exclusive. I've now explained this how many times?

Look, here is where I am coming from with this: I've too often seen people think that we can eliminate all problems through policy changes as if problems will never occur. What everyone needs to realize is that problems will always exist. So the response to this guy is not just "well, we'll change the policy in the future and this will never happen again." Yes, fix crappy policies. But the other thing that needs to occur is that people need to be willing to call upon the legal system to remedy the problem for themselves. I don't like the idea of hearing a story like this and saying, "That sucks, let's make a policy change." I guess my response is, "If that's true, this guy needs to get a lawyer and take this to court. And then let's address any policy problem that allowed this to happen."
posted by dios at 9:11 AM on March 6, 2009 [1 favorite]


However, despite how often they're conflated in popular terminology, in health economics "universal coverage" doesn't imply "single payer" at all--it just means that everyone is covered.

If single-payer coverage would pay for all citizens' healthcare needs, that sounds like the very definition of the term "universal coverage". In what sense do you suggest it is otherwise?
posted by Blazecock Pileon at 9:14 AM on March 6, 2009


My only point, which I thought was relatively clear, was that we will always have problems, and we cannot forget that there are legal solutions that can be pursued.

And my only point, which I thought was also relatively clear, was that there are well-funded and -organized efforts to undermine and/or decimate the legal remedies to which you refer, and that those efforts are on a coordinated and parallel track with well-funded and -organized efforts to stymie any effort at policy changes that would make health care more universally accessible and/or affordable.

Contigency fee.

A litigator will only agree to take your case if he or she thinks there is a case to make (and to succeed at making) in a court of law, contingency fee or not.
posted by blucevalo at 9:17 AM on March 6, 2009 [1 favorite]


BP, I think the point there is that single-payer means strictly government-run, whereas universal coverage implies, potentially, a mix of public and private insurers/payers. The latter is where the Obama admin. says it wants to go, probably for pragmatic reasons.
posted by Mister_A at 9:19 AM on March 6, 2009


I get you, dios. Policy changes to protect the abstract future victims of similar situations, and a lawyer to help this guy, in his actual situation right now? Makes sense to me.
posted by infinitywaltz at 9:19 AM on March 6, 2009 [1 favorite]


However, despite how often they're conflated in popular terminology, in health economics "universal coverage" doesn't imply "single payer" at all--it just means that everyone is covered.

If single-payer coverage would pay for all citizens' healthcare needs, that sounds like the very definition of the term "universal coverage". In what sense do you suggest it is otherwise?


I think what was meant is that you can have universal health care with single payer. Not that single payer isn't universal health care.
posted by Sova at 9:20 AM on March 6, 2009


The legal system can help, but it's not enough. If every person who was justly wronged by the current healthcare system filed a suit against their insurance company, pretty soon we'd run out of lawyers.

And still no one would have decent healthcare.

Yes, lawsuits need to be filed, but the system also needs to be fixed. Both statements are true.
posted by grapefruitmoon at 9:20 AM on March 6, 2009 [1 favorite]


Urh, 'without single payer' is what I meant. The government doesn't need to run the thing, as there are other options.
posted by Sova at 9:21 AM on March 6, 2009


You italicized "instead." Where did I say "instead"? Options are not mutually exclusive. I've now explained this how many times?

Let's examine the record:
We could take this one example as a reason to fundamentally change our healthcare system.

Other option would be for this guy to get a lawyer and pursue a claim that will, if the facts are as straight-forward as presented, remedy the situation.

That's what great about our legal system. Lawsuits fix these kinds of situations. Wrongs can be remedied in courts; they do not require massive change in a foolish attempt to eliminate wrongs though policy.
You presented two options. Since they both, according to you, fully fix the person's problem then each one is presumably sufficient and therefore only one is required. You then explicitly say that the lawsuit "does not require massive change" which again implies exclusivity.

You are not being intellectually honest. And that's helping to kill people.
posted by DU at 9:22 AM on March 6, 2009 [4 favorites]


Another happy comrade from the Canadian gulag. Single-payer health-care is the only civilized, AND most efficient way to provide health care. Period.

For those willing to look into it further: The Canadian publicly-funded healthcare system doesn't cover everything. It doesn't cover most drugs, or dental, and it only guarantees a basic (though complete) level of health services. There's still a place for employers to offer their employees additional coverage (through private insurers) for drugs, upgraded services like semi-private rooms and more complete after-care (eg physiotherapy).

But whether or not a person has employer-provided additional coverage, the fact remains that in Canada everyone has free access to a high standard of care. A serious illness does not necessarily require a choice between poor care, or flirting with bankruptcy, or a protracted battle with a private insurer.

Some doctors in Canada grumble about being effectively "government employees", but in fact most physicians in Canada run their practice like a small business and invoice for services, except that the payer is the government. It's my understanding that in the US most physicians in family-practice spend an astounding amount of time per week (like 25% or more) not treating patients, but having to fight with insurance companies on behalf of their patients.

Private enterprise is getting involved in Canadian healthcare through provision of services, such as X-ray and Imaging providers, medical transport, and private clinics for off-list things like cosmetic surgery, weightloss treatments, etc etc. Some here view these private suppliers as the thin of a wedge to create a two-tier system, but I think this can be managed.

Final point (though I could go on for days) - In Canada, the labour force is alot more mobile and adaptable (not to mention healthier) because employer-paid healthcare is not a big issue or trap. Everyone has guaranteed basic care, and most employer-provided health plans are roughly equivalent.
posted by Artful Codger at 9:23 AM on March 6, 2009 [1 favorite]


Wouldn't Pat almost certainly lose such a lawsuit? This sounds like a slam-dunk case for the insurance companies: pre-existing conditions aren't covered, it says so right in the contract; his kidney failure predates the current contract; case closed.

The law isn't going to care that it was a cruel, amoral, shitty contract; it's just going to say that Pat should've read the fine print more carefully.
posted by ook at 9:25 AM on March 6, 2009 [4 favorites]


As you can see in the Health Affairs article, the authors (both of whom are hugely well-respected in this area) are estimating that the additional cost to the health care system of bringing the 16% of uninsured people into the current system is $120 billion, about. Notably, they point out that it may cost the government more than $120 billion because of crowd-out--that's another clue that they're talking about entire systems costs, not cost to the government.

This comment actually falls under the "arguments for single-payer universal health care" column, believe it or not. The cost to bring the 16% of our population that is uninsured into the current system is 75% of the estimate of what it would cost to insure EVERYONE in the USA.

The current system is incredibly, utterly inefficient. If it really costs $160 billion for the US to be a single-payer insurer, that should be the most obvious move ever. $500/year to insure every child, woman, and man. But no, for the sake of the profits of a few, nearly 50 million of us have no insurance at all.

Including me.
posted by explosion at 9:26 AM on March 6, 2009


I wish I would've kept some notes. I was researching Canadian health care last night because my co-workers are a) under the impression that Obama is going to force single payer health care b) that would be horrific c) Canadian health care is the model of inefficiency.

It has it's quirks, and having two aging parents I've been exposed to those quirks to some degree but by and large it seems pretty good. At least as good as the insurance I have here in the US with a rather well paid engineering position.

I started researching and average HMO administrative overhead was about 33% and for the Canadian system it was 17%. So from an administrative point of view Canada wins, unless your goal is to keep administrators employed.

Single payer health care isn't a panacea, but it seems a lot better than what is available here. The conservative rallying cry seems to be "look at single payer's faults" and rather than trying to fix the existing system, or replace it, try to brush the current systems faults with "freedom to choose".
posted by substrate at 9:28 AM on March 6, 2009


*facepalm*

So you know what? I got a bonus this quarter. yep - take that bitches.

And you know how much income tax they withheld - this is in California by the way. They withheld 48%.

48-mother-fucking-percent marginal tax.

True, that's withholding and not my actual tax rate, but it won't be far off.

I paid a lower marginal rate in Ontario and got health coverage the didn't run out when I lost my job. Oh - plus I'm paying just over $150 a month for my employer-provided healthcare here.

So for any American who thinks that universal health coverage will raise taxes, let me say that many Canadians (certainly the middle class and definitely me) pay less marginal tax and have health coverage to boot. Also, I know know why people are always crowing about tax in the US. A lot of Americans are actually paying Swedish-style taxes but get nothing in return. I just thought you were all whingers before. Your country is somewhat broken.
posted by GuyZero at 9:29 AM on March 6, 2009 [11 favorites]


I guess my response is, "If that's true, this guy needs to get a lawyer and take this to court. And then let's address any policy problem that allowed this to happen."

My concern, dios, is that this man will get no remedy in court because the contracts he signed actually allow the insurer to do what they're doing. My understanding of the legal system is that you can't just sue someone because you discovered that you signed a contract that's not completely biased on your own favour.
posted by GuyZero at 9:32 AM on March 6, 2009


BP--universal coverage implies that everyone has access to health care, which is fundamentally a health care delivery issue. Single payer is a finance issue. The two are related--it's hard to deliver services without paying for them--but there are multiple ways to set up a system that would achieve universal coverage, and multiple ways to pay for it. A "Medicare for All" sort of single-payer system would achieve universal healthcare, but not all universal coverage is single-payer--many other countries have universal healthcare that isn't single-payer (both Switzerland and France are examples of this, I believe) and I would argue Massachusetts has gotten pretty close to universal, since they're running at about 96% of their population covered.

The United States has some pretty fundamental problems related to health care delivery that, while exacerbated by the way we finance care, is a totally separate issue from how we need to reform financing so that everyone is covered. I blame a lot of this confusion on reporters and, worse, academics who should know better (shame on Uwe for perpetuating this), who like to compare U.S. health care costs with other countries and then point to financing as the key difference while totally avoiding talking about the HUGE differences in how countries have organized the delivery of care. Atul Gawande is one notable exception--his article linked to above by docgonzo is a must-read for people who are pro-reform, in my opinion.

In fact, in that article Gawande makes my point for me: single-payer can't be the solution in and of itself, because we currently have two single-payer systems in the U.S. (Medicare and the VA), and they have vast differences in cost. The VA is 30% cheaper than Medicare, and probably delivers better outcomes, despite the fact that both programs are financed by a single payer: the federal government. The difference lies in the way that health care delivery is structured--in the VA, it's delivered through doctors that are basically employees of the federal government, in hospitals that are owned by the government, which is a really similar set-up to England. In Medicare, it's delivered through a privately-owned system by doctors who are largely self-employed or members of for-profit group practices. This is totally unlike the health care delivery system anywhere else; the closest you can probably get is Canada, but most of their hospitals and physicians groups are non-profit, while most of ours are for-profit, which is not a trivial difference.

All of which is a long derail from the original article in the FPP, which is obviously a huge tragedy. It certainly does call out for reform--if nothing else, I'd love every state insurance agency to disallow any insurance policy that's not guaranteed renewable, because I think there's literally not a single justification for that type of policy in any situation, ever.
posted by iminurmefi at 9:35 AM on March 6, 2009 [1 favorite]


Let me offer an example on my point here:

At my previous job, I handled a lawsuit for someone who is, unfortunately, a quadriplegic due to a rollover in a particular automobile. Now part of the defense was that the roof crush and vertical excursion in the seat belts were within NHTSA standards, and thus, to hold manufacturers responsible, we should change the policy with NHTSA. We ultimately recovered substantial sums for this individual, and his living expenses will be paid. Also, the manufacturers started using different seat belt pretensioners to prevent this in the future, despite no change in the policy. I am glad I was part of a team to help him and effect change instead of just saying, "let's fix the policy."

Incidentally, a similar defense was just shot down by the US Supreme Court two days ago in Wyeth v. Levine. There the drug manufacturer roughly argued along the lines of "don't complain to us; the FDA they approved this." The Supreme Court shot that down and said that a state jury can still find something actionable despite the fact that a federal policy seems to address it. I like that from a result standpoint. I don't think we can answer all problems with policy.
posted by dios at 9:35 AM on March 6, 2009 [1 favorite]


So, while I take you rpoint diso, that kind of ad-hoc bandaid approach to product saftey and public policy is a pretty bad way to approach things. You end up with policy being a twisty maze of passages that no one can understand. Common law has its place, but that place isn't everywhere for everything.
posted by GuyZero at 9:41 AM on March 6, 2009


BP, I think the point there is that single-payer means strictly government-run, whereas universal coverage implies, potentially, a mix of public and private insurers/payers.

If 85% of the "administrative overhead" costs are due to private insurance, eliminating the necessity of private insurance in the course of transitioning to a single-payer system would remove nearly all of the administrative costs, which would in turn pay for most if not all of that system.
posted by Blazecock Pileon at 9:42 AM on March 6, 2009


I asked my self-described dittohead stepfather what he thought, and he told me we've got such good healthcare here that pregnant Canadians are streaming across the border to have their babies here; they can't get an appointment before their due date.

That's just completely untrue. I can't imagine where he might have read or heard that, unless it's a distortion of a situation sometime last year (I think) when-- as I recall-- a dangerously premature baby with major health complications had to be treated at a hospital out of province for a short time because the emergency facilities here were full. Note that what this meant was that the government picked up the flight and travel tabs, as well as accommodation for the family. I can try and dig up some more specifics if necessary; it was considered a flaw in the system that the family had to be flown somewhere else, and there was quite a bit of debate about it at the time.
posted by jokeefe at 9:42 AM on March 6, 2009


That's what great about our legislative system. Laws fix these kinds of situations. Wrongs can be remedied in congress; they do not require massive litigation in a foolish attempt to eliminate wrongs though lawsuits.

ftfy


You can't change the system every single time there is a problem.

this isn't a "problem", it's a crisis - any time you want to transcended the narrow parameters of your profession and start considering this issue as a CITIZEN, you can

or you can be considered irrelevant - your choice
posted by pyramid termite at 9:43 AM on March 6, 2009


A lot of Americans are actually paying Swedish-style taxes but get nothing in return.

True, dat. I have friends who moved to New York, where they lived for six or seven years. They were paying the same tax rate there as they would at home here in Canada, but, as one of them said, At least in Canada you get some services for the taxes you pay.
posted by jokeefe at 9:45 AM on March 6, 2009


Evil doesn't cackle. Evil doesn't grin, or sneer, or stab. Evil doesn't plot, prevaricate or pet a long haired white cat who hisses into the camera. Evil is looking someone in the eye and saying, "no, I won't help you, even though I could."

These fucking evil fuckers who say "shan't" must perish, and perish in fire.
posted by seanmpuckett at 9:45 AM on March 6, 2009 [2 favorites]


Wouldn't Pat almost certainly lose such a lawsuit? This sounds like a slam-dunk case for the insurance companies: pre-existing conditions aren't covered, it says so right in the contract; his kidney failure predates the current contract; case closed.



I may be wrong here and if I am I will happily take a correction, but I believe that if it's a preexisting condition that wasn't previously diagnosed and was found after your insurance coverage began, they must treat it.

