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How I lost my health insurance at the hairstylist's
July 8, 2009 10:12 AM   Subscribe

How I lost my health insurance at the hairstylist's is one story among millions about the insanity of US health care. 59% of the American public and 59% of physicians support single-payer national health insurance, but in a recent prime time town-hall meeting on health reform proposals, ABC did not air a single question about single-payer. HELP is on the way. At a HELP hearing on single-payer, Kucinich pwned a doctor who claimed Canadian health care was worse than the US's.
posted by shetterly (561 comments total) 58 users marked this as a favorite

 
Oh, that Kucinich exchange was fantastic. Also:

Metafilter: My position is respectable, and I dislike your comment, sir.
posted by gurple at 10:18 AM on July 8, 2009 [11 favorites]


Single-payer what what now? Oh, you mean SOCIALIZED MEDICINE??

Seriously, that's about how the conversation goes around here, including family members and friends who are getting utterly shafted by the current system. But by golly it's still better than wearing gray clothes and standing in line waiting for their government cheese and free leg amputation.

Yes, I'm a little frustrated.
posted by LordSludge at 10:20 AM on July 8, 2009 [11 favorites]


But single-payer socialized medicine will turn our fine American system into a complex bureaucratic nightmare of red tape. There will be endless forms to fill out in complex jargon and appointments to keep and and at the end of it all, some faceless clerk will deny you care.

So, it would be like what we have now, except without the billing.
posted by Rat Spatula at 10:24 AM on July 8, 2009 [75 favorites]


> Seriously, that's about how the conversation goes around here, including family members and friends who are getting utterly shafted by the current system.

Millions of Americans would rather die in the poorhouse than go to bed at night knowing that someone, somewhere is receiving something they helped pay for.
posted by Stonewall Jackson at 10:26 AM on July 8, 2009 [199 favorites]


Talking to someone at work, I suggested that the problem in the US is that the debate seems to be about "health insurance" when it really should be about "health care", and I got the strangest look back in return. I don't want to go out in a free market of insurance companies that see me as part of an extraction economy; I want to take care of myself, my wife and my kid.
posted by boo_radley at 10:27 AM on July 8, 2009 [5 favorites]


Also, ask me about the endless piles of forms I fill out for FSA reimbursement.
posted by boo_radley at 10:30 AM on July 8, 2009


America is a land where someone without any health insurance will deride single-payer insurance because a millionaire on TV told them it's bad.
posted by Legomancer at 10:34 AM on July 8, 2009 [113 favorites]


My prediction: we know the middle class are getting (relatively) poorer, and the population is ageing. Eventually the terms of the debate have to change, because the balance of voters in favour of a system that doesn't penalise anyone who is excluded from insurance will reach a tipping point.
posted by MuffinMan at 10:35 AM on July 8, 2009


As a Brit in the US it's kind of interesting watching one of my co-workers who is losing his job scramble around to figure out how he'll cover his kids medical bills if he doesn't immediately get a new job. And by interesting I mean fucking frighting, especially when everyone here is two or three spots of bad luck away from experiencing the joys of that ourselves.

On the plus side they pamper you a lot more here if you are covered. Not that it wasn't possible to sign up for private healthcare back home and get the same glossy sheen to things.
posted by Artw at 10:36 AM on July 8, 2009 [7 favorites]


Well, I'm scared.
posted by idiotfactory at 10:37 AM on July 8, 2009 [1 favorite]


Corporate health insurance is spending over $1 million daily on trying to kill the public option. For that alone we should go single payer and drive them out of business.
posted by DU at 10:38 AM on July 8, 2009 [44 favorites]


I fucking love Canada.

And yeah, that Kucinich exchange was pretty entertaining.
posted by chunking express at 10:39 AM on July 8, 2009


The thing that's finally going to fix health care in the US is the cost to businesses. When it was just poor people going sick without treatment, no one cares. When it's just middle class people crushed into bankruptcy because of health costs, no one cares. But now that businesses are going broke because they can't afford insurance benefits anymore, enough politicians care that something might finally change.

The Economist had a fantastic analysis last week about the status of changing American health care. The part that really made my jaw drop is that the US already spends more public money per person for health care than any other country. We're already paying the cost of national health care, why not just give it to us!

That leukemia store linked in the post is heartbreaking.
posted by Nelson at 10:39 AM on July 8, 2009 [13 favorites]


The endless whining I heard from an insurance exec being interviewed on the radio about how "public insurance" (his words) would be impossible to compete against nearly made me pitch the radio out the window.
posted by rtha at 10:39 AM on July 8, 2009 [1 favorite]


Now I believe every word in the story in the first link, but I find it odd that these insurance companies bill you more when you suddenly get sick. WTF are you paying them monthly premiums for when no one is sick? Is it insurance or not? Billing you extra for using it is... it's like not having insurance at all. Is US health insurance a lie?

But single-payer socialized medicine will turn our fine American system into a complex bureaucratic nightmare of red tape.

I wave my little green card around. My wife had surgery in Canada, my daughter had surgery that involved general anesthesia, I filled out maybe one piece of paper each time. I got pneumonia and when I told them "MYSTERIOUS UNKNOWN RESPIRATORY INFECTION" I didn't even have to fill anything out - they just took me into an isolation room.

In fairness, the meal when my wife was in the hospital sucked. And the doctors are brusque. And my GP once told me I had degenerative arthritis when I had pulled a muscle (sigh). But I find it somewhere between shocking and boring that the same stupid arguments/lies keep getting rehashed about single-payer.

Also, Kucinich: you're all right.

(I know you were being sarcastic, but I also know that a lot of people actually believe this, though probably not around here).
posted by GuyZero at 10:39 AM on July 8, 2009 [4 favorites]


My wife went in for her yearly yesterday. She and her doctor got into a discussion about insurance. The doctor stated flatly that she and the other doctors in her group have simply ceased performing tubal ligations because the insurance reimbursement was too low to make it worth her while. For the time it takes her to perform a single tubal, she can stay in her office and perform an afternoon full of pelvic exams and make much more money at it. So, her group doesn't do tubals anymore.

Another part of the conversation took a fairly odd turn. It seems the doctor is under the opinion that, if we DO get a public program, everyone will be forced to use the public program. Obviously, there's a lot of fud out there drowning-out facts.
posted by Thorzdad at 10:40 AM on July 8, 2009 [2 favorites]


My prediction: we know the middle class are getting (relatively) poorer, and the population is ageing. Eventually the terms of the debate have to change, because the balance of voters in favour of a system that doesn't penalise anyone who is excluded from insurance will reach a tipping point.

But the system doesn't include older people from insurance: they're covered by a massive, government operated, single payer system.

Lucky fuckers.
posted by mr_roboto at 10:42 AM on July 8, 2009 [1 favorite]


Sorry, exclude.
posted by mr_roboto at 10:42 AM on July 8, 2009


Ask MetaFilter: You respond, if you have an answer.
posted by Riki tiki at 10:42 AM on July 8, 2009 [2 favorites]


Rat Spatula: But single-payer socialized medicine will turn our fine American system into a complex bureaucratic nightmare of red tape. There will be endless forms to fill out in complex jargon and appointments to keep and and at the end of it all, some faceless clerk will deny you care.

Myth: Canada's health care system is a cumbersome bureaucracy.

The U.S. has the most bureaucratic health care system in the world. More than 31 percent of every dollar spent on health care in the U.S. goes to paperwork, overhead, CEO salaries, profits, etc. The provincial single-payer system in Canada operates with just a 1 percent overhead. Think about it. It is not necessary to spend a huge amount of money to decide who gets care and who doesn't when everybody is covered.
posted by gman at 10:43 AM on July 8, 2009 [47 favorites]


And yeah, that Kucinich exchange was pretty entertaining.

That's the thing with Dennis, you can always expect him to come in without gloves on and tell it like it is.

Cleveland keeps re-electing him for a reason.:)
posted by spirit72 at 10:43 AM on July 8, 2009 [8 favorites]


The endless whining I heard from an insurance exec being interviewed on the radio about how "public insurance" (his words) would be impossible to compete against nearly made me pitch the radio out the window.

Well the government should be honest that in a perfect world, yes, all those insurance companies would be put out of business. Because certainly there are no health insurance companies in Canada... wait what?
posted by GuyZero at 10:44 AM on July 8, 2009


TDDR

Too Depressing; Didn't Read
posted by incessant at 10:45 AM on July 8, 2009 [7 favorites]


I get rather furious when I hear some senator or congress person go on and on about rationing and waiting in line for medical care. These folks have obviously never used the American health system that the vast majority of us, even those firmly entrenched in the middle class workforce, use. They live in a magical fantasy land where their doctors get to make decisions instead of some guy in a call center in India; or worse some expert system that spits out a "cost efficient" solution based on what will be most profitable for the insurance company and keep you limping along until they can drop you or deny coverage.
posted by humanfont at 10:46 AM on July 8, 2009 [15 favorites]


Millions of Americans would rather die in the poorhouse than go to bed at night knowing that someone, somewhere is receiving something they helped pay for.

That's absolutely true. Somebody very close to me once said, "I'd rather me and my whole family go bankrupt and DIE before having any sort of nationalized health care."**

I'm... just... how do you argue with that? It's beyond rationality. How do we reach these people?

** Followed up by, "And, you know, just a few hundred years ago people didn't live much past their 30s, and that was NORMAL. It was JUST FINE." WTF??
posted by LordSludge at 10:48 AM on July 8, 2009 [5 favorites]


I get rather furious when I hear some senator or congress person go on and on about rationing and waiting in line for medical care.

Me too, because they already have "socialized medicine". I'd really love some interviewers to get all the congressional opponents of single-payer on record on whether they eschew that eeeeeevil commie doctorin'.
posted by DU at 10:49 AM on July 8, 2009


i just want to put this here, for the record: one of the commenters in the kucinich link complains that they should look to other countries besides canada as examples for universal health care. that will soon be the case, because people like this get their ideological direction from here, which features prominently here.

i'm a broken record, i know.
posted by klanawa at 10:49 AM on July 8, 2009 [3 favorites]


I am a single mother of three kids. My annual income is a bit over $30,000. I pay $750 a month in health care premiums for my family. This is more than my rent and grocery bill. It is the highest bill I have. And this is with each child having a $1000 deductible and co-pays. So most of the time, when my kids are healthy (thank god) my insurance pays nothing.

One of the reasons my premiums are so high is because they are each on their own individual plan because we don't qualify for any kind of family plan (and my employer does not cover dependents). We don't qualify for a less expensive family plan because I have had some eye surgeries in the past and will not be underwritten on any insurance plan I have ever found except for my employers HMO, (which cannot deny me for pre-existings.) The family plans all require an adult along with the dependents. So, in total, I have 5 insurance cards (I have two), 5 premiums, 5 co-pays, etc. Talk about bureaucracy.

My mother worked and paid premiums all her life and was basically healthy. Then she lost her job and took on a private insurance policy to tide her over for the two years until she would age into medicare. In those two years, she got a terminal brain tumor. She maxed out her insurance cap in 8 months and became uninsurable. Then she paid out of pocket, over 100,000, until she died a few months later. If she wouldn't have died, she would have been bankrupt and destitute for the rest of her life.

There are a million stories like this in this country. I have relatives in Canada. It is not perfect, no. But the way they are able to live their life there, to not have to worry about this, is something that we just cannot even imagine here. Their ability to change jobs when they want or need to, get divorced or married when they need to, get care without a second thought when they need to is a level of security we just don't understand here.

Illness happens to everyone. And insurance rescinding (dropping a contract or surcharging your employer to death as in the first story) WILL happen when any of us get a major illness. This will affect you and your family for the rest of your life, limiting your options and your freedom. I know I'm mostly preaching to the choir here, but it is unconscionable how many detractors of health care reform have NO understanding of what can and will happen to them at the first sign of serious illness. And no willingness to learn these issues because they have been trained to be afraid of a little word called socialism. Security = freedom.
posted by Bueller at 10:53 AM on July 8, 2009 [122 favorites]


As gman said, 31% of American health care money goes to administration, in Canada 1% goes to administration. Who is bureaucratic now?
posted by blue_beetle at 10:53 AM on July 8, 2009 [9 favorites]


It's sadly ironic how at the very very *very* bottom of that first article, there's a paid advertisement in blue that says:

"QUIT WHINING. OUR HEALTHCARE SYSTEM IS FINE."
posted by miss lynnster at 10:53 AM on July 8, 2009 [1 favorite]


Nelson: "The Economist had a fantastic analysis last week about the status of changing American health care."

Indeed, tackling inflation in American health care remains the most important and difficult part of the treatment. According to our poll, cost is a tender nerve: 61% thought the high cost of care and insurance was a bigger problem than the number of uninsured, against 31% who believed the reverse. Only 21% would be willing to support a reform plan if they had to pay more in insurance or tax; 62% would not.
posted by KevinSkomsvold at 10:54 AM on July 8, 2009


Security = freedom.

Sorry Bueller, but:

They who can give up essential liberty to obtain a little temporary safety, deserve neither liberty nor safety!!!! Nor health care!!!eleven!!!

Benjamin Franklin was against single-payer!
posted by GuyZero at 10:55 AM on July 8, 2009


It's sadly ironic how at the very very *very* bottom of that first article, there's a paid advertisement in blue that says:

"QUIT WHINING. OUR HEALTHCARE SYSTEM IS FINE."


That's what they call "reverse psychology". It's a pro-reform campaign from the SEIU. So the irony is intentional I suppose?
posted by mr_roboto at 10:56 AM on July 8, 2009


It's sadly ironic how at the very very *very* bottom of that first article, there's a paid advertisement...

It's intended irony. The advert goes to the SEIU (kinda) which is working on healthcare.
posted by DU at 10:57 AM on July 8, 2009


I thought it was:

They who can give up essential liberty to obtain a little temporary safety, deserve neither and will loose both.

CIV 4 wouldn't lie to me!
posted by The Whelk at 10:58 AM on July 8, 2009 [2 favorites]


BTW, my Blue Shield payments were raised from $203 a month to $700 over five years. My income has progressively gone down, cost of living hasn't, so I reduced my coverage. Now I'm paying $390.

I used to go all the time but haven't been able to afford to go to the doctor or dentist in two years. It bothers me that whatever potential illnesses I should be keeping aware of and preventing with standard medical care are probably going to be a lot more expensive and painful down the road since I'm ignoring my health almost entirely.

I'm not paying for new fillings... instead, I'm paying for emergency root canals.
posted by miss lynnster at 11:01 AM on July 8, 2009 [8 favorites]


You think that's bad, Thorzdad? There are veteran OB/GYNs who are dropping the OB part--they'll take care of a woman right up to the point that her water breaks, but won't deliver the baby themselves because the potential liability if something bad happens during the delivery costs way more in increased insurance premiums than they could possibly recoup. The way they see it, they've already caught enough babies in their career, and they don't want to see their savings wiped out as they approach retirement.

And I completely believe the nightmare that the Kos diarist went through. I went through something recently where, months after I'd switched my primary care provider and had a few appointments with the new one, someone in her office came into the exam room--after the exam had started--and told me that she was not authorized as my PCP, and did I want to reschedule or pay the entire fee? I told her, look, you tell them that they have already authorized the doctor and have paid for several visits already, I am not going to try arguing over the phone with my voice gone from bronchitis! Found a message on my answering machine when I got home, from the insurer, to the effect of: whoops, our bad. And I have a few different conditions that require minor, but continuous, medical maintenance. Good grief, if I had something serious, I'd buy a one-way ticket up north and put myself on an ice floe, while there still are some.
posted by Halloween Jack at 11:01 AM on July 8, 2009 [1 favorite]


Millions of Americans would rather die in the poorhouse than go to bed at night knowing that someone, somewhere is receiving something they helped pay for.

I have an aunt and uncle whose sole source of news is Fox. They've become completely unhinged by the Obama presidency. They have a son who had to declare bankruptcy due to medical bills. They rant against socialized medicine. They make me sad (but not as sad as that first link).
posted by Mavri at 11:01 AM on July 8, 2009 [3 favorites]


I've been following the health-care reform debate pretty closely. (Ezra Klein's blog is the best resource I've found--he's a brilliant young policy wonk who I hope will end up in a high-level administrative position at some point) This is what I've figured out:

a) A chance at health care reform, historically, has come around about once every fifteen years. This round, due to point d, is likely to be decisive.

b) The best-case scenario for health care reform right now is not single-payer (never gonna happen). It's not even a strong, Medicare-style public plan (the Republicans and the insurance industry have successfully killed that possibility). It's a public plan without government subsidies, or in other words a regular insurer but government-run. And even that isn't guaranteed.

c) This is due entirely to the astounding inability of Senate Democrats to enforce anything approaching party discipline or do anything against the routine use of the filibuster.

d) Health-care costs right now are on track, in the short-to-medium term, to reach fifty percent of GDP. The currently-viable health reform proposals are unlikely to reverse or even seriously stall this trend (although they might substantially increase coverage, which doesn't do much in the absence of cost reduction).

Therefore:

e) We're fucked. Seriously. Move to Canada.
posted by nasreddin at 11:03 AM on July 8, 2009 [13 favorites]


This just makes me so furious. Stonewall Jackson's comment above is so on the money. I am in the business of deciding who gets free government-funded healthcare. It's just mental health care, which apparently everyone considers important enough to poorly fund agencies to provide to the really, really needy.

And let me tell you who the absolute worst people are to deal with. It's the formerly wealthy, white, Republicans who want their slice of the huge piles of money they've heard poor people get.

They have so much entitlement that I actually had a woman in here screaming at me on Monday because her Medicaid (free government funded healthcare) won't pay for her to see a doctor other than the one they referred her too, whom she doesn't like because of his race. Despite the fact that she's already seen several doctors, and received medication, but it wasn't "good enough" for her, so she stopped taking it. She said she knew the problem was because she is just "the wrong color."

So even when they themselves are demanding that the government pay for their health care, they still begruge anyone else who gets something for free.

I kicked her out of the office (due to foul language) and refused her services on the grounds that I'm not here to enable anyone's racism.
posted by threeturtles at 11:03 AM on July 8, 2009 [38 favorites]


US health care costs are $2.6 trillion per year, which is far more than any other country per capita. For those that think it's simply because we're "paying for the best health care in the world", that's not true because not everyone enjoys access to an awesome corporate group plan. Hell, I make a really good living being self employed but the health insurance options I have access to are atrocious, overpriced, and I'll probably lose 'em as soon as I use 'em. I am no socialist but I am plenty pissed off at how extensive profiteering has carved itself into the American health care infrastructure. Do a search for hospital CEO compensation and you'll see that there's executives aplenty making tens of millions of dollars per year. WTF?
posted by crapmatic at 11:04 AM on July 8, 2009 [1 favorite]


"The endless whining I heard from an insurance exec being interviewed on the radio about how "public insurance" (his words) would be impossible to compete against nearly made me pitch the radio out the window."

Frankly, sir, our health is more important than your business.
posted by klangklangston at 11:06 AM on July 8, 2009 [15 favorites]


Guys, we don't have to worry because Obama is going to fix it as soon as the Insurance companies have time to tell him what changes they're willing to think about making if we ask nicely and maybe do a little dance to entertain them.
posted by Legomancer at 11:07 AM on July 8, 2009 [9 favorites]


Er, for point b, I shouldn't have said "subsidies," but rather "Medicare-like negotiating power and funding."


Indeed, tackling inflation in American health care remains the most important and difficult part of the treatment. According to our poll, cost is a tender nerve: 61% thought the high cost of care and insurance was a bigger problem than the number of uninsured, against 31% who believed the reverse. Only 21% would be willing to support a reform plan if they had to pay more in insurance or tax; 62% would not.

It's really easy to spin this into "OMG SELFISH MURICANS," but it's a legitimate concern. What good is insuring 40 million (mostly low-income) people if they have to pay thousands of dollars out of pocket every time they actually receive care? For all intents and purposes, they're not much better off.
posted by nasreddin at 11:07 AM on July 8, 2009 [1 favorite]


My thoughts: Single payer ain't happening in America.

Yet.

I don't know whether this is Obama's intent long term, but to me it's pretty obvious that once a public option is in place , it'll morph into a single payer system with Republicans and the private health insurance industry screaming bloody murder at every step, though I couldn't guess at the time frame.

For a variety of reasons, most of them stupid, single payer is just too big of a fight in the US. The only way it's going to happen is gradually, as people get a taste of it and realize it's a better solution. All of this is dependent on making sure the public option is good, which a certain political party and industry have no interest in doing.

At this point I wish the single payer crowd would stop complaining and pushing for it. They should start working on plans to shift the public option to single payer over time.

Private health insurance industry? Fuck'em.
posted by Brandon Blatcher at 11:08 AM on July 8, 2009 [7 favorites]


So what you're saying is that Kucinich went all unixrat on him?
posted by tizzie at 11:08 AM on July 8, 2009


US health care costs are $2.6 trillion per year

At $200,000 per job, that's 13 million jobs, almost 10% of the workforce.
posted by @troy at 11:09 AM on July 8, 2009


I am a single mother of three kids. My annual income is a bit over $30,000. I pay $750 a month in health care premiums for my family.

It's strange to compare Bueller's story with that of my college friend whose husband is a defense contractor, has three children from a previous marriage, and can finance multiple rounds of IVF for them that his insurance covers, despite repeated failure. She quit her job soon after getting married (because her salary probably wouldn't have paid the utility bills on their smallest vacation home) and has been attempting to incubate for the past 4 years.

In short, I'd like to be rich.
posted by anniecat at 11:13 AM on July 8, 2009


At $200,000 per job, that's 13 million jobs, almost 10% of the workforce.

I'm not quite sure when the US went from economic growth through improved productivity to economic growth through massive wastage.
posted by GuyZero at 11:16 AM on July 8, 2009 [1 favorite]


but I also know that a lot of people actually believe this, though probably not around here

I think we've run them all off, (un)fortunately.
posted by @troy at 11:17 AM on July 8, 2009


Links:
* DailyKos
* Democracy In Action blog
* NYT OpEd
* Advocacy Blog

Content:
* Nothing new
* Rehashed x100 in previous FPPs

Comments:
* Nothing new
* Rehashed x100 in previous posts

Summary:
* GYOB
* Double post
posted by FuManchu at 11:17 AM on July 8, 2009 [6 favorites]


One of my big regrets in life is that I didn't become a Canadian when my parents and sister did--they love Canadian health care. (Like any system, it varies a bit from place to place; their experience with it has been in northern Ontario and just outside Edmonton, Alberta.)

Alberta is a conservative province, essentially the Texas of Canada. I was once talking to a maid at a motel whose politics were Christian rightwing--she thought Reagan and Bush were great people. But when I mentioned that Americans didn't get universal health care, she was appalled.

I've also got friends who are French. When one told about getting an operation, I couldn't decide whether to cry or start killing Republicans--even the cost of her taxi to the doctor was reimbursed.
posted by shetterly at 11:18 AM on July 8, 2009 [3 favorites]


HULK SMASH
posted by maxwelton at 11:18 AM on July 8, 2009 [5 favorites]


The part that really made my jaw drop is that the US already spends more public money per person for health care than any other country. We're already paying the cost of national health care, why not just give it to us!


Well, one reason is high drug prices. The American consumer pays for drug development and the rest of the world free rides on that through price controls. If and when we get a single payer system in the US, with price controls, the rest of the world is going to see their drug prices skyrocket.

As for all that hogwash about Canada's system being a bureaucratic mess, the US would be lucky to get such a well run system if and when we change ours. All the different factions fighting over everything is going to produce the biggest, baddest bureaucracy the world has ever seen. It will make running the USSR economy seem like balancing a personal checkbook.
posted by caddis at 11:18 AM on July 8, 2009 [2 favorites]


Ooo, are we telling private insurance stories? Cool.

My husband and I both work and have no kids. We both have insurance through our jobs. We also both have chronic health conditions. The best choice of insurance offered to my husband has a $3000 deductible which applies to every dime. So we pay $250/month for just one medication for him (he takes about ten). We pay out of pocket for all his doctor visits (several times per month) and lab work (once per month.) He recently had to go to a new specialist. One visit cost $225. We do this so that if he has to have surgery or go in the hospital, the insurance will pay 100% after we meet the deductible. Otherwise, we would already be bankrupt.

My insurance is pretty ok. I manage fairly well just paying my copays for office visits and prescriptions. But I learned recently that one of the reasons (among others) that I can't have surgery for my back is that Blue Cross Blue Shield doesn't pay for disc replacements. Cause they cost too much. Isn't that nice to know? So if that was medically an option for me (techinically, I'd need three disc replacements) I still couldn't get it. Instead I would continue to experience constant pain until I can't work anymore and lose my insurance. Cause then it's not their problem. And also, if I wanted to cover my husband on my insurance, as a back-up or an alternative to his crappy insurance? It would cost a third of my salary.