I could be wrong on this though, it's just been my personal experience with the insurance system.
posted by Holy foxy moxie batman! at 9:46 AM on March 6, 2009


The dittoheads are misinformed but Canada's major failing is that its health care system gets less capital investment than the US system does, though I don't know why personally. Canadian hospitals are mostly older (though maybe this is just my perception because I lived in central Toronto), they're generally more crowded (when my wife was in a Mtn View hospital recently it was like a hotel, and not a particularly busy one) and they tend to lack fancy stuff like MRIs. In terms of operational expenses, the system is far, far better. But Canadian hospitals do run out of beds from time to time. Thus you get the chorus of people in Canada that want to set up a parallel private system. it should be noted in fairness that a lot of Canadians don't like the Canadian system and actually think the US one is better for some reason. Well, some, maybe not a lot.
posted by GuyZero at 9:47 AM on March 6, 2009


A lot of Americans are actually paying Swedish-style taxes but get nothing in return.

Hey! We get cheap gasoline.
posted by Blazecock Pileon at 9:48 AM on March 6, 2009


Yeah, dios, that's nice but hardly analogous to this story unless you think that Pat has a case in current law. Do you think he has a legal case? If not, then a policy change really is the only way to avoid this situation.
posted by grouse at 9:48 AM on March 6, 2009


If 85% of the "administrative overhead" costs are due to private insurance, eliminating the necessity of private insurance in the course of transitioning to a single-payer system would remove nearly all of the administrative costs, which would in turn pay for most if not all of that system.

No. I'm sorry, it would be great if this were true, but administrative costs represent a pretty small part of the pie for health care--85 to 90 percent of total systems costs are medical costs. While it might be great if we could shave that to be smaller, especially by removing inefficiencies, it's never ever going to get us to saving enough a money to pay for all the medical costs. We need to reform health care delivery and get the big slices of the pie--the medical costs, which includes a lot of unnecessary or inappropriate treatment--in order to get costs down. Single payer has a lot to recommend it as a financing system, but it is not by itself going to change anything about health care delivery in our country, which is the real source of the problem.
posted by iminurmefi at 9:49 AM on March 6, 2009


I wonder how many people stay in shitty jobs, with shitty working conditions, shitty bosses, possibly questionable labor practices, at least in part because they need to maintain continuous health insurance coverage. I'm not saying single-payer healthcare would revolutionize labor, but it would certainly change the scene.

That was me, until I was laid off. Now we have no insurance. But back when I had a job and insurance, Blue Cross/Blue Shield denied so many of my claims, it was almost like not having insurance, only I paid the insurance company money every month. The only difference was that my wife and I had cards that let us see a doctor.

The health insurance industry is the boot on the neck of the American worker. The reason right-wingers love the private health insurance system so much is because it keeps people working in jobs for less pay. Holding you and your family's health over your head tends to make you more pliable in wage negotiations. I didn't get a raise for three years, even after my take-home pay dropped by almost 10% after I got married and brought my wife under my health insurance. That might be changing, however. My old boss was a classic, cheap-labor Republican. Then her son was severely injured playing high school football and guess what? Blue Cross/Blue Shield totally fucked her. Surprise! By the time I was let go—and I am convinced that the cost of keeping me and my wife on the health insurance was a factor in my ass being on the chopping block—she was convinced that the current system had to go.

I'm trying to make it as a freelancer (good luck to anyone else trying to do this right now), so yesterday we met with an insurance broker who came highly recommended. The available programs and premiums for two healthy, relatively young people are, respectively, shitty and outrageous. And it's guaranteed that every time I try to go to the doctor, the insurance company will deny the claim and I will have to fight them to live up to their obligation. Even the broker who was trying to sell me insurance admitted as much. The best part, of course, is that as a freelancer, if I get sick and can't work, I can't pay the premium and the health insurance company gets to avoid paying!

Here's a telling exchange from yesterday's health care summit, as reported by the Washington Post:

Grassley, the top Republican on the Senate Finance Committee, argued that the "public option" would make government "an unfair competitor" to private insurers.

"The thinking on the public option has been that it gives consumers more choices and helps keep the private sector honest," Obama replied.


Here's a Republican Senator basically admitting that private health insurance can't compete with a public plan. Well, Mr. Free Fucking Market Rules All, what does that tell you? The health insurance companies crying "unfair"? Cry me a motherfucking river.
posted by vibrotronica at 9:50 AM on March 6, 2009 [13 favorites]


You're good people, dios, like most lawyers I've known.

However, like all lawyers I've known, you have mad skills in dealing with... stuff... forms and procedures and crap. It's hard for the rest of us in much the same way that programmers on Slashdot have a hard time understanding why the rest of the world can't parse code. But there's a shitload of barriers to entry that aren't real obvious to those whose training doesn't include either legal wranglings or the wranglings necesary to hire a lawyer on contingency.

I'm reminded of the quip that the law is like sausage, you don't want to see it made. OTOH, I've made sausage and, like good law, good sausage is a joy to be seen made.
posted by stet at 9:54 AM on March 6, 2009 [4 favorites]


That's just completely untrue. I can't imagine where he might have read or heard that, unless it's a distortion of a situation sometime last year (I think) when-- as I recall-- a dangerously premature baby with major health complications had to be treated at a hospital out of province for a short time because the emergency facilities here were full.
Early last February I had to take my mom to Henry Ford Hospital in Dearborn, MI, for an MRI. She had seen her doctor the week before, he ordered an MRI, she got an appointment for the following week. Between the prep time and the time to do the test, I was in their waiting area for about an hour. I started chatting with the other folks there (there were eight others), and it turned out I was the only American - they were all Canadians. The come from Windsor to Detroit to get MRIs because there is such a long wait for the test in Canada. I later met a physician in the coffee shop and I mentioned the number of Canadians coming over just for an MRI, and he laughed. Turns out he was Canadian, commutes from the Windsor area every day to work in a US hospital, where he can earn much more money. He told me that probably 60% of the patients he treats there are Canadians. I sort of laughed, like he was exaggerating but he said "You're a writer (we'd also discussed my occupation), do some research. See if I'm kidding."

I'm one of those who has stayed an all but unbearable jobs just because I needed the Blue Cross, so I agree that the US needs some sort of change in its health care system, but I question whether the Canadian model is all it is purported to be?
posted by Oriole Adams at 9:55 AM on March 6, 2009


Yeah, dios, that's nice but hardly analogous to this story unless you think that Pat has a case in current law. Do you think he has a legal case? If not, then a policy change really is the only way to avoid this situation.
posted by grouse at 11:48 AM on March 6


I'm going to assume so because Assurant paid based only on a complaint to TDI. That indicates to me that they knew they had to pay.

There are a great number of consumer protection statutes under state laws as well as under federal law that such individuals can avail themselves of. And if the problem is systemic, the whole insurance company can be put on trial.

Incidentally, Andrew Cuomo is doing some fine work on this front prosecuting national insurance companies for their practices.
posted by dios at 9:55 AM on March 6, 2009 [1 favorite]


BP--universal coverage implies that everyone has access to health care, which is fundamentally a health care delivery issue. Single payer is a finance issue. The two are related--it's hard to deliver services without paying for them--but there are multiple ways to set up a system that would achieve universal coverage, and multiple ways to pay for it.

The article I cited seems to clearly imply that nearly all of the inefficiency in healthcare delivery is due to the free market being unable to contain its costs. As such, reducing the involvement of private insurers in the role of delivery of health care, so as to eliminate these inefficiencies, would imply moving to a nationalized or single-payer healthcare system, which could be paid for by such a change.

The other major alternative payment method being proposed seems to involve requiring all people to buy private insurance, which would seem to make vast cost inefficiencies worse by completely eliminating any motivation to eliminate them in the first place. None of those administrative costs pay for any actual treatment. In any case, I don't see the article arguing for this seemingly irrational proposal, but I clearly don't know enough about the larger subject to say anything more informed than that.
posted by Blazecock Pileon at 9:57 AM on March 6, 2009


Contingency fees are all well and good to the extent that you get some relief without an upfront cost (if you win). What is bad about the contingency fee setting is that the attorney recoups 33% (the going rate when I was last working in the field). It's not like you're getting something for nothing and when you still have to make up 33% of your costs at the end of the process it's not like you're being made whole.

Not to mention the process takes months (best case) and you're on your own until the settlement is reached. Let's just hope you don't die before you do settle or get a judgment.

And, yeah, I'm really pretty emotionally invested in universal health coverage for reasons described in previous threads on this topic. I'm not saying litigation isn't an option, nor should it be removed from the arsenal going forward. I am saying that the current system leaves one with litigation as the only option. Further it is so heavily stacked against the consumer that it's not a great option. Which is to say that by pointing out that this one guy in this specific instance might sort of solve his problem via litigation feels a bit hand-wavy. Couple that with your allusions to *danger danger* sovereign immunity, dios, and it really starts to feel like you're engaging in some hand-waving. Finally, you present as an attorney so it's not a stretch to think that you've got a vested interest in keeping around a situation where one's only recourse is via litigation.

To some extent you *are* speaking a different language. The world is much wider than your constrained legal one. In the case of providing health care, some policy changes are most definitely in order.
posted by Fezboy! at 9:59 AM on March 6, 2009


iminurmefi, I agree with your analysis that part of the cost problem is to do with for-profit provides, and that a single-provider system in addition to single-payer would solve this. However, a single payer system would still ameliorate the situation assuming that the government preset tariffs for certain treatments, and simply didn't pay the bills as they came in. For example, if they said that the cost of mending a broken arm was $5000 (I don't know the real price, it's just a number), then suddenly most hospitals would find they could fix broken arms for $5000. Of course the tariffs have to be reasonable, but it's one way in which a single payer system could use its monopsony status to bring down costs.
posted by Sova at 10:00 AM on March 6, 2009


I question whether the Canadian model is all it is purported to be?

This has been hashed out a lot here before, but two points - one, the Canadian system is, as I mentioned, underfunded for capital expenses. MRIs are the major example.

Two - all systems ration health care. Canada rations it based on urgency and makes people wait. In the US, it rations it to those willing to pay the most, either via cash or via more expensive insurance.

So in Canada you get people waiting months for an MRI or knee surgery or you go to that hernia clinic in the north of Toronto that can see you in a day but uses an older procedure that has slightly worse outcomes but they have it down to an assembly line process.

In the US, everything is great until you lose your job and/or insurance. Or if you make a claim that the insurance company declines.

IMO, the Canadian system mitigates risks much better. The US system is like playing "Deal or No Deal" with your life.
posted by GuyZero at 10:06 AM on March 6, 2009 [5 favorites]


Oh, and if you don't like the Canadian model, there is the UK model, the Australian model, the French model, etc, etc. Feel free to pick any of them or some combination thereof.
posted by GuyZero at 10:08 AM on March 6, 2009


What is bad about the contingency fee setting is that the attorney recoups 33% (the going rate when I was last working in the field). It's not like you're getting something for nothing and when you still have to make up 33% of your costs at the end of the process it's not like you're being made whole.

That's not true. On a case like this, there are multiple forms of damages. Including in this is a right to recover attorney fees (consumer protection statutes as well as contract law both provide for recovery of attorney fees), as well as penalties, fees and interest. There is an overlay here with ERISA.

Couple that with your allusions to *danger danger* sovereign immunity, dios, and it really starts to feel like you're engaging in some hand-waving. Finally, you present as an attorney so it's not a stretch to think that you've got a vested interest in keeping around a situation where one's only recourse is via litigation.

I'm not trying to scare someone off of changing the policy. What I am saying is that changing the policy is not the answer for this person and is not something which eliminates the potential of this ever occurring--so it should not be seen as one. The Wyeth v. Levine case that came down two days ago from the Supreme Court just got me thinking about this issue of policy considerations occupying an issue ripe for litigation. My only point about sovereign immunity is that if you think that, as you said, "it is so heavily stacked against the consumer" now, from a general standpoint it is usually far worse when the federal government is the party against whom a complaint is made. None of which informs against policy changes.
posted by dios at 10:10 AM on March 6, 2009


whether the Canadian model is all it is purported to be?

Having a waiting room full of older, affluent and healthy Canadians in Michigan paying for an MRI is not an indictment of the Canadian system.

Having an ER full of patients in Canada needing emergent care without access to doctors, treatment or MRIs? That would be an indictment -- but it doesn't exist, mostly.

My point is this: The Canadian system is set up, like a good medical system should be, based on the triage system. Patients are seen and treated based on need. If I walked into an ER right now with blurred vision, an intense headache and altered behaviour, I would be in an MRI suite within 10 minutes -- and I would never pay a dime. If I twisted a knee playing beer league hockey? I'd get the care I needed immediately but I'd go to the back of the MRI line (I wouldn't pay for any of this, either.)

Does this mean that some people suffer for longer than they'd like with ailments that could be corrected immediately given difficult, expensive or resource-intensive treatment? Yes, unfortunately. Do people "die on waiting lists", as the dittoheads charge? No.

The triage system means healthcare is delivered more efficiently, more effectively and more consistent with the ethical and moral imperatives of medicine.
posted by docgonzo at 10:15 AM on March 6, 2009 [16 favorites]


Whatever comes down the pike, vis-a-vis "healthcare reform", I will say this...if the powers-that-be start holding-up so-called "Consumer Driven" plans as a solution, then you will know that the insurance industry has won the war. There is no more cynically-named, nor more economically ruinous family of insurance coverage than those that fall under the umbrella of "Consumer Driven" plans.
posted by Thorzdad at 10:15 AM on March 6, 2009


In the US, everything is great until you lose your job and/or insurance. Or if you make a claim that the insurance company declines.

If you're an American and you're not rich you can pretty much expect everything in this link to happen to you eventually. Even if you have a job with insurance.

My wife and I own a small business. We always wanted to the right thing by our employees. But. Our insurance rates have tripled in the last five years. Have a couple employees get pregnant or sick and you are fucked. We pretty much had to choose between giving people a job or giving them insurance. In fact my wife and I had to cancel our own insurance as it jumped from a $300 dollar month premium to $650 in the span of six months. Each. We had to go to much less robust and comprehensive health care savings plan instead which is still absurdly expensive. We never get get sick and we do everything right. It doesn't matter.

I have accesses my insurance precisely once in the last eight years for a kidney stone and the amount of fucked-up out-and-out daily haggling that had to do to get them to meet their sworn frigg'n obligation was insane. And they still only covered a third. The system is completely broken. And with the economy in free fall it's only gonna get worse.
posted by tkchrist at 10:22 AM on March 6, 2009 [4 favorites]


I never said "instead". I merely listed two options.

And presented one of them as "great", a "fix", and a "remedy".

And the other as "foolish".

That's all.

Really, you people need to stop snarking at me and try improving your reading comprehension skills.
posted by Flunkie at 10:22 AM on March 6, 2009 [2 favorites]


How do those fucks sleep at night?
posted by Devils Rancher at 10:23 AM on March 6, 2009


The article I cited seems to clearly imply that nearly all of the inefficiency in healthcare delivery is due to the free market being unable to contain its costs. As such, reducing the involvement of private insurers in the role of delivery of health care, so as to eliminate these inefficiencies, would imply moving to a nationalized or single-payer healthcare system, which could be paid for by such a change.

What? In a single payer system, the payer has the leverage. Single payer is a monopsony, analogous to a single seller being a monopoly. They are both inherently economically inefficient in the sense that in the long run they result in a market with fewer services and higher prices.

You should assume that in switching to a single payer system, many sellers on the margin would exit the market (assuming that the single payer pays less than what is paid now).

The market inefficiency in the health care system is in the health insurance industry. The reason for this is because health insurance is not sold in a free market. How many people in this thread chose their health insurer on the open market, and how many were forced to pick one of a few choices from a job (or had to take their spouses insurance)? Now how many got their car, homeowner's, or life insurance that way.

There is absolutely no goddamn reason for health insurance to be tied to your job. They two have nothing to do with one another. It makes as much sense as your employer mandating where you buy groceries.

If insurance health insurance were decoupled from employment, it would reduce costs immediately, because all those insurers would have to compete with each other.
posted by Pastabagel at 10:23 AM on March 6, 2009 [1 favorite]


The article I cited seems to clearly imply that nearly all of the inefficiency in healthcare delivery is due to the free market being unable to contain its costs. As such, reducing the involvement of private insurers in the role of delivery of health care, so as to eliminate these inefficiencies, would imply moving to a nationalized or single-payer healthcare system, which could be paid for by such a change.

Well, like all other policy areas, health care reform advocates are not immune from stating their case in ways that are misleading in order to bolster the case for their own preferred solution. If the impression you got from the blog post was that reducing the involvement of private insurers would pay for a single-payer system, then shame on Uwe Reinhardt for being misleading. It's just not true.

For some hard numbers (from the the National Health Expenditure Accounts):

As a nation, we spent $2.24 trillion on health care in 2007. $156 billion, or 7 percent of total costs, was administrative and overhead. (See row 578.)

7 percent.

I'm willing to grant that there may be admin costs folded in elsewhere. Heck, I wouldn't totally quibble with someone who argued that true admin costs are twice that figure, or 14 percent of total health care expenditures (although I think that's probably stretching it). But it's madness to suggest that lowering administrative costs, or even eliminating them entirely, will somehow create such huge savings that we could have a single-payer system. Such are arguments are either magical thinking (which, hey--I understand why people want to believe that, because it just doesn't seem possible that our system is this screwed up without an easy villain to blame) or pushing their own agenda by being misleading with their statistics and sloppy wording, as apparently Uwe Reinhardt was.

I agree that the private market has shown itself not particularly able to contain costs. (Neither has Medicare or Medicaid, for the record, even though they are publicly financed.) However, please let me point out: the private market does not only include insurers. It also includes the vast majority of health care providers, from your friendly dentist to your primary care physician to the CVS pharmacy to the hospital most of us will one day visit. It's intellectually dishonest to rail about the failures of the private market and propose that making the financing public will somehow fix everything, unless you're also proposing that we nationalize the entire health care system, so that all health care workers become government employees and all hospitals and clinics become government property. Hell, maybe that's what we need at this point, but it's a different (and more nuanced) argument than "insurers are the only reason our health care is screwed up!", which just is ignoring politically-unpalatable truths in favor of what we wish were true.
posted by iminurmefi at 10:24 AM on March 6, 2009


your friendly dentist
I'm guessing you've never actually been to a dentist.
posted by Flunkie at 10:27 AM on March 6, 2009 [1 favorite]


If I walked into an ER right now with blurred vision, an intense headache and altered behaviour, I would be in an MRI suite within 10 minutes -- and I would never pay a dime.

Heh. Noooo. I have gone to Canadian emerg twice. Once with 2 of those 3 symptoms. No MRI, either time. X-ray once. And I did get a 10 minute wait once. But the other time was something like 3 hours. Canadian emergency rooms are the same mixed bag as any US emergency room, except for the not paying directly thing.

And yes, you did pay a dime for that hospital service, just not directly. Let's not conflate single-payer with free.
posted by GuyZero at 10:29 AM on March 6, 2009 [1 favorite]


docgonzo: I think your point about the triage system is excellent, and I think it should be the operating principle. My only concern with it, however, is how to reconcile that with the idea that patients are bad historians and unreliable. If I go into the hospital with what was a sentinel headache, but I undersell it to the nurse, I might get sent home because I was not accurate enough and end up with some subarachnoid hemorrhage or something. So I wonder how from a clinical perspective, one deals with that. It seems to me that the solution is to be incredibly risk adverse such that one is overly-cautious.

Of course, that same concern exists now, but I think it is off-set some by the fact that providers can be incredibly risk adverse due to dangers of litigation, etc. So how do you incentivize the triage procedure in such a way to be risk adverse while keeping it workable as the guiding principle?
posted by dios at 10:29 AM on March 6, 2009 [1 favorite]


I'm guessing you've never actually been to a dentist.

Heh. Fair enough. Your fear-inducing-but-cheap-enough dentist who hits on you, then. (TMI?)
posted by iminurmefi at 10:30 AM on March 6, 2009


Michael Moore's Sicko.
posted by ericb at 10:31 AM on March 6, 2009


How do those fucks sleep at night?

I think you may be wrong in your assumption. My belief is that they sleep during the day. In a coffin. With some dirt. Guarded by phalanxes of lawyers.
posted by Kirth Gerson at 10:33 AM on March 6, 2009 [6 favorites]


i went to try to get a physical or checkup the other day (in canada). the doctor told me, "we don't really do that anymore, unless you pay."

"well," i said, "would you like me to go and come back when i have cancer?"

[rimshot!]

i think that pretty much any problem with canadian healthcare boils down to 3 things: we canadians are sabotaging what could be a perfect system from the inside.
posted by klanawa at 10:37 AM on March 6, 2009


the problem for Republiterians like dios is that to admit that there are severe structural problems with our very market-based health care industry is to reject the central tenet of their political faith:

EVERY ECONOMIC DISTORTION AND SOCIAL INJUSTICE IS ULTIMATELY THE RESULT OF GOVERNMENT INTERVENTION IN THE MARKETPLACE.

So, every problem must be individualized: either bad business practice or consumer fraud. The best they can do is to advocated for universal insurance ala Massachusetts. This is ok because it blames the problems with health care on irrational actors in the marketplace (as versus the perfect rational actor) i.e. the "indestructibles" who refuse to buy insurance like everyone else. (Google "indestructible" and "health insurance" to see this argument.)

the problem with the "single-payer now" argument is that the socialized parts of our system i.e. Medicare are in just as much a crisis as the others because the industry itself is broken (in lots of ways.) Changing how you pay for the health care won't change this overnight or at all depending on how the statute is written. Socialized medicine isn't just about money but about building medical infrastructure. In the end this infrastructure is expensive and you can bet the greedheads will fight tooth and nail against spending 'your' money on clinics and doctors for 'them.' You know the deficit and all...
posted by geos at 10:43 AM on March 6, 2009


the doctor told me, "we don't really do that anymore, unless you pay."

I need a button for this: *facepalm*

That sucks. And emigration of educated Canadians to the US continues apace.
posted by GuyZero at 10:43 AM on March 6, 2009


the doctor told me, "we don't really do that anymore, unless you pay."


Change your doctor. Mine still does physicals. I'm pretty sure they can bill OHIP for them like any other service.
posted by chunking express at 10:44 AM on March 6, 2009


The administrative costs (case review and appeals) of denying or delaying treatment outweigh the cost of just providing the goddamn treatment in the first place.
posted by troybob at 10:44 AM on March 6, 2009


I'm pretty sure they can bill OHIP for them like any other service.

klanawa's profile mentions BC which makes OHIP billing impractical. I fear that there may be gaps growing between the provincial health systems.
posted by GuyZero at 10:47 AM on March 6, 2009


the private market does not only include insurers. It also includes the vast majority of health care providers, from your friendly dentist to your primary care physician to the CVS pharmacy to the hospital most of us will one day visit.
posted by iminurmefi at 1:24 PM on March 6


Add to this that in a single payer, there is no incentive to innovate beyond what the payer will pay for, unless the single payer has to pay for the innovations as well. At that point, you might as well nationalize biotech R&D along with health care providers.

The market is screwed up because the price discovery mechanism that operates in every other market is thwarted by the screwed up relationships between provider, employee, employer, and insurer.

The market is screwed up because the person who supplies the service and the person who buys the service are not arguing over the price. The insurer pays, but the employee doesn't really get to pick their insurer either, their job does, and they have to pay whatever the employer says the insurance costs.

To have a free market, either the marginal buyer and the marginal seller negotiate at every transaction to reach a price; or, in this case, the buyer negotiates with the insurers at the margin to arrive at a price for insurance coverage, which in turn causes the insurer to minimize costs in order to maximize profits.

The problem now if that no one is negotiating with anyone, and insurers don't compete against each other for customers.

Add to this the nonsensical fact that employer-plans price all employers the same way not at all taking into account the different risk profiles of different people. The system is screwed up, but not in a way that a single payer will fix.

EVERY ECONOMIC DISTORTION AND SOCIAL INJUSTICE IS ULTIMATELY THE RESULT OF GOVERNMENT INTERVENTION IN THE MARKETPLACE.

I just described to you the massive distortion in the marketplace that has nothing to do with the government. I have no idea why we have this bizarre system where employees get their insurance from their job. It's completely fucked up. But it has nothing to do with the government.
posted by Pastabagel at 10:51 AM on March 6, 2009


the problem for Republiterians like dios is that to admit that there are severe structural problems with our very market-based health care industry is to reject the central tenet of their political faith:
posted by geos at 12:43 PM on March 6


Hey, jerk. Try reading before casting asperions. Maybe then you look less like an asshole. If you had bothered, you may note that I (1) support reform of the US system, (2) not anywhere ever stated support for a Republican or the Republican party, and (3) acknowledge that there are structural problems, but admit that there are multiple solutions that should be pursued, including litigation.

In other words, don't abuse my name as if I am some strawman for your political enemies.
posted by dios at 10:53 AM on March 6, 2009 [2 favorites]


Incidentally, a similar defense was just shot down by the US Supreme Court two days ago in Wyeth v. Levine.

Your citing the recent Wyeth v. Levine decision is well-taken, but as Jess Bravin noted in the Wall Street Journal, "In none of these cases (Wyeth and two other recent similar cases dealing with similar areas of state tort law) is the Court issuing a new doctrine intended to make new sweeping changes on preemption." It's a case-by-case scenario.

In the Wyeth dissent, Justice Alito wrote, "Tragic facts make bad law," which is the sort of argument that a corporate defendant in a case similar to that of Karen Tumulty's brother might be expected to make.

In any case, the same folks who argue that there are too many "frivolous lawsuits" are now up in arms about the Wyeth decision, saying (in the case of one such person) that the decision is the "worst anti-business decision" in over 40 years, and (in the case of another such person) that a result of Wyeth could be that "the specter of heavy litigation expense and crushing liabilities by runaway juries could easily block the pharmaceutical industry from initiating life-saving changes."
posted by blucevalo at 10:55 AM on March 6, 2009


"I wonder how many people stay in shitty jobs, with shitty working conditions, shitty bosses, possibly questionable labor practices, at least in part because they need to maintain continuous health insurance coverage."

Me!

Well, I like my boss and my co-workers, and I'm treated pretty well, but I'm not paid all that well, and I do tech support, which in itself has a high-burnout ratio. But I have excellent health insurance which is paid entirely by my employer (we're taxed on it as wages, but the cost of the premium isn't deducted from my base pay). That is reason enough to stay right now, but I'm also working on the side and starting up another business.
posted by krinklyfig at 10:55 AM on March 6, 2009


Americans do not pay "Swedish-style" taxes.

In the Sixties, the top tax rate was around 60% in the U.S. Now it's around 35%. That's part of the reason we are in such deep shit, added to the fact that corporations get away with paying next to nothing. In Sweden personal income tax peaks around 60%.

And let me tell you, you get a lot of services for that 60%.
posted by kozad at 10:56 AM on March 6, 2009


If you want to know why our (fucked up) system is the way it is, figure out who benefits from it. I'll bet you that it is the health insurance industry. Ironically, lots of big businesses (like General Motors) would hugely benefit from health care reform but, apparently, seem unable to bring themselves to advocate for it.
posted by LastOfHisKind at 10:57 AM on March 6, 2009


blucevalo: I get the sense you are trying to disagree with me about something, but I cannot figure what. I see who you want to disagree with it, but I do not understand what that has to do with me or anything I've ever stated.
posted by dios at 10:58 AM on March 6, 2009


"I'm guessing you've never actually been to a dentist."

My dentist is very friendly. Of course, locally he's known as a great dentist if you have insurance. I do.

This doesn't mean he's not a sadist.
posted by krinklyfig at 11:00 AM on March 6, 2009


You think that the single payer system will be problem free? Have you
ever seen a nationally-run program that has no problems? And guess
what: when the federal government is running it, you sometimes don't
get to complain or seek a legal remedy. Sovereign immunity, baby.


Dios, if you're going to wharrgarbl about this, at least keep the terms of your wharrgarbling consistent.

Single payer does not mean the federal government is running anything. It means only that the federal government is paying for it. Under single payer care, hospitals, clinics, and smaller practices (can) remain private businesses.

In this case, the person's claim would never have come up because ABAICT there aren't any pre-existing conditions exceptions in single-payer health care systems.
posted by ROU_Xenophobe at 11:00 AM on March 6, 2009 [1 favorite]


And you know how much income tax they withheld - this is in California by the way. They withheld 48%.

48-mother-fucking-percent marginal tax.


No. Withholding != taxation.

You'll pay whatever your normal marginal tax rate on that bonus should be, and get the difference back next April. Or, knowing that you were over-withheld on your bonus, you should feel comfortable reducing your withholding for the rest of the year.
posted by ROU_Xenophobe at 11:02 AM on March 6, 2009 [1 favorite]


"In the Sixties, the top tax rate was around 60% in the U.S. Now it's around 35%."

Shit, in the '50s, the top rate was above 90%. That's right, the Fabulous Fifties, when everyone was pure and happy and had a great job and a large house, and they all met at the malt shop to celebrate each wonderful day.
posted by krinklyfig at 11:03 AM on March 6, 2009 [2 favorites]


The market inefficiency in the health care system is in the health insurance industry.

To be fair, Pastabagel, there are serious informational asymmetries in the delivery of healthcare that make it so far from the model of a "perfect competition" that I doubt there are any reforms that would make a mostly-market-based delivery system workable. What you're talking about is the hope of the consumer-driven health plans, and there hasn't really been any empirical evidence that they are any more effective at containing costs than any other way of getting care. Markets don't price correctly if the buyers don't know the ultimate value of what they're purchasing, and unless a patient is themselves an M.D. there is just no way for them to figure out the marginal benefit of a given procedure. (Hell, we have so little comparative effectiveness research that most docs probably couldn't compare the marginal benefits of different treatment courses for a whole lot of common treatments.) Patients rely instead on a provider to tell them how much it is worth. This is not a free market with symmetrical information between buyer and seller, to put it mildly.