Oh, yeah, I'm so glad I'm lucky enough to have private health care.
posted by threeturtles at 11:20 AM on July 8, 2009 [9 favorites]


Outrage Level:
* High

America-Bashing:
* Aplenty

Statements of Canada's Superiority:
* Significant

Summary:
* AWESOME POST
posted by GuyZero at 11:20 AM on July 8, 2009 [52 favorites]


What I don't get is...everybody I know is, at most, one or two degrees of separation from someone who has a story like this. Yet we can't even talk about the possibility of maybe doing something different? At what point does the system break down enough to force a change?

(I have some of the best health insurance you can get. And this still scares the crap out of me.)
posted by JoanArkham at 11:21 AM on July 8, 2009 [8 favorites]


I hate this debate. It seems so non-sensical. On my last visit to the hospital (yes, I was that sick), around day 2, there was this nurse whose sole job was to handle insurance paperwork. That's all she did. She went to nursing school, spent money on an education in healthcare, and her sole job is to do paperwork. Can someone explain to me how this is "efficient"? When being checked in at the E.R., the longest wait is entirely due to processing. They have to get all kinds of information from you. Name, social security #, phone number, address, insurance information, then they have to verify with the insurance company that you will be covered. Meanwhile, you're sitting there wheezing, unable to breathe because of a massive asthma attack. Explain to me how this is "the best healthcare"?

The only people I know who don't have to go through the rigamarole of "processing" are those who are unresponsive and carted in by an ambulance. I've never seen anyone walk into an E.R. that didn't have to wait, even though there was no one else waiting. Sure, anecdotal, but this has been my experience several times all over the country.

I seriously fear that the "business is best" mentality will be what leads our world into anarchy. Though strangely, I'm ok with that, being an anarchist and all....
posted by daq at 11:23 AM on July 8, 2009 [2 favorites]


Links:
* DailyKos
* Democracy In Action blog
* NYT OpEd
* Advocacy Blog

Content:
* Nothing new
* Rehashed x100 in previous FPPs

Comments:
* Nothing new
* Rehashed x100 in previous posts

Summary:
* GYOB
* Double post


Flag it and move on, or take it to Metatalk, please.
posted by Blazecock Pileon at 11:25 AM on July 8, 2009 [33 favorites]


Oops! There's one! Let's get'm!
posted by @troy at 11:27 AM on July 8, 2009


I have incredible insurance, just unbelievable. Have for years. Covers just about everything, some things that I never expected it to cover. Barely costs me anything at all.

But then, my company lets me see how much they are paying for my benefits, beyond what I'm paying, and the amount is staggering. If they gave me the amount directly so that I could pay for health care myself, I'd be in a different tax bracket.

Somehow, I suspect many if not most of the people who believe everything's fine are being supported by their company's health care payments, so they're underestimating how much health care is actually costing them. Presumably they believe that if their taxes went up to cover other people's health care, they'd end up with less overall -- but I suspect the truth is they'd end up ahead if they elected to use the tax-subsidized health care and negotiated a raise for some of the amount their company would no longer be paying.

Then again, the cynic in me realizes that (initially at least) as people stop paying premiums to move to tax-subsidized health care, their employers would simply pocket what they were paying before. Capitalism is fun.
posted by davejay at 11:27 AM on July 8, 2009 [5 favorites]


The best-case scenario for health care reform right now is not single-payer (never gonna happen). It's not even a strong, Medicare-style public plan (the Republicans and the insurance industry have successfully killed that possibility). It's a public plan without government subsidies, or in other words a regular insurer but government-run. And even that isn't guaranteed.

Urge. To kill. Rising. Must. Leave thread.
posted by DU at 11:29 AM on July 8, 2009 [3 favorites]


GuyZero, you're right, I forgot what counts on MeFi.

Blazecock Pileon, sorry, forgot snark is looked down upon in MeFi.
posted by FuManchu at 11:31 AM on July 8, 2009 [1 favorite]


I can't be the only person who daily expects that they'll have one day without reading something abysmally stupid from the conservatards, and then - oh look - they're doing something stupid and not-fact-based and not compassionate and provincial and irrational and fearful and selfish again.

I think every day this week I've felt like punching a Republican at least once.
posted by kldickson at 11:33 AM on July 8, 2009 [1 favorite]


Blazecock Pileon, sorry, forgot snark is looked down upon in MeFi.

You don't have to like the thread and your assessment is IMO entirely accurate but BP is also correct in that MetaTalk is the place for that kind of discussion.
posted by GuyZero at 11:35 AM on July 8, 2009


I am so sick of the health care debate that I probably should go to the doctor. Of course, I can't - I am not a congress person.

Last January I thought maybe finally we would see an improvement since things had gotten so unbelievably bad. Naively, I thought that well, the fact that even businesses, not just individuals, were suffering meant that surely, at last, this country would see the light and there might be actual available health care in my lifetime. Now, though, it's like one of those horror movies where you just want to keep shouting "NO! Don't go off in separate groups! Don't go in there! Just leave!" and yet, nothing happens: you don't affect the actions on the screen. I've emailed my senator and emailed my congress person and written them and others begging for a single payer plan or at least a public option. I've written them and others about my own, typical, not surprising, health care and insurance woes (short version: I am one of those Americans who went bankrupt partly due to medical bills and, frighteningly enough, I am healthy as a horse, as is my entire family and we had insurance at the time.) yet nothing happens and it looks more and more like nothing ever will. No changes are made. Real changes are dismissed as unlikely; hope is scoffed at and here we are, stuck in the horror movie morass of American "health care."
posted by mygothlaundry at 11:37 AM on July 8, 2009 [5 favorites]


I have relatives in Canada. It is not perfect, no. But the way they are able to live their life there, to not have to worry about this, is something that we just cannot even imagine here. Their ability to change jobs when they want or need to, get divorced or married when they need to, get care without a second thought when they need to is a level of security we just don't understand here.


QFT. I grew up with healthcare, then moved to the USA. It staggers me how much of the (vast) cost of US healthcare is completely invisible to Americans, because people here grow up so thoroughly caged that there is never a way to see or understand what freedom is. The lack of it is so interwoven with life and so insidious, at so many levels.

Another sad fragment of the picture is that it's the "American" Dream that if you work hard you can make something of yourself, but it's America where exactly this dream of social mobility is largely precluded by a healthcare system that routinely prevents people from switching jobs or self-upskilling or taking other risks, and so America is unlike other countries in that no-matter how hard you work, you're more likely (than elsewhere) to get nowhere, and end up destitute. I guess it's sadly fitting that it's called The American Dream, not The American Way.
posted by -harlequin- at 11:41 AM on July 8, 2009 [16 favorites]


I recently attended a town hall forum with my Congresswoman on this very topic. She supports "the Obama Plan" of private health insurance reform with a public option. It consisted mostly of her getting yelled at by a) supporters of a single-payer system and b) opponents of any kind of public plan. The thing that was most striking was that none of the people who oppose making changes to the system had any ideas on how to make the current system better, only that the gum'mint would muck things up and they were not going to pay for "someone else's" health care (spoken with the inflection that one might use when saying "child molester"). The only thing I could figure was that all of the detractors had either never gotten a potentially life-threatening disease that couldn't be cured with antibiotics, or they were bazillionaires.
posted by ahdeeda at 11:42 AM on July 8, 2009 [1 favorite]


FuManchu, I knew this post was far from awesome when I made it. But as a general rule, timely is more important than awesome. People can pressure politicians now if they want to. Soon, it'll be too late.

Also, if you've got better links to offer, please do! One of my few frustrations with Metafilter is we can't do ETAs on posts to provide additional information.
posted by shetterly at 11:44 AM on July 8, 2009


At $200,000 per job, that's 13 million jobs, almost 10% of the workforce.

Er... yes? Lots of people work in the health care field, because everyone gets sick, and the problem is getting worse as the population ages. I'm not really sure what you're on about, but it sounds kind of like you're contending that eliminating private health insurance in favor of a national policy would eliminate 10% of the jobs in the country, which is... well, more than a bit specious.
posted by Mayor West at 11:44 AM on July 8, 2009


I don't know, that exchange between Kucinich and the industry shill may be entertaining and useful for rallying the troops, but didn't really serve much purpose. Not really much different than what O'Reilly does on his show.

Although at least you know O'Reilly is a shouty prick. How bad must it feel to get shouted down by a weird little elf like Kucinich?
posted by electroboy at 11:45 AM on July 8, 2009 [1 favorite]


Er... yes? Lots of people work in the health care field, because everyone gets sick, and the problem is getting worse as the population ages. I'm not really sure what you're on about, but it sounds kind of like you're contending that eliminating private health insurance in favor of a national policy would eliminate 10% of the jobs in the country, which is... well, more than a bit specious.

Not to mention being a glaring example of the broken-window fallacy.
posted by nasreddin at 11:46 AM on July 8, 2009


What I don't understand is why aren't the American companies and industry coalitions all screaming for government health care? It's a huge huge drag on business and makes it ridiculously expensive to hire workers. And it makes starting a small business even harder, how many potential entrepreneurs don't even bother to try to start a new company because of the cost of providing decent insurance for their employees?
posted by octothorpe at 11:49 AM on July 8, 2009 [5 favorites]


FuManchu, one more site I like: The Health Care Reform Debate Blog - cmhmd .
posted by shetterly at 11:53 AM on July 8, 2009 [1 favorite]


not really sure what you're on about

$2.6T is abstract and out of context; 1 out of 10 workers, each putatively earning a damn-good salary -- more than I ever will in my life -- is not.

I agree that health care is & should be a central sector of our economy, for to be healthy is a prime component of being well in the sense of personal wealth.

But to have so much of the national income funneled through the medical service sector is quite literally taxing everyone else.

Something's gotta give.
posted by @troy at 11:56 AM on July 8, 2009


Free market healthcare = fucked public health

Q.E.D.
posted by Benny Andajetz at 11:56 AM on July 8, 2009 [1 favorite]


electroboy, unlike O'Reilly, Kucinich rebutted with facts. Maybe you knew them already, but if everyone did, health care in the US would've been fixed decades ago.
posted by shetterly at 11:56 AM on July 8, 2009 [2 favorites]


I'm feeling more and more hopeless.

My pregnant daughter has a month to go in her pregnancy. The next appointment she can get (she's a Navy wife) is AFTER her due date.

Pardon me if I'm not a fan of government health care.

But that first link up above is enough to make me defiantly glad I don't have any health insurance since at least they can't screw me over. Meanwhile I watch a friend recover from her mastectomy and can honestly tell you that for her dealing with the cancer was a cakewalk compared to dealing with her insurance carrier.
posted by St. Alia of the Bunnies at 11:57 AM on July 8, 2009 [1 favorite]


Fun fact: Humana donates the maximum allowed to every Republican state legislative official I've bothered checking.
posted by pwnguin at 11:57 AM on July 8, 2009 [5 favorites]


What I don't understand is why aren't the American companies and industry coalitions all screaming for government health care? It's a huge huge drag on business and makes it ridiculously expensive to hire workers.

THIS. Auto companies mention health care when they set up plants in Canada ALL THE TIME. Oddly it doesn't seem to really influence the tech startup scene which stinks more than it should in Canada given this economic edge. So maybe it's not that important after all. I wish there was a quality study to isolate the effect of nationalized health insurance on business costs.
posted by GuyZero at 11:59 AM on July 8, 2009 [1 favorite]


I've emailed my senator and emailed my congress person and written them and others begging for a single payer plan or at least a public option. I've written them and others about my own, typical, not surprising, health care and insurance woes (short version: I am one of those Americans who went bankrupt partly due to medical bills and, frighteningly enough, I am healthy as a horse, as is my entire family and we had insurance at the time.) yet nothing happens and it looks more and more like nothing ever will. No changes are made. Real changes are dismissed as unlikely; hope is scoffed at and here we are, stuck in the horror movie morass of American "health care."

And as long as our legislators are given Cadillac health care and are not required to deal with it as the rest of us do, I doubt that will change.
posted by St. Alia of the Bunnies at 12:00 PM on July 8, 2009


The next appointment she can get (she's a Navy wife) is AFTER her due date.

Pardon me if I'm not a fan of government health care.


This nonsense doesn't happen to normal people in normal countries. I have no idea why it's happening but other government-managed health care systems (Canada, UK, etc) don't have this.
posted by GuyZero at 12:01 PM on July 8, 2009 [6 favorites]


A story from the UK...

I had my haircut today. (Why, thank you. I like it too.) My hairdresser & I are both avid mountain bikers although he is a lot more avid than me what with his 50 mile training rides every other day.

So he's telling me about this wipe out he had 5 weeks ago. Bombing down a chalk path when two guys coming up the hill cut across him and he ends up ramping a few bumps before flying over the handle bars and planting his face on the trail.

He wakes up about 25 mins later to the sound of the air ambulance helicopter landing next to him. A quick shot of morphine & off to hospital for 2 days of observations before a 5 hour operation to put paltes, pins & staples all over his face. Apparently a 90% chance of brain damage. Saved. And all for free (OK, paid for out of his & everyone else's National Insurance.)

Anyhow, 2 weeks later he's back at work and 5 weeks later he's cutting my hair with hardly a scar on his face. He had to show me a picture of him in the hospital before I realised exactly what had happened.

I go to the US at least once a year and conversations always come round to health care. All my friends always have this background fear of getting sick. Recently a friend had a major hip operation, all covered by her company healthcare apart from the small matter of £20,00 she had to pay out of her own pocket. What?!

The food might be low grade, but the National Health Service is, compared to the fear engendered by whatever the hell is going on in the US, is bloody marvellous. You guys want the same, you really, really do. I hope you get it.
posted by i_cola at 12:02 PM on July 8, 2009 [26 favorites]


Although at least you know O'Reilly is a shouty prick. How bad must it feel to get shouted down by a weird little elf like Kucinich the only congressman who gives more of a shit about his constituents than his donors?

FTFY
posted by klanawa at 12:02 PM on July 8, 2009 [33 favorites]


Every time I see one of these threads it makes me sad. Not because Canada is so super, but the differences in our health care systems are astounding. I cannot imagine, simply cannot conceive of, having to pay for health care. Hell, I get annoyed at having to pay for the dentist, and I have benefits that do that.

Not to drag out the same old story, but as someone born 3 months premature to a simgle mother on welfare, I shudder to think about what would have happened to me if I had been born in the U.S. Here in Canada I received neonatal intensive care, enrollment at a special preschool for kids with special needs, a case worker to check in with me during school years, and covered physio therapy.

In any other system I would possibly have been left languishing in some institution, or even if my mother didn't go even more broke paying for my care, I certainly wouldn't have had the early years care that I did. And now I am university educated and working in our public service. Working in the system that helped me.

What I love the most is the rationality behind our health care. A few years back, Ontario stopped covering the cost of optometrists visits. I was annoyed. However when I went to the eye doctor, they took my health card and said my vists were still covered because I have an eye disease. If anything, most private insurance doesn't cover those with existing conditions. Even when they were stripping away a benefit, OHIP ensured those who needed the coverage the most would have it. That's amazing to me.

All that to say, it just seems such an obvious choice, and I agree with those who suggest it comes down to the fact that a fair chunk of Americans would rather go broke than think they paid for someone else. I just wonder, why didn't Canadians take this view point as well? What is different in our sociological make up? Or was it simply that universal health care was introduced at "the right time"?

Perhaps one of those unanswerable questions.
posted by aclevername at 12:02 PM on July 8, 2009 [4 favorites]


I find it astounding that's there's even a fight on this subject.

I mean, you have two sides that both say " the current situation is unsustainable", and one side is offering the solution of "more of the same".

(The public, I think, is finally ahead of the politicians on this one. Congresscritters that actively impede progress on this are gonna be losing jobs next election cycle. One can hope, anyway.)
posted by Benny Andajetz at 12:02 PM on July 8, 2009 [3 favorites]


Where's America now to tell us all how scrappy insurance CEOs make it great? *spit*
posted by adamdschneider at 12:02 PM on July 8, 2009


While the old saying "If you don't have your health, you don't have anything" is a bit facile, it's not that far off the mark. That's not to say anyone in less than a 100% state leads a an empty life, but rather that a physical ailment which is not appropriately treated can quickly and completely degrade a quality of life.

We have developed a spectrum of effective treatments for most known ailments. As such, we have the ability to identify and treat (whether it's an outright cure or just management of the condition) the majority of illness which would without these measures have a significant negative impact on those afflicted.

Given this, it seems clear that access to universal health care is probably the greatest social issue of our time. And the fact that the nation which is (or has been until recently) the world's sole super power and wealthiest nation does not as a fundamental principle provide this for its citizens attests that this is far from being resolved.

Quoting wait-times in other countries (whether correct or not) or trying to scare the populous with the socialism boogie-man does not change the fact that guaranteeing everyone has access to appropriate medical attention would greatly improve the lives of a significant portion of the population. If every citizen has the right to a decent basic education, then every citizen has the right to decent medical care. It is a measure of a society whether this policy is in place.


Also, from the Kucinich exchange:
Metafilter: My position is respectable, and I dislike your comment, sir.

posted by sloe at 12:05 PM on July 8, 2009 [4 favorites]


The best-case scenario for health care reform right now is not single-payer (never gonna happen).

Oh, it'll happen. After way, way too many uninsured people have died, and way too many failed options have been tried. Then, as with school desegregation and Social Security, it'll be the thing everyone's always favored.
posted by Rykey at 12:06 PM on July 8, 2009 [2 favorites]


"Now I believe every word in the story in the first link, but I find it odd that these insurance companies bill you more when you suddenly get sick. WTF are you paying them monthly premiums for when no one is sick? Is it insurance or not? Billing you extra for using it is... it's like not having insurance at all. Is US health insurance a lie?"

All for profit insurance works this way. Someone steals your car? Your insurance goes up. Arsonist burns down your house? Insurance goes up. Water floods your basement? Insurance goes up (sometimes even if you don't have flood insurance which is essentially impossible to get if you actually need it)..


"At $200,000 per job, that's 13 million jobs, almost 10% of the workforce."

If you completely ignore capital and supply costs.
posted by Mitheral at 12:08 PM on July 8, 2009


If you completely ignore capital and supply costs.

Capital infrastructure and medical supplies materialize out of thin air now? ;)
posted by @troy at 12:10 PM on July 8, 2009


Something's gotta give.

What's your solution?
posted by dirigibleman at 12:11 PM on July 8, 2009


[Make that $20,000]
posted by i_cola at 12:11 PM on July 8, 2009


Perhaps one of those unanswerable questions.

Not really.

My understanding (and it is probably flawed) is this:

In Canada the fight for medical coverage was led by prairie populists (Tommy Douglas) whose supporters were primarly farmers. So naturally they turned to the government to handle the issue.

In the US the issue was handled around the same time by trade unions who, when the government brushed them off, agreed that it should be the employer's responsibility to provide health insurance. I'm sure at the time that it seemed like a good idea and certainly meshed with the American belief that the government shouldn't be doing every old thing and who would want to raise taxes anyway.

So it's all due to who was fighting to get health insurance and who they thought they could squeeze for it.
posted by GuyZero at 12:11 PM on July 8, 2009 [7 favorites]


The current health care system is unjust. It's unreliable, unstable and therefore untenable for the majority of the population. I think it's inevitable that we'll either see a real public option/single-payer system or the eventual collapse of the system, it's just a matter of time, but not doing it soon enough will have immediate political consequences.
posted by peppito at 12:12 PM on July 8, 2009


American here, spending time in the states after 3 years in Europe.

I'm usually separated out from politics. I'm a cynic and generally believe that shit never changes, but mostly, politics don't really affect my day to day.

I'm coming from NHS in the UK, and Kela in Finland. Each was supplanted with private insurance. I'm now in California with a Blue Shield high deductible plan.

I've gone from walking into a doctor's office, seeing a specialist, getting the meds I needed and either paying 6 GBP per month, or 0 euros in Finland.

I had Hernia Surgery and paid for nothing out of pocket. I paid out of pocket for 3 fillings and a root canal in Helsinki and paid 200 euros. That was without having any dental coverage.

I am now in the richest country in the world. My insurance refuses to pay for most of my prescriptions. They refuse to pay for my wifes prescriptions.

I'm putting off visits to the doctor because of the out of pocket costs. 700 dollars for my wife to go see an allergist and receive emergency asthma treatment. 400 dollars to get her breathing back under control.

For myself, I'm cutting pills in half, searching for overseas pharmacies to send me off-brand generics. India, Canada, Mexico.

I've gone from paying nothing a month in health care to over 1000$ a month for maintenance.

I've gone from HAVING health care to not. And I have Insurance. I have an HSA.

Suddenly , I've gone from someone who felt he was outside of the political arena, who had given up on the corruption and process in DC to someone who is utterly filled with rage about how fucked things have gotten.

Sure, we write letters, send emails, call people. What do we get? Jerked around. We get the plan in Massachusetts, the bullshit that is the Medicare prescription program.

Graft, corruption and an utter refusal to acknowledge how fucked this situation actually is.

The majority of Americans want, and NEED single payer health care. Call it the public option or whatever, call it what you want, but make damn sure that it's a real fucking plan.

And ram it through.

Fuck the republicans if they won't vote for it. They're in the minority. Fuck Lieberman and the random corrupt democrats as well. Steamroller them. Fuck the lobbyists, insurance companies and whoever the fuck else stands in your way.

This is a make or break moment. We're in the middle of the largest economic downturn in the history of the United States. It will continue, and probably get worse.

You want to trigger a new entrepreneurial spirit in the US? Want to see people go back to the farm and grow food locally? Want to see people really take some chances with business and get this shit back on it's feet?

Give me healthcare. Real affordable healthare.

Make it so I don't have to worry about where I'll scrape together enough money for prescriptions so I can function. Make it so I don't have to ship drugs in from India because you've gotten your pound of flesh from the pharmaceutical companies.

Get this plan passed and give Health Care back to America.
posted by Lord_Pall at 12:15 PM on July 8, 2009 [69 favorites]


Every time I read these sorts of posts it makes me want to cry.

My wife is currently having a very hard second pregnancy. She gets to see a midwife every week and pops into the hospital every two weeks for scans (the funky modern 3D scans, one performed by the head of maternal medicine for our region).

She's had several blood tests, and can pick up the phone and talk to a maternal health expert whenever she feels like it.

We're booked in for a caesarean delivery and a short hospital stay in August.

We will pay nothing for this. Not a cent. The same standard of care would apply to a homeless individual.

I earn NZ$130k gross, and pay something like NZ$41,000 in tax overall. I don't know how this compares with the USA, but it's certainly not socialist. I have plenty left over to pay the mortgage, broadband internet, cable TV, endless Lego sets for my son, and imported gourmet food. I am free to assemble wherever I want, speak my mind, and practise any religion (or none).

What the FUCK more do you want? Rise up, and sort your shit out. Seriously. What sort of country lets their middle class wallow like that, let alone their most helpless and needy? And surely the health profession must understand the implications of putting people under huge stress just when they most need to be cared for? Surely it extends illness?

On preview - this reads as anti-american. It's not. I'm sad and angry. Yours is a fantastic country with such amazing history. Please keep it up.
posted by pivotal at 12:15 PM on July 8, 2009 [45 favorites]


I like this article because it attempts (although that's usually futile with human beings, much more so Republicans) to put the reader in the place of someone who quite suddenly finds themselves in not only the middle of a health crisis, but the sudden victim of a Brazil-like bureaucracy due to perverse financial incentives that so many worshipfully admire. It's kind of a stretch for people who typically can only imagine themselves getting rich.

The people who reject single-payer because it's "socialism" are the same sort of Lotto Republicans who just know that one day they'll make it big just as soon as their heroes force the government to stop strangling The Little Guy. Pop-up campers with satellite dishes dance before their eyes; their most fabulously tacky middle class dreams will come true. One day their big reward will come due — in the meantime, any number of petty cruelties might be inflicted on others just so long as ideology is served. They have no grasp of what can happen to them and just how near they are to the edge of a financial abyss.

Maybe it's time we start viewing Republicans as people suffering from Stockholm Syndrome as they're held captive by various millionaires and corporations. I don't know of anything else which so accurately describes people who enthusiastically and irrationally side with those most likely to victimize them.
posted by adipocere at 12:16 PM on July 8, 2009 [12 favorites]


six paragraphs down

Almost exactly two years later and nothing has changed on the ground other than my new job might bankrupt us slower if we are forced to put her on that plan. She's still married to the [now only emotionally] abusive man, we still live in fear that he will drop the hammer and divorce her so that she loses military health insurance, and we still have lo listen to people--even in her own family--bitch and moan about having to pay so "some wetback can get a free ride" and/or having to line up for the state mandated gray clothes and leg amputation.

I really don't care if you feel this is a double, FuManchu. I understand that Metafilter might not be the very best place to discuss this. Oh the other hand, exactly how many YouTube discography posts does it take for the Metafilter community to finally grasp the concept that YouTube is the new MTV? It's not like this is a daily occurrence on MeFi and it provides a way for many like-minded folks to continue to feel not so incredibly alone and isolated by the dissonance between their life experiences and the full-frontal assault against any meaningful progress toward a more sane solution.