The market inefficiency in the health care system is in the health insurance industry, yes, but also in the increasingly regionally monopolized hospital markets, and the proliferation of small provider practices rather than large multi-specialty practices (which are inherently more efficient), and in the lack of comparative effectiveness research available to either patients or doctors, and on and on. To some extent, some of these inefficiencies exert counter-vailing forces--the rise of PPOs and HMOs in the 1980s and 1990s dramatically lowered medical cost inflation across the country, by providing a counterweight to the consolidation and privatization, and ensuing price increases, in most hospital markets--which is why I think it's very dangerous to talk about modifying one part (like financing) in isolation without considering what might happen to the whole shebang.

For instance, while it is somewhat inefficient that your choice of plans is limited by your employer, you're also gaining a lot of bargaining power by buying insurance in a large group. Putting people into the market to buy insurance individually is almost always more expensive, both because the administrative costs of underwriting one person are vastly more expensive than underwriting an employer group of 100 people and because employers have some clout to bargain insurance companies down. (Three cheers for offsetting inefficiencies!) The bigger the employer, the better of a deal they can extract. Massachusetts recognized this problem when trying to reform their market, and came up with the Connector, which allowed individuals to band together across the state to extract volume discounts from insurers. (As grapefruitmoon points out, though, it hasn't really solved the underlying problem of high costs.)

In my opinion, 99% of the problems in the American health care system come down to high costs, which just continue to rise and rise. Insurance is almost a red herring; if it didn't cost hundreds of dollars to see a doctor for relatively minor medical issues, then the problem of uninsurance and underinsurance (which is what screwed Pat over) wouldn't be so acute. Reforming financing is only going to "fix" things if we can attack the underlying problem, which is that we spend 16 percent of our GDP on health care--and over 90 percent of that is on actual medical costs--yet our outcomes certainly aren't any better than countries that spend far less. How to get there from here is the $2 trillion dollar question, though.
posted by iminurmefi at 11:03 AM on March 6, 2009 [9 favorites]


If insurance health insurance were decoupled from employment, it would reduce costs immediately, because all those insurers would have to compete with each other.

That is unmitigated bullshit. Millions of Americans already buy their health insurance on the open market, decoupled from any employer tie-in. It's called private coverage. I do it. It's not in any way remotely lower in cost to the consumer. It's one of the reasons people regularly go bankrupt in this country. The costs, deductibles, riders, restrictions and general lack of coverage are far more onerous than in employer group plans. The very reason employer-based coverage came into existence in the first place was because individuals couldn't afford proper coverage on their own. Things haven't changed.
posted by Thorzdad at 11:06 AM on March 6, 2009 [1 favorite]


I really need to get more active in preserving our health-care system up here in Canada. It's worth preserving, and this two-tier stuff is garbage.

The problem (one of many) is that health care keeps getting better. It wasn't so hard to run a public health care system in, say, 1980, when the options for something like cancer were a handful of treatments, most of which did very little good. But now, if there's a new $6 million treatment for leukemia and Young Joey gets stricken with this terrible malady, there is an inherent sense that Young Joey should get the $6 million cancer treatment, because it is available and because we are morally obliged to offer the best care possible to every single citizen of the country.

A poster above mentioned that Canadian hospitals tended to be older, less advanced, and more crowded than American hospitals; that's very true, but we also suffer from the fact that the technology (and the cost of such technology) available for health care services is far outstripping our ability to pay for everyone to get the latest, best treatment in a punctual and consistent manner. The for-pay system (and ensuing health insurance debacle) has a simple intellectual hook: if Young Joey wants a $6 million leukemia treatment, he needs $6 million to cover it, either through insurance or through being a very very rich Young Joey.

It's brutal and unjust, but you're never left wondering if Young Joey's treatment has closed a geriatric wing in another hospital, or if the $300,000 laser scalpel that surgery just got is why we can't afford another three beds in Ward C, and so on.
posted by Shepherd at 11:11 AM on March 6, 2009


Also, the manufacturers started using different seat belt pretensioners to prevent this in the future, despite no change in the policy. I am glad I was part of a team to help him and effect change instead of just saying, "let's fix the policy."

This is mind-bogglingly wrong.

There was a policy change. The policy change said "If you use the old pretensioners, you will pay $zillions every time someone gets fucked up in a car wreck, because of the decisions rendered in this case."

On the one hand, we could have policies and standards set by NHTSA or other agencies. Agencies that are chock full of actual no-shit experts in automotive engineering. Agencies that have actual experts in risk assessment that can be part of the regulatory process. Agencies who are required to put their proposed standards through cost-benefit analysis. Agencies who, by virtue of the foregoing, tend to be very deliberate and predictable in their decisions.

On the other hand, we could have the policy set by some judge. A judge who knows bupkis about engineering. A judge who has had positively fuck-all training in risk assessment.

Or, on the other other hand, we could just have twelve random dipshits set policy.

Oddly, you are advocating for the policy-setting process that pays you. Go figure. Me, I would be more comfortable if the policies about car safety were set by clear and specific regulations crafted by people in whom I could have some confidence that they knew the first goddam thing about what they were doing.
posted by ROU_Xenophobe at 11:13 AM on March 6, 2009 [9 favorites]


I don't care if the cow also wanted to blow up Iran.

Typical Neocowservative warmongering. The agenda hasn't changed a bit since the Project for a New Bovine Century.
posted by homunculus at 11:24 AM on March 6, 2009 [1 favorite]


Coming soon from Sidney Lumet: Twelve Random Dipshits, starring Ed Begley Jr. as the racist dipshit, and Zombie Henry Fonda as the dissenting dipshit #8.
posted by ook at 11:28 AM on March 6, 2009 [1 favorite]


I wish I would've kept some notes. I was researching Canadian health care last night because my co-workers are a) under the impression that Obama is going to force single payer health care b) that would be horrific c) Canadian health care is the model of inefficiency.

See the link in this comment.
posted by Brandon Blatcher at 11:28 AM on March 6, 2009


Sorry to burst everybody's lovely little insurance-hater bubble, but the simple fact is that everybody wants the best healthcare, but nobody wants to pay for it. With a group-buy-in system, where everybody pays into a bank, and somebody else doles out the money, there will be groups which get more money than they "should" and those who get less money. The assumption everybody makes is that the insurance companies are banks, where money goes in and it is saved to pay out future claims. This is called "float" and is supposed to be a liability, when in reality, it is invested in order to make profit (which is where Berkshire Hatahway made its money, via its General Re and GEICO insurance subsidiaries). However, losses to float do not have to be repaid, so the only way to remain profitable when investments go down in flames is to stick it to the customer.

So why are we in this situation? Because people don't want to pay for good healthcare. Instead of paying their doctor directly, people thought it would be a good idea to pay other people to pay the doctor. Where they got that idea, beats me. It might have to do with the fact that if they recieved faulty care, they were determined to sue the pants off of "fat cat" doctors who they thought were out golfing all day. But I digress. Managed health care, by making the goal to decrease costs, has shifted the goal of medicine from ensuring health to keeping profits high. Single payer health care will just shift the blame from the insurance companies to the government, where the issue won't be profits at the expense of the insured, but waste of taxpayer money.

The solution? Stop trying to get away with paying a small premium each month and expecting to get the fillet mignon. There is no "shopping around" for good health care. There is no economy of scale. More patients only means cheaper care in terms of drugs. Often times for life-threatning illnesses, there is only one treatment option, and it is expensive. Value your doctors. As you can see if you read the article, the doctors were willing to work with the patient to reduce his costs, to the detriment of the doctor. I think that you'll find this is a common occurance with insurance denials. Talk with your doctor to see what might happen if you do lose your insurance or become sick and insurance won't pay for it. Discuss payment plans. But most of all, don't depend upon your insurance or the government to bail you out. They'll bleed you dry and then sell your corpse. Check your fine print, and get a GOOD insurance plan. Not the cheapest, but the best you can afford, if you fear for your health. Live a healthy lifestyle, and if you do get sick, call your insurance company and find out what you need to do to stay covered.
posted by wayofthedodo at 11:31 AM on March 6, 2009


What do you think would have happened to this guy if his sister hadn’t been a big shot D.C. reporter for TIME magazine? He’d probably be fucked. Who knows if he would have even been able to get the Texas Insurance commission or whatever on the phone, much less get their help?
Other option would be for this guy to get a lawyer and pursue a claim that will, if the facts are as straight-forward as presented, remedy the situation.

That's what great about our legal system. Lawsuits fix these kinds of situations. Wrongs can be remedied in courts; they do not require massive change in a foolish attempt to eliminate wrongs though policy.
-- dios
This is so far removed from reality as to be absurd. Sorry if you feel that’s a "snarky bomb" But who cares? You may as well have come in here and said we could pay for healthcare with magical gold from the moon. And interestingly for a "lawyer" you didn't even say what laws you think they broke. This is Texas we're talking about here, but in most of the country insurance companies routinely go through people’s medical records to boot absolutely anyone for "pre-existing conditions". There's nothing illegal with it at all, except in California where the supreme court recently changed the laws.

Now maybe if we had a free, instant justice dispenser your plan would work. But lawsuits are expensive and take a long time. So much time and so much money that it’s unlikely that the patient would have enough money to pay for medical care and laywers, and they might not even live long enough to see the trial through.
Now you seem just to be arguing that lawsuits can sometimes have good results and people should be allowed to bring them. Nobody disagrees with this, and many systems of nationalized healthcare accommodate legal redress.
That’s what he always does. Makes some absurd claim, usually throwing in an argument from authority as a “lawyer” and then changes his claim around to something much softer while at the same time trying to claim that the people the people who attacked his first claim because his second claim is obviously true. It's very tiresome, and often it completely derails threads into arguments about obscure legal issues.
Grassley, the top Republican on the Senate Finance Committee, argued that the "public option" would make government "an unfair competitor" to private insurers.
Here's a Republican Senator basically admitting that private health insurance can't compete with a public plan. Well, Mr. Free Fucking Market Rules All, what does that tell you? The health insurance companies crying "unfair"? Cry me a motherfucking river.
There's republican thinking for you: Healthcare isn't a fundamental right for individuals, but profits for insurance companies are.
posted by delmoi at 11:36 AM on March 6, 2009 [5 favorites]


There was a policy change.

No there was not. The policy remained the same. The incentive was given to the manufacturer to go above and beyond that policy. The federal government provided a floor by policy. But federal policy did not protect this young father. And a policy change would have done nothing for him. But litigation did. And litigation protected other individuals in the future until such time as the federal policy caught up with it.

Or, on the other other hand, we could just have twelve random dipshits set policy.

Glad to see that you have such a favorable opinion of one of the central tenets of our government: the right to trial by jury. Incidentally, those juries learned more from experts, including those same experts you just applauded, than they ever need to know. So they were informed.

Oddly, you are advocating for the policy-setting process that pays you. Go figure. Me, I would be more comfortable if the policies about car safety were set by clear and specific regulations crafted by people in whom I could have some confidence that they knew the first goddam thing about what they were doing.
posted by ROU_Xenophobe at 1:13 PM on March 6


No. I'm not advocating any policy-setting process. What I am advocating is not to look at a situation as if it can only be cured by blog posts and calling your senator and trying to advocate for change in policy. Yes, work for the policy change. But you can't look only to Congress. Litigation can remedy wrongs and stop bad behavior. Fix bad policies. But the federal government is not a cure-all. You want to stop Assurant Health from doing this? Don't call Congress. Call Andrew Cuomo. He is doing more to stop this than congress.
posted by dios at 11:38 AM on March 6, 2009


An added note from someone who was once in the can't-quit-suck-job-need-insurance position: when I shattered my elbow, and had to have multiple surgeries and other fun, it was covered by the health insurance I had through my employer, of course.

When I sued the cause of the accident that made it happen and WON, the insurance company got to turn around and force ME to send part of the money I'd won in the lawsuit to THEM.

So in effect, they get paid twice. My (former, huge) employers sends them an ungodly sum every month, whether or not they ever have to pay out on anything, and if they do have to pay out, they can recoup it from me... who, chances are, will be ending up with some pretty awful arthritis and other stuff in that elbow years from now, not to mention the permanent damage I already have. Which they'll not have to cover or deal with in any way, because I don't work there anymore...

Ugh! employer-sponsored plans are maddening enough without the greed of the insurers kicking in!
posted by bitter-girl.com at 11:40 AM on March 6, 2009


I know you care about being snarky and you don't give a fuck-all about actually engaging in a discussion like a mature individual

[...]

Hey, jerk. Try reading before casting asperions. Maybe then you look less like an asshole.


This schtick never gets old.
posted by Combustible Edison Lighthouse at 11:41 AM on March 6, 2009 [3 favorites]


How do those fucks sleep at night?

Prescription drugs. Lots of 'em.
posted by grapefruitmoon at 11:41 AM on March 6, 2009


call your insurance company and find out what you need to do to stay covered.

Or move to pretty much any other country on the planet and stop worrying about shit like that. Things I also don't worry about: where the fuck my power comes from; how the roads are paved; how water comes out of my taps; who mows the lawns at my local park; etc.
posted by chunking express at 11:42 AM on March 6, 2009 [1 favorite]


And interestingly for a "lawyer" you didn't even say what laws you think they broke.

I'm glad you find it so interesting. The causes of action against the insurance company may include off the top of my head, among others, breach of contract, violation of Chapter 541 of the Texas Insurance Code, violation of Chapter 542 of the Texas Insurance Code, breach of fiduciary duty, and arguably common law fraud as well as equitable remedies. But hell, what do I know. I'm just some "lawyer."

Incidentally delmoi, because you are such a professional in this area, are there any HIPAA issues with this?
posted by dios at 11:47 AM on March 6, 2009 [2 favorites]


Sorry to burst everybody's lovely little insurance-hater bubble, but the simple fact is that everybody wants the best healthcare, but nobody wants to pay for it.
Bullshit. Hardly anyone chooses their insurance policies, that's done by their employer for no particular reason.
So why are we in this situation? Because people don't want to pay for good healthcare. Instead of paying their doctor directly, people thought it would be a good idea to pay other people to pay the doctor. Where they got that idea, beats me.
So you don't even understand the concept of insurance? The reason "someone else" pays is that the people who get sick can't afford care, and the people who don't get sick incur no costs. But since we don't know who is going to get sick and who isn't, we all pool our money so that when people do get sick, they get care. That way, everyone gets piece of mind. It's the same with Car insurance, flood insurance, etc. It's amazing that you don't understand this, and you really ought to learn something about how this stuff works.
The solution? Stop trying to get away with paying a small premium each month and expecting to get the fillet mignon. There is no "shopping around" for good health care. There is no economy of scale.
Healthcare doesn’t work, so let's just get rid of health insurance entirely. There's no "economy of scale" but since you don't even understand the concept of insurance and risk management this would be the kind of idea you'd come up with.
Check your fine print, and get a GOOD insurance plan. Not the cheapest, but the best you can afford, if you fear for your health.
Again, this is absurd. People don't chose their health insurance, they get it from their employer. And it's impossible to know in advance if your insurance will do you any good, because of the terrible state of our insurance system. Half of all people who go bankrupt due to health issues have insurance.
posted by delmoi at 11:52 AM on March 6, 2009


The solution? Stop trying to get away with paying a small premium each month and expecting to get the fillet mignon.
He's figured it out! I can go to the doctor now! OK, my family of 3 now has an income of 27k a year. Please provide a link where I can sign up for my "fillet mignon".
posted by Bernt Pancreas at 11:57 AM on March 6, 2009


Final point (though I could go on for days) - In Canada, the labour force is alot more mobile and adaptable (not to mention healthier) because employer-paid healthcare is not a big issue or trap. Everyone has guaranteed basic care, and most employer-provided health plans are roughly equivalent.