Admittedly, I am not adept at filtering my commentary on this topic so I should probably just close this tab and move on. But I am bad at filtering so here we go...
posted by Fezboy! at 12:18 PM on July 8, 2009 [7 favorites]


My favorite bit of status-quo-preservationist axe-grindery is how important my right to "consumer choice" is. Because, yeah, I really want to choose my insurance policy, just like a DVD or a Swatch or an end table.

"Consumer choice" is just code language for "make the consumer do the work, and pocket the cash." This is the same pseudo-logic that's peddled to justify replacing actual pensions getting replaced by "efficient" 401(k) plans that let the consumer choose where to invest.

on preview, thanks for "Lotto Republicans"
posted by Rat Spatula at 12:19 PM on July 8, 2009 [1 favorite]


If every citizen has the right to a decent basic education, then every citizen has the right to decent medical care. It is a measure of a society whether this policy is in place.

My "framing" to link these two philosophically is that we all should have access to the goods and services required to become and remain a productive member of society without regard to ability to pay. So things like free libraries and time-efficient, affordable local transit are included.

Haven't quite worked out the housing angle yet, unfortunately, but if the land were free of rent, given the long usable life of housing goods (50-100 years), housing would be very inexpensive on the margin, unlike now where Section 8 is more a price support to the LL than assistance to the renter.
posted by @troy at 12:20 PM on July 8, 2009


Yes, this debate is tiring but we must keep having it. The more the teeth gnash, the better.

I cannot voice my opinion of what I think would foster change because it would get me locked up and put Matt & Co. in an awkward place of having to delete my comments. I cannot look a person in the face when this topic comes up because I fear that if they scream "SOCIALISM" I may attempt to strangle them. It is that visceral for me. My wife and I have gone without health insurance for two years now. We literally fear for our lives. We know that financially, we could be wiped out at any moment. How can ANYONE live like that in a civilized society?

Anyone on the other side of the debate is welcome to sit around, pull their pud and debate the socialized medicine/higher taxes angle but you're fucking wrong. Dead fucking wrong and you know it in your heart. If that scares anyone off from debating here on MetaFilter, good. Fuck them. The less I hear of the other side, the louder we become.
posted by KevinSkomsvold at 12:20 PM on July 8, 2009 [10 favorites]


DU: "Urge. To kill. Rising. Must. Leave thread."

I should have taken your advice, bro.
posted by KevinSkomsvold at 12:22 PM on July 8, 2009 [1 favorite]


Over on AskMe, a poster linked to this blog, January First which is the ongoing story of a family whose six year old daughter is mentally ill.

A large part of his story involves his battles with Blue Cross, and his struggles to get her care paid for. In a nutshell, his claim is, for a long while, routinely denied every three weeks (because in Blue Cross's world she should be "stable" after three weeks of treatment) and they have to go through the process of appeals again, and again, and again. Also, neither of the residential programs in California that would appropriate for her will take her, because they don't take private insurance, only MediCal (the public option). You see, they consider coverage by private insurance too unstable.

This family is living an unimaginable nightmare, one made worse by the need to struggle constantly with the insurance company and continue to justify their daughter's very necessary care.
posted by anastasiav at 12:23 PM on July 8, 2009 [4 favorites]


At least you have unlimited ice & air conditioning, eh?
posted by i_cola at 12:27 PM on July 8, 2009 [1 favorite]


"My pregnant daughter has a month to go in her pregnancy. The next appointment she can get (she's a Navy wife) is AFTER her due date. "Pardon me if I'm not a fan of government health care."

Your extrapolating pretty hard from a single data point here.

One of the many appalling things for me about about the American system is number of service people I've talked to who signed up strictly for the health benefits for their kids, even post the Iraq disaster. Rational people who see risking getting blown up or permanently disabled as the best trade off to obtain even the widely denigrated health care the military provides for their families. Makes me want to sit in the corner and cry for a while.
posted by Mitheral at 12:30 PM on July 8, 2009 [4 favorites]


Something's gotta give.

private insurance/pharmaceutical subsidies? Outrageous CEO salaries? 30% overhead? Those would fit.
posted by Rykey at 12:32 PM on July 8, 2009 [6 favorites]


At $200,000 per job, that's 13 million jobs, almost 10% of the workforce.

You're right! Denying people health care is one of the last homegrown industries we have in this country! Remember that the next time your claim gets rejected! This health care denial was made in America!
posted by vibrotronica at 12:34 PM on July 8, 2009 [3 favorites]


And as long as our legislators are given give themselves Cadillac health care and are not required to deal with it as the rest of us do, I doubt that will change.

That part isn't going to change, ever - except that even if the rest of us get single payer, the Congress will get something better. Because they can.
posted by Kirth Gerson at 12:35 PM on July 8, 2009


What's your solution?

First, single payer with mandatory coverage. Ie. bump medicare from 3% to 10%, capped at some level though to make it not entirely redistributive.

End-to-end public sector research & development for pharmaceuticals; Big Pharma only snakes 10% or so of the pie but the rent-seeking here is obscene.

Increase supply: anybody who wants to be a medical service provider should enjoy subsidized education and work off the cost via service. This will require expanding medical education capacity significantly.

Closer integration of retirement living facilities with elderly care. There should be more gradation here between semi-assisted living and the terminal case room & a bed.

These are just the ideas rattling around, no warranty on whether they're optimal or even possible.
posted by @troy at 12:36 PM on July 8, 2009


...Kucinich rebutted with facts...

That's sort of my point, it's not really a rebuttal if you're doing all the talking.

In any case, both Kucinich and Gratzer appear to be correct regarding wait times, but they're both cherrypicking the data to strengthen their various arguments. Kucinich is using Statistics Canada data that is self-admittedly highly variable, while Gratzer is using a free-market think tank's data, which obviously has it's own ideological axe to grind.

This paper (pdf) suggests that the lack of standardization and intra and inter- province variability makes it almost impossible to get a solid estimate of the true wait times.
posted by electroboy at 12:36 PM on July 8, 2009


What I don't get is that why are all these millionaires griping about single payer, when they'll still have the choice to buy private insurance, or pay for services from private doctors who opt out of a national system.
posted by electroboy at 12:39 PM on July 8, 2009


I have relatives in Canada. It is not perfect, no. But the way they are able to live their life there, to not have to worry about this, is something that we just cannot even imagine here. Their ability to change jobs when they want or need to, get divorced or married when they need to, get care without a second thought when they need to is a level of security we just don't understand here.

It may sound flippant to say that my heart breaks for you and those in your situation, but it does, because health care is a human right. I find it incomprehensible to imagine avoiding going to the doctor because you simply can't afford to. The insanity of this is seen in the linked article in the FPP: you don't go to the doctor until the situation is dire, so what could have been caught early has now become catastrophic and therefore much more expensive to treat.

I have a friend who has been battling cancer for a number of years now; I have no idea what the costs of his treatment has been and neither does he. He's got enough to think about, with making his likely farewells to life. The cruelty of anyone having to worry, at that point, that they're also going to bankrupt their family by their death is beyond belief.
posted by jokeefe at 12:42 PM on July 8, 2009 [3 favorites]


Well, one reason is high drug prices. The American consumer pays for drug development and the rest of the world free rides on that through price controls. If and when we get a single payer system in the US, with price controls, the rest of the world is going to see their drug prices skyrocket.

From this article check out this graph. I hear this fact from insurance and pharm reps all the time. Turns out they're paid to lie.
posted by a robot made out of meat at 12:43 PM on July 8, 2009 [9 favorites]


Sorry for not reading the whole thread, but i just had to react to this early comment:

>But single-payer socialized medicine will turn our fine American system into a complex bureaucratic nightmare of red tape. There will be endless forms to fill out in complex jargon and appointments to keep and and at the end of it all, some faceless clerk will deny you care.

Bullshit! Bullshit! Bullshit! I've completed more paperwork mailing a package to the US than I have for medical care.

(Apologies if the poster was actually being sarcastic)
posted by Artful Codger at 12:45 PM on July 8, 2009


AC, yes, the poster was being sarcastic, as evidenced by his next sentence.
posted by boo_radley at 12:49 PM on July 8, 2009


When you buy car insurance, do you use it to pay for your oil change?

The government should make sure there is cheap, easy to use health care available for every American. If it is not available then it should be subsidized. People then can get health insurance to cover major medical or can be covered by a very basic health system which will not provide cadillac-care but is better than the nothing many people have to deal with now.
posted by JJ86 at 12:49 PM on July 8, 2009


The great thing is, now that everyone is losing their jobs, they understand the problems with employer provided health care. I think that's a terrible and absurd system. Why should our health depend on our jobs? Why should your boss you (may) hate be able to decide the fate of your health and your families health?

Anyway, I think most people here support single-payer or at least a public option. Oh, and by the way did you know that France, which has one of the best systems out there, is not single payer? Compared to the UK's which kinda sucks compared to other systems (but is very low cost).

I do think that we'll see a system with a public option coming out by the end of the year. I don't think these pussy-ass "centrist" senators are really going to have the balls to stand up for the insurance industry against the brutal whims of the common man and his obnoxious need for healthcare.
posted by delmoi at 12:51 PM on July 8, 2009 [5 favorites]


When you buy health insurance do you use it to cover you liability for someone's medical care after you beat them senseless for making stupid, inapplicable analogies?
posted by Fezboy! at 12:52 PM on July 8, 2009 [2 favorites]


Caddis: Well, one reason is high drug prices. The American consumer pays for drug development and the rest of the world free rides on that through price controls. If and when we get a single payer system in the US, with price controls, the rest of the world is going to see their drug prices skyrocket.


Can someone explain how this works? In the two nationalised systems I have experience with (UK and NZ), there's government funding agency that purchases drugs. In NZ, they typically purchase cheaper/generic versions (so you would usually be prescribed fluoxetine for depression, because it's a generic). The patient pays very little (usually an administration fee, not for the cost of the drugs). But the government is surely paying full price. If not, why are the drug companies selling these drugs so cheaply? Why can't they just refuse to sell them, if the price isn't right? How does the rest of the world implement price controls on US companies?

Not to mention that five of the top ten pharmaceutical companies aren't in the US anyway....
posted by Infinite Jest at 12:54 PM on July 8, 2009


What I don't get is that why are all these millionaires griping about single payer, when they'll still have the choice to buy private insurance, or pay for services from private doctors who opt out of a national system.

Because it's teh commonism, dammit.
posted by spirit72 at 12:55 PM on July 8, 2009


I should have previewed; a robot made of meat answered my question.
posted by Infinite Jest at 12:56 PM on July 8, 2009


Four year ago my mom was diagnosed with cancer. Her insurance situation was very similar to Bueller's mother. After it ran out I burned through all of my savings and much of my income from the last few years to cover her treatment.
A couple months ago I separated my shoulder and the doctor says I'll need surgery to fix it. Another six months and I should hopefully have enough saved to cover the procedure. For the time being I'm careful and take lots of pain medication.
posted by Tenuki at 12:56 PM on July 8, 2009


I didn't see the actual video of the exchange between Rep. Kucinich and Dr. Gratzer, so here it is.
posted by splatta at 12:58 PM on July 8, 2009 [6 favorites]


I do think that we'll see a system with a public option coming out by the end of the year. I don't think these pussy-ass "centrist" senators are really going to have the balls to stand up for the insurance industry against the brutal whims of the common man and his obnoxious need for healthcare.

"Public option" can mean two things:

1) Effectively a Medicare duplicate that has the ability to set compensation rates and so on.
2) A government-run insurer with no special bargaining advantages.

1 is out at this point. 2 does very little to help, and accordingly the insurance industry doesn't really care.
posted by nasreddin at 1:03 PM on July 8, 2009


This paper (pdf) suggests that the lack of standardization and intra and inter- province variability makes it almost impossible to get a solid estimate of the true wait times.

The concern about that is all bullshit coming from the anti-health crowd. Give me healthcare that I can use and I won't care if I wait 15 minutes or 3 hours. I suspect that most uninsured feel similarly.
posted by anti social order at 1:03 PM on July 8, 2009


2) A government-run insurer with no special bargaining advantages.

Once you insure a few million people, you have bargaining advantages.

The LCBO in Ontario pays less for wine than any other wine purchaser in the world because guess what - it's also the single largest wine purchaser in the world. Big is all the advantage an government insurer needs.
posted by GuyZero at 1:05 PM on July 8, 2009 [2 favorites]


There's an elephant in the room with a lot of healthcare policy discussions, and that's the question of supply. If we were to somehow magic a universal healthcare payment system into existence tomorrow — and that's really all that's being discussed, paying for healthcare — that wouldn't magically make more doctors and nurses and hospitals exist.

Maybe you'd be able to recover some people from their roles dealing with insurance, but in most cases I've seen those people aren't actually trained as healthcare providers. They specialize in dealing with paperwork, that's their job.

I don't think there are nearly enough doctors and hospital beds in the US for everyone who needs/wants to use one. If you open up the system without first taking care of that, there will be lines, and people who previously had access to healthcare aren't going to have it, because all the people who currently don't have access are going to be demanding services as well. It seems like there's the potential for a lot of political backlash there.

If you don't do it very carefully, the rapid introduction of a single-payer system might look very much like the "long lines and rationing" that many of its detractors have said it'd be.

Talking about payment strikes me as putting the cart before the horse. I don't think we have a healthcare system that's even capable of taking care of everyone in the country to any reasonable standard that voters will find acceptable. Right now we provide an acceptable level of service to some people, while others get nothing. If we want to broaden the people receiving services, the first thing we need to do is make sure the capability to deliver services exist.

Otherwise, we'll essentially end up "overselling" our capacity to actually deliver services, by trying to open a system that's been designed for a minority up to everyone. However fair that may seem, and however satisfying it might feel to some to watch the privileged get screwed for a change, I don't think that's a winning strategy in the long run. The people you'd be alienating are those who have a ton of political capital; the second the public's interest moves along to some other issue, they're going to be there, gutting the public system and probably setting up some parallel system for themselves. What I suspect you'd end up with is two healthcare systems; one private and one public. While that might arguably be better than the current status quo, I think it's hardly optimal.

I don't see anyone in Congress doing much to address the actual healthcare system capacity, and that strikes me as a massive oversight. It's well and good to say that everyone ought to be insured, but it's going to fall flat on its face if there isn't enough in the way of actual healthcare capacity or resources backing it up.
posted by Kadin2048 at 1:07 PM on July 8, 2009 [8 favorites]


hey, the preferred phraseology is Crafted with Pride in U. S. A.
posted by Rat Spatula at 1:07 PM on July 8, 2009


I don't see anyone in Congress doing much to address the actual healthcare system capacity, and that strikes me as a massive oversight. It's well and good to say that everyone ought to be insured, but it's going to fall flat on its face if there isn't enough in the way of actual healthcare capacity or resources backing it up.

Cost reduction, even in a single-payer system, won't happen unless we also remedy the massive overuse of services (like MRIs or whatever), which would eventually lead to less overproduction of specialists and help prop up capacity. You're right, though, that these things need to happen at the same time.
posted by nasreddin at 1:15 PM on July 8, 2009 [1 favorite]


So to make amends for my earlier comments, I figured I would link to this McKinsey report yet again. Page 5 on the interactive graph is especially useful (if entirely confusing). It gives a good look at exactly where the US is spending so much more than other countries. (Hint: they largest contributor is not administration) To me eyes, is seems agnostic on the issue of single-payer, and developed with both business and government readers.

I think that single payer advocates need to change their rhetoric to really effect any change. I think gradual expansion of Medicare would be the most feasible action. People generally like what they have, but want the downtrodden covered. Even Medicaid has its own issues (unfunded liabilities will mean either less coverage or more taxes in the future), but it's probably the best the US can hope for. I think there is actually less of a difference between countries' healthcare than people assume from anecdotes. I also think guaranteeing helathcare is different than guaranteeing insurance or having a single payer system.

Americans liked driving their SUVs even when they knew it was stupid and wasteful. Americans like getting their MRIs and lab tests done 'just in case'. American hospital dramas reinforce this idea. Americans will not like having these things taken away from them. Americans only stopped buying SUVs when they had to pay for gas. Americans will only stop getting extraneous outpatient care when they have to pay for it, or are told the insurance or government will not pay for it. Americans hate being told what to do.
posted by FuManchu at 1:15 PM on July 8, 2009 [1 favorite]


I'm trying to get a feel for the anti-universal healthcare side of the argument. I went to the website for Conservatives for Patient Rights. They have alot of stuff about how government-run healthcare would deny choices, raise taxes, etc. But I can't find anything about how they intend to make sure America's 40 million uninsured can have access to healthcare.

Could anybody here answer that question from a conservative viewpoint? What happens to these 40 million people when they (inevitably) get sick? Do we let them die? What?
posted by Avenger at 1:15 PM on July 8, 2009


They can choose to pay cash to whomever they like.
posted by GuyZero at 1:18 PM on July 8, 2009


Even Medicaid has its own issues (unfunded liabilities will mean either less coverage or more taxes in the future), but it's probably the best the US can hope for

Medicaid is broken because it depends on the states for funding, and states are increasingly running massive budget deficits and thus willing to sacrifice it. Not sustainable on any level.
posted by nasreddin at 1:19 PM on July 8, 2009 [1 favorite]


I think the anti-public healthcare side is the same free market argument you see all the time. Government healthcare would be a bloated bureaucracy that delivers below average services with long wait times at high costs. I think conservatives imagine it'll be like going to the DMV every time you need a checkup.

The thing is, there's so many counter-examples in Europe and Canada, that it's a difficult argument to make honestly.
posted by electroboy at 1:22 PM on July 8, 2009


I didn't see the actual video of the exchange between Rep. Kucinich and Dr. Gratzer, so here it is.

This exchange is quite shameful. It's not a "pwning" at all; it's not even a civilized debate. If you prefer to praise clips in which one person is bullied, not allowed to talk, and is interrupted at every turn, well I guess you've found it.

If, however, you prefer to hear both sides of an argument like open-minded individuals do, try this and this.
posted by gushn at 1:22 PM on July 8, 2009


"Closer integration of retirement living facilities with elderly care. There should be more gradation here between semi-assisted living and the terminal case room & a bed."

This is a hobby horse of mine but It would be great if the national governments, both in Canada and the US, came out with a mandate legalizing Garden Suites similar to the FCC mandate on exterior antennas. I realize those powers aren't held by the national goverments but it sure would be nice. As it stands Garden Suites are illegal practically everywhere that has zoning oversight and it is a failing of the system.
posted by Mitheral at 1:24 PM on July 8, 2009


I'm waiting for some asshole to come on here and say "Americans DO get free healthcare. Just go to an Emergency Room when you need to." I see that All. The. Time. in the comments section of the local newspaper. Makes me crazy.
posted by Ron Thanagar at 1:24 PM on July 8, 2009


splatta, thanks for finding that! I hadn't realized Gratzer was straight from central casting. Hollywood could not improve on him.

The video was posted by what looks like an interesting group: Hillbilly Report: Progressives in Rural America. They claim 18,000 Americans die each year from lack of health care insurance.
posted by shetterly at 1:25 PM on July 8, 2009


Could anybody here answer that question from a conservative viewpoint? What happens to these 40 million people when they (inevitably) get sick? Do we let them die? What?

I believe that the standard Republican line is that most of those people could have health insurance if they wanted it, but they've chosen to spend the money elsewhere, on luxuries like shelter and food. Therefore whatever happens to them is their own damn fault for not procuring insurance, and the rest of us have no responsibility for them.

And, as Bush said, they can always go to an ER in a pinch (and bankrupt themselves if it's something at all serious.)
posted by Pater Aletheias at 1:29 PM on July 8, 2009 [1 favorite]


Millions of Americans would rather die in the poorhouse than go to bed at night knowing that someone, somewhere is receiving something they helped pay for.

+

They who can give up essential liberty to obtain a little temporary safety, deserve neither liberty nor safety

Yeah, well.
We must all hang together, or assuredly we shall all hang separately.
Seems to me you're all going to hang separately.
posted by vivelame at 1:29 PM on July 8, 2009


What happens to these 40 million people when they (inevitably) get sick? Do we let them die? What?

Sometimes we let them die. But in most cases, we still pay for it. We pay for it in higher taxes/fewer services, we pay for it in state budget fights that leave people rushing to deposit IOUs into their accounts while the bank will still accept them, we pay for it in an increased number of sick days (therefore, lower productivity) that un- and underinsured people have to take. We pay for it in a million other ways.

I heard a piece on...Marketplace, I think, yesterday. There was apparently some noise in Congress about the cost of covering long-term care for the elderly and disabled, specifically covering services that help keep people out of nursing homes if they don't actually need to be in nursing homes. "It'll cost too much!" was the cry. Until someone came around with the numbers that show (surprise!) that fulltime nursing home care costs much more than providing aides and other forms of assistance that helps keep people out of nursing homes unless and until they really need it. Duh, right? But that's where the level of argument is right now.

The "But it's going to cost too much!" coming from the insurance industry and those who are against "socialized" medicine is so disingenuous is offensive. It's already costing us too much, dummies. It's nickel-and-diming (and dollaring) us to death, in some cases literally.
posted by rtha at 1:29 PM on July 8, 2009 [4 favorites]


Plus in the case of mental illness you get some awesome homeless people out of it...
posted by Artw at 1:34 PM on July 8, 2009


Bush spent a fair amount of time talking about health care yesterday, as well.

"The immediate goal is to make sure there are more people on private insurance plans. I mean, people have access to health care in America," he said. "After all, you just go to an emergency room."

posted by Pater Aletheias at 1:35 PM on July 8, 2009 [1 favorite]


You know, if a guy was appearing in some Senate hearings for questioning and used the Canadian health system as an example of poor health care or whatever, you'd think he would be able to answer pretty simple statistical questions. If he was honest and was an expert who knew his subject inside and out. You would think.
posted by Ron Thanagar at 1:35 PM on July 8, 2009 [3 favorites]


So it's all due to who was fighting to get health insurance and who they thought they could squeeze for it.

Guy Zero, no, that's not quite how it happened. But I quote your remark because it reveals something, at least to me: the idea that health care is a commodity for which somebody has to be squeezed, and from which somebody gets to profit. A business, instead of a common public resource into which we all collectively pay and from which we all individually benefit. I would hazard that these underlying conceptions of what health insurance is or should be underlie the difference between our two systems (or perhaps I should say the American system and the rest of the developed world).
posted by jokeefe at 1:36 PM on July 8, 2009 [2 favorites]


I don't think there are nearly enough doctors and hospital beds in the US for everyone who needs/wants to use one.

Fine-- get the AMA to stop artificially limiting/lowering the number of (qualified) students admitted to medical school each year.
posted by availablelight at 1:36 PM on July 8, 2009 [4 favorites]


Bush spent a fair amount of time talking about health care yesterday, as well.
"The immediate goal is to make sure there are more people on private insurance plans. I mean, people have access to health care in America," he said. "After all, you just go to an emergency room."
posted by Pater Aletheias


Ah. Of course that stupid idea flowed from the mind of Bush. Of course.
posted by Ron Thanagar at 1:39 PM on July 8, 2009


FYI, employer provided healthcare is an unintended consequence of World War II-era price/wage controls. Wages had been frozen, but fringe benefits were still allowed, so to attract employees and to avoid high excess profits taxes, companies started offering health insurance benefits. This (google books link) suggests that the number of people covered by Blue Cross went from 7 million to 26 million during World War II as a result.
posted by electroboy at 1:43 PM on July 8, 2009 [1 favorite]


`` "In 2003, Americans spent an estimated US$5,635 per capita on health care, while Canadians spent US$3,003... Canada’s single-payer system, which relies on not-for-profit delivery, achieves health outcomes that are at least equal to those in the United States at two-thirds the cost." What do wealthy, educated Americans living in Canada think? ''
posted by Blazecock Pileon at 1:49 PM on July 8, 2009


Rise up, and sort your shit out.

Y'know - potentially this does not require either a revolution or a complete reliance on government action.

I believe that non-profit, charitable or "co-operative" organizations are still allowed in the U.S., correct?

Get enough people together and form your own organization. Ensure that it's charter will not disallow "xyz" procedures/treatment options and must allow anyone to buy-in.

The biggest problem is getting the initial funding going without a few million or so members right away.

Of course - was this not the origin of things like "Blue Cross"? Did they just morph along the way as things became more complex?
posted by jkaczor at 1:50 PM on July 8, 2009


Rat Spatula: ""Consumer choice" is just code language for "make the consumer do the work, and pocket the cash." This is the same pseudo-logic that's peddled to justify replacing actual pensions getting replaced by "efficient" 401(k) plans that let the consumer choose where to invest."

Right on. BC/BS bases their entire ad budget on that concept. Every day on the drive home their commercials play out on my radio. Some poor sap yammering on in halting tones about how BC/BS of Illinois is great because he was allowed to choose his doctor and specialist.

See? The consumer IS in control. Not those pedophile socialists!
posted by KevinSkomsvold at 1:52 PM on July 8, 2009


Why should I have to pay the medical bills for people who eat meat, don't exercise, drink too much, smoke and have unsafe sex? I'll be happy to support a single-payer system that requires participants to live the same lifestyle I do. Let the bacon-chompers, drunks, smokers and bareback pokers pay their own way. In any case, just because 58 percent of the people want a single payer system doesn't mean it's constitutional for the government to use its power to create one. If 58 percent of the population wanted free ice cream, does that mean the government would have the right to nationalize Haagen Daz?
posted by Faze at 1:56 PM on July 8, 2009 [2 favorites]


Faze: "Why should I have to pay the medical bills for people who eat meat, don't exercise, drink too much, smoke and have unsafe sex? I'll be happy to support a single-payer system that requires participants to live the same lifestyle I do. Let the bacon-chompers, drunks, smokers and bareback pokers pay their own way. In any case, just because 58 percent of the people want a single payer system doesn't mean it's constitutional for the government to use its power to create one. If 58 percent of the population wanted free ice cream, does that mean the government would have the right to nationalize Haagen Daz?"

I'm favoriting this because it's a hilarious parody of the type of jackraggery I hate. Well played!
posted by KevinSkomsvold at 1:58 PM on July 8, 2009 [9 favorites]


Every time I read something like this I think that I'd better plan on offing myself if I don't have good insurance and/or a rich husband by the time I come down with something bad. Dear GOD.
posted by jenfullmoon at 1:59 PM on July 8, 2009 [1 favorite]


Guy Zero, no, that's not quite how it happened. But I quote your remark because it reveals something, at least to me: the idea that health care is a commodity for which somebody has to be squeezed, and from which somebody gets to profit.

First, it's a bit hard to attribute either the US or the Canadian system to me personally as I spent my life up to now in one and now I'm living in the other. Don't read too much into my profile page.

But I use "squeezed" facetiously really. One legitimate solution to the issue in both cases would be to leave health care costs to individuals. But obviously it's the kind of situation where insurance works much better to take care of people. It's my rather unstoppable cynicism that equates insurance with someone being squeezed, not any deeper world view or belief in the role of government.

I have said it before but can't be bothered to dig it up now that health care should be considered a human right in the first world. Every western nation has managed to pull that off with one exception.
posted by GuyZero at 2:00 PM on July 8, 2009


"Can someone explain how this [drug prices] works? In the two nationalised systems I have experience with (UK and NZ), there's government funding agency that purchases drugs. ...The patient pays very little (usually an administration fee, not for the cost of the drugs). But the government is surely paying full price. If not, why are the drug companies selling these drugs so cheaply? Why can't they just refuse to sell them, if the price isn't right? How does the rest of the world implement price controls on US companies?"

A cut&paste from elsewhere that might help:

In some countries, but not the USA (more on that later), the free market is used to slash drug prices, by making drug companies compete against each other for sales. For example, something like medicare would, among its duties, be a big buyer of drugs. This buyer represents millions of customers, and therefore can negotiate prices with the drug giants, because it has the financial heft of millions of customers.
This buyer might say to a drug company "Ok, you're the only company in the world who can sell us [Patented Drug X], so you have a monopoly on selling it and thus can name your price. But if you sell it to us at [much-lower-price-$Y], we'll shift our bulk purchases of [generic drug H] to your company. How does that sound?
Except it's much more vicious than that - they could threaten to shift existing bulk purchases to competitors, and so on. Drug companies are pitted against each other HARD, slashing prices so as to outcompete each other.
Since the collective buyer gets the good deals, everyone buys from the collective rather than from the drug companies, so the stakes are high for the drug companies and they must be very competitive.

By contrast in the USA; Congress, the Senate, and the Bush Administration were sufficiently in the pocket of the drug industry to make this free-market competitive approach illegal - the federal government is prohibited from drug price negotiation, it must pay whatever price is dreamed up by a drug company. Over a course of years, that is a Trillion (that's with a "T") dollar kickback being ripped out of medicare (which in turn comes out of our taxes) instead of all that money say... buying us some healthcare.

It is pointless to try to fix healthcare by spending more money in a system that is rigged to steal that money instead of spending it on actual healthcare. You must first fix the system so that it doesn't steal the money that you are trying to spend.
posted by -harlequin- at 2:00 PM on July 8, 2009 [7 favorites]


Also: no, that's not quite how it happened.

Totally serious here, I would really love to be corrected / clarified. The history of the structure of the medical insurance systems in Canada and the US is something I'd love to understand better.
posted by GuyZero at 2:03 PM on July 8, 2009


Faze, are you sarcastically trolling or being serious? Honestly I can't tell.
posted by anti social order at 2:05 PM on July 8, 2009


I'll be happy to support a single-payer system that requires participants to live the same lifestyle I do.

No you wouldn't.

I'm a smoker, I'm a toker, I'm a baaare-back poker. Git mah health care on the ruuuuun...
posted by LordSludge at 2:06 PM on July 8, 2009 [4 favorites]


"Why should I have to pay the medical bills for people who eat meat, don't exercise, drink too much, smoke and have unsafe sex?"

Because you're already paying for it now AND you're getting ripped off as well! Why not just pay for it without getting ripped off? You'd be left with more money to spend, and they would be left with a higher quality of life.

Everyone wins when market inefficiencies (like the destructive-incentives-driven US healthcare system) are fixed.
posted by -harlequin- at 2:12 PM on July 8, 2009 [3 favorites]


This is how we got employer provided healthcare in the US.

From what I understand, Medicare was a compromise between two rival factions of the AMA. One advocated for universal health care, the other for keeping things pay as you go. This is a short timeline of how it evolved.

The " Two decades of debate ensue, with opponents warning of the dangers of "socialized medicine." bit is particularly depressing.
posted by electroboy at 2:17 PM on July 8, 2009


"the federal government is prohibited from drug price negotiation, it must pay whatever price is dreamed up by a drug company."

Wait, What?! So probably the largest buyer of lots of different drugs is prevented from negotiating the price of those drugs? That's just crazy.
posted by Mitheral at 2:21 PM on July 8, 2009


Health insurers refuse to limit rescission of coverage

Life as a Preexisting Condition
posted by homunculus at 2:23 PM on July 8, 2009


Can someone explain how this works? In the two nationalised systems I have experience with (UK and NZ), there's government funding agency that purchases drugs. In NZ, they typically purchase cheaper/generic versions (so you would usually be prescribed fluoxetine for depression, because it's a generic). The patient pays very little (usually an administration fee, not for the cost of the drugs). But the government is surely paying full price. If not, why are the drug companies selling these drugs so cheaply? Why can't they just refuse to sell them, if the price isn't right? How does the rest of the world implement price controls on US companies?

Not to mention that five of the top ten pharmaceutical companies aren't in the US anyway....


The drug companies sell the drugs in the US market at full mark-up. (It is more complicated than that, with a range depending upon managed care etc.) Let's say that averages $100 per unit, whatever that unit might be. In most other countries there is some form of price control which generally means the government tells the drug company what they are willing to pay. Since that number still exceeds the incremental cost of the drug the company sells at the government price. This might be something more like $30 to $50 per unit. It doesn't matter whether that drug company is based in the US or the UK, they still find a prime market in the US for new patent protected drugs. When the US decides that it will set prices the disparity will disappear. The drug companies will still need about the same total revenue to support the intensive capital investment in the drug so they will refuse to sell below a certain price. This will put governments in the position of denying potentially life saving medicine to patients. Price setting like this is effectively a negotiation anyway between the government and the companies, govt. price too low, company won't sell, company price too high, govt. won't buy. The end result is that prices in the US will come down but to support that they would have to rise in other markets. The other markets won't be able to convince the companies to take such a low price when there isn't the extra money coming from the US market, hence a reduction in priced disparity. The overall cost of drugs might come down somewhat, but it is not like big pharma has been rolling in it over the last few years.
posted by caddis at 2:26 PM on July 8, 2009


Guy Zero: Totally serious here, I would really love to be corrected / clarified. The history of the structure of the medical insurance systems in Canada and the US is something I'd love to understand better.

electroboy gets you started.
posted by dogrose at 2:26 PM on July 8, 2009


On non-preview: See?
posted by dogrose at 2:27 PM on July 8, 2009


Also, there may be more shifting toward generics. This already occurs with most insurers but there is often not a generic for new drugs. Is the new drug really better? Insurers right now already ask those questions. Even when there is a generic some drugs need to be titrated carefully in the blood and one version will not always give the same blood level as another. If you buy the brand name you get the same version every time. If you buy the generic you could get a different version every time. (This very real problem could be solved by always getting the same brand generic but that system does not appear to exist yet.)
posted by caddis at 2:30 PM on July 8, 2009


aclevername: . . . and I agree with those who suggest it comes down to the fact that a fair chunk of Americans would rather go broke than think they paid for someone else. I just wonder, why didn't Canadians take this view point as well? What is different in our sociological make up?

Slavery and its legacy on politics.
posted by flamk at 2:37 PM on July 8, 2009 [3 favorites]


The overall cost of drugs might come down somewhat, but it is not like big pharma has been rolling in it over the last few years.

Not what I've heard. A soundbite is that Pharma spent more on just advertising alone than on R&D (no cites - anyone got a debunk?). Once you throw in admin, political graft/corruption/lobbying, and all the other expenses, plus that without maintaining serious R&D, a company has no business left (because patents expire and anyone can make generics at practically no cost), I'm not concerned at pharma companies having to get more competitive.

Secondly, I am/was as wary of globalisation as your average WTO protestor, but I have to concede that it has successfully demonstrated that companies heavily "protected" by tariffs and welfare do inexorably become significantly less efficient, not more efficient, than those more connected to their markets. The US system is plain corporate welfare, and it's conceivable, likely even, that it creates such complacency and inefficiency that removal of the welfare and full exposure to real competition could be a global good rather than a curse.
posted by -harlequin- at 2:53 PM on July 8, 2009 [2 favorites]


dogrose: "Guy Zero: Totally serious here, I would really love to be corrected / clarified. The history of the structure of the medical insurance systems in Canada and the US is something I'd love to understand better.

electroboy gets you started.
"


Also, here is a good place to start.
If you saw "Sicko", Michael Moore briefly touches on how HMOs got started and spurred managed care in the US. I worked in the managed care industry and I can tell you that they are all a bunch of filthy whores, myself included.
posted by KevinSkomsvold at 2:54 PM on July 8, 2009 [1 favorite]


To clarify, I'd agree that in the short term, Pharma would try to extract any loss [of US income] from foreign markets. Long term however, this tactic will fail.
posted by -harlequin- at 2:56 PM on July 8, 2009


Data point on health insurance costs. I'm self-employed and thus self-insured. Since I'm self-insured I have an individual plan and not a group plan.

I'm 33 years old and my insurance costs about $600 a month. Just for me. That's double what it was 5 years ago. At the rate it is increasing the cost of insuring only myself will exceed my total income before retirement age.

Something has to be done.
posted by Justinian at 2:58 PM on July 8, 2009


...a fair chunk of Americans would rather go broke than think they paid for someone else.

First off, no one's gonna go broke. The health care "crisis" is being driven by a populace being driven mad by the scent of a government handout, just as they're driven mad by the hope of getting a ticket to Michael Jackson's funeral. And why should I, who make an enormous effort to stay in shape, avoid bad habits, and eat a good diet (a regimen that allows me to never miss a day of work, make a lot of money and, incidentally, pay more taxes as a result of my lifestyle), support some overweight meat-eater who parks his ass in front of a computer all day playing games and shoving Cheetos down his throat?

You'd be left with more money to spend, and they would be left with a higher quality of life.

I'm not responsible for Mr. Steak-lover's quality of life! I take responsibility for my own life, the life of my family and my elderly parents. Let the burger-bitin' barbeque crowd take responsibility for its own quality of life.
posted by Faze at 2:58 PM on July 8, 2009 [1 favorite]


Blazecock Pileon: In 2003, Americans spent an estimated US$5,635 per capita on health care, while Canadians spent US$3,003...

And since then, it's only gotten worse. I could only find the 2005 stats, but I just watched a BBC program which showed the 2007 OECD results and the US stood at $7290/capita, whereas Canada was $3837.
posted by gman at 3:00 PM on July 8, 2009 [1 favorite]


As a Canucklehead, I would caution anyone who thinks Canada's health care system is perfect. It is far from it.

Our system suffers backlogs from mothers who run their kids to the doctor for every sniffle because "the kid can't go to day care like this". My niece is an emergency ward nurse, and the emergency wards fill up on a Friday nite with people who have conditions that could have been addressed while the clinic was open. So, with the publicly available health care system, who pays? Who needs to be held accountable for the fact that you feel you need to be "medically serviced" at 10 pm on a Friday nite AFTER you have sat in the bar?

A second problem are the horrendous wait times. I find it odd that politicians, star athletes and doctors can get an MRI within 3 days. I can't. Last I checked for a condition, my wait time was 8 months. And, I have to drive an hour to get to it. For an MRI? Hell, a Calgary vet has an MRI machine and my dog would only have to wait 1 day.

Canada has a dual system. Whether we admit it or not, the powerful have access to faster and better medical care. And therein is the problem. I have been lucky enough to have some monies saved so that I can pay for a medical operation myself. But, unless I go to the
US, I can't get this operation for another 12 months. In the US I can get the operation within 3 months. (It is not life threatening, but it is life limiting). This would obviously change if the US were to adopt a health care system like Canada's. But I would prefer to have access to a specialist who can resolve my problem instead of being given the first available doctor as we are now.

The doctor's are not as good by and large as the US. Why? Because they can only charge to a maximum amount. So I have to see a doctor for every little thing that a nurse or an out sourcing clinic could do. This causes a further backlog in the system. If you are a truly good doctor, you can make WAAYYY more money in the US. And don't believe that doctors
are motivated only by the desire to cure the sick. They need to make money to pay back the incredible debt burden and stress that they undergo.

Having said that, our system is great in many ways. Those who are in DIRE need do get access. But I know far more elderly people who could afford an improved quality of life - but time is their limiting factor.

So, be careful when negating the value of the open market system or blanket blessing Canada's socialist health care. For the un-established, or the poor it is a great system. But what is needed for our government to establish a properly dual care system so that I can go to see a physician of my choice. The US would be wise to follow a compromise of both systems - then you have a game changer.
posted by fox_terrier_guy at 3:00 PM on July 8, 2009 [3 favorites]


Faze, are you sarcastically trolling or being serious?

Given their posting history, I'll go with serious....


Why should I have to pay the medical bills for people who eat meat, don't exercise, drink too much, smoke and have unsafe sex?

Why should I have to pay the school costs for people who read comics in class, don't do homework, dawdle too much, daydream and have unsafe sex?

If private education had the same creepy grip on the balls of politics and the public school system was dismantled....
posted by CynicalKnight at 3:05 PM on July 8, 2009 [2 favorites]


At least one place where I've worked came right out during the insurance meeting and told us all that if we weren't "more responsible health-care consumers," they'd just vape the entire benefit package out from under us the next year.

It's a little refreshing to just get a "Nice benefit package you have there, shame if something were to happen to it" now and then.
posted by fairytale of los angeles at 3:06 PM on July 8, 2009


> First off, no one's gonna go broke.

This might be the dumbest thing I have ever read on MetaFilter.

It's nice that you take care of yourself. Good thing healthy people never, ever get into car accidents, develop cancer or, you know, get old.
posted by you just lost the game at 3:10 PM on July 8, 2009 [3 favorites]


fox_terrier_guy: A second problem are the horrendous wait times. I find it odd that politicians, star athletes and doctors can get an MRI within 3 days. I can't. Last I checked for a condition, my wait time was 8 months. And, I have to drive an hour to get to it. For an MRI?

Totally depends on your condition. 8 months? That means your condition can't be too personal. Can I ask what it is? My drunk 66 year old uncle was forced to wait two and a half months for an MRI. Yeah, he whinged, but fuuuuuuck, he did it to his own knee. Me? 2 years ago, when I was 31, and the doctor thought I had neurological issues, I had an MRI here in Toronto within 2 days.

The doctor's are not as good by and large as the US.

Horse shit. I've dealt with both systems extensively and when I was taking my father (who had top insurance) from hospital to hospital last year, I was appalled at the inhumane way they treated him in Ft. Lauderdale. I had to ask for a new doctor at Holy Cross. It's a frickin' business down there and patients are seen as profit. Not to mention the fact it took the final hospital 24 hours to check his insurance before they'd admit him. Do you know how fuckin' disconcerting it is to walk into a hospital and see Visa and Mastercard stickers beside the sliding doors?

Let me tell you one more quick one - a buddy in Northern Califronia walked through some poison oak. Doctor looks in the room and asks 'pills or cream?' That's it. Oh, and here's a bill for $300.
posted by gman at 3:14 PM on July 8, 2009 [5 favorites]


"I'm not responsible for Mr. Steak-lover's quality of life! I take responsibility for my own life, the life of my family and my elderly parents. Let the burger-bitin' barbeque crowd take responsibility for its own quality of life."

Noting that this will fall on deaf/stupid ears, you're already indirectly responsible for the costs incurred by Mr. Steak Lover, as his reduced ability to get the care he needs preemptively strains the greater system. Given the insane prices of emergency care, which are passed along in the form of higher premiums and higher up-front costs, you're already paying for it. What you're not getting now is a very good deal for your money.

If fiscal conservatives did any sort of real research or gave any sort of thought to economies of scale, they'd be for either single-payer or hybrid health care with a significant government option. Instead, a blinkered ideological belief that each person can somehow be independent in a real manner from his society prevents them from acting in their own best interests.

Your choices are not to be responsible for your neighbors' health and enable bad behavior or to stand apart and only care for folks you choose to, they are to pay an incredible emergency premium for your neighbors' bad behaviors or to come up with a system that mitigates those costs through planning and distribution. The only way that your construction makes sense is if you feel there is more utility in paying extra to guarantee your neighbor will be sick than there is in paying less to ensure they won't be.
posted by klangklangston at 3:17 PM on July 8, 2009 [9 favorites]


"The doctor's are not as good by and large as the US. Why? Because they can only charge to a maximum amount."

Or because there's, like, a metric fuckton fewer doctors in Canada, and because there are far fewer major population centers.
posted by klangklangston at 3:20 PM on July 8, 2009


All I want is what McCain and all the congressmen and senators have--govt health coverage, via got. When they get it it is ok. When we ask for it, it suddenly becomes socialism. Let McCain try to get private insurance with his preexisting health problems and see what happens.

Why can't we have what congress authorizes for itself? We fucking pay for them to get it.

ps: bureaucratic messes etc? ask vets using V.A. hospital how they like it.
posted by Postroad at 3:23 PM on July 8, 2009 [1 favorite]


And because they can all move to the US and make a lot more. Yay TN visas!
posted by GuyZero at 3:23 PM on July 8, 2009


I'm not responsible for Mr. Steak-lover's quality of life! I take responsibility for my own life, the life of my family and my elderly parents. Let the burger-bitin' barbeque crowd take responsibility for its own quality of life.

Methinks you don't understand the concept of insurance.

Here's the concept, as it should be:

1. Everyone gets coverage
2. Everyone gets thrown in the same coverage "pool"
3. Everyone pays a median cost where, essentially, the young and healthy pay a little more than they are likely to receive, the middle-aged and reasonably healthy pay about what they are likely to receive, and the old and sick pay less than they are likely to receive. That way, the healthy pay for the sick, the system continues, and everyone progresses through the stages.

That's not the way it works now and, in fact, the insurance industry rigs the game even further:

1. They flat-out refuse coverage to some, AND
2. They create "pools" that increase their profits while increasing the cost of coverage. For instance, they separate people into separate "healthy" and "not healthy" pools, charge both groups the max, and reduce the power of the healthy subsidizing the unhealthy.

You are getting hosed by not being willing to let the numbers work for you for a change. All for a snarky value judgement.
posted by Benny Andajetz at 3:24 PM on July 8, 2009 [4 favorites]


When the drug companies start paying more for research than they do for marketing, I will try to give a damn about their pricing and profits.

As for the rest of the mess:

It's the difference between a culture that thinks universally versus a culture that thinks selfishly.

And if humans are going to survive at all well on this planet, we need more universal thinking. Selfish thinking is what has brought us into all these messes.
posted by five fresh fish at 3:25 PM on July 8, 2009 [4 favorites]


First off, no one's gonna go broke

bullshit

The health care "crisis" is being driven by a populace being driven mad by the scent of a government handout, just as they're driven mad by the hope of getting a ticket to Michael Jackson's funeral.

Nice ad hominem strawman. An ad strawminem?

And why should I, who make an enormous effort to stay in shape, avoid bad habits, and eat a good diet (a regimen that allows me to never miss a day of work, make a lot of money and, incidentally, pay more taxes as a result of my lifestyle), support some overweight meat-eater who parks his ass in front of a computer all day playing games and shoving Cheetos down his throat?

Because every single uninsured person is exactly like that. Because it is never the case that someone is struck by some environmental trigger out of the blue that, because of unfortunate genetics and insurers practicing medicine a condition is not diagnosed until it becomes chronic/terminal? Because it is the choice most any sane person would make when engaging in writing a social contract without prior knowledge of their particular station in said society?


I'm not responsible for Mr. Steak-lover's quality of life! I take responsibility for my own life, the life of my family and my elderly parents. Let the burger-bitin' barbeque crowd take responsibility for its own quality of life.


You also build your own roads, put out your own fires, and refuse to pay property taxes because you don't have children in the public education system while eschewing every convenience and luxury that comes part and parcel with living in a putatively civilized society because doing otherwise would create all sorts of moral obligations that might infringe on maximizing your own personal monument at Gault's Gulch?
posted by Fezboy! at 3:29 PM on July 8, 2009 [21 favorites]



My pregnant daughter has a month to go in her pregnancy. The next appointment she can get (she's a Navy wife) is AFTER her due date.


Isn't military health for families and dependents (Tricare) run by private insurance companies? In your region, it used to be Humana HMHS.
posted by dilettante at 3:30 PM on July 8, 2009


"The end result is that prices in the US will come down but to support that they would have to rise in other markets."

I'm calling at least a partial shenanigans on this. The recent thread on HFC inhalers is an excellent case in point. HFC inhalers have been out and used for years in other markets at essentially the same price as the CFC inhalers. In the US they are apparently an order of magnitude more expensive. For emergancy medicine. Why? Patents and an healthcare system that doesn't seem to care because the insurance companies either haven't approved the new formulations (even though the old ones are being discontinued, you'd think that would move them up the ladder a bit in a fair system) or have come right out and said they aren't going to cover them. Something is wrong with this picture.

"First off, no one's gonna go broke. "

AskMetafilter is full of questions from people going or gone broke from the defective health care system in the states.

"The doctor's are not as good by and large as the US. Why?"

Cite? Cause I've never heard that before in any sweeping generalization. I do know that American doctors spend a lot more time dealing with insurance compnies and billing (see that ~30% of revenues statistic) than Canadian doctors.

Of course Canada's system isn't perfect. Yep, some people with a sense of entitlement either from the luck of good health or wealth think Canada's system sucks. But when it comes down to it I'd much rather have rationing decisions decided by health boards and governments, who at least have a chance of having the best interests of the population at heart, than by who has the biggest wallet.
posted by Mitheral at 3:32 PM on July 8, 2009 [2 favorites]



"I'm not responsible for Mr. Steak-lover's quality of life! I take responsibility for my own life, the life of my family and my elderly parents. Let the burger-bitin' barbeque crowd take responsibility for its own quality of life."


You live in a society with people around you. Call it the social contract, culture, whatever. There is such thing as a common social good.

I think as human beings we've risen beyond the survival of the fittest approach to culture, especially in the modern world.

It doesn't mean being touchy feely and taken advantage of, but a basic framework of "The Golden Rule" is a positive force, even if it means you might be inconvenienced, or have to spend an iota of your own personal time, work, finances or resources on the well-being of others.

Spend a bit of time in a Scandinavian country. Spend a bit of time broadening your horizons of how people can actually live together in a positive fashion, not this agressive macho bullshit that's been the centerpiece of american society over the past 30 years.

It's time to grow the fuck up as a society and adopt an actual social contract for american society.
posted by Lord_Pall at 3:32 PM on July 8, 2009 [13 favorites]


fox_terrier_guy:

1) US emergency rooms go just as nuts at night or whenever the moon is full. It's not just in Canada.

2) Wait times: My mom got knee joint replacements in about 6 or 7 months from getting the go-ahead from the surgeon. Both my parents have received chemo and cancer surgery within 3 weeks of their diagnosis. Wait times will always be a consideration, but they've improved considerably in the last few years.

3) Most US general care physicians spend a significant amount of their week doing paperwork, coordinating benefits and battling with private insurers. Canadian Drs can spend most of their time treating patients (and billing for it).

4)US doctors are better, in general? I don't believe that. Of course you can attract the cream of any profession by salary alone, but there's more to a career than just money ... eg see 2 above. Canadian Drs can make a very good living practicing in Canada. We have great teaching and research hospitals, too.