More accurately, it's not a big issue or trap for people who don't need medications for chronic conditions. Also, the formularies of covered drugs vary considerably between plans, which means that people who respond better to newer, more expensive medications are often stuck paying 100% out of pocket.
posted by thisjax at 11:59 AM on March 6, 2009


Sorry to burst everybody's lovely little insurance-hater bubble, but the simple fact is that everybody wants the best healthcare, but nobody wants to pay for it.

This is flatly not true. Did you read the part where I mention that I pay HALF of my monthly salary for insurance? I'm totally willing to pay for healthcare, I just want to also be able to buy food and live indoors.
posted by grapefruitmoon at 11:59 AM on March 6, 2009 [4 favorites]


blucevalo: I get the sense you are trying to disagree with me about something, but I cannot figure what. I see who you want to disagree with it, but I do not understand what that has to do with me or anything I've ever stated.

I don't think I was being particularly disagreeable or obtuse, but if I was, I stand corrected.
posted by blucevalo at 12:03 PM on March 6, 2009


My bubble is burst! By someone spouting nonsense!
posted by Astro Zombie at 12:07 PM on March 6, 2009


Honestly, if a cow ran for President...

I totally agree with you. Only problem is, I don't think cows can grow to be 35 years old.
posted by jock@law at 12:16 PM on March 6, 2009


The reason for this is because health insurance is not sold in a free market. How many people in this thread chose their health insurer on the open market, and how many were forced to pick one of a few choices from a job (or had to take their spouses insurance)? Now how many got their car, homeowner's, or life insurance that way.

Well, yes, in theory a free market would be the best way to allocate a scarce resource like healthcare, same as for almost any other good. In theory.

But what we have in America is not a free market. According to classical economic theory, a free market is great. With no concerted effort, it allocates resources to those who value them the most; nobody can be made better off without someone else suffering (Pareto optimality), the supply curve meets the demand curve, and there is no deadweight loss. With no regulation or even conscious effort to do so, our theory has produced utopia! Hooray!

This result is elegantly (even alluringly) beautiful, but what people, especially on the right, often forget (or willfully neglect to remember), is that its functionality is predicated on several important assumptions:

1) Perfect information - all consumers and producers know everything there is to know about the products being sold, and all of that information is reflected in the price. It's easy to show that if one side knows something the other doesn't, they will do better, but the other side will probably be so much more worse off as to reduce total utility.

2) No transactions costs - It shouldn't take any additional effort or cost to make a transaction on the market (i.e. no time, research, bargaining costs, etc.)

3) Perfect competition - Nobody has enough market share to create a monopoly or monopsony, which in most cases again create deadweight losses and reduce total utility.

Now consider the American economy, healthcare in particular.

1) If the market is truly free, all sides will have perfect information. Well, say you're buying a toy. What do you know about the toy? Basically nothing: it looks nice on the shelf, here's a price tag, your niece would probably like it. But what does the toy company know? How it was made, its inventory, it has researchers observing the market for similar toys, its components, safety hazards, etc. So who has more information? You or the big company?

Now say you're buying healthcare. Your contract has 10 pages of fine print that the healthcare company has written itself and hired lawyers to interpret favorably (for it). You just have your brain, with its paltry knowledge of legalese. And the agent has led you to believe that if you don't sign now, this GREAT LIMITED TIME ONLY offer will be off the table (he knows it isn't that great). Maybe you've seen ads on TV, misleading ads, but you don't know that. The company does, though. Again, who has more information? You or the big company?

2) No transactions costs - Well, obviously both sides have transactions costs. For healthcare, you have to compare providers, read the fine print (i.e. acquire information), etc. The healthcare company has to pay its agents and workers. But it's a big company, of course it has workers to pay, that's how it does business. In fact, it is paying those workers, oftentimes, to increase your transactions costs, as a tactic to pressure you into signing up right away. Furthermore the company makes transactions like this all the time, and thus has trained, proficient staff to minimize its costs, whereas you make one or two such purchases per year, so you don't really have much experience. Who here, for this one transaction, has more transactions costs? You, or the big company?

3) Perfect competition - Say you and 150 million other Americans want to buy a soda. Well, you have a choice, don't you? Coke or Pepsi. Yes there is RC, 7-Up, etc., but they've probably been bought out by either Coke or Pepsi, and plus, the transactions costs of finding a vending machine that actually sells RC or 7-Up are pretty astronomical compared to the price of a soda. Who has the monopoly? You, or the big company?

Now say you and 150 million, overwhelmingly un-unionized Americans want to sell your labor. You have a skill set that is valuable to maybe 5 or 10 big companies. Well, who has the monopsony? You, or the big company?

So it turns out that (surprise, surprise), three fundamental assumptions of the free market are violated pretty consistently in the American economy, and (surprise, surprise), all three of the violations end up benefiting big, rich companies (and, by extension, the elites running them) and harming the 'common citizen.' What would we have to do to fix these things? To actually create some semblance of a free market and the efficiency and prosperity it probably would provide for all (or almost all)?

1) Information - well, companies would have to more freely disclose how they create their products, what it is you are actually buying, etc. Government regulation probably wouldn't work--in this arena it usually is stupid and misguided, and companies can find their way around it (by intentionally obfuscating, etc.). You'd need companies to voluntarily, out of a recognition of how doing so would help create a truly free market and thus benefit society, disclose things like "this may cause cancer," or "this policy is actually a sham designed to take your money, we won't ever actually pay out." And you'd need to invest in education. If people can't understand the language in the contracts they sign, and they don't even realize they don't understand, well, they need to be educated. And so government would probably have to pay for that in some way or another.

2) Transactions costs - Companies would have to legitimately try to be user friendly. I'd say that you have no idea how many hours I've spent on the phone with utility companies this year, trying to find out why I've been billed for things I didn't buy, or the price went up without my knowing, or any number of things, but you've probably had this experience too. And plenty of people decided to just pay the outrageous and false gas bill rather than spend the 10-15 hours necessary to fix it. That couldn't happen anymore. Again, companies would have to just decide to play fair. A truly free market assumes fairness, that nobody seeks to game the system. So everyone who games the system would have to just stop, or be forced to stop.

3) Monopoly - Teddy Roosevelt and his trustbusters would have to return from the grave. Smash up some of these big companies, including health companies. We wouldn't need a single payer system if people had a choice between numerous healthcare companies that were transparent, easy to deal with, and didn't try to cheat them.

So I'm all for free market healthcare. I just think Republicans like Grassley may not know what they're talking about when they say 'free market.' Does he really mean increases education funding, trustbusting, holding companies accountable for taking advantage of people? Or does he use 'free market' as a convenient euphemism for 'robber baron profiteering?' And I'm not talking about healthcare only, this goes for the U.S. economy as a whole, in fact it probably applies more to other sectors. The bottom line is that all these Republicans currently espouse the 'free market,' but if someone were to try to enact REAL free market reforms, you can bet that these same Republicans would be crying in terror and doing everything they could to stop them.

(And yes, some economists argue that the informational asymmetries, transactions costs, and nonzero market share create only negligible inefficiencies in the economy. Similarly, some physicists, wedded to the beauty of their gravitational model, insist that a piece of paper, when dropped from shoulder level, will accelerate straight downwards at precisely 9.8 m/s^2. These are shitty physicists.)
posted by notswedish at 12:17 PM on March 6, 2009 [13 favorites]


Thus you get the chorus of people in Canada that want to set up a parallel private system.

And the people in this chorus are generally those who hope to profit from it, should it be enacted.

Though anecdotal evidence doesn't count for much, I just want to offer a corrective to the Canadian ER posts above (and the physician declining to do a checkup: wtf?). An elderly friend of mine fell the other weekend while out shopping and shattered her shoulder and broke her arm. She was in surgery within 12 hours; she's home now, and has a physiotherapist visiting her there for followup care. On the other hand, the day that I had an, um, incident due to the combination of my son' friend cleaning (and accidentally breaking) a glass bong in our bathtub, his somewhat slipshod job of cleaning up the mess, and me deciding to have a bath an hour later (clear glass is invisible in water, don'tcha know), I took a book with me to Emergency because I knew that needing stiches in my butt wasn't going to be exactly high priority. It made a good story though.
posted by jokeefe at 12:17 PM on March 6, 2009


Her insurance Only Covers $1,000 Per Year, so a woman in Colorado is using Super Glue to keep her teeth from falling out.
posted by Bernt Pancreas at 12:19 PM on March 6, 2009


game warden to the events rhino:
dios, you're being hugely disingenuous here.

You began your contributions to this thread by suggesting that instead of taking the article in the FPP as an argument for universal healthcare, the guy in the article should just sue. ("Other option...")
Please try not to be so extraordinarily stupid. "Universal healthcare" is not the same as "fundamentally changing our system," and doesn't necessarily require it. He said this was an option OTHER than X. That doesn't mean that he disagrees with Y. Your jumped-to conclusion is so mindbogglingly idiotic as to defy all explanation. Talk about disingenuous.
posted by jock@law at 12:25 PM on March 6, 2009


Lawyers.
posted by dirigibleman at 12:32 PM on March 6, 2009


All you people beating up on dios seem to be missing the very, very, very important point that major litigation causes a shift in market policy. Do you really think that car safety standards only exist because of the NHTSA? Do you really think that the FDA will protect you from dangerous drugs like, oh, say, Vioxx, which they approved?

Anyone upthread who has responded to dios, and has never read a single Posner opinion, has never studied the use of punitive damages as economic incentive, has never considered the possibility that the award in the McDonald's hot coffee case might actually have been too small, needs to consider him- or herself to be utterly and thoroughly pwn3d.
posted by jock@law at 12:37 PM on March 6, 2009 [1 favorite]


"Single payer health care will just shift the blame from the insurance companies to the government, where the issue won't be profits at the expense of the insured, but waste of taxpayer money."

What does this mean in practice? We do have examples of socialized medicine. Can you point out how this issue becomes a bigger problem than private insurance companies?

"The solution? Stop trying to get away with paying a small premium each month and expecting to get the fillet mignon."

I'm curious where you find that this works in a large scale. I mean, we don't have an efficient system as it is.

I think most people would be happy to have a system where we wouldn't go broke over health-related issues, and where we'd get reasonable care. I don't know anyone who expects premium care in this scenario.
posted by krinklyfig at 12:38 PM on March 6, 2009


"Anyone upthread who has responded to dios, and has never read a single Posner opinion, has never studied the use of punitive damages as economic incentive, has never considered the possibility that the award in the McDonald's hot coffee case might actually have been too small, needs to consider him- or herself to be utterly and thoroughly pwn3d."

Is public health policy through private litigation the best method?
posted by krinklyfig at 12:41 PM on March 6, 2009


Is public health policy through private litigation the best method?

Maybe. Maybe not. But regardless of the answer, it's not okay that, when someone suggests it is a method of accomplishing X, everyone jumps on that someone as being against X.
posted by jock@law at 12:50 PM on March 6, 2009


Is public health policy through private litigation the best method?
posted by krinklyfig at 2:41 PM on March 6


No. But my point all along is that there is not going to be a system this large created by imperfect beings that is going to be good enough to not have unfortunate stories like this. We cannot make one and it is foolish to think we can. So the answer to unfortunate stories is not to offer only a policy proposal. Individuals like this need to also be proactive and protecting their own individual rights. And there will be benefits from the litigation.

The issue is one of tradeoffs. I was talking to one of my clients just yesterday about the amount of charity care they do. Massive and expensive treatments that they just write off and never collect a dime. Those kind of things won't happen under a single payer system. But they happen now because my client can (1) afford to do it, and (2) is so risk adverse that they are willing to do it. And one of the primary reasons they are risk adverse is because of litigation, another incentive that won't exist under a single payer system run by the federal government.

There certainly needs to be major changes, and the tradeoffs that come with a single payer system certainly appear more and more acceptable.

But at the end of the day, the only thing that is going to help this person is to pursue his legal rights. Which he did, and it was paid. And with enough legal pressure, Assurance will stop this behavior with or without any change to the single payer system.
posted by dios at 12:57 PM on March 6, 2009


Dual Canadian/US citizen, here.

I grew up in Canada, but came to the States six years ago to start my A.B. My introduction to the US health care system occurred while I was sitting in the closest government office to my school, in Trenton, NJ, waiting for my new Social Security card.

A man at a clerk's window across the room was arguing with the clerk passionately, in tears, because he could no longer afford insulin and blood sugar testing strips.

I'm sitting there, a Type 1 diabetic myself, absolutely floored by this concept, staring with disbelief, wanting to cry myself.

People ask me why I'm planning to move back to Canada as soon as I finish this Master's program (as soon as my school's insurance plan runs out). Our system may have its flaws, but I think of that incident from six years ago, and it's not even a question.
posted by ilana at 1:03 PM on March 6, 2009 [5 favorites]


Sick in the head: Why America won't get the health-care system it needs. This was in Harper's last month. It's an interesting read.
posted by chunking express at 1:11 PM on March 6, 2009


No. But my point all along is that there is not going to be a system this large created by imperfect beings that is going to be good enough to not have unfortunate stories like this.
Then you have no point. I grew up under a system of socialised health care where such a story would be impossible; that system has served my family marvellously for three generations now.
posted by Abiezer at 1:18 PM on March 6, 2009


delmoi, what is your point? I'm saying that when you pool your money and expect somebody else to manage it, you can't expect to get a good result. Maybe your motives are to ensure that the sick get care, but that's not the HMO's plan. We need to have the people in charge of paying for the healthcare have the same motives as the people who are recieving the healthcare. That is why managed care doesn't work, no matter if its HMO's or the government, management's goals are vastly different than the patient's. Perhaps it's not "insurance-hating bubble", but rather "single-payer loving bubble."

The reason "someone else" pays is that the people who get sick can't afford care, and the people who don't get sick incur no costs. But since we don't know who is going to get sick and who isn't, we all pool our money so that when people do get sick, they get care. That way, everyone gets piece of mind.

I think we fundamentally disagree on what insurance is. Pooling money and paying an insurance company to manage your money (which, in essence, is what an insurance company is) are two VASTLY different things. The fact that this post exists is proof of that. If you think insurance companies are all about saving your money for a rainy day, perhaps you don't really understand how the real world works, where things aren't driven by altruistic motives but by the underlying need to produce profit for the shareholder.

It's the same with Car insurance, flood insurance, etc.

Two points:1. These are insurance on property, something that has an intrinsic value, was purchased for x dollars. What is the cost of a human body? If my body gets damaged, can I buy another? These insurances are based on the fact that an immediate, one-time cash payout is made when a claim is recieved, but how often does that happen in medical insurance, where life-long managed care is not deemed necessary (denials are usually because the company doesn't want to foot the bill on a decades-long treatment plan, and this is exactly what happened on this post). 2. These only cover total loss. What about dings and scrapes? You're responsible. Now you want your coverage to cover everything, but you want to keep your same premium. How will the insurance company be able to do that and stay in business?

People don't chose their health insurance, they get it from their employer.

Having your employer choose your insurance makes no sense whatsoever, and this is just a cop-out of your ultimate responsibility. Are you unable to opt out and/or choose a different plan? I'm pretty sure that that's illegal. Once again, their goals are to keep costs low, whereas yours are to stay healthy. You may be able to get a better rate, but you're giving up vital information and benefits (such as when you are covered, being able to actually see a doctor) in order to do so.
posted by wayofthedodo at 1:19 PM on March 6, 2009


And with enough legal pressure, Assurance will stop this behavior with or without any change to the single payer system.

No they won't.

What they will do is pool their money with other unscrupulous insurance companies under the rubric of some sort of Political Acton Committee and spend billions lobbying congress to change tort laws so they can't be sued. And they will still do this even if it was cheaper in the long run to simply change business practices. That's the how the precious market works.

The whole system is insane.
posted by tkchrist at 1:20 PM on March 6, 2009 [4 favorites]


Half of all people who go bankrupt due to health issues have insurance.

So then it doesn't matter if you have insurance or not, you're still equally likely to go bankrupt if you have health issues. Then why are you paying for insurance, especially one that you didn't even select?
posted by wayofthedodo at 1:27 PM on March 6, 2009


Limbaugh: Kennedy Will Be Dead By The Time Health Care Bill Passes.

Shut up, you fat, drug-addled, irrelevant fucker.
posted by ericb at 1:36 PM on March 6, 2009 [4 favorites]


Then why are you paying for insurance, especially one that you didn't even select?

What exactly are you arguing for? Do you think if there was no insurance and people just hashed things out with their doctors they'd be better able to pay for their crazy double buy pass surgery? Seriously? Nationalised Health Care works because it distributes costs and risks. And there are lots of examples of it working well all over the world.

I can't think of too many examples of libertarian junk science working out for society, but maybe you do?
posted by chunking express at 1:36 PM on March 6, 2009


Andrew Card: Health Care Is A ‘Want,’ Not A ‘Need’ — ‘Don’t Have The Government Fund It’.

Rep. Wamp: Healthcare Is A ‘Privilege,’ Not A ‘Right’ For All Americans.
posted by ericb at 1:39 PM on March 6, 2009


If the worst thing about the Canadian health care system is that it's harder to get an MRI, I think they're doing all right.
More than 95 million high-tech scans are done each year, and medical imaging, including CT, M.R.I. and PET scans, has ballooned into a $100-billion-a-year industry in the United States, with Medicare paying for $14 billion of that. But recent studies show that as many as 20 percent to 50 percent of the procedures should never have been done because their results did not help diagnose ailments or treat patients.

“The system is just totally, totally broken,” said Dr. Vijay Rao, the chairwoman of the radiology department at Thomas Jefferson University Hospital, in Philadelphia.
posted by designbot at 1:45 PM on March 6, 2009 [1 favorite]


Shut up, you fat, drug-addled, irrelevant fucker.

Would that he were irrelevant. Too many people are paying him far too much attention, whether for strategic or ideological reasons, and he is loving every damned minute of it.
posted by blucevalo at 1:51 PM on March 6, 2009 [1 favorite]


Christ. This country is just totally fucked up.
posted by perilous at 1:54 PM on March 6, 2009


I'm saying that when you pool your money and expect somebody else to manage it, you can't expect to get a good result… That is why managed care doesn't work, no matter if its HMO's or the government, management's goals are vastly different than the patient's.

Dude, have you heard of every other civilized country in the world?

Having your employer choose your insurance makes no sense whatsoever, and this is just a cop-out of your ultimate responsibility. Are you unable to opt out and/or choose a different plan?

Do you know anything at all about health insurance in America? Your employer generally makes an exclusive deal with one insurance provider. You may or may not get one or two plans to choose from. If you want to opt out or choose a different company, a) you'll forfeit any contributions from your employer, and b) you won't be able to qualify for any decent insurance anyway, because you're just an individual, not a group.
posted by designbot at 1:56 PM on March 6, 2009 [1 favorite]


Are there any single Canadian women reading this thread? Because this is for you!

Oh, is there not one maiden breast
Which does not feel the moral beauty
Of making worldly interest
Subordinate to sense of duty?
Who would not give up willingly
All matrimonial ambition,
To rescue such a one as I
From his unfortunate position?

Oh, is there not one maiden here
Whose homely face and bad complexion
Have caused all hope to disappear
Of ever winning man's affection?
To such an one, if such there be,
I swear by Heaven's arch above you,
If you will cast your eyes on me,
However plain you be I'll love you!
posted by orthogonality at 1:57 PM on March 6, 2009


You may be able to get a better rate, but you're giving up vital information and benefits (such as when you are covered, being able to actually see a doctor) in order to do so.

What makes you think it's different in the non-employered-sponsored market? You get to choose a plan with a company that will....make you give up vital information and restrict how, when, and by whom you can be seen.

Only it's generally more expensive, with higher co-pays and higher-deductibles. And they can still tell you no, you can't see this specialist that your GP says you should see, or have the tests that your doctor says you should have. Well, you can, but you get to pay for all of it instead of not all-of-it.
posted by rtha at 1:57 PM on March 6, 2009


Why is there a hyphen in "higher-deductibles"? I have no idea. Edit function please oh please.
posted by rtha at 1:59 PM on March 6, 2009


What exactly are you arguing for?

I'm saying that a lot of the criticisms that are directed towards insurance companies are going to be the exact same criticisms of universal health care: people complaining about the price and other people not getting treatment they feel they deserve. This is because of the inherent nature of managed care systems. Until we put people in charge who have the patient's best interest at heart (doctors, not insurance companies or politicians), then we will have the same problems over and over again.
posted by wayofthedodo at 2:00 PM on March 6, 2009


"I'm saying that a lot of the criticisms that are directed towards insurance companies are going to be the exact same criticisms of universal health care: people complaining about the price and other people not getting treatment they feel they deserve."

That may be true, but we may eliminate the biggest complaint, that dealing with a serious health issue often causes catastrophic financial problems for people. If someone can get sick without going bankrupt, it's an improvement.
posted by krinklyfig at 2:11 PM on March 6, 2009


Having lost my job a few months ago, and about to start paying COBRA rates, I cannot emphasize enough how glad I am that the stimulus bill passed and that, for a while, part of the astronomical rates will be covered by the US (I have to pay the exorbitant $989 for two months but then there's a rebate of some sort.) That $989 is for myself and my teenager. I have until the end of the month to pay for mid-January to mid-March, January being when the buyout insurance package ran out. I tried looking around for other kinds of insurance and found a mix of possibilities through a professional affiliate organization. One would have cost around $500 a month, but covered virtually nothing. Other policies offered were nearly as high as COBRA rates, so, I held off, hoping the stimulus package passed and thankfully, it did. Essentially, I was without insurance, though both the company and the COBRA outfit assured me that I MIGHT be able to get reimbursement.

Meantime, I got sick with bronchial, sinus and related problems, went to a clinic on a weekend and ended up paying $416 for four prescriptions. I MAY get reimbursed, I don't know. So, I'm for whatever the government can do and I wish to hell we could deliver and maintain that message so people stop getting spooked by the GOP and their "socialism" message.

My former employer, meantime, cut its insurance offerings to one, United Healthcare. While there a few different options with that one company's plans, there aren't many. Former colleagues who chose different plans to suit their own particular medical issues are in many cases in deep trouble--whereas one company might have been better at chronic conditions, another at something else, for example, the employees are now all thrown into the same overall plan.

It is amazing how quickly one can slide down the ladder thanks to medical issues. And I'm not even terribly sick.
posted by etaoin at 2:15 PM on March 6, 2009 [1 favorite]


"Until we put people in charge who have the patient's best interest at heart (doctors, not insurance companies or politicians), then we will have the same problems over and over again."

Do you have any examples of how this might work? Is anyone doing this today? It's fine to say we should put doctors in charge. What does this mean in practice? Doctors set the rates and bill you personally for services? Doesn't this mean they will have to lower their prices, because nobody can afford the up-front cost of surgery, for instance? Or does it mean you only get care if you have enough cash on hand?
posted by krinklyfig at 2:15 PM on March 6, 2009


To clarify: that's $989 each month, not total.
posted by etaoin at 2:16 PM on March 6, 2009


"To clarify: that's $989 each month, not total."

Yeah, perfect example. It's obscene, really.

I have a pre-existing condition of cancer in my history. Although I have excellent insurance through my employer, I can only get covered for cancer with catastrophic care coverage, which thankfully was set up for me by my family when I was first diagnosed almost 20 years ago, so I'd never be without it. But I'm damn lucky, and it shouldn't have to be this way.
posted by krinklyfig at 2:23 PM on March 6, 2009


delmoi, what is your point? I'm saying that when you pool your money and expect somebody else to manage it, you can't expect to get a good result.

My point is that that's totally wrong. Pooling your money and expecting a good result is the entire basis of the economy and has been for hundreds of years. Not only are you claiming that Insurance can't work, even though it's existed for centuries, but also banks and the entire concept of a corporation with stocks people can invest in? You're also claiming government can't work, which you probably believe as well.

So my point is that yes, you can expect a good result and no, you don't have any idea what you're talking about.
posted by delmoi at 2:23 PM on March 6, 2009 [2 favorites]


Meantime, I got sick with bronchial, sinus and related problems, went to a clinic on a weekend and ended up paying $416 for four prescriptions. I MAY get reimbursed, I don't know. So, I'm for whatever the government can do and I wish to hell we could deliver and maintain that message so people stop getting spooked by the GOP and their "socialism" message.

There are a lot of ways to reduce prescription costs, from buying them from canada to getting reimbursed by insurance companies.
posted by delmoi at 2:25 PM on March 6, 2009


Doctors set the rates and bill you personally for services? Doesn't this mean they will have to lower their prices, because nobody can afford the up-front cost of surgery, for instance? Or does it mean you only get care if you have enough cash on hand?

In the cases of doctors who are setting up so-called concierge practices, this is exactly how the system works -- they treat you, and they treat you well, but only if you can afford to pay, and even if you can pay, they will put a cap on the number of patients they will accept to join the pool.
posted by blucevalo at 2:26 PM on March 6, 2009


No there was not. The policy remained the same.

No, it didn't. The actual, de facto regulatory policy in force changed.

This is one of the commonplace reasons why firms, especially large firms, can come to favor regulatory rulemaking. There is going to be put into place some kind of regulatory scheme -- some set of regulations and requirements that firms either abide by, or face some negative consequence. The question is whether that regulatory scheme will be put into place piecemeal by court decisions, and probably with relatively high variability, or whether that regulatory scheme will be put into place by a regulatory agency.

Glad to see that you have such a favorable opinion of one of the central tenets of our government: the right to trial by jury.

My opinion of juries in technical matters is indeed extremely low, because jurors almost certainly do not have the technical expertise to really understand the issues in play. I like that you impugn my patriotism rather than provide any evidence of the knowledgeability of juries. Tell me: in what ways are the opinions of people who are less patriotic about the US Constitution worse than those who love all its central tenets?

Incidentally, those juries learned more from experts, including those same experts you just applauded, than they ever need to know. So they were informed.

Really? We can grab those jurors and quiz them about engineering principles, risk assessment, cost-benefit analysis, and so on and they'll know more about it than federal regulators do?

No. I'm not advocating any policy-setting process. What I am advocating is not to look at a situation as if it can only be cured by blog posts and calling your senator and trying to advocate for change in policy.

Yes, you are. You explicitly advocated litigation not in addition to policy change, but as an alternative to changes in health care policy.

Except, in both cases you actually get changes in de facto health care policy, just less organized changes made by less informed decision-makers.
posted by ROU_Xenophobe at 2:26 PM on March 6, 2009 [1 favorite]


I'm saying that a lot of the criticisms that are directed towards insurance companies are going to be the exact same criticisms of universal health care: people complaining about the price and other people not getting treatment they feel they deserve.

Complaints we won't have:

- Can't go to the doctor for [small problem] because of lack of money for co-pay/deductible (meanwhile, [small problem] blossoms into large, much more expensive problem)

- Oh noes! Got laid off and can't afford COBRA payments!

- Got a job that doesn't have benefits: options are to go uninsured and pray nothing happens, or - as someone upthread said - choose between a roof+food and an individual plan that might cover you if you get hit by a bus

- Current job is causing depression, stress, possible psychosis, but can't leave because the benefits are too good to give up

- Oh noes! Went 30 seconds longer without insurance than the law allows, and now any pre-existing condition doesn't have to be covered
posted by rtha at 2:28 PM on March 6, 2009 [7 favorites]


There are a lot of ways to reduce prescription costs, from buying them from canada to getting reimbursed by insurance companies.
posted by delmoi at 5:25 PM on March 6 [+] [!]


Hmm. Since my next step was heading to the ER because I lightheaded from coughing, couldn't get enough air with each breath and my lungs sounded like a broken accordion, waiting for something in the mail or driving to Canada wasn't an option.

And basically, I got sort of trapped, partly my own doing, by timing. I was stalling on starting COBRA payments, trying to wait to see what the stimulus package would do, or opting out of COBRA and buying a private plan, which I'm extremely glad I didn't do. At any rate, my point is that even a temporary illness can be quite damaging to the wallet. Since I'm working a freelance job that has no benefits, my other big loss was my complete income for 10 days. So the problems multiply. Still, not cancer, not kidney failure, not a major accident.
posted by etaoin at 2:33 PM on March 6, 2009


"I'm not sure what your little rant has to do with my point. This guy can get help. I hope he does."

We shouldn't have to depend on lawyers to get decent health care without going broke.
posted by krinklyfig at 2:36 PM on March 6, 2009 [5 favorites]


I thought single payer, the only real solution, was off the table. I'd be delighted to be proven wrong, though.

I'm sure this has already been covered, but I don't have the time to sort through the 1000s of comments since I last checked on this thread to double-check, but in response to DU way up-thread just in case: in a last-minute reversal, single payer advocates have been invited to the table.

Also, the constitution unequivocally guarantees three things: Life, Liberty and the Pursuit of Happiness. Denying someone access to quality health care is one of the surest ways to cause death, costing more lives annually than drunk driving and murder combined and impinging on those constitutional guarantees.