The Canadian uberrich can of course jet down to the Mayo for any little thing... justified or not. Notwithstanding, the Canadian system provides excellent care and most of the well-off folks I know are content with the treatment they receive within the Canadian system. This is NOT a two-tier system.
posted by Artful Codger at 3:33 PM on July 8, 2009


oops eg see #3 above, not 2.

Also... preview is my friend. Gotta remember that.
posted by Artful Codger at 3:38 PM on July 8, 2009


Yeah, a lot of people everywhere like to wait until off hours to see a doctor. Doctor friends around the world have complained about that: it's not specific to Canada.

Canada's medical system is imperfect, but there's not going to be a perfect medical system. Yes, politicians and hockey players can get better treatment than the rest of us: all it is, though, is a different kind of unfairness. Rich people who have donated lots of money to hospitals (and their families) also get better treatment.

But when I am sick, I see a doctor. When I need to go to hospital, I go there that day, I don't need to wait around for someone to approve it. When I had elective surgery and specified that I would only do it at certain times because it would incapacitate me for over 2 months, I got my surgery at the exact time I wanted. (This was in part because it was a very short surgery and could be fit in around other things.) I had access to multiple different specialists for my elective surgery; my grandparents have had access to their own specialists for knee replacements, hearing aids, lung cancer and heart failure. All without paying, and all without having to wait excessively long -- in Quebec, where we do have longer waits because of weird disincentives to working in cities. My grandmother, for instance, had to wait about 4 months for her first knee replacement, and had no wait once she was medically cleared for her second. My other grandmother got radiation treatment for her lung cancer within a week of the diagnosis. Waits aren't so terrible.

Are our doctors as good as those in the US? Well, again anecdata, but I know a lot of people in medical school who cannot ever even consider going to the US because they could never, ever get insurance coverage, so they can't afford to work there. Not everyone is inspired solely by where they can get paid the most, either: some people want to continue to live in Canada, even if they won't earn as much.

I'll concede to problems -- as I've mentioned, there are, here, weird disincentives to setting up a practice in a city, so a lot of people leave the province altogether. There is a lot of perverse legislation making it hard for foreign-trained doctors to practice here. Because doctors are limited to a certain salary each quarter, many of them just take off on holiday for the end of each quarter. Eye care isn't covered. Dental care isn't. (And I can live with a lot of things, but not without glasses.) God knows there's no good coverage for psychiatric care. But I've never worried about paying for something, or avoided a doctor because of any kind of financial concern. I can be jobless without being terrified of getting sick. And -- again, at least here -- once you have been living with someone for a year or have a kid together, you can have them be your spouse for insurance purposes if you have work-provided insurance that covers, say, travel insurance or prescription drugs.
posted by jeather at 3:38 PM on July 8, 2009 [1 favorite]


First off, no one's gonna go broke.

I'm assuming you have some sort of substantial challenge to claims like this to make such a statement.

The health care "crisis" is being driven by a populace being driven mad by the scent of a government handout

I can work up a good lather of misanthropy myself on a lot of days, particularly when this topic comes up.

However, I have some pretty strong doubts that this is related to simple desire for a handout. Partly for the same reason I suspect the Haagen Dazs analogy employed above isn't apt. I'd wager some hard cash that if you commissioned a serious survey about whether the government should spend tax dollars providing a pint a month of free Haagen Dazs for each person, you'd never get even a majority, much less approach a near supermajority. People can be very greedy and lazy and many of us grow more this way over time, but a lot of them also have some innate sense of fairness and necessity.

But the better part of the reason I don't think your explanation holds up are the non ice-cream related statistics already out there regarding costs and coverage. Not to mention anecdotes like those in thread, particularly those about people who pay into the system their whole lives only to fall through the cracks when they need it. It's one thing to make logistical or economic arguments against a single-payer system or even a public insurer, but it's another thing to chalk up public enthusiasm for reform to mere unrestrained greed when there's so much data and so many stories that point to real problems.
posted by weston at 3:39 PM on July 8, 2009


59% of the American public and 59% of physicians support single-payer national health insurance

Unless I am mis-reading the linked articles, this is not really honest. Clicking through, I did not find any poll indicating that 59% of the American public support single-payer national health insurance.

The cited poll (NYT/CBS 1/11-15) states this has 59% of the respondents favoring "national health insurance" in response to this question: "Should the government in Washington provide national health insurance, or is this something that should be left only to private enterprise?" The linked page of polls also has 58% responding "bad thing" to a Quinnipiac 6/23-6/29 poll asking "If the government ran the health care system, do you think that would be a good thing or a bad thing?"
posted by Slap Factory at 3:42 PM on July 8, 2009


As a Canucklehead, I would caution anyone who thinks Canada's health care system is perfect. It is far from it.

I think I can speak for at least many of my fellow Americans when I say that even if the quality of service was never one whit better in Canada, we'd still be gleeful for having something that didn't depend on having the right kind of job, that we couldn't lose just because we lost our jobs or wanted to go freelance, and didn't leave us with bills running up to the tens of thousands of dollars just because we actually had the nerve to use that insurance.

An awful lot of my friends, due to this shitty economy, have either no job, or a temp job, or a part-time job or two. Others are freelancers. Offhand, I'd wager that among my social group - consisting, basically, of people all over the 20s in age - less than half have health insurance. I know for a fact two will be uninsured in a couple of months when their (ruinously expensive) COBRA runs out, because the one who had benefits got laid off, and hasn't been able to find anything with health care since then. Another is probably only insured because she's a full-time student. I'm constantly horrified at the fact that most of the people I know and care about would have to pay for any and all medical expenses they might encounter fully out of pocket, and most of them don't have much money. So yeah, even if we see zero improvement in the quality or overall cost of our health care... can we please just make sure everybody has it?
posted by Tomorrowful at 3:46 PM on July 8, 2009 [2 favorites]


@Faze: You already are paying for the people with unhealthy lifestyles. You're paying for them with increased premiums - you're also paying increased premiums and higher group coverage rates for coworkers with genetic and pre-existing conditions. Additionally, you're paying more for health care than people in Canada do. So even if you are totally selfish and not just a complete troll (I honestly can't tell), the fiscally selfish opinion for you would be to support a healthcare system similar to Britain or Canada because you'd be paying less into a country-wide risk pool as opposed to paying more into a very small risk pool.
posted by LukeyBoy at 3:47 PM on July 8, 2009 [6 favorites]


Unless I am mis-reading the linked articles, this is not really honest. Clicking through, I did not find any poll indicating that 59% of the American public support single-payer national health insurance.

The cited poll (NYT/CBS 1/11-15) states this has 59% of the respondents favoring "national health insurance" in response to this question: "Should the government in Washington provide national health insurance, or is this something that should be left only to private enterprise?" The linked page of polls also has 58% responding "bad thing" to a Quinnipiac 6/23-6/29 poll asking "If the government ran the health care system, do you think that would be a good thing or a bad thing?"


That not dishonest at all. Single-payer means the government pays for it, but it says nothing about who provides it. The government running health care means the government employs doctors and nurses directly, UK NHS style; single-payer means independent third-party doctors, nurses, hospitals, etc, who provide the actual care, and send the bills to the government. Which is what "national health insurance" would entail, and that's what 59% of the country supports.
posted by Tomorrowful at 3:48 PM on July 8, 2009


I've generally been impressed by health care outside the U.S. : France's providers seem almost completely private. Indeed, the consumer even chooses their own laboratory since doctors don't keep secretaries, lab techs, or other staff. Their single-payer market distortion keeps the system functioning smoothly, while co-pays prevent abuse. I can attest that Britian's fully socialized medicine delivers hospital care effectively & free, although they've few dentists. Germany has some hybrid pubic-private mandatory insurance system with mandatory insurance, which I never actually used.

I prefer the French "fully private but single payer" model for game theoretic reasons. I doubt people less honest than the Germans could handle their mandatory insurance system, well maybe that's the U.S.'s whole problem. I'm also wary that fully socialized system are subject to right wing sabotage, as happens in Britain.
posted by jeffburdges at 3:52 PM on July 8, 2009


And why should I, who make an enormous effort to stay in shape, avoid bad habits, and eat a good diet (a regimen that allows me to never miss a day of work, make a lot of money and, incidentally, pay more taxes as a result of my lifestyle), support some overweight meat-eater who parks his ass in front of a computer all day playing games and shoving Cheetos down his throat?

Funny, I had a friend living just the way you are now....who got hit with stage IV cancer after decades of never having to darken the door of a doctor's office. Good luck with that whole, "only bad people get sick" thing.
posted by availablelight at 3:58 PM on July 8, 2009 [20 favorites]


Totally depends on your condition. 8 months? That means your condition can't be too personal. Can I ask what it is? My drunk 66 year old uncle was forced to wait two and a half months for an MRI. Yeah, he whinged, but fuuuuuuck, he did it to his own knee. Me? 2 years ago, when I was 31, and the doctor thought I had neurological issues, I had an MRI here in Toronto within 2 days.

Yep. It's triage; you can get bumped down the list depending on how serious your condition is. When my neighbour broke her ankle she was in surgery within 24 hours; my godmother had to wait for her knee replacement for a number of months. I never heard her complain.

I'm not saying our system is perfect, but it's a fuck of a lot better than paying thousands of dollars for an MRI, or not having one at all.
posted by jokeefe at 4:00 PM on July 8, 2009


As a Canucklehead, I would caution anyone who thinks Canada's health care system is perfect. It is far from it.

Everyone whines about how bad their care is, no matter what country or what system. But the problems you list compared to those in the USA are like comparing a stubbed toe to a severed limb.
I have friends in many countries. Everyone faces problems. Everyone thinks they're getting the short end of the stick, and that their system can't go on like this. But what happens to my friends in the USA makes my blood boil. There is simply no comparison.

I know this is not the argument you're making, but a common fallacy I keep hearing in support of the status quo is "that [foreign] system has problems too - both healthcare system are imperfect [therefore] both health systems are equal, just different".

It's utter bullshit. Canada is flawed, but the worst thing that has happened to anyone you know in the Canadian system is a picnic with flowers compared to what systematically happens to people you know if you live in the USA.
posted by -harlequin- at 4:06 PM on July 8, 2009 [4 favorites]


I think this is relevent here. (flickr prev.)
posted by chugg at 4:06 PM on July 8, 2009


Unless I am mis-reading the linked articles, this is not really honest. Clicking through, I did not find any poll indicating that 59% of the American public support single-payer national health insurance.

The polling data is kind of all over the place with respect to health reform. There seem to be big swings in responses depending on the phrasing of the question. This usually indicates that public opinion is pretty malleable still--people don't have a very deep understanding of the issue, or very firm positions on it yet, so slight changes in word choice or question sequencing can result in two apparently-similar polls giving really divergent answers. Hell, even on metafilter, which is generally filled with smart/educated people, you see a lot of confusion about what exactly different phrases mean (e.g. whether "universal healthcare" is the same as "single payer"), so I would almost be surprised to see polling that showed consistency across time and different phrasing.

I also suspect that metafilter has not-entirely-typical attitudes about our healthcare system. My sense is that American mefites skew young and self-employed in much, much higher numbers than the general population, and those are exactly the groups that are most shafted under the current system. One pretty consistent poll finding is that Americans in general, even those that are generally supportive of reform, are somewhat satisfied with their own doctors and their own insurance set-up. The first link in this FPP is a really good argument for why people who seem to have good insurance really shouldn't be satisfied with it--it's easy to be happy with your health insurance if you are generally healthy and getting a good deal through your employer--but the truth is that most people probably don't spend a whole lot of time pondering the awful medical calamities that are likely to befall them. (If they did, and took a good look at the numbers, you'd see a lot more than 1% of people buying long-term care insurance. People don't like to think about growing old or getting sick.)
posted by iminurmefi at 4:12 PM on July 8, 2009 [1 favorite]


You'd be left with more money to spend, and they would be left with a higher quality of life.

I'm not responsible for Mr. Steak-lover's quality of life! I take responsibility for my own life, the life of my family and my elderly parents. Let the burger-bitin' barbeque crowd take responsibility for its own quality of life.


You are saying that you WANT a lower paycheck, and you're fine with more people being sick to give you that loss of income?

If you're the "I've got mine, screw you!" type, then just take the free money and greater economic and career opportunities that a proper healthcare system would give you, and if it's really really necessary, just pretend that no-one is being made healthier by you being wealthier.
posted by -harlequin- at 4:19 PM on July 8, 2009 [3 favorites]


I was sick for a really long time, and I lived in Canada. I was out of my mind and a terrible alcoholic. If you don't believe me, just look at my profile. I went to see a doctor, who, since she knew she would get paid, could focus on helping me. She did, and she got me hooked up with another doctor who specialized in problems like mine, and he helped immensely.

Prescriptions still cost money in Canada, but the Government will cut you a break if you're poor. I was living, basically, on the streets, and I couldn't afford them. The provincial government covered them, and when they wouldn't, the pharmacist turned a blind eye and gave them to me anyway.

The Canadian healthcare system saved my life. I don't really know enough to talk about the pros and cons, but it has saved at least one person who was thinking about diving into the river or jumping in front of a bus.
posted by kfx at 4:20 PM on July 8, 2009 [13 favorites]


Good luck with that whole, "only bad people get sick" thing.

that is unfair to the original opinion. Single-payer / universal coverage without financial incentives to remain healthy might be considered taxation without adiposation.
posted by @troy at 4:20 PM on July 8, 2009


A couple of my military -wife friends are informing me that my daughter's problems with appointments are not out of the ordinary. One told me she went out of the system for her own care because of this. Living in a military town as I do I already know the rep of military health care is not really the best...


I remember as a kid when everyone paid for their own regular doctor's appointments and only held major medical insurance for things like accidents and cancer. Back then we could afford to go to the doctor. And we could afford insurance. What the heck happened?
posted by St. Alia of the Bunnies at 4:20 PM on July 8, 2009


Why should I have to pay the medical bills for people who eat meat, don't exercise, drink too much, smoke and have unsafe sex?

You have a health insurance policy that only covers vegetarian teetotaling abstinent fitness enthusiasts?
posted by designbot at 4:27 PM on July 8, 2009 [3 favorites]


There are a million stories like this in this country. I have relatives in Canada. It is not perfect, no. But the way they are able to live their life there, to not have to worry about this, is something that we just cannot even imagine here.

Right back at ya. This stuff reads like dystopic speculative fiction.
posted by Durn Bronzefist at 4:28 PM on July 8, 2009


Or because there's, like, a metric fuckton fewer doctors in Canada, and because there are far fewer major population centers.

And because they can all move to the US and make a lot more. Yay TN visas!

I flew into Pearson a month ago. Right after I cleared customs, there were giant advertisements aimed at getting doctors to move up there.
posted by oaf at 4:28 PM on July 8, 2009


Why should I have to pay the medical bills for people who eat meat, don't exercise, drink too much, smoke and have unsafe sex?

What about internet dwelling rage-ahol addicts?
posted by Artw at 4:29 PM on July 8, 2009 [1 favorite]


A couple of my military -wife friends are informing me that my daughter's problems with appointments are not out of the ordinary. One told me she went out of the system for her own care because of this. Living in a military town as I do I already know the rep of military health care is not really the best...

Again, sounds like a problem with the private insurance companies that run it.
posted by dilettante at 4:31 PM on July 8, 2009


there were giant advertisements aimed at getting doctors to move up there.

That's because they advertise things that people wouldn't think of doing by themselves.
posted by GuyZero at 4:32 PM on July 8, 2009


That's because they advertise things that people wouldn't think of doing by themselves.

The U.S. needs more primary-care physicians, but Ontario needs them just as badly (and the rest of Canada may as well). They're not running those ads because they think the idea of a special lane for U.S. doctors on the 401 is funny and they want to share it.
posted by oaf at 4:37 PM on July 8, 2009


And in fact, looking at the actual questions in the linked poll here, you do find exactly what I'd expect (although it depresses me a little):

* Among the 88% with health insurance, 49% are "very satisfied" and 36% are "somewhat satisfied" with their insurance

* 70% think they get "a good value" for their money (I'd bet you $10 most of them don't even know what the full cost of their premiums are, because it never shows up on your paystub if you're getting it through your employer)

* 52% think other Americans don't get "a good value" for their money

* 69% approve of a public option for health insurance in the market, but only 28% would prefer to buy insurance from the government (53% would prefer to purchase coverage in the private market even if a government option were available)


I think I may have to call shenanigans on the claim in the second sentence of this FPP that 59% of Americans support single payer. I've looked through all the polling data linked to by FAIR, and the only things that seem to have the 59% number are the questions:

Do you think it is the responsibility of the federal government to make sure all Americans have health care coverage, or is that not the responsibility of the federal government?

which could mean a lot of things, including single payer, but definitely not limited to single payer; and

Should the government in Washington provide national health insurance, or is this something that should be left only to private enterprise?

which again could be read as either support for single-payer or support for the public option. Given all the other polling results that seem to indicate low support for forcing people onto a government plan, but high support for giving people the option of a public plan, I think it's pretty fair to interpret the responses as support for the public option and not single-payer.
posted by iminurmefi at 4:41 PM on July 8, 2009 [1 favorite]


You have a health insurance policy that only covers vegetarian teetotaling abstinent fitness enthusiasts?

No, but he was asking an insincere rhetorical question for the sake of trolling an internet forum. Mission accomplished, methinks. There's a reason why he dropped that stinkbomb and then disappeared.
posted by dersins at 4:45 PM on July 8, 2009 [1 favorite]


Why should I have to pay the medical bills for people who eat meat, don't exercise, drink too much, smoke and have unsafe sex?

YEAH, and people who are ALIVE because of their increased risk of.... um.... DYING.
posted by klanawa at 4:48 PM on July 8, 2009


premiums… never shows up on your paystub if you're getting it through your employer

Really? I'm up here in Canada, and all my paycheques have shown a detailed breakdown of deductions. I know how much I pay for unemployment insurance, medical premiums, income tax, etcetera.

Seems to me a good first step in the US would be to mandate that paycheques show a detailed breakout of premiums, taxes, and other mandatory items.
posted by five fresh fish at 5:01 PM on July 8, 2009 [2 favorites]


Should also point out that MeFi folk are probably unusually informed as to what happens wrt healthcare in other nations.

Your average America would have no idea that there are better ways, so of course they are satisfied with the situation. In the context of what they know, things appear to be peachy — even as they go bankrupt.

It's all the more difficult to educate them when vast corporate interests are spending millions of dollars to blow sunshine up their asses.
posted by five fresh fish at 5:05 PM on July 8, 2009 [1 favorite]


Mitheral - cites:

Conversation with a personal friend of mine. She used to be heading up a department at the Foothills. She is from Calgary, now has re-located to Boston. Her rationale was exactly as stated. I have seen other references to this as this has been a hot topic of late, but would have to try to locate them. There fore, I will just use this one reference. Not encyclopedic but any stretch.

gman:
Well, you had a singular bad experience and now our doctors are better? I have had multiple bad experience with Canadian doctors and as you have, US doctors. There are good and bad doctors in both countries. However, in Canada we are seeing the decay of an unsustainable system, and whether you wish to believe it or not, it is creating a significant crisis in Canada as we increase with an aging population. Perhaps your daughter broke her collarbone, and 6 different doctors advised you to "just leave it be - it'll heal on its own"? The seventh one advised you to have the pins put in. OK, who did the nurses say was an extremely competent physician? You guessed it - Mr. Number 7. The others were "good doctors". Just sayin'...it is possible though that the present physicians are overworked.

Of course, you could just yell "horse shit". That'd teach me.

I'm not saying that the poor should not have coverage, or that the rich can go burn. (Sorry, why is it bad to be wealthy again?). I am simply saying that there are advantages and disadvantages to both systems. If the US is going to adopt one (you are still a capitalistic society - even though you are making great strides to go socialist) you should learn from the successes and failures of others. Then you will have a medical system that is the envy of the world, not just "a health care plan".

This is a great idea, and an awesome plan and I sincerely hope my US friends can get coverage, because some of them are going without during this difficult financial time.

Finally, wrt waiting rooms. Hey, I understand that waiting rooms are full on both sides of the border. But in Canada, the guy who showed up every Saturday nite in emerg with something different stuck up his butt never saw the price of his visits increase. Does anyone here think that this is normal? Perhaps a psychologist could help him out...but that is a waiting time of 3 months...
posted by fox_terrier_guy at 5:10 PM on July 8, 2009


So I'm sitting here reading this post, and I suddenly get a phone call from my husband telling me that he's been in a big crash while mountain biking, and had totally smashed his face (broken nose, big cuts). I'm at home with the baby freaking out, but at least I know that his friend is taking him to a hospital to get the best care, and that cost won't even be a consideration. I can't even imagine how I would be feeling right now if I was unlucky enough to be an American without health insurance.
posted by Go Banana at 5:11 PM on July 8, 2009 [1 favorite]


As someone who has spent time overseas with ZOMG! COMMIE MEDICINE!1!! I can honestly say that the quality of care I received over there was as good if not better than what I receive here. Why is it so much more expensive here?

The ridiculous profiteering from the insurance industry is the most obvious reason, but another reason that is often overlooked is that Europeans don't sue their doctors. The concept is completely alien to them. As the daughter-in-law of a surgeon, I know that malpractice insurance eats up a HUGE portion of a doctor's income. They're so afraid of getting sued, that instead of spending time talking to a patient and using their education and experience to make a diagnosis, American doctors send you off for tests, tests, and more tests. Expensive ones. They're simply trying to cover their own asses, and who can blame them?

Americans are always saying how horrible government run health care is, and how dreadful the situation is in Canada and the UK. They're also all too eager to shout "We're Number One! We're Number One!" Well, it's time to put your money where your mouth is. If America really is the best at everything (and I have yet to see documentation to back this up), there's no reason why we can't take a system like the UK's NHS and do it better.
posted by ValkoSipuliSuola at 5:28 PM on July 8, 2009 [5 favorites]


It all starts with campaign finance reform.
posted by Max Power at 5:31 PM on July 8, 2009 [5 favorites]


But what is needed for our government to establish a properly dual care system so that I can go to see a physician of my choice.
posted by fox_terrier_guy at 6:00 PM on July 8


What province are you in? I'm from Nova Scotia, and not once have I ever had a problem seeing the physician of my choice. I only encountered that when I moved to Tennessee and had to pick my doctor from a list the HMO provided.

In any case, both systems ration care. In Canada, care is rationed according to a sort of triage - if your condition isn't life-threatening, you have to wait longer. In the US, care is rationed strictly by ability to pay. Unless you want costs to spiral out of control, care has to be rationed somehow. I know which one I prefer. (This is not to say that wait times are as bad as the Republicans would have us believe. They cherry-pick stats to support their arguments. But they're longer than those in the US enjoyed by people who don't encounter any problems with their insurance.)
posted by joannemerriam at 5:39 PM on July 8, 2009 [1 favorite]


Do we still have horse-buggy whip manufacturers? No, and for good reason. There is no longer a market for horse-buggy whips. The makers of horse-buggy whips gradually lost their jobs and probably found new ones. Within a generation or so after that, the horse-buggy whip industry became a mere historical blip.

Do we now mourn the lack of horse-buggy whip makers? No, we don't. We don't because we don't need them. Health insurance companies are our horse-buggy whip manufacturers of the 20th/21st century. They are obsolete, but they don't know it, and for those of us who do know it are ahead of ourselves. They won't go away quietly or without a fight. But they will go away, and probably in my lifetime. And if we have any sense of social justice, by the time my grandkids are born (25 years from now, give or take), they won't have to worry about healthcare. And their grandkids will be puzzled by the mere concept of health insurance companies ("You mean these companies made money off sick people?")
posted by zardoz at 5:40 PM on July 8, 2009 [2 favorites]


Several years had passed since my parent's divorce. During that time my mother could not afford health insurance and so she had none. She developed a pain in her thigh ... a muscle pull, a bruise, whatever, somehow it would not get better. She eventually went to a doctor and found that her femur was cracked. During treatment they discovered that the bone was cancerous. Not only that, the cancer had metastasized and had spread to virtually every part of her body. The diagnosis was that the disease was terminal. I was in the room when they told her. My mother, dear that she was, had a tenuous grasp of reality in the best of times, so after the doctor had left the room I asked her if she really understood what the doctor had just told her ... if she really understood what "terminal" meant. She smiled at me and said it meant she was going to have to work "extra hard to get better". 4 months later she was dead ... at 63. During those 4 months she lost everything she had, which granted was not all that much. As an only child, it fell on me to deal with funeral arrangements and costs. It took several years to pay off those bills but I begrudged not a penny. After all, I had a job and could afford it. 3 months ago I lost that job and in the economic hell that is Detroit I have little hope of finding one anytime soon. Eventually, the COBRA will run out for me and my family. Will we be forced to uphold the family tradition?
posted by DaddyNewt at 5:42 PM on July 8, 2009 [15 favorites]


A copy of "The social transformation of American Medicine" by Paul Starr is on its way to me by inter-library loan. I look forwards to regurgitating its contents the next time we have this same discussion.