Exactly the same core arguments that justify the existence of modern police departments and emergency rescue services apply just as well to health care because they are all necessary conditions to satisfying the basic constitutional guarantees of life, liberty and the pursuit of happiness. A national health care program would be as American as your local fire department.
posted by saulgoodman at 2:36 PM on March 6, 2009 [1 favorite]


Also, the constitution unequivocally guarantees three things: Life, Liberty and the Pursuit of Happiness.

Nope.

That's the Declaration of Independence. The Constitution does not "unequivocally" guarantee any of those things. Any right in the Constitution is subject to encumbrance if the encumbrance passes strict scrutiny.

I don't think there is a Constitutional argument for "universal' health care.
posted by dios at 2:41 PM on March 6, 2009 [1 favorite]


And because I know the reading comprehension problems here: while there is not a Constitutional argument for "universal" health care, there is not a Constitutional argument against it. Rather, the Constitution is silent on the issue.

Just wanted to make that clear before the reflexively illiterate jump on that loose thread.
posted by dios at 2:43 PM on March 6, 2009 [1 favorite]


If someone can get sick without going bankrupt, it's an improvement.

Alright, valid point. But you can't expect things to be radically different when you replace corporate bureaucracy with federal bureaucracy.
posted by wayofthedodo at 2:44 PM on March 6, 2009


Yes, while we Canadians also love our health care, it's not in any way connected to the Canadian Constitution. I might think health care is important, but legally it's not the same as equality, freedom from discrimination or one's right to vote.
posted by GuyZero at 2:45 PM on March 6, 2009 [1 favorite]


But you can't expect things to be radically different when you replace corporate bureaucracy with federal bureaucracy.

Again, unless you live in any Western country other than the USA. No one has ever gone bankrupt because of illness in Canada, France, Germany, England, etc, etc. Well, maybe someone has, but it's not on the scale that it happens in the US.
posted by GuyZero at 2:47 PM on March 6, 2009


"Also, the constitution unequivocally guarantees three things: Life, Liberty and the Pursuit of Happiness."

Yeah, I agree with what you're saying, but it's sort of dangerous from a legal POV to hang your hat on that phrase, because it's nebulous and does not have legal standing. Also, it's in the preamble to the Declaration of Independence, not the Constitution.
posted by krinklyfig at 2:48 PM on March 6, 2009


Nope. That's the Declaration of Independence.

At last weekend's CPAC, Rush Limbaugh himself confused the two founding documents:
"We want every American to be the best he or she chooses to be. We recognize that we are all individuals. We love and revere our founding documents, the Constitution and the Declaration of Independence. [Applause] We believe that the preamble to the Constitution contains an inarguable truth that we are all endowed by our creator with certain inalienable rights, among them life. [Applause] Liberty, Freedom. [Applause] And the pursuit of happiness. [Applause] Those of you watching at home may wonder why this is being applauded. We conservatives think all three are under assault. [Applause] Thank you. Thank you."
posted by ericb at 2:59 PM on March 6, 2009


No. Withholding != taxation. You'll pay whatever your normal marginal tax rate on that bonus should be, and get the difference back next April.

So I am sort of cherry-picking here because I probably live in the most heavily taxed part of the USA on every level. The Bay Area cost of living is high, so salaries are high but so are costs. Making $150K in Mountain View doesn't go quite as far as in, say, Baton Rouge. Real estate prices are still high, coupled with CA's infamous prop 13 make the property taxes disproportionately high, especially for people who purchased recently (me!). I seriously doubt I could find a way to pay any more tax if I tried. Anyone who is anti-immigration should have a look at how much tax I and other resident aliens around here pay and then send us a thank-you card.

But my rough estimate of the marginal tax I pay is this:

25% federal
9.3% state
6.2% social security (which, as a non-citizen is useless to me)
1.45% medicare

Which is only 42%, true. I think some of that withholding may have been my 401k - my bad. But it's not hard for someone else to have a higher federal marginal rate - 28% or even 33%. Heck, that's not even the top rate - you pay 35% over about $178K, which may seem like a lot, but for the bay area isn't really. (ok, well, it sort of is, yeah, but it's certainly not uncommon)

So if you're actually in the 28% or 33% bracket, you get 42% witholding but you still owe more money next april - your total marginal rate is 45 or 50%. True, it's not 60% or whatever you think is "Sweden" levels actually are, but it's still a heck of a lot. To get... ? A broken state government, social security that I'l never take advantage of and the added benefit of paying for my own health insurance.

I know taxes pay for a lot more than that of course, but my point is that for the same levels of taxation we get the same set of government services in Canada plus all the medical services you can stand in line for.
posted by GuyZero at 3:00 PM on March 6, 2009


...while there is not a Constitutional argument for "universal" health care, there is not a Constitutional argument against it.

True.

I suspect that some might interpret the Constitution's preamble regarding "promot[ing] the general Welfare" of our nation and citizens to be an argument for "universal health care:"
"We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defense, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America."
posted by ericb at 3:02 PM on March 6, 2009


"To get... ? A broken state government, social security that I'l never take advantage of and the added benefit of paying for my own health insurance."

Well, also one of the best higher education systems in the country. I was blown away that all the state schools have such cheap tuition for residents - UCLA, Berkeley, UC Santa Cruz, etc. That's a big plus, seriously.
posted by krinklyfig at 3:08 PM on March 6, 2009


Alright, valid point. But you can't expect things to be radically different when you replace corporate bureaucracy with federal bureaucracy.

You should see your doctor about your reading comprehension problem, since there is abundant evidence right here in this thread that this is simply not the case.
posted by rtha at 3:11 PM on March 6, 2009


I would wager good money or my cat that anyone who argues that there are "cheap alternatives" to prescriptions in the US isn't someone who has to take a name-brand prescription for which there are no generics on a regular basis. I've had to pay up to $500 out of pocket for medication and no, I couldn't get a generic and no, I couldn't import them from Canada.

It's easy to come up with theoretical alternatives. However, when you're in need of medication every single day to stay functional (and I mean basic function here, nothing *optional*), the situation is vastly different. You don't have time to wait for the drugs in the mail, Canada doesn't have what you need, etc.

Like the guy who couldn't afford his diabetes supplies mentioned upthread: there comes a point with any chronic condition where if you don't have proper care, you're just truly, truly fucked. I've been extremely lucky that I've had help from my family, but I still ended up racking up at least $5,000 in credit card debt to pay for medication when I was uninsured.

For those who don't have to plan their lives around doctor's visits, blood tests, and medication: you are truly blessed and please, for the love G-d, don't take your health for granted. And please, try to remember that not everyone is as lucky as you are and the options here in the US are few for those who are *too sick* to work and thus can't get insurance through the workplace. Our system needs fixing. I'm all up for debate on HOW to fix it, but claiming there are ways around the current system that people just haven't *thought of * yet is to be totally oblivious to the reality that people with chronic health problems live in day in and day out.
posted by grapefruitmoon at 3:14 PM on March 6, 2009 [4 favorites]


So, I'm a bit past needing any more higher ed degrees. My kids may or may not pursue post-secondary education here - that's still a number of years away. But I doubt Berkley has much cheaper tuition than, say U of T, Waterloo, Queens or any other number of Canadian schools. Which isn't to say that the CA state university system isn't really good - it is very good, unarguably. But no one would move from Canada to California simply to get discounted state resident tuition rates unless they had a very specific program in mind.
posted by GuyZero at 3:15 PM on March 6, 2009


Here's a Republican Senator basically admitting that private health insurance can't compete with a public plan. Well, Mr. Free Fucking Market Rules All, what does that tell you? The health insurance companies crying "unfair"? Cry me a motherfucking river.

I'll take this opportunity to note that Chuck Grassley is the same shithead who thinks that private educational institutions should be required to spend at least 5% of their endowments every year. I'll bet you that, under his plan, the University of Iowa wouldn't be required to try to spend itself out of existence. Free market, my ass.
posted by oaf at 3:17 PM on March 6, 2009


canada is mostly politically on the right

This is false. 37.65% is not a majority. People keep forgetting that.
posted by oaf at 3:42 PM on March 6, 2009


You should see your doctor about your reading comprehension problem, since there is abundant evidence right here in this thread that this is simply not the case.

Fortunately, I don't rely on posts on the internet as evidence to wholly inform my worldview.
posted by wayofthedodo at 3:47 PM on March 6, 2009


canada is mostly politically on the right

This is false. 37.65% is not a majority. People keep forgetting that.


Not to mention that in American terms, our "right" would be considered moderate Democratic.
posted by jokeefe at 3:51 PM on March 6, 2009


Fortunately, I don't rely on posts on the internet as evidence to wholly inform my worldview.

From your description of how single-payers systems work, you use nothing at all to inform your worldview. Have you done any reading at all on what the actual problems are facing the health care systems in the UK or Canada? Single-payer health care is not some magic mystical place - there are a dozen implementations of it that show very clearly what its pros and cons are, none of which are the ones you mention.
posted by GuyZero at 3:51 PM on March 6, 2009


I might argue that the Declaration of Independence provides the legal foundation for the constitution, and is implicitly incorporated by reference, but you'd be right to call that sophistry. I was sloppily conflating the two.

The actual constitutional language about promoting the "general welfare" is even better though. It offers explicit support for making America into a welfare state! (Kidding. Sort of.)
posted by saulgoodman at 3:58 PM on March 6, 2009


"I don't think there is a Constitutional argument for 'universal" health care."

Or until the 13th Amendment, is any Constitutional argument against slavery -- indeed, the Constitution euphemistically endorses it ("...three fifths of all other Persons.").

Or black suffrage, until the 14th, or women's suffrage, until the 19th.

But almost no one would argue -- today! -- that it would be moral or just to enslave people, or to prevent blacks and women from voting.

Nothing in the Constitution, even today, argues against child labor, or sterilizing the retarded, or the right of men to beat their wives, or to set dogs fitting for sport. But we rightly recoil in horror at those things -- today.

God willing, we will soon look back to these times when we let one man die for another man's profit as the shameful barbarism it is. How many more have to die for your narrowly legalistic scruples?
posted by orthogonality at 3:59 PM on March 6, 2009 [3 favorites]


That was a joke, right?
posted by dios at 4:03 PM on March 6, 2009 [1 favorite]


none of which are the ones you mention

Fuchs and Emanuel beg to differ.
posted by wayofthedodo at 4:19 PM on March 6, 2009


so does Gawande
posted by wayofthedodo at 4:22 PM on March 6, 2009


Maybe you wouldn't mind pulling the money quotes you have in mind there? Both those articles say a lot of things.
posted by GuyZero at 4:27 PM on March 6, 2009


Maybe you wouldn't mind informing your worldview. I didn't.
posted by wayofthedodo at 4:30 PM on March 6, 2009


I don’t see any ‘right to make money off people’s suffering and death’ in the constitution.
Jesus, these people are f’ing ghouls. How do they live with themselves? I can imagine if I were a real bastard maybe shooting someone and taking their money. But consigning them to a slow miserable death as disease eats them up while I take payments – damn.
I don’t know a freaking gangster that would do that. This legalese crap is just pretending it’s ok.
posted by Smedleyman at 4:30 PM on March 6, 2009 [1 favorite]


To further elaborate what notswedish said, let's remember that information asymmetry plays a key role in not allowing a market to approximate perfect competition conditions.

If the insurance company collect data about its potential customer and by its analysis decides that a formerly good client is becoming a potential cost generator, an incentive is immediately formed to reduce the risk. The company has no interest in letting the customer know about the potential risk, as letting him/her would probably ask wheter such risk is covered by the insurance company. If it is not covered, the insured would probably stop making payments, thus reducing company cash flow and/or profiteability, therefore attempts will be made to let the customer know that the costs will not be covered just as soon as the question is raised.

Additionally, if the insurance companies believes that the expenses will accumulate for many years, due to the duration of the illness, it may become cost-effective to stall the payments as much as possible or start a legal fight that may prove to be too expensive for the customer finances.

All of this would be coherent with the profit maximization behavior (another requirement of companies operating in a perfect competition marketplace) yet there would be a number of person that would find themselves out of insurance market and in deep problems, as evidently no insurance company would accept such a customer.

Similarly, many banks loaded themselves with excessive risk and attempted to offload it to anybody else but themselves, yet the critical information of the "risk content" of their product may have been diluted or misrepresented by ineffective rating companies. All of this is, again, coherent with the behavior of profit maximization.

Of course, perfect information is an ideal objective and it will never be achieved, but if these are the suboptimal, second-best condition, and if the government is either not willing or not able to reshape a market into better second-best condition, then we should figure out way not to let devastating second-best events happen.
posted by elpapacito at 4:31 PM on March 6, 2009 [1 favorite]


If the insurance company collect data about its potential customer and by its analysis decides that a formerly good client is becoming a potential cost generator, an incentive is immediately formed to reduce the risk.

There is no if about it. HIPPAA is completely toothless. Their CIO's just laugh about any notion of patients owning their own clinical data. Your insurance company is the exclusive owner of all claim data, to do with as they please. HIPPAA protects your medical records, but the claims provide more than enough data to make these risk assessments.

They do this. I've written the software for it. I've heard the laughs. Makes it hard to sleep.
posted by butterstick at 6:19 PM on March 6, 2009 [1 favorite]


Any right in the Constitution is subject to encumbrance if the encumbrance passes strict scrutiny.

I'm no constitutional scholar, but that is one very wide-open "if."
posted by blucevalo at 6:31 PM on March 6, 2009


The come from Windsor to Detroit to get MRIs because there is such a long wait for the test in Canada.

Yah, you see, here's what you've got to think: it's cheaper to send people to Detroit than to Windsor. Because, y'know, Detroit is fucking brokeass. It's like going to Mexico to get dental work.

Not having to deal with paperwork is the single biggest benefit to single-payer healthcare, IMO. Both myself and my wife have spent days in intensive care due to misadventure. The only bill was from the ambulance service. In her case, injuries were massive. She took the top of the triage list and things happened now. No questions asked about payment: things just happened. Specialists were brought in, Important Technologies were used liberally, there was no waiting or signing or dickering or screwing-over, shit got done pronto.

What a relief.
posted by five fresh fish at 12:04 AM on March 7, 2009


How did it come about that US citizens have to get insurance through their employers? I'm an Aussie and as far as I'm concerned, my boss shouldn't have anything to do with such a personal issue as my health or how I pay for it. But it seems to be so widespread in the US, and given the usual 'rugged individualist' attitudes of Americans, I don't understand how it happened.
posted by harriet vane at 12:27 AM on March 7, 2009


One year ago I broke my leg in a traffic Beijing. Cost me $3800, including time in the hospital. Subsequent checkups were $30 w/ x-ray, prescriptions for the whole procedure were $50, and soon the bar will come out for an operation fee of $1300.

A visit to the doctor for my asthma costs me $3! Four months of preventative medication + emergency inhalers $100.

I'm uninsured, but I can easily afford this. This stuff is routine. I'm paying routine prices. I have no idea why the US should be any different. I didn't get "top-quality care", no. I got tried and true medical technologies that have been around for a decade. Most of the time I'm just in, out, 5 minutes, done deal. I don't make an appointment, I take a number and wait in line at non-peak hours. The Chinese medical system definitely has its problems, but for routine treatment, Christ's sake, they make it way simpler in Beijing than it would be in the US. The economic disparities...Chinese PPP is 1/3 the US's, so multiply by 3. My medical bills in the states were 6-7 times what I pay here.