Also: LIBRARIES: COMMUNIST OR SOCIALIST???
posted by GuyZero at 5:45 PM on July 8, 2009


@pivotal

What sort of country lets their middle class wallow like that, let alone their most helpless and needy?

A country whose time on this Earth seems more and more likely to be coming to an end thanks to corruption from within.

(New Zealand: beautiful place. May the blight we're suffering never reach your shores.)
posted by Twang at 5:45 PM on July 8, 2009 [1 favorite]



Fifty years ago I went out on a limb for a Marine Corps buddy. I devised, at great personal risk, a story/scenario that saved him from a court martial that would have resulted in him serving some very serious brig time. We were not friends. Just corps comrades.
Twenty years ago, after we had been friends as a result of that Marine Corps incident, when he had a government position that provided complete health coverage for him and his family with no fees, I asked him the following: (an approximation) Ted, if writing a check for a thousand dollars and paying it to the government would of and by itself provide free health care for every person, rich and poor in the U.S. would you do it? He thought for about five seconds and said, "now why in the hell would anyone do that?"
posted by notreally at 5:46 PM on July 8, 2009 [4 favorites]


I don't know how you put up with it, U.S. Mefites. Reading some of these horror stories, I imagine myself getting really mad one day & doing something I'd surely regret later.
posted by stinkycheese at 5:46 PM on July 8, 2009


However, in Canada we are seeing the decay of an unsustainable system

Bull. Shit.

We spend a piddling 6% of GDP on healthcare. A pittance compared to the 15% the USA spends. We have a monstrously efficient system, and if we tossed a piddling 4% more at it, most issues would evaporate.

But, no, we have bastards in government who are doing their damnedest to destroy every one of our public institutions so that fatcat ratbastards can turn our health into a hugely profitable venture.

Fuck. That. Shit.
posted by five fresh fish at 5:46 PM on July 8, 2009 [17 favorites]


It took several years to pay off those bills but I begrudged not a penny.

Huh. My aunt in BC smoked all her life, got lung cancer which eventually spread throughout her body. Her and her husband we retired at the time. She lived several years and died before she would have had she not smoked, but that whole part about going broke... not so much. She got pretty good cancer treatment for a lifelong smoker in her 60's.
posted by GuyZero at 5:48 PM on July 8, 2009


fox_terrier_guy: "(Sorry, why is it bad to be wealthy again?)"

It's not. However, it's it's reprehensible to say "I got mine, fuck you." writ large.
posted by notsnot at 5:48 PM on July 8, 2009 [10 favorites]


"I'm not responsible for Mr. Steak-lover's quality of life! I take responsibility for my own life, the life of my family and my elderly parents. Let the burger-bitin' barbeque crowd take responsibility for its own quality of life."

Their health should absolutely be your concern. Just as it's in society's interest to have a well-educated population (hence subsidised primary, secondary schooling), it's in society's interest to have a healthy population. When SARS hit Toronto in 2003, 43 people died. How many would have died had it emerged in a big American city instead, where large swaths of the population have little to no access to health care? The economics of single-payer insurance makes this a no-brainer already -- is it really going to take another Plague to convince everyone of the necessity of a real public health care system?
posted by emeiji at 5:48 PM on July 8, 2009 [5 favorites]


premiums… never shows up on your paystub if you're getting it through your employer

Really? I'm up here in Canada, and all my paycheques have shown a detailed breakdown of deductions. I know how much I pay for unemployment insurance, medical premiums, income tax, etcetera.
posted by five fresh fish at 8:01 PM on July 8


Your paystub shows how much you pay. It doesn't show how much your employer pays. My paystubs in Canada never showed how much my employer paid for my dental & drugs, either.
posted by joannemerriam at 5:50 PM on July 8, 2009


But single-payer socialized medicine will turn our fine American system into a complex bureaucratic nightmare of red tape. There will be endless forms to fill out in complex jargon and appointments to keep and and at the end of it all, some faceless clerk will deny you care.

So, it would be like what we have now, except without the billing.
posted by Rat Spatula at 1:24 PM on July 8 [38 favorites -] Favorite added! [!]


Very good comment, but I do have to make on correction. I don't remember filling out any forms, except replacing my health card and that was easy. And once you have the card, you just show your card, and that's that. This idea of health care bureaucracy is just alien to my pre-American experience.
posted by jb at 5:53 PM on July 8, 2009


I'm up here in Canada, and all my paycheques have shown a detailed breakdown of deductions. I know how much I pay for unemployment insurance, medical premiums, income tax, etcetera.

Mine do too, but, that's how much we pay toward these things. I'm not sure how it works up there, but if you're a W-2 employee (not a contractor), you're only contributing half of the amount toward Social Security (CPP/OAS); your employer contributes the other half, which never appears anywhere on your paystub. Employers here pay portions (often the majority) of health-insurance premiums, but those also don't appear. I imagine that employers' contributions to health-care taxes also don't appear on Canadian paystubs.

My paystub has 15 non-zero lines on it every month.
posted by oaf at 5:54 PM on July 8, 2009


Think about it: socialized medicine in the US = no more medical posts on AskMeFi.
(or, Mathowie gets 5$ each such post from your Government)
posted by _dario at 6:04 PM on July 8, 2009


The doctor's are not as good by and large as the US.

pshawww, and I am in a position to be more than a little biased. I think we might have more than our share of superstar docs, of which most of us will never see, because they are drawn to the high incomes available to them here. I know a bunch of superstar surgeons around the globe, and the ones in the US seem to be doing the best of all, although that is a pretty good gig wherever you live. The average docs here and Canada, or Europe, well they all seem to be by anecdotal evidence as well as by some statistics about the same level of proficiency.
posted by caddis at 6:04 PM on July 8, 2009 [1 favorite]


"I remember as a kid when everyone paid for their own regular doctor's appointments and only held major medical insurance for things like accidents and cancer. Back then we could afford to go to the doctor. And we could afford insurance. What the heck happened?"

Two things—new medicine (procedures and drugs), and HMOs. The former, with incumbent costs of R&D and early-adopter pricing, really did increase the cost of care for a lot of ailments, but it also does increase lifespans and quality of life. When you were a kid, good luck finding an MRI anywhere. The latter increased costs by increasing overhead. Every few weeks, there's a news story about some doctor no longer accepting insurance, but rather charging folks a flat fee (or sliding, income based, if they're lefty) because they find that they can immediately eliminate a majority of their paperwork, no longer rely on basically working for credit (HMOs reimburse for procedures rendered).

A third, but smaller by an order of magnitude, cost has been rising premiums for malpractice insurance, but that's mostly a smoke-screen that's represented disproportionately by people who make a lot of money with the system the way it is.
posted by klangklangston at 6:23 PM on July 8, 2009


Here's another anecdote from Canada for the American Mefites. In the mid-90s, when I was still a student, I went to Ontario (from Nova Scotia) for the summer. Now, people talk about the Canadian healthcare system, but really there are 13 systems, since the program is administered by the provinces. So my health insurance (MSI) was through the Nova Scotia government, not the Canadian government. Before I left, I called the MSI office and asked if I needed to transfer to OHIP, and they said no, not if I was planning to return to Nova Scotia at the end of the summer.

I got sick. We still don't know for sure with what, but the best guess was pesticide poisoning. I couldn't keep any fluids (let alone food) down for two weeks and had a slight fever. Since I hadn't bothered to get a doctor since I was a (I thought) healthy 21 year old who was leaving again in 4 months, and I thought all I had was a nasty flu, I was going to emerg to get my fluids replaced. They didn't admit me or anything, I just went in, showed them my MSI card and gave them my name and social and address, they asked a few questions about my condition, decided based on my symptoms that I had the flu and hooked me up to an IV. Ontario had a shortage of rooms at the time (might still, I wouldn't know) so I sat in the waiting room with the IV and read a book for four or five hours and then they removed the IV and sent me home.

After a week and a half it was becoming obvious that this wasn't the flu. On my third visit to emerg, they admitted me. This time I had to sign some forms, but they did that after they gave me some salty orange juice to drink and had me hooked up to an IV, and IIRC I only had to fill them out because I wasn't on OHIP (Ontario's health insurance).

I spent the first 8-10 hours or so on a cot in the hallway (but being treated) while they waited for a room to open up. I was put in a room with two other occupants (I turned down the option of having my parents' supplemental BCBS pay for a private room), a crackerjack elderly lady who told awesome stories about WWII and had to pee every ten minutes, and a woman who had had a balcony detach from her slum ghetto housing and fall on her, breaking her leg. Now, I don't know how wait times are measured, but it's entirely possible that my wait time would have been recorded as something like 10-12 hours, since that's how long it took me to get a room, but I started getting treatment right away.

They did an ultrasound and an endoscopy and took a lot of blood and came back with a diagnosis of ketosis, which means, "we don't know why she keeps throwing up, but boy are her electrolytes out of whack." (They didn't test me for pesticide poisoning. It was my GP, months later, who came up with that working hypothesis.) They kept an IV in my arm for the next two days, around the clock, for fluids and also something to suppress the vomiting, and gave me free run of the nurse's kitchen as well as my three meals of soft foods, so I could gain back some of the 20 pounds I'd lost in the past week and a half. I was there for three days and then they released me.

A month later I got a bill from the hospital, because OHIP had refused to pay for me and they had assumed that I was a foreign student or something. I forget the amount but it was in the thousands of dollars. I called them and explained that I was a Nova Scotian and they should talk to MSI. MSI presumably paid for me, because I never heard from them again.
posted by joannemerriam at 6:24 PM on July 8, 2009 [2 favorites]


* Among the 88% with health insurance, 49% are "very satisfied" and 36% are "somewhat satisfied" with their insurance

There is another reason this is misleading: there is an assumption that those people are going to be able to keep their current health insurance in the future. They are not. The current system is unsustainable and the question isn't whether to change it but how to change it.

If we do nothing a big chunk of the very or somewhat satisfied people are going to find themselves uninsured in the medium term. They just don't know it being woefully ignorant of the challenges facing the current system.
posted by Justinian at 6:30 PM on July 8, 2009 [1 favorite]


I really do sympathise with you guys. It's an incredible conundrum, with logic having almost no show. Irrespective of the evidence from fairly successful health care systems in many other first world countries, that tradition in the States (held by many/a majority I suspect) of distrusting government hangs like an albatross around the debate. I don't know if that developed in concert with the rise of capitalism and the god-like power of the dollar or if its origins are more complex, but it is a huge impediment to progress to a more equitable and (to me) sensible system. So I think the debate for hearts and minds is best played out on a purely economic front rather than bothering about the emphasis on social welfare and widened coverage. The economy will be much stronger if everyone has adequate health care access. Obviously. I wish you well; I'm not particularly optimistic, but jayzussborkingfuck, this is one of those cornerstones of basic humanity actually worth harassing your local political representatives about. And now is the time. Good luck. You'll need it.
posted by peacay at 6:34 PM on July 8, 2009 [1 favorite]


"Why should I have to pay the medical bills for people who eat meat, don't exercise, drink too much, smoke and have unsafe sex?"

Because those unhealthy louts will subsidize you when they keel over cheaply at 65 as you health freak freeloaders drain the system for 90 years and expensive therapies.

Seriously, there is not that much of a correlation to lifetime health care costs and living a healthy lifestyle. Being in poor health may not be fun, but on a national level, it's not that much more expensive (apparently)
posted by delmoi at 6:41 PM on July 8, 2009 [2 favorites]


Back then we could afford to go to the doctor. And we could afford insurance. What the heck happened?
new medicine (procedures and drugs)


Does it seem to anybody else that medical advances don't seem to follow the falling cost increased capability curve that markets have yielded in other areas (say, computing)? Sometimes it seems to me MRIs should be cheap by now, X-Ray cheap, but I'm not well-versed enough to feel really confident about this.

I do know that it really doesn't seem to me that health care operates the same way other markets do. Providers often don't talk about cost with patients up front, and while insurers can negotiation prices, providers seem happy to bill patients for any remainder of the fee they'd like to capture, so that negotiation seems tenuous as a downward force on costs...
posted by weston at 6:52 PM on July 8, 2009


"Mitheral - cites:

"Conversation with a personal friend of mine. She used to be heading up a department at the Foothills. She is from Calgary, now has re-located to Boston. Her rationale was exactly as stated. I have seen other references to this as this has been a hot topic of late, but would have to try to locate them. There fore, I will just use this one reference. Not encyclopedic but any stretch."


So hearsay anecdotal evidence. I think I'll wait for something a little more reliable before I go spreading around how much better american doctors are.

"wrt waiting rooms. Hey, I understand that waiting rooms are full on both sides of the border. But in Canada, the guy who showed up every Saturday nite in emerg with something different stuck up his butt never saw the price of his visits increase. Does anyone here think that this is normal?"

What's the other option? Keep escalating the price until he can't afford to pay and then turn him away only to treat him two months later for a perforated bowel? This guy is obviously some sort of crazy, an increase in ER bills is unlikely to do anything. Should the same sliding scale apply to someone unlucky enough to get in a series of traffic accidents (as a passenger) or should be only be penalizing "icky" clients? Who gets to decide which sliding scale to apply?
posted by Mitheral at 7:01 PM on July 8, 2009 [1 favorite]


daddynewt, availablelight: That's why the U.S. has no national insurance. It's the ugliest aspect of the U.S. I can think of.

Most of my family members are physicians or dentists. They always have and always will work with anyone who asks for a payment plan or a barter arrangement. (That's how our driveway got asphalted and our tank got properly graded. We got a dozen eggs each week for a year from one root canal.) They always have and always will resent the hell out of anyone who treats them as a "service provider" instead of a highly skilled and highly educated professional.

They all loathe the idea of a single-payer plan -- and I really believe it's mostly about two things: the loss of control and the loss of respect.

And then there's the loss of income. And the odd unwillingness to test the efficacy of treatments.
posted by dogrose at 7:09 PM on July 8, 2009 [1 favorite]


They always have and always will resent the hell out of anyone who treats them as a "service provider" instead of a highly skilled and highly educated professional.

In my department, everyone (well, except the admin assistants I guess) has two degrees. We don't even do anything very fancy. Lawyers are service providers in spite of a lot of education. Welcome to the service economy - the days of highly skilled and highly educated professionals are over. Them's table stakes.
posted by GuyZero at 7:15 PM on July 8, 2009 [1 favorite]


fox_terrier_guy: But in Canada, the guy who showed up every Saturday nite in emerg with something different stuck up his butt never saw the price of his visits increase. Does anyone here think that this is normal?

OMG, f_t_g! You're so insightful! Of course no one below the 45th parallel has ever, or would ever, show up in an ED with "something different up his [or her] butt". (I'm sure you never meant to exclude the distaff side.) And of course, each and every one of those hapless victims of rogue candles, vegetables, or aerosol cans are fully paid up with private insurance, which will penalize (heh!) each and every visit to the ED. And therefore, the Canadian system is fucked-up and inconvenient.

Thank you so very much, f_t_g, for solving the U.S. health-care problem!
posted by dogrose at 7:24 PM on July 8, 2009


"Why should I have to pay the medical bills for people who eat meat, don't exercise, drink too much, smoke and have unsafe sex?"

You already are. And in the current system, these are actually profitable for everyone concerned - as you've probably already noted, there's very little emphasis on preventative medicine in the United States.

In social democracies, the single payer has every incentive to try to keep costs down as low as possible - preventative care, trying to reverse bad lifestyle choices or early detection of costly illnesses.

In these strange places where people are actually better socialized, there is also a sense of social responsibility relating to health. At least in Canada, there's an idea that it's a civic duty to keep yourself healthy in order to reduce the strain on the health care system. I understand this idea is alien to many of you reading this but I assure you that it does exist, at least in parts of the society.
posted by lupus_yonderboy at 7:27 PM on July 8, 2009 [4 favorites]


Funny how when O'Reilly does the shout-down thing (and I disdain O'Reilly) it's considered bullying and not-valid, but when Kucinich does it, it's cool and respectable. Then again, I don't really expect Democrats (or Republicans, for that matter) to be consistent.

Once the U.S. government takes over health care, every fat-laden snack food will be taxed to the max, any restaurant that isn't serving only alfalfa sprouts will be laden with fees and we'll all be forced to wear monitored pedometers to ensure we're exercising enough or be fined. I may be exaggerating, but I really don't want even more freedoms stifled by government, especially government liberals.

Where is the sane third-party when we need it?

However, to avoid just ranting, the first link nearly brought me to tears.
posted by hrbrmstr at 7:35 PM on July 8, 2009 [2 favorites]


Your paystub shows how much you pay. It doesn't show how much your employer pays. My paystubs in Canada never showed how much my employer paid for my dental & drugs, either.

Oooh, you're right, you're right. I wonder why employers don't bother showing that, when it would make one feel that one is being paid a fair bit more?
posted by five fresh fish at 7:39 PM on July 8, 2009


From my own, personal experience, I have to say - and pardon the language - our health care insurance system in the US is a shitty, shitty mess. I won't go into the specifics. But those of you who've been there know what I mean.
posted by darkstar at 7:45 PM on July 8, 2009


I may be exaggerating, but I really don't want even more freedoms stifled by government, especially government liberals.

OK, you're against "government liberals" (as opposed to what -- anarchist liberals?) telling you what to do. Fine.

What do you suggest we do with the 40 million Americans who have no access to affordable healthcare? Whats going to happen to them when they get sick?
posted by Avenger at 7:46 PM on July 8, 2009 [1 favorite]


Every time I read something like this I think that I'd better plan on offing myself if I don't have good insurance and/or a rich husband by the time I come down with something bad. Dear GOD.

I wonder what would happen if we had a steady drumbeat of people doing this. Every day. On the steps of Congress. Would we see change then?

If you're going to die miserably anyway, maybe a making a statement with it would be the way to go. And I say this as a person who would probably choose that option myself.
posted by marble at 7:51 PM on July 8, 2009


Btw, until we get some affordable healthcare in this country, everybody familiarize yourself with my post on Where There Is No Doctor, a manual originally meant for developing nations.

Like ours, apparently.
posted by Avenger at 7:51 PM on July 8, 2009 [2 favorites]


GuyZero: Welcome to the service economy - the days of highly skilled and highly educated professionals are over. Them's table stakes.

I was thinking mainly of my father and uncles. I get it. They can't. I'm talking about men who were born in the mid to late '30s, who grew up with nothing and used VA benefits to get themselves out. If they did it, then anyone can.

I've tried (gently and unsuccessfully) to get them to see that they had at least two advantages not everyone has: they're smart, and their mother and extended family almost literally whipped into them the idea that they could do better. (Not to mention they're white men who came of age during an unprecedented economic boom, with access to an unprecedented federal program supporting higher education and professional training.)

My cousins have, beyond all reason, appropriated "if I did it then anyone can." They'll argue hard against your table stakes. I'm sure they'll lose, eventually, but they won't go down easy.
posted by dogrose at 7:59 PM on July 8, 2009 [1 favorite]


dogrose, you've undoubtedly heard about people born on third base. They're backed up by the people who were born on first and have made it to second without ever realizing that not having to face the pitcher gives you one hell of an advantage.
posted by shetterly at 8:06 PM on July 8, 2009 [9 favorites]


hrbrmstr: I may be exaggerating, but I really don't want even more freedoms stifled by government, especially government liberals.

You're not exaggerating. You're just ill-informed, and kinda silly.

What healthcare freedoms do you have now that government, liberal or conservative, might stifle? Please be specific.
posted by dogrose at 8:07 PM on July 8, 2009


Kucinich was being a dick in that exchange, but that doesn't change the fact that our healthcare system is broken, perhaps beyond repair. I mean, there are huge incentives to throw every test you can think of at someone complaining of non-specific pain in the lower back, and eventually you'll get to do surgery, even though most patients who undergo surgery for back pain fare no better than those who don't; and after surgery, many expensive visits to the therapist, the surgeon, radiology, many expensive anti-inflammatory drugs which may or may not have any clinical benefit beyond what OTC pills offer, and probably some narcotics too!

It's just ridiculous the way the AMA, drug companies, etc. pay lip service to evidence-based medicine but bristle when you point out that most studies are looking at surrogate endpoints, not real clinical endpoints–we're looking to see whether some value went up or down, not whether the patients lived longer or better.

That's not to say that all medicine is bad medicine - if you have breast cancer, for example, there really is a pretty clear evidence-based best practice based on the stage and other particulars (receptor status, for instance) of your cancer. We have a good idea what to do, and we have evidence that taking a particular course of action will prolong life, often by decades.

But so many other expensive treatments are of questionable value. Coronary stents, for instance, relieve symptoms for patients, but do not necessarily extend life. The evidence is not black-and-white at all, but the perception is that you must get a stent placed if angiography shows an obstruction in a coronary artery. I'm not saying no one should get a stent, but I think it's time to be a little more selective, and to communicate the risks and benefits to the patients more honestly.
posted by Mister_A at 8:12 PM on July 8, 2009


Once the U.S. government takes over health care, every fat-laden snack food will be taxed to the max, any restaurant that isn't serving only alfalfa sprouts will be laden with fees and we'll all be forced to wear monitored pedometers to ensure we're exercising enough or be fined.

Wow, the US must be a very weird country. All the rest of us Western nations have public funding without any of those things happening.
posted by i_am_joe's_spleen at 8:13 PM on July 8, 2009 [8 favorites]


A second problem are the horrendous wait times. I find it odd that politicians, star athletes and doctors can get an MRI within 3 days. I can't. Last I checked for a condition, my wait time was 8 months.

When my grandfather needed an MRI (in T.O.) he only had a 3 day wait because he agreed to go for his appointment at midnight, instead of in the morning or the afternoon when they're all booked up. Same thing when my b/f needed one after a rugby injury; he went at 1am for his appt and only had to wait 4 days for it. You need to find out if you too can get a non-business hours appointment.
posted by zarah at 8:13 PM on July 8, 2009


I am a single mother of three kids. My annual income is a bit over $30,000. I pay $750 a month in health care premiums for my family. This is more than my rent and grocery bill. It is the highest bill I have. And this is with each child having a $1000 deductible and co-pays. So most of the time, when my kids are healthy (thank god) my insurance pays nothing.

That's horrifying. I have a 2 year old. It's free to take her to the doctor until she's five? Six? Something like that. Then it's subsidised at a rate based on my income. I cannot imagine having to dole out her doctor's visits based on whether I can afford it this week or not. Actually, I can, and I don't like it.

But the government is surely paying full price. If not, why are the drug companies selling these drugs so cheaply? Why can't they just refuse to sell them, if the price isn't right? How does the rest of the world implement price controls on US companies?

Drug companies routinely target Pharmac, our drug-purchasing agency, in order to get rif of it, through advertising campaigns, political donations, and so on; you can google the fuss over herceptin if you want an example.

So drug companies do indeed hate Pharmac, but there's really nothing they can do. They did manage to break the equivalent scheme in Australia by lobbying the US government to make its destruction a condition of a so-called free trade agreement the Aussies signed up for under their last right-wing government. I imagine if we lose Pharmac here it will be in much the same way.

"The doctor's are not as good by and large as the US. Why?"

If that were the case, I'd expect to see the life expectancy of US citizens be higher than in comparable first-world countries.

Ooops.

Back then we could afford to go to the doctor. And we could afford insurance. What the heck happened?

You all kept voting for Republicans who told you that pulling together as a society was Communism.

(Assuming your recollection isn't rose-tinted glasses, of course)


Once the U.S. government takes over health care, every fat-laden snack food will be taxed to the max, any restaurant that isn't serving only alfalfa sprouts will be laden with fees and we'll all be forced to wear monitored pedometers to ensure we're exercising enough or be fined. I may be exaggerating, but I really don't want even more freedoms stifled by government, especially government liberals.


Yes, because that's exactly how it works in other countries.

Are you this fucking stupid about everything, or is this some sort of issue-selective mental defect?
posted by rodgerd at 8:17 PM on July 8, 2009 [7 favorites]


Ted, if writing a check for a thousand dollars and paying it to the government would of and by itself provide free health care for every person, rich and poor in the U.S. would you do it? He thought for about five seconds and said, "now why in the hell would anyone do that?"

I'm going to repurpose a nice folk tale here, so forgive me.

A liberal farmer and a republican farmer were neighbors. One day, a djinni appeared in front of the republican farmer and said: "I will grant you any wish, but be aware, that whatever wish you express, I'll do double of that for your neighbor". The republican farmer thought for a long time, then told the djinni: "pluck out one of my eyes".

Anyhow, on a completely different tangent, the profit motive is deeply corrupting the U.S. health care system in all sorts of ways. For example, pharmaceutical companies - and medical devices companies - come up with drugs and devices which are not necessarily optimal for health - but optimal for profit. That's how you get tons and tons of drugs which keep addressing the same disease but are in fact no better, and often worse than the older drugs. Why do they do it? Because the older (and often better) drugs are going generic, and they need to keep generating profits, so they invent minor variations on older drugs, often with worse efficacy to maintain profits. And they address only the diseases or conditions which are profitable - or indeed, invent a "condition" which may in fact not be a condition at all, but which they can profit from. That drives the costs of drugs and devices through the roof, but often results in worse outcomes for the patients.

Profit as a motive, should be eliminated from the heath care system of any country that deems itself civilized. It is the wrong place for the profit motive.
posted by VikingSword at 8:18 PM on July 8, 2009 [2 favorites]


Why should I have to pay the medical bills for people who eat meat, don't exercise, drink too much, smoke and have unsafe sex?

Yeah, well, why should I have to pay the taxes on a pack of Marlboros when other people are getting the benefit of all the secondhand smoke? And why is it my pocket that gets hit by the state markup on booze, when it's your trollgument I want to throw up all over?
posted by turgid dahlia at 8:26 PM on July 8, 2009 [2 favorites]


Yes, VikingSword, profit motive has gutted the healthcare system. I remember when hospitals were all not-for-profit. The rage for deregulation has destroyed many institutions, the US hospital system not least among these.
posted by Mister_A at 8:30 PM on July 8, 2009


Mister_A, in his defense, Kucinich was provoked. Gratzer is either a liar, an ideologue, or an incompetent, because his argument contained basic errors. For example, as a commenter notes at youtube, correcting Gratzer, "Many American-Canadianian citizens/residents do go to Canada to get health care. In fact, the industry of Americans who get medical procedures outside of the United States is HUGE."
posted by shetterly at 8:37 PM on July 8, 2009 [1 favorite]


That Dr. Gratzer is one smarmy douche.
posted by schoolgirl report at 8:53 PM on July 8, 2009 [2 favorites]


I think what bothers me most about discussions of this nature, where some pinch-faced douchewrangler inevitably slimes their way in with a soft-cocked vituperation about paying for the healthcare of smokers, drinkers, eaters and sitter-downers, is that it betrays a wholly alarming contempt for the wellbeing of society as a whole. These scumbags neglect to realise that they are also contributing to the quality of life of Sharon, the tireless animal shelter volunteer studying to be an environmental scientist while battling crippling depression; and Brian, the guy who makes your bullshit double-decaf celery espresso frappucino just the way you like it and just needs to be able to afford his Ventolin inhaler; and old Mrs. Jones, the widow who likes stay at home and knit and watch her stories and treat herself to a little chocolate from time to time and looks forward to that phone call from her son or daughter that never comes and only needs a couple of mass-produced pills to keep her blood pressure down; and Mister Gogol with the gammy leg, who plays the electric organ at whatever dumbfuck fundie god-inventing-and-then-bothering house of lunacy it is that you hypocritically whoop and holler at every Sunday morning.

Don’t get me wrong, I hate people as much as anyone and wouldn’t bat an eyelid if I woke up tomorrow and we were all dead, but simultaneously, I don’t begrudge the fact that part of the tax I pay to the government goes towards taking care of some of us. Illness isn't a personal failing and being ill doesn't indicate that you are more of an asshole than anybody else, it's just a thing that happens.
posted by turgid dahlia at 8:58 PM on July 8, 2009 [62 favorites]


The Health Care Express: Congress has only 22 working days left to reform America's health care system.
posted by shetterly at 9:07 PM on July 8, 2009


In furtherance of your point turgid dahlia I often wonder how many of the people who don't think it's a big deal that 40 million Americans don't have health insurance and even more can't really afford to go except in an emergency because their insurance is catastrophic or near enough as to make no difference ever give a second thought whether the guy who cooked their meal has hepatitis or the cute waitress at the bar has typhoid but has been undiagnosed for a couple weeks because they don't have insurance.

It's in there own selfish interest to ensure everyone has affordable access to least basic health care.
posted by Mitheral at 9:11 PM on July 8, 2009 [4 favorites]


@dogrose: Um. Pls read my post. I give examples. I'll keep this thread bookmarked so that in 1.5-3 years I can do an "I told you so" (via a FPP) when there is regulation/taxation/fines passed on U.S. citizen consumption of "X" since it has a theoretical remote correlation to health problem "Y" which may end up costing the government insurance program more money. It's freedoms in general, not necessarily health care freedom.

@i_am_joe's_spleen: Many Western nations have a rich history of the masses uprising when they are about to get screwed over (the French even riot over the economy). Americans are pretty much taught to be obedient and just sit back and take it. There is also a significant attempt by both "sides" here to deliberately promote class battles rather than work towards the common good, since that - for some reason - is not thought to be a good strategy to get re-elected.

Many MeFites will dismiss both replies, but it doesn't change reality. Even without the government running (ruining?) health care for everyone, states have already done things like ban trans fats (and I would bet it has something to do with states being responsible for Medicare costs). [@i_am_joe's_spleen: what was that about other Western nations not having any of those things happening?]

Also, the BBC has some interesting statistics that Kucinich may want to reference next time.

Mind you, I'm not defending the current system. I would just prefer the solution to not be the U.S. government being my insurer. I also do not want it to be my banker or car dealer, but the fine folks in power seem to want to get into those industries as well. They take enough of my money and control far too much already.
posted by hrbrmstr at 9:15 PM on July 8, 2009


Gonna answer my question, hrbrmstr?
posted by Avenger at 9:23 PM on July 8, 2009


Mister_A, in his defense, Kucinich was provoked. Gratzer is either a liar, an ideologue, or an incompetent, because his argument contained basic errors.

Oh bullshit. Is it so hard for you to accept that people can have different opinions without being liars or incompetent? Kucinich was grandstanding for the benefit of the cameras, and wasn't interested in an honest exchange.

For example, as a commenter notes at youtube...

Seriously?
posted by electroboy at 9:33 PM on July 8, 2009


Well, how about you keep your private insurance, then, and let those of us who don't have that option instead choose a public option?

The arguments against that usually boil down to 1) it's too expensive and 2) it'll kil private options.

In response to 1, you're paying for it anyway, and worse. It's just not obvious because the costs are hidden.

In response to 2, it seems to be pure conjecture that is refuted by many examples. Other countries somehow manage to have both public and private options. And offering a public option for a service in the states does not run out of business the private industry. Public libraries have not caused the privately owned bookstore industry to die. Publicly provided police has not killed off the private security industry. The Post Office has not killed off the private shipping industry. Public transit has not killed off the privately owned taxi industry. Public broadcasting has not killed the privately owned broadcasting media industry.

So you like your private health care insurance? Fine, keep it (for as long as you can, anyway), but let me have a public option when I lose my full-time health benefits and get sick.
posted by darkstar at 9:33 PM on July 8, 2009 [4 favorites]


hrbrmstr, fight for your basic human right to binge on trans fats, and rise up and carry the brownish-yellow flag of Cholesterol Freedom if that happens to be your cause celebre. You could have a nationwide Lard Party or something, eh?

I'll be over here fighting for some solution to our health care crisis - one that the wealthiest, most industrialized nation in the world should be ashamed of - all because the profit motive of denying care stands in the way of a physician's profit motive of providing care.

We needn't worry about the government restricting our freedoms; the insurance industry pretty much has it beat at that game.
posted by contessa at 9:36 PM on July 8, 2009


In these strange places where people are actually better socialized, there is also a sense of social responsibility relating to health. At least in Canada, there's an idea that it's a civic duty to keep yourself healthy in order to reduce the strain on the health care system. I understand this idea is alien to many of you reading this but I assure you that it does exist, at least in parts of the society.

Absolutely. That's the reason for all the Canadian PSAs on the subject of general health and why (for example) I get an annual reminder to get my ass to the hospital for a mammogram (and they're tough; they'll call and bug you): preventative care saves the system money. There's also social pressure to get to the doctor before a problem can develop into something serious, and putting off a doctor's appointment when, for example, a person might be having digestive problems or chest pain is considered evidence of emotional problems to do with denial. There's also social pressure, however, to not overtax the system by running to the doctor for every little thing. It's a balance, and the Government tries to educate the public in knowing the difference.

Also adding in my agreement that the rhetoric about the "collapsing" Canadian health care system is largely fueled by interests that are just desperate for a chance to try and duplicate American style profits north of the border.
posted by jokeefe at 9:43 PM on July 8, 2009 [1 favorite]


hrbrmstr: you are drawing a link between government health regulations and government supply of healthcare, but I see no evidence that such a link exists.

The US already has an complex regulatory apparatus for food, drink and other things that impact health (eg compulsory fortification of basic foodstuffs by law). My country doesn't have "sin taxes" on anything other than alcohol and tobacco, yet it has government funding of healthcare. Your country does, and yet government does not fund healthcare.

I note the the article you link to says that restrictions on trans fats in Canada are currently volutary, and that "The voluntary compliance period is coming to an end however the Canadian government has not indicated that it will enforce the 2% – 5% rule." Weak sauce, I think.

Seen as a business (a reductive view which I object to, but which premise I'll grant since you seem to assume it), states have an incentive to regulate for health irrespective of whether they pay for care, as dead citizens pay not tax, while disabled citizens pay less tax and reduce their families' ability to pay tax as they take time off to care for them.

What can I say? I live a country that has the kind of regime that scares you, and yet we don't suffer from the problems you fear. It's as simple as that. (In fact, visitors remark on our cavalier attitude to safety and lack of regulation, because we don't have the vicious litigation regime you do in the US, but that's a whole other kind of you-suck-more-than-in-certain-ways argument).
posted by i_am_joe's_spleen at 9:44 PM on July 8, 2009 [1 favorite]


This debate reminds me of a health care economics class I took a while ago. The book was free-market biased. The professor was free-market biased. The students were majority free-market biased. By the end of the class, it was obvious that the closest thing to a solution the US would have to its health care problem is single-payer, which the book, professor, and students all reluctantly admitted.

It really struck me that people who believe in the power of free markets were so unwilling to accept that free markets don't work best in every type of market. After this point I realized two horrible truths: most economists are insane/intellectually dishonest and it was too late to change my major.
posted by SouthCNorthNY at 9:53 PM on July 8, 2009 [1 favorite]


electroboy, check the definition of ideologue. I agree he's not necessarily a liar or an incompetent, but his devotion to the free market seems to have made him blind to basic facts about Canadian health care that an objective expert should know.

The commenter at youtube is correct. One of the less-discussed burdens on the Canadian health care system is Americans who sneak in to make use of it.
posted by shetterly at 9:58 PM on July 8, 2009


caddis wrote: The American consumer pays for drug development and the rest of the world free rides on that through price controls.

Don't you really mean to write that "the American consumer pays for drug advertising and the rest of the world only pays what the drugs themselves are worth"?
posted by wierdo at 9:59 PM on July 8, 2009 [9 favorites]


The naysayers are essentially claiming that the USA can not do what most of the world does do.

Ironically, many of those naysayers are likely to be the same sorts who claim the USA is #1.

Jingoism may be one of the USA's bigger liabilities these days.
posted by five fresh fish at 10:13 PM on July 8, 2009 [2 favorites]


It's not uncommon for myself and some friends who are also on Metafilter to mention as AskMe thread where some poor member has a growth coming out of his or her knees, face, neck, or foot and is basically asking for a diagnosis because they can't go to a doctor. It always astounds us.

I have no problem whatsoever with paying taxes that will go to health care and pay for the treatment of others, not to mention myself. I have no problem paying taxes that will go to support infrastructure, local, provincial, and national. This does not mean I support wasteful spending and in Canada there has been a lot of cost reduction over the years (the most obvious example being in for surgery and get out rather than stay at the hospital for days).

Being freelance, I don't have a drug plan so I have to pay for drugs out of pocket but I'm not complaining, fortunately, thus far, it hasn't been an issue. Very often, in fact, I'm asked if I have drug coverage. When I respond that I do not, the doctor heads to the sample closet and gives me boxes of samples. I appreciate that tremendously. When one of my ex-girlfriends went, a teacher with coverage, she wasn't offered samples.

I don't go often, but when I've had to go, I just go to the local walk-in clinic and get treatment. Sometimes that has lead to minor surgery later on. I didn't pay a direct cent of course, but I'm aware that part of my tax contribution funded it. We don't have free health care by any means, and no one believes it to be perfect but compared to what I'm reading here now and in the past I'm rather thankful and would hope that you get something similar.
posted by juiceCake at 10:20 PM on July 8, 2009


Hearing these stories about American health insurance always amazes and grieves me. I don't have any fantastic insights on restructuring healthcare systems, I can only relate on a personal level, so skip the next bit if that level of discussion infuriates you.

I can't imagine what my life would be like now if I was in the USA.
If anyone cares to hear another socialised medicine story, and this is medical care that is NOT a result of steak-eating, or smoking (possibly a case may be made for *cough* the other):

I had my son just over a year ago. He was a big boy - 4.36kg, (just over nine and a half pounds), and ten days overdue, which meant an induction, gas, an epidural, specialist on call at 1am. He was born with pneumothoraces (collapsed lungs), and taken immediately to the Neonatal ICU, where he was kept for a week, x-rayed multiple times, etc. Meanwhile the hospital boarded me so I could be close and establish breastfeeding.

The day after the night we took him home I collapsed, and ended up in Emergency. Pretty damn ill, I was. Another week in hospital for me, specialist gyn ward, massive amounts of antibiotics, blood thinners, a D&C in the acute theatre.
Meanwhile, my husband stayed overnight with me for the first two nights, my midwives looked in on me several times a day, the NICU staff visited and brought baby supplies so that my husband didn't have to run errands ...

I can't imagine what it would cost to get cover for this from an American insurance company, and there seem to be few guarantees that they would pay out anyway. And then what would our bills be?

Does anyone have a comparable experience who can tell me how much it cost them? I would love to know.

We didn't have these worries to add to what was already a nightmarish situation.

My husband's income (I'm stay-at-home right now) is NZ$49K, and he pays approx. NZ$10K in tax on that. We'll happily pay tax at these levels for the rest of our lives, having personally received the benefits already.
posted by Catch at 10:25 PM on July 8, 2009


Faze: "Why should I have to pay the medical bills for people who eat meat, don't exercise, drink too much, smoke and have unsafe sex? I'll be happy to support a single-payer system that requires participants to live the same lifestyle I do. Let the bacon-chompers, drunks, smokers and bareback pokers pay their own way."

In all seriousness I think anyone who thinks single-payer is a good idea needs to come up with a non-snarky, cogent, convincing response to this. Because you're going to encounter it a lot.

And to be honest I think there's a serious problem at its core. The US has a pretty nasty let-me-tell-you-how-to-live-your-life streak, and it's not necessarily just a conservative thing.

I think there are a lot of people who are willing to pay for healthcare for people who are just like them. But I suspect you'll start running into greatly increased resistance if you start asking questions like: "would you pay higher taxes to pay for health care for people who injure themselves while engaging in extreme sports?" or "do you think taxes should cover medical care for people who start and make no effort to quit smoking?" (And those are exactly the sorts of questions you're going to start seeing the insurance industry ask in an effort to frame the debate if single-payer becomes a real risk; they're not going to let it be about kids with cancer or grandma with her medication, it's going to be about "your tax dollars" paying for other people's "lifestyle choices." Bet on it.)

But rhetoric aside there's a real nightmare scenario in there; one where we get a single-payer system, but you can get disqualified for doing anything that's even remotely risky or out of the ordinary, and people start obsessing over others' personal choices in order to avoid having their tax dollars used to subsidize what they perceive to be negligent or objectionable behavior. And I fully expect anti-abortion and anti-contraceptive groups to attempt to use any public healthcare system as an avenue for their agendas. (Which there's historical precedent for.) How do we prevent that?

I look around at the current intersection of politics and private life in the US, and it doesn't inspire a whole lot of confidence. Other nations seem to have the "live and let live" thing down, at least enough so that people don't seem to be obsessing about whether their neighbors had three glasses of wine with dinner or stuck to the recommended 1.2, but I can see exactly that sort of bullshit going on here.

The insurance companies are soulless and profit-driven, but aside from making money they don't seem to really have any particular agenda. Most health insurance companies pay for abortions — much to the chagrin of pro-lifers — because abortions are cost-effective. An insurance company might try to kill you to make a better return this quarter, but they generally don't have any ideology beyond that. Any system arising from the political process in the US is almost certainly going to have one, and it's going to change as the political winds do. I'm not suggesting that it's necessarily a deal-breaker for a public option or even single-payer, but it's something that needs to be factored in as a risk.
posted by Kadin2048 at 10:26 PM on July 8, 2009 [3 favorites]


Has anyone mentioned the TeleHealth Ontario toll-free 24-hr number staffed by nurses? Very helpful in deciding when you actually need to go to the doctor. And probably a big cost saver. Oh, and by the way, I've made rather abundant use of the Ontario/Canadian healthcare system and have been thoroughly satisfied. Had oodles of choice and quick easy access too. Still waiting for Mr. Go Banana to return from the emergency room however....
posted by Go Banana at 10:29 PM on July 8, 2009 [1 favorite]


Kadin2048: I can only say that supporting the healthcare for feckless numbskulls annoys me too, but it turns out to be cheaper than going it on my own. But if it comes to that, there aren't even that many of them, relative to the average person, and the best suffferers from chronic, lifestyle-related conditions can hope for is treatment, not cures -- they're not really getting away with much.
posted by i_am_joe's_spleen at 10:51 PM on July 8, 2009


as a commenter notes at youtube, correcting Gratzer, "Many American-Canadianian citizens/residents do go to Canada to get health care.

If they're simply citizens they're not doing this legally. It's my understanding that you have to be a resident of a province (for 3 months ?) to get coverage. You can't just skip across the border and get care based on citizenship.

Now if you maintain a (false) permanent canadian address, well, that's another thing. A shitty thing that takes advantage of the system.
posted by aclevername at 10:53 PM on July 8, 2009


aclevername, yep, they do it illegally. I think Michael Moore included one of them in Sicko. Canadian medical people will sometimes take a "don't ask, don't tell" position, because clearly, you don't sneak into Canada for health care because there's nothing on TV.
posted by shetterly at 11:07 PM on July 8, 2009


And to be honest I think there's a serious problem at its core. The US has a pretty nasty let-me-tell-you-how-to-live-your-life streak, and it's not necessarily just a conservative thing.

You can easily frame this argument the other way. Fundamentally, a single-payer system means that we're all in the same risk pool, and hence less risky agents are pretty much forced to subsidize risky ones (as Faze complains about). How does this fit into live-and-let-live at all?

Do we actually have any hard economical/quantitative evidence that a single-payer system would result in my paying less overall taxes? Because it's kind of hard to believe, and there's all kinds of numbers on both sides... not to mention the budgetary disaster of a little brother that is Medicare. I'm already having a hard enough time paying my own insurance bill; I'd really not rather pay for anyone else's, especially if we're introducing serious moral hazard issues into the picture.
posted by gushn at 11:08 PM on July 8, 2009


The Simple Solution to the Health Care Crisis: Medicare for All.
posted by shetterly at 11:13 PM on July 8, 2009


Reading some of these horror stories, I imagine myself getting really mad one day & doing something I'd surely regret later.
Americans don't do that because they're afraid of losing the almost-sort-of-decent health insurance that covers them and their entire family.

Upthread, someone said that "Germany has some hybrid pubic-private mandatory insurance system with mandatory insurance, which I never actually used ... I doubt people less honest than the Germans could handle their mandatory insurance system, well maybe that's the U.S.'s whole problem." I've been wondering about that recently. See, when I registered with the TK, I thought it was incredible. €60ish/month, plus €10/quarter if you see any doctor, and that covers pretty much everything, unlike the cheapest emergency-only plans available in the US. Costs of any further doctor visits can be written off by a referral. Meds are damn cheap - €10ish for my most expensive, and that's €10 for a decent supply? It's quite possible that things are different if you have a family, or major health problems, or a large income, but for a poor student or recent graduate or someone in a fairly menial job (the sort of person who is most often uninsured in the US), it's incredible.

And it's a system that still has multiple providers, both public and private. Being uninsured is not legal. The public, non-profit ones are very tightly regulated indeed; minimum coverage, maximum prices, etc., and most people use them. The private ones provide more choice and a certain amount of preferential treatment, but are more expensive, are only accessible if you make a fair bit of money, and as of late, I think you can't easily switch back to public insurance if your financial circumstances change. I've been wondering if this might not be the easiest way to reform the US system: prevent insurance companies from dumping people or refusing sick people, and mandating minimum coverage and maximum fees, and a universal insurance requirement. Insurance companies, or at least non-profits, could choose to follow certain strict guidelines and fall under the aegis of "public" insurance and maybe get some bonus for it, while others could choose to be fully private.

I'm not sure it's a great answer, but it seems to me like it might be the easiest system to emulate, at least at first, given the current American system. It would be far, far better than the current system, and probably better than the sort of defanged and hobbled "public option" certain Congresspeople are suggesting. It might also be sort of palatable to the "OMG SOCIALISM!!1!!" crowd, since it preserves choice and competition in both public and private plans.
posted by ubersturm at 11:20 PM on July 8, 2009


i didn't read all the comments or all the links, but i did read the story about going to the hairdresser

we are being ripped off and lied to - this whole system we have is nothing but a fucking con game and in a just society, the people responsible for it would be in prison
posted by pyramid termite at 11:23 PM on July 8, 2009 [1 favorite]


You can take my BC Care Card out of my cold, dead hand.
posted by deborah at 11:31 PM on July 8, 2009


I doubt people less honest than the Germans could handle their mandatory insurance system

You're going to have to trust me, because I am not motivated enough to dig up the reference, but some research indicates that people worry about abusing public systems and generally don't do it.

Which makes intuitive sense. For crying out loud, I hate going to the doctor. Making and keeping an appointment is annoying. Surprisingly, I don't want surgery merely for the hell of it. Neither do I take antibiotics for kicks. I'm sure there are some people who do wilfully use services they don't really need, but I'm equally sure they're a small minority.

I guess things might be different in an insurance-based model where you first incur the cost and then submit a claim -- perhaps the ease of making false claims might be tempting -- but in a true state-run system you go, and it's free or subsidised, and there is no claims system to abuse.
posted by i_am_joe's_spleen at 11:51 PM on July 8, 2009


I really wish I knew what I could personally do about this. I've written letters, and I have hope for my senators, but my US Rep is a bought-and-paid-for shitstain who wouldn't vote for public healthcare if he had a gun jammed down his throat.
posted by sugarfish at 11:51 PM on July 8, 2009


I think there is actually less of a difference between countries' healthcare than people assume from anecdotes.

You are wrong; people in countries with civilised healthcare systems don't go bankrupt over hospital bills.

You are right, however, if what you meant was "I think there is actually less of a difference between countries' healthcare, other than the USA, than people assume from anecdotes.
posted by dirtynumbangelboy at 12:46 AM on July 9, 2009 [1 favorite]


If America really is the best at everything (and I have yet to see documentation to back this up), there's no reason why we can't take a system like the UK's NHS and do it better.

Ah, but that would require admitting there's something wrong with the system.
posted by dirtynumbangelboy at 1:35 AM on July 9, 2009 [1 favorite]


So drug companies do indeed hate Pharmac, but there's really nothing they can do. They did manage to break the equivalent scheme in Australia by lobbying the US government to make its destruction a condition of a so-called free trade agreement the Aussies signed up for under their last right-wing government.

Er, no, actually.
posted by Wolof at 1:44 AM on July 9, 2009


Funny how when O'Reilly does the shout-down thing (and I disdain O'Reilly) it's considered bullying and not-valid, but when Kucinich does it, it's cool and respectable.

Because when O'Reilly does it, it is to silence things like 'facts' and 'reality'.

When Kucinich does it, it is to ensure that those two things are heard.

You were probably trolling, and I fell for it, but what the hell.
posted by dirtynumbangelboy at 1:45 AM on July 9, 2009 [5 favorites]


Once the U.S. government takes over health care, every fat-laden snack food will be taxed to the max, any restaurant that isn't serving only alfalfa sprouts will be laden with fees and we'll all be forced to wear monitored pedometers to ensure we're exercising enough or be fined. I may be exaggerating, but I really don't want even more freedoms stifled by government, especially government liberals.

Silly me, I should have finished reading your comment before responding. You are trolling.
posted by dirtynumbangelboy at 1:46 AM on July 9, 2009


Do we actually have any hard economical/quantitative evidence that a single-payer system would result in my paying less overall taxes?

Yes. Compare overall tax rates for every other country in the Western Hemisphere that provides decent healthcare to all of its citizens based on need, not based on their bank accounts.

The fucking trolling over this issue is repellent. It's like you people live on a different planet.
posted by dirtynumbangelboy at 1:58 AM on July 9, 2009


I doubt people less honest than the Germans could handle their mandatory insurance system, well maybe that's the U.S.'s whole problem.

Germans may or may not be honest, but they're usually hypochondriacs, and the system manages to run pretty well even with them heading to the doctor at the slightest hint of illness.

It's quite possible that things are different if you have a family, or major health problems, or a large income, but for a poor student or recent graduate or someone in a fairly menial job (the sort of person who is most often uninsured in the US), it's incredible.