Fucked up is what it is.
posted by saysthis at 12:30 AM on March 7, 2009


I wonder how much the US system is also distorted by the fact that doctors graduate with six-figure loan debt here, and are forced to made decisions about compensation levels, specialization, etc. under that 5-ton weight.
posted by availablelight at 1:23 AM on March 7, 2009 [1 favorite]


To be fair, the AMA maintains this by controlling who and how many students get into medical schools. By controlling the number of doctors and the training options, they have a non-insignificant measure of control over costs for those who want to become doctors.
posted by Blazecock Pileon at 3:35 AM on March 7, 2009


I wonder how much the US system is also distorted by the fact that doctors graduate with six-figure loan debt here

It certainly weighs in. Once one has the doctors motivated by high salaries (carrot) and by a lot of debts (stick) they are more likely to perpetuate a system that sustains or generates negative externalities or socializes costs.
posted by elpapacito at 3:39 AM on March 7, 2009


"I asked my self-described dittohead stepfather what he thought, and he told me we've got such good healthcare here that pregnant Canadians are streaming across the border to have their babies here; they can't get an appointment before their due date. I have no idea where he got this. Are only the people that can afford to fling gobs of money at their insurance companies American enough to have real medical care?"

It happens in a extremely minute number of cases almost always high risk pregnancies that encounter complications. The flagship case in Alberta was a women pregnant with identical quadruplets; literally a 1 in half a million occurrence. Over blown hype and a number surely dwarfed by the number of births not attended by doctors in the states because the parents couldn't afford one (or even pre-natal care). I'm guessing on the last but considering there were only 418 quadruplets born in the US in 2005 I think it's a pretty save bet.

"The come from Windsor to Detroit to get MRIs because there is such a long wait for the test in Canada. I later met a physician in the coffee shop and I mentioned the number of Canadians coming over just for an MRI, and he laughed. Turns out he was Canadian, commutes from the Windsor area every day to work in a US hospital, where he can earn much more money. He told me that probably 60% of the patients he treats there are Canadians.

This is just vanity medicine. I'd bet few if any of those patients were there on recommendation of their doctor. For example when my father-in-law fell and broke his hip and other signs were pointing to a brain tumour he was MRI'd within 3 days. Patients demanding unnecessary tests run rampant in both systems but under the US system the delusional but affluent are better able to divert resources from the poor.

"If insurance health insurance were decoupled from employment, it would reduce costs immediately, because all those insurers would have to compete with each other."

Well 4.5+ million Americans have lost their jobs so far in this recession, that means private insurance rates are plummeting right? Anyone here experienced a private rate reduction for the same level of care?

"i went to try to get a physical or checkup the other day (in canada). the doctor told me, 'we don't really do that anymore, unless you pay.'"

Thirding you need a new doctor. Mine (in BC) gives me a general check up every year. I know he requires payment for a licencing physical but that's completely understandable as the paper work runs to several pages and it is an elective procedure.
posted by Mitheral at 4:17 AM on March 7, 2009 [2 favorites]


it's cheaper to send people to Detroit than to Windsor

Care to back that up? The numbers I'm able to find suggest that an MRI in Detroit averages over US$3,000, and OHIP will reimburse a maximum of about C$2,000. That would mean that an MRI in Windsor costs the government a little over half what it does in Detroit.

At least if we fix our health-care system down here, it might get rid of the two-tier system in Canada and put a stop to people choosing to practice medicine not in Canada, where they can make a living, but in the U.S., where they can make a killing.
posted by oaf at 5:52 AM on March 7, 2009


Nice to see about mid-thread that the free-marketeers showed up for a bit. That must have taken alot of courage, since the last few years have clearly proven, to just about anybody who reads/watches the news, that a completely unrestricted, unregulated free market is as unworkable and dangerous a fantasy as Marxism.

For the sake of my blood-pressure I'll only react to a couple of items.

In my opinion, 99% of the problems in the American health care system come down to high costs, which just continue to rise and rise. Insurance is almost a red herring; if it didn't cost hundreds of dollars to see a doctor for relatively minor medical issues, then the problem of uninsurance and underinsurance (which is what screwed Pat over) wouldn't be so acute. Reforming financing is only going to "fix" things if we can attack the underlying problem, which is that we spend 16 percent of our GDP on health care--and over 90 percent of that is on actual medical costs--yet our outcomes certainly aren't any better than countries that spend far less. How to get there from here is the $2 trillion dollar question, though.

The cost, though important, is irrelevant to this discussion. Consider actual medical cost as a given: an X-ray costs '$X' (heh) period. Our problem is how to ensure that people who need X-rays all get them at the lowest overall cost. Clearly a for-profit insurance system might reduce the totals spent on X-rays, but it does so only because it denies access to X-rays to some who might actually need them. For health care, that's a fail.

Second - hellooo, all you MBA McFlies - if there's that much money going into health care, then there are PLENTY of opportunities for entrepreneurship and business savvy to participate and profit, even in a single-payer system. Trouble is, for-profit health insurance is such an easy gravy-filled scam that it makes genuine innovation in delivering health care look like work (or "socialism").

Finally, someone mentioned upthread how one way to reduce health care costs is to get mail-order drugs from Canadian pharmacies. WHAT THE FUCK. Do you have a clue WHY drugs are cheaper up here? It's because of the clout wielded by a single payer system to negotiate lower prices. Anyone who buys drugs from Canada is benefiting from a single-payer system.

I don't think there is a Constitutional argument for 'universal" health care.

But there COULD be! That would be a better measure of progress as a country, certainly moreso than having the highest per-capita ownership of big LCD tvs.

And that $$ for checkup in Canada is not true. you are entitled (and expected) to have a checkup once a year.

On the topic of medical education - yes both Canada and the US need to address this,to reduce the cost, especially as a barrier to med school enrollment, and to increase the number of doctors graduated.
posted by Artful Codger at 8:36 AM on March 7, 2009


I don't think there is a Constitutional argument for "universal' health care.

Article I, Section 8
The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States; but all Duties, Imposts and Excises shall be uniform throughout the United States; ( my emphasis )

And: To make all Laws which shall be necessary and proper for carrying into Execution the foregoing Powers, and all other Powers vested by this Constitution in the Government of the United States, or in any Department or Officer thereof.

Here's an excerpt from Justice Roberts in US v Butler regarding the phrase "provide for the general Welfare":

Madison asserted it amounted to no more than a reference to the other powers enumerated in the subsequent clauses of the same section; that, as the United States is a government of limited and enumerated powers, the grant of power to tax and spend for the general national welfare must be confined to the numerated legislative fields committed to the Congress. In this view the phrase is mere tautology, for taxation and appropriation are or may be necessary incidents of the exercise of any of the enumerated legislative powers. Hamilton, on the other hand, maintained the clause confers a power separate and distinct from those later enumerated, is not restricted in meaning by the grant of them, and Congress consequently has a substantive power to tax and to appropriate, limited only by the requirement that it shall be exercised to provide for the general welfare of the United States. Each contention has had the support of those whose views are entitled to weight. This court had noticed the question, but has never found it necessary to decide which is the true construction. Justice Story, in his Commentaries, espouses the Hamiltonian position. We shall not review the writings of public men and commentators or discuss the legislative practice. Study of all these leads us to conclude that the reading advocated by Justice Story is the correct one. While, therefore, the power to tax is not unlimited, its confines are set in the clause which confers it, and not in those of § 8 which bestow and define the legislative powers of the Congress. It results that the power of Congress to authorize expenditure of public moneys for public purposes is not limited by the direct grants of legislative power found in the Constitution. ( my emphasis ) source

This is also touched upon in Ellis v City of Grand Rapids. It was about a private religious organization getting private benefits from the city's use of eminent domain, but it does establish that promoting the general welfare includes a compelling interest in the health of the people.

In interpreting whether the proposed project constituted a "public use," the court pointed to the Preamble's reference to "promot[ing] the general Welfare" as evidence that "[t]he health of the people was in the minds of our forefathers." "[T]he concerted effort for renewal and expansion of hospital and medical care centers as a part of our nation's system of hospitals, is as a public service and use within the highest meaning of such terms. Surely this is in accord with an objective of the United States Constitution: 'promote the general Welfare.'" source

Hospitals operated by religious organizations, for example, provide significant public, secular benefits to the surrounding community and often do not operate solely for the benefit of private religious interests. Such institutions provide services to the general public and do not discriminate in the provision of necessary and often life-saving medical care. Education is another essential public service provided by private religious institutions, and so long as religious schools comply with curriculum requirements, such schools often enhance the general welfare. source (pdf; p1126)

I'm no expert but could this sort of thing provide a precedent for establishing universal healthcare? Has either of these rulings been countered by later rulings?
posted by effwerd at 10:53 AM on March 7, 2009


This is just vanity medicine. I'd bet few if any of those patients were there on recommendation of their doctor.
I doubt it's strictly "vanity medicine." A friend of my mom's lived in Niagara Falls, Ontario, and been having strange symptoms/health problems. After several rounds of tests, her doctor started to suspect a brain tumor and scheduled her for a CT scan. (This was in the late 1980s.) She had the option of waiting six months to get it done in Hamilton, the nearest facility with a CT machine, or nine months to get it in Toronto. She ended up going to Buffalo instead. Oh, and she did have a tumor, which eventually killed her. Maybe early diagnosis didn't matter in her case, I don't know. And regarding maternity cases, I've seen news flashes on Channel 9 (from Windsor) several times announcing that Hotel Dieu Grace was not accepting any maternity cases due to staff shortages and overcrowding, and that all such women should report directly to Windsor Regional Hospital. Then the next evening's edition of Windsor Evening News would have film footage of hospital hallways full of pregnant women on gurneys (some gave birth in the corridor, it was reported).
posted by Oriole Adams at 11:05 AM on March 7, 2009


effwerd, it's clear from context that dios means only "I don't think that the Constitution requires universal health care."
posted by ROU_Xenophobe at 12:27 PM on March 7, 2009


Well, that's kinda what I'm getting at.

In providing for the common defense, Article 1, Section 8 enumerates specific aspects of that familiar to the times. There's no requirement for an Air Force in the constitution but we establish the requirement today because it's a reasonable extrapolation of intent and we have the technology. The idea of national healthcare wasn't among the templates for social institutions at the time like the army or the navy were, so it wasn't enumerated as a way to provide for the general welfare. Given that the general welfare is mentioned in hand with the common defense, it would be just as valid to presume national healthcare is an equally compelling interest. The fact that we haven't acted on this implication yet isn't necessarily an argument against requiring such provisions today, and since we are now at a time when the general welfare of the nation is at risk, healthcare is a major part of that, and we have the capacity to address it, it seems appropriate to figure out exactly what powers Congress has in this regard.
posted by effwerd at 2:36 PM on March 7, 2009


There's no requirement for an Air Force in the constitution but we establish the requirement today

I don't think anyone seriously maintains that not having an air force would be unconstitutional.
posted by ROU_Xenophobe at 3:47 PM on March 7, 2009


Sure, I get it, the Air Force was established in an act passed in 1947 and is not required by the constitution. That's not the point. The point is that no one would argue that the Air Force is unconstitutional.

I guess I just should have said I'm not interested in this "required" argument. If it can be established that the constitution places a power within the scope of Congress, what does it matter if it's required or not? My question was: can it be established that universal healthcare falls within the scope of the powers granted Congress by the General Welfare Clause?
posted by effwerd at 7:01 PM on March 7, 2009 [1 favorite]


Why Conservatives Are Radical on Health Care
posted by homunculus at 4:20 PM on March 8, 2009


"friend of my mom's lived in Niagara Falls, Ontario, and been having strange symptoms/health problems. After several rounds of tests, her doctor started to suspect a brain tumor and scheduled her for a CT scan. (This was in the late 1980s.) She had the option of waiting six months to get it done in Hamilton, the nearest facility with a CT machine, or nine months to get it in Toronto."

20 odd years ago the installed base of CT/MRI machines was much lower. This is why those quadruplets and quintuple births so often head to the states as Canada does not have as many cutting edge machines, probably never will. It's great that your mom's friend was able to jump the queue by travelling to the US but from a public health point of view that probably means an American's treatment was either delayed or denied.

As always it comes down to how do you choose to ration? Based on perceived need or on who has the biggest vault. Insurance companies are firmly on the side of the biggest vault; Canadians for the most part are on the side of need. Will doctors make what turns out to be wrong decisions in hindsight? Of course, no profession doing projections is 100%. Thousands of people will have stories of how they survived despite the care of their doctors in the same way thousands have survived serious accidents by not wearing seat belts. However the greatest good is obtained by wearing seat belts and by allocating medical care based on need rather than wallets.
posted by Mitheral at 4:30 PM on March 8, 2009 [1 favorite]


I don't think there is a Constitutional argument for "universal' health care.
posted by dios at 2:41 PM on March 6


Neither do I. But there's certainly a moral argument. It's a shame that so many on your side forget that.

And the King shall answer and say unto them, Verily I say unto you, Inasmuch as ye have done unto one of the least of these my brethren, ye have done unto me. fuck you got mine
posted by Optimus Chyme at 4:52 PM on March 8, 2009 [1 favorite]


effwerd: I really wish you read my comments closer.

I said there is nothing in the Constitution requiring it, and there is nothing prohibiting it. As such, discussing the Constitution with respect to this is a waste of time. Nobody disputes the ability of Congress to pass legislation regarding healthcare. We have the Department of Health and Human Serves. Under same, we have CMS for Medicare and Medicaid. We have the FDA. We have the CDC, NIH, AHRQ, SAMHSA. Clearly Congress can regulate the health care industry.

Simply, the Constitution has no part of this discussion.

As for the "general welfare" language, there is Constitutional basis to argue that it requires the government to do anything with respect to the healthcare industry. We know this because at the time of the passage of the Constitution, the federal government was not required to provide health care. And neither was it created in the First Congress. Therefore, it is plain that the "general welfare" language does not require that the Government do so; if that's what that language meant, then we would have had it at the time or immediately upon passage of the Constitution.

There are plenty of good arguments for a more robust federal system of healthcare. There is no reason to turn to the Constitution for further support--nor will there be any further support forthcoming from it.
posted by dios at 7:27 AM on March 9, 2009


As for the "general welfare" language, there is Constitutional basis to argue that it requires the government to do anything with respect to the healthcare industry.

There obviously should be a "no" between "is" and "Constitutional" in that sentence.

/wishing for edit button
posted by dios at 7:37 AM on March 9, 2009


The decisions that are made regarding my health are never determined by the insurance company's bottom line, but by my doctor's determination that such-and-such is the best treatment option.

I can not imagine trusting my health care to an insurance company. Especially when the insurance companies have demonstrated conclusively that they'll choose to protect their bottom line even if it means killing the client.
posted by five fresh fish at 7:34 PM on March 9, 2009


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