I've also wondered why more people haven't talked about migrating towards a German system in America - it seems like it would be easy to do in stages, but all of the articles I've read don't mention anything about it. I mean, I make a good salary in Germany, I'm on the most expensive public insurance plan (with 8% of my salary every month going to pay for half of my insurance and my employer paying the other half) and it's still cheaper than what I was paying in the US when my employer paid for the majority of my coverage. Plus the quality of care is much better and GPs make house calls.

It's not a perfect system, but it's far, far better than what America has now.
posted by cmonkey at 2:26 AM on July 9, 2009


Don't you really mean to write that "the American consumer pays for drug advertising and the rest of the world only pays what the drugs themselves are worth"?

I wouldn't be so smug; Canada, France, etc. they all pay for tons of marketing and are also the target of tons of marketing. Even if we bring US and other market pricing more into balance there will still be a lot of marketing dollars in those prices just as there are today. A huge percentage of the marketing goes for samples, then to detailers (the sales people who call on doctors etc.) and then direct to consumer, which is a significant yet minority portion of the marketing allocation. Don't think there isn't any DTC advertising in Europe and other markets where it is technically prohibited, they just refocus it as unbranded consumer education campaigns, but when you contact your physician with the very specific questions there is one clear solution and that physician knows the solution because the detailers have already done their job.
posted by caddis at 4:10 AM on July 9, 2009


Will the proposed public option for U.S. health care reform pay for abortions? birth control?

'cause that may be a sore point for some.
posted by Brandon Blatcher at 4:16 AM on July 9, 2009 [1 favorite]


I wonder what would happen if we had a steady drumbeat of people doing this. Every day. On the steps of Congress. Would we see change then?

Yes. Un[der]insured sick people would no longer be allowed near Congress.
posted by oaf at 4:52 AM on July 9, 2009


actually, advertisements for drugs are forbidden in France: Direct-to-consumer advertising is forbidden in France for reimbursed and prescription-only drugs, with the exception of vaccines and products used in smoking cessation. ("smoking cessation" a literal translation of the French, actually meaning "products used to help quit smoking").

I'm an American living in France. I also spent two years in Finland. I was raised by parents who dismissed the fact that I passed out once a month from pain and hemorrhaged for eight to ten days straight with my periods; they claimed God was punishing me. Our family doctor diagnosed me with endometriosis; my parents, again due to their religious beliefs, refused to let me take the Pill to treat it. My doctor told me privately that I could get it from a clinic, but I knew that my parents would manage to find out, and not entirely understanding the gravity of untreated endometriosis, I preferred 8-10 days of physical torture to "harlot who's going to hell, we're disinheriting you" from my parents (they had indeed threatened to throw me out if they ever caught me taking the Pill).

Luckily for me, I didn't have any cysts burst until I got to Finland. Even more luckily, when one inevitably did, I lived a block away from the excellent Women's Hospital in Helsinki. I walked there thinking I had appendicitis... the doctors took a quick ultrasound (my American-insurance-minded brain going "oh dear God this will be expensive") and told me I was going to surgery, now, and no, it didn't matter that I'd eaten a few hours ago, because if they waited any longer, I'd be dead from the hemorrhaging.

I ended up paying 300 Finnish markka (about 50 euros) for everything. The diagnosis, surgery (laparoscopy), overnight stay, food, pain medication -- everything. Fifty euros to save my life.

I need the Pill to have a normal life; here in France it only costs 25 euros for a three-month supply. My employer has a 20-euro/month plan that covers the 5-10% of mild things (general practitioner, dentist and eyeglasses co-pays) not covered by the sécu. I can go to the doctor -- any doctor I choose, though you do need (it's not required, but incentivized) to declare a primary care provider. I can go whenever I want, usually getting an appointment the same day. Free. Prescription medication: free, with very few exceptions, and the exceptions usually cost about two euros. I've had to go to the emergency room twice for cyst scares: free. I have bad eyesight: I get a free pair of glasses every year, if I want, and free contact lenses up to a reasonable limit. Dentists, opthalmologists: free. I fell off my mountain bike two years ago, spraining my ankle so badly that the emergency room doctor jokingly complimented me on being flexible enough that I didn't manage to break it despite the condition it was in. Free. The subsequent physical therapy: free when prescribed by primary care provider.

My heart breaks when I read health care stories from the US. I only pay 14% income taxes in France and I have a take-home (net after non-income taxes, which include health care) salary of 30,000 euros.
posted by fraula at 5:02 AM on July 9, 2009 [9 favorites]


One of the less-discussed burdens on the Canadian health care system is Americans who sneak in to make use of it.

Is there any evidence that this is a significant burden?
posted by oaf at 5:22 AM on July 9, 2009


Do we actually have any hard economical/quantitative evidence that a single-payer system would result in my paying less overall taxes?

Yes. Compare overall tax rates for every other country in the Western Hemisphere that provides decent healthcare to all of its citizens based on need, not based on their bank accounts.


And when doing this, remember—your health insurance premium? Your co-pays? The giant bills you receive in the mail because your insurer commits fraud and denies valid claims? Those function as taxes. They're somewhat less predictable, though.
posted by oaf at 5:25 AM on July 9, 2009 [4 favorites]


The fucking trolling over this issue is repellent. It's like you people live on a different planet.

Of course, anyone with a different opinion from yours is trolling.

But to get back to an intelligent discussion of the topic... Before we create a huge new government single-payer bureaucracy to deal with the healthcare "crisis," there are a number of cheaper, easier government-driven options we should implement first. The things I'm proposing are all within the power of local, state and the federal government to do tomorrow, and they would lower the demand for healthcare services overnight, and make a single-payer system unnecessary. They would also obviate the need for global environmental legislation, since they would more or less cover our national obligation to reduce carbon emissions and prevent climate change:

1.) Ban the eating of meat or dairy products.
2.) Enforce a 35 mph speed limit.
3.) Enact and enforce helmet laws for automobile drivers as well as motorcyclists.
4.) Ban smoking.

You may protest that this would give the government tyrannical power over individuals. But it would be no more tyrannical of the government to ban meat eating than it is for the government to seize my paycheck to pay for heart surgery for some XXXL oaf who's spent his life sucking pork off greasy rib bones, gobbling deep-friend Mars bars, stinking his car up with piles of Whopper wrappers, shoving his face into Haagen Daz containers, slavering over sirloins, shoving ducks up turkey asses on Thanksgiving, filling ashtrays, catching STDs from prostitutes, gruntingly slurping up milkshakes, and collecting disability 'cause he hurt his widdle head in a motorcycle accident...
posted by Faze at 5:34 AM on July 9, 2009


It's not trolling because it's different, it's trolling because you repeat the same thing and go LA LA LA LA I CAN"T HEAR YOU to rebuttals.

Faze: "You may protest that this would give the government tyrannical power over individuals. But it would be no more tyrannical of the government to ban meat eating than it is for the government to seize my paycheck to pay for heart surgery for some XXXL oaf who's spent his life sucking pork off greasy rib bones, gobbling deep-friend Mars bars, stinking his car up with piles of Whopper wrappers, shoving his face into Haagen Daz containers, slavering over sirloins, shoving ducks up turkey asses on Thanksgiving, filling ashtrays, catching STDs from prostitutes, gruntingly slurping up milkshakes, and collecting disability 'cause he hurt his widdle head in a motorcycle accident..."

IT WOULD COST LESS MONEY OVERALL FOR EVERYONE!!!! CAN YOU FUCKING READ!?!?!?

And it's no more constitution for the gummit to sieze the fatso's paycheck to pay for your heart attack on the track. You're about 22 and invincible, aren't you.
posted by notsnot at 5:41 AM on July 9, 2009 [1 favorite]


some XXXL oaf…

HEY

Seriously, though, it's not tyrannical to mandate that you (or anyone else who's healthy now) be part of the risk pool.

Let's say you've got the ability to be covered by a group health-insurance plan through your employer for your whole adult life. If you get the cheap high-deductible plan when you're young and healthy, but then join the swankiest plan once you reach middle age, there's one word for you: freeloader.

Anyway, whenever I want a shake, they're always cleaning the fucking shake machine.
posted by oaf at 5:48 AM on July 9, 2009


OK, so it's settled then. Faze will personally sit in judgment over anyone who needs medical care. Once the population thins out a bit I'm sure it will be easier for the Healthy and Righteous to afford healthcare.

Mmmm. Soylent Green, anyone?
posted by JoanArkham at 5:52 AM on July 9, 2009


Once the U.S. government takes over health care, every fat-laden snack food will be taxed to the max, any restaurant that isn't serving only alfalfa sprouts will be laden with fees and we'll all be forced to wear monitored pedometers to ensure we're exercising enough or be fined.

LOL, someone's obviously never been to Scotland where they have free health care under the NHS. Last I heard they still love their pints and fried pizzas.

Seriously, Britain STILL wrings their hands over the health of the country. People smoke too much, eat too much, move too little. Kids refuse school lunches and go to the local chippy instead to chomp on fried fish. Don't worry, I don't think "socialized" health care is going to take away your burgers and 125 oz. soda FREEDOMS away from you (but don't tell Faze that).

The only thing it will take away is a smidgen of stress and worry if you have an accident/get ill when stressing and worrying about how you're going to pay for it is the last thing you need.
posted by like_neon at 5:53 AM on July 9, 2009


It would be super funny if hrbrmstr and Faze were covered by the same insurance company.
posted by like_neon at 5:57 AM on July 9, 2009 [1 favorite]


Whoa. Faze came back?

And why should I, who make an enormous effort to stay in shape, avoid bad habits, and eat a good diet....

Sprain your ankle running? I don't want to pay for it. Got E. coli from your salad? I don't want to pay for it. Got a busted nose from being punched in the face for trolling? I don't want to pay for it.

You don't understand how insurance pools work, and you don't understand how the healthcare system works, and you seem perfectly comfortable airing your ignorance in public. You should see somebody about that.
posted by rtha at 6:02 AM on July 9, 2009 [2 favorites]


5.) Ban Living past the age of 65.

"In 1999, people age 65 or over made up only 13 percent of the population yet consumed 36 percent of spending for personal health care."
From Age Estimates in the National Health Accounts
posted by Tenuki at 6:03 AM on July 9, 2009 [1 favorite]


IT WOULD COST LESS MONEY OVERALL FOR EVERYONE!!!! CAN YOU FUCKING READ!?!?!?

Not just because you say it is. Who are you to sayscream? You have done nothing in this thread but bitch about how stupid everyone is who disagrees with you. That is stupid.
posted by caddis at 6:06 AM on July 9, 2009


The fucking trolling over this issue is repellent. It's like you people live on a different planet.

Seriously, grow up. If you don't like opinions other than yours, maybe you shouldn't be on a discussion forum.
posted by gushn at 6:09 AM on July 9, 2009 [1 favorite]


that tradition in the States (held by many/a majority I suspect) of distrusting government hangs like an albatross around the debate. I don't know if that developed in concert with the rise of capitalism and the god-like power of the dollar or if its origins are more complex, but it is a huge impediment to progress to a more equitable and (to me) sensible system.

Actually, it is just a bit more complex. One thing that isn't mentioned, and needs to be borne in mind by those outside of America, is that the United States was born as a result of a Revolution, and that Revolution essentially began as a tax revolt.

Even almost 250 years down the road, this continues to be a major part of the American psyche. And it's not a bad thing, in most cases. But sometimes it is.
posted by spirit72 at 6:20 AM on July 9, 2009


I think it's pretty amazing hrbrmstr and Faze feel the same about health care for completely opposite (but equally invalid) reasons. Unfortunately, I also think that about covers the majority of Americans' opinions.

I have smart friends who think like Faze and the "looking out for number 1" mentality is just really sad (while they drive on public highways, go to university on federal grants, study at the public library, and send Christmas cards in the mail).

I have smart friends who think like hrbrmstr and the "don't you tell me what to do" mentality is just really sad (while they are grateful that smoking indoors is illegal in CA, obey the speed limit, and think gay people shouldn't marry).

Both these views are rooted in selfishness and ignorance.
posted by like_neon at 6:24 AM on July 9, 2009 [4 favorites]


Faze:

We get it; it's all about you. Seriously, it must be great knowing you're never going to be sick. That must really take a load off. (And if you do, God forbid, get sick, at least you'll have a bunch of trustworthy corporations to look out for you instead of a filthy (elected) government.)

My question: who's gonna pay for your compassion transplant?
posted by Benny Andajetz at 6:30 AM on July 9, 2009


Because when O'Reilly does it, it is to silence things like 'facts' and 'reality'. advance his agenda.

When Kucinich does it, it is to ensure that those two things are heard. advance his agenda.

Fixed that for you.
posted by electroboy at 6:36 AM on July 9, 2009


the "looking out for number 1" mentality is just really sad (while they drive on public highways, go to university on federal grants, study at the public library, and send Christmas cards in the mail)

Regardless of your beliefs on spending policy, what is wrong with driving on public highways, using the libraries, etc., when your tax dollars are already paying for it? Even if I were writing to my representatives to advocate the abolishment of the public library system (which I'm not), I don't see it as hypocritical to use it while it exists. Conversely, just because a law you don't like is passed doesn't mean you can disobey it.
posted by gushn at 6:37 AM on July 9, 2009


Benny Andajetz: "Faze:

We get it; it's all about you. Seriously, it must be great knowing you're never going to be sick. .....
"

What do you expect from someone who doesn't like Frank Zappa?

That outta draw him out ;)
posted by KevinSkomsvold at 6:38 AM on July 9, 2009


It's not a perfect system, but it's far, far better than what America has now.
posted by cmonkey at 5:26 AM on July 9


No, it isn't. I have great health insurance coverage. What are you talking about?

First, stop using the code word "single payer." It's single buyer. Its a fucking monopsony, which is just as economically inefficient as a monopoly.

Second, "single payer" is a lie. There isn't a single payer, there are lots of payers. Everyone whose taxes have to go up are the payers.

And the reason a single buyer system is bad is precisely because it is a single buyer. The consumer of the service is not internalizing their own health care costs. If you buy life insurance, you have to get a physical and answer all kinds of questions about your lifestyle so that they can set a price for your policy. Why isn't health insurance the same way? It isn't that way now because we get our insurance from our employer. No matter what risky behavior your co-worker engages in, you pay the same that they do.

If you smoke, you should pay considerably more for health insurance. This is obvious. That person is going to pay a lot more for life insurance than a similar person who doesn't smoke. If you're more likely to die because of your habit, you're more likely to get injured because of it. If you are overweight, have high blood pressure, high cholesterol, etc, you should pay more. You are a greater risk to the system. Of course, anyone can have accidents. The health care system is not burdened by accidents, it is burdened with chronic avoidable problems from smoking, drinking, obesity, and the like.

The problem with the insurance system now is that individuals don't internalize the additional costs their own risky behavior imposes on the system. It's spread out among everyone. If you have a history of reckless driving, you pay more for car insurance. Likewise, if you have a health profile that statistically is more likely to land you in the hospital or require prolonged medication, you should pay more. It's not a moral judgment, you shouldn't be offended that you should pay more, because you are choosing to.

IT WOULD COST LESS MONEY OVERALL FOR EVERYONE!!!! CAN YOU FUCKING READ!?!?!?

Do you understand what you are reading? Costing less overall does not mean that everyone pays less, it means the total is less. I don't pay the total. Faze doesn't pay the total. First, I dispute that the premise is even true - I can't imagine that a government bureaucracy of that size is going to be more efficient than an industry that has to control costs to maintain a profit.

Second, it is a certainty that "less overall" is code for some people will pay less, and a few people will pay a lot more, which is what is happening. I don't want to pay more, even if it means someone else has to pay less. Maybe this makes me a bad person? If so, it also makes the people receiving the benefit bad people for not thanking those who have to pay more so they can pay less, by the way.
posted by Pastabagel at 6:46 AM on July 9, 2009 [2 favorites]


I don't see it as hypocritical to use it while it exists.
posted by gushn at 6:37 AM on July 9 [+] [!]

I don't know if hypocritical is the word I would use. I would reserve that for someone who thinks America shouldn't have public healthcare but enjoys it themselves, ie government officials.

My point (admittedly not well said) is that I just don't understand why people think public health care is so different from other publicly funded services, especially when the need for it is quite strong and to me seems like common sense, just as much as a public library and state highways. It's not that much of a mental leap and yet I know people who face this chasm.
posted by like_neon at 6:53 AM on July 9, 2009


it is a huge impediment to progress to a more equitable and (to me) sensible system.


Please don't change the rules in the middle of the game. The purpose of the founding of the country, the motivation of everyone who has ever lived it, has never been to establish an equitable system. Liberté, égalité, fraternité is the national motto of France. Life, liberty, and the pursuit of happiness was the principle stated explicitly in the declaration of independence. Implicit in pursuing happiness is not having someone else take the fruit of your labors. The country was not founded by the middle class, it was founded by the wealthiest elites in the colonies. And after they established the country, they never set an income tax except in times of war, and only then temporarily. Otherwise, what the hell is everyone working for? Because they like selling cars and fixing other people's toilets? That's their happiness? To work in cubicles and be good little citizen drones?

My point (admittedly not well said) is that I just don't understand why people think public health care is so different from other publicly funded services,

It isn't. Other publicly funded services stink. You want to use the roads as your example? The roads are in shitty condition, if you haven't noticed. The defense industry, despite producing ridiculous feats of technology, is grossly inefficient and corrupt. The post office loses money because they charge the people who use the system the most (bulk and junk mailers) less than they charge everyone who uses it infrequently. Medicare is awful. Social Security is an illusion - if you are in your thirties, you should assume that the pittance you eventually get won't be worth anything in real dollars, if you ever get it at all.

Please identify for me a single government service that is inarguably superior to an equivalent provided by the public sector.

Also, no one here advocating for a government consolidation of the insurance industry would be doing so if a Republican were in the White House. Implicit in calls for single payer healthcare is the notion that they would be administered by a Democratic administration.

Suppose you get your single payer system. Now assume Sarah Palin becomes president. That is the future you are advocating for.
posted by Pastabagel at 7:06 AM on July 9, 2009 [1 favorite]


it is burdened with chronic avoidable problems from smoking, drinking, obesity, and the like.

All compounded by an aging population which is not avoidable.

It's not a moral judgment, you shouldn't be offended that you should pay more, because you are choosing to.

But I don't wanna grow old! I want to stay young and pretty!

I can't imagine that a government bureaucracy of that size is going to be more efficient than an industry that has to control costs to maintain a profit.

I think you have half a point here. But when the NHS talks about trying to be more efficient because costs are skyrocketing it is a public debate and any proposals that might affect the availability of services is widely derided.

When a private company tries to be more efficient to maintain a profit, they talk behind closed doors and the next thing you know your premiums are up and your "pre-existing" condition is no longer covered.
posted by like_neon at 7:08 AM on July 9, 2009


Suppose you get your single payer system. Now assume Sarah Palin becomes president. That is the future you are advocating for.

Yeahhh, but Britain got the NHS, and then they got Margaret Thatcher.

But even Maggie refused to mess with it....
posted by spirit72 at 7:13 AM on July 9, 2009


I think *good* public healthcare is a very tough challenge. I don't think any country's got it right.

But the basic premise of it, that everyone has the ability to access services and support to take care of their mind and body is far superior to the premise of private insurance: you only deserve if you can pay for it and even then we better make some money off of you.
posted by like_neon at 7:19 AM on July 9, 2009 [2 favorites]


If you smoke, you should pay considerably more for health insurance. This is obvious. That person is going to pay a lot more for life insurance than a similar person who doesn't smoke.

Agreed - if you are running a system for PROFIT. The free-market mentality is so deeply rooted in our psyche that it is automatically used as the yardstick by which every endeavor should be designed and measured. I submit that the logic is faulty.

Roads, defense, post offices, libraries, and health care are INVESTMENTS. The benefit is a happy, contributing, tax-paying population. In other words, they can be money-losers, if necessary, if the net result is achieved. (They don't have to be money-losers, though).

One large insurance pool (in our case 300+ million people), would mitigate, to a large extent, individual peccadilloes.
posted by Benny Andajetz at 7:19 AM on July 9, 2009 [8 favorites]


"Do we actually have any hard economical/quantitative evidence that a single-payer system would result in my paying less overall taxes?"

Yes. Compare overall tax rates for every other country in the Western Hemisphere that provides decent healthcare to all of its citizens based on need, not based on their bank accounts.

The fucking trolling over this issue is repellent. It's like you people live on a different planet.


The overall tax burden in the US is among the lowest in the world:

Denmark 49.1
Sweden 49.1
Belgium 44.5
France 44.2
Norway 43.9
Finland 43.5
Italy 42.1
Austria 41.7
Iceland 41.5
Netherlands 39.3
U.K. 37.1
Hungary 37.1
Czech Rep. 36.9
N.Z. 36.7
Spain 36.6
Luxembourg 35.9
Portugal 35.7
Germany 35.6
Poland 33.5
Canada 33.3
Ireland 31.9
Greece 31.3
Australia 30.6
Slovak Rep. 29.8
Switzerland 29.6
U.S. 28
Japan 27.9
Korea 26.8
Turkey 24.5
Mexico 20.6
posted by caddis at 7:24 AM on July 9, 2009 [1 favorite]


Second, it is a certainty that "less overall" is code for some people will pay less, and a few people will pay a lot more, which is what is happening. I don't want to pay more, even if it means someone else has to pay less.

Implicit in pursuing happiness is not having someone else take the fruit of your labors.

Well said, Pastabagel. I don't want to shut anyone out, but at the same time I'd rather people keep their hard-earned money and spend it as they please.
posted by gushn at 7:25 AM on July 9, 2009


Also, no one here advocating for a government consolidation of the insurance industry would be doing so if a Republican were in the White House.

I would and I have, therefore you are full of shit.

Implicit in pursuing happiness is not having someone else take the fruit of your labors. The country was not founded by the middle class, it was founded by the wealthiest elites in the colonies. And after they established the country, they never set an income tax except in times of war, and only then temporarily. Otherwise, what the hell is everyone working for? Because they like selling cars and fixing other people's toilets? That's their happiness? To work in cubicles and be good little citizen drones?

Pastabagel, i think I can speak for just about everyone here when I ask: what the fuck are you talking about?

Seriously - this weird little screed against people who work for a living - what is your point? Should we not have taxes anymore? At all? Are you getting all GOOGLE RON PAUL on us all of a sudden? You're usually a fairly lucid writer, but I defy anyone here to explain what you are trying to tell us.
posted by Optimus Chyme at 7:26 AM on July 9, 2009 [6 favorites]


it is burdened with chronic avoidable problems from smoking, drinking, obesity, and the like.

All compounded by an aging population which is not avoidable.


Compounded? People don't get sick from being obese in their 20's (unless they are very very obese). They get diabetes in their 40's from being obese in their 20's and staying that way. The difference is that the guy who isn't overweight isn't going to get type 2 diabetes ever, even when he's 50 or 60.

Of course everyone gets old. Getting old doesn't automatically mean heart or liver disease or any of the preventable cancers.

I'll do you one better - preventing obesity doesn't actually substantially lower overall healthcare costs in society. This is because when you eliminate obesity, people live longer, and then they get the diseases that older people get that are totally unrelated to obesity. If fact, if you want to lower overall costs, get everyone to start smoking, so that most people die early of lung cancer and don't linger around for years and years with Alzheimers or Parkinsons's. The difference is that people who don't die of heart attacks in their 40's can continue to live, earn money, buy insurance, and pay taxes at the point in their life where their income is the highest. The economic benefit of that longer life offsets the increased cost.

But preventing obesity would reduce how much an individual has to pay, because the costs associated with that are bourne in the present. Obese people pay 75% more in health care costs in a year that similarly situated non-obese people. And eliminating obesity is still beneficial, because it exchanges near term costs with more distant future costs that can be spread over a larger population that pays into the system over a longer period of time.
posted by Pastabagel at 7:35 AM on July 9, 2009 [1 favorite]


Hmm, so - overall - Canada's overall tax burden is roughly 5% than the US, *and* they get national healthcare?
posted by contessa at 7:38 AM on July 9, 2009


* more than
posted by contessa at 7:39 AM on July 9, 2009


Implicit in pursuing happiness is not having someone else take the fruit of your labors.

Well said, Pastabagel. I don't want to shut anyone out, but at the same time I'd rather people keep their hard-earned money and spend it as they please.
posted by gushn at 7:25 AM on July 9 [+] [!]


Since when have you stopped paying taxes?
posted by like_neon at 7:41 AM on July 9, 2009


Since when have you stopped paying taxes?

I've always paid my taxes. And I would like to pay less in the future rather than more.
posted by gushn at 7:47 AM on July 9, 2009


Pastabagel, right now, all the fat ass fatties in Canada can get treated for diabetes or whatever other aliments they pick up. Same with evil ass smokers. Same with people sticking coal up their butt. And at the end of the day, we're spending WAY less than America on Health Care. So i'm not sure what your point is exactly. I might be slow. Mind you, I could go see a neurologist about that.

This sort of sums up your argument, no? "Millions of Americans would rather die in the poorhouse than go to bed at night knowing that someone, somewhere is receiving something they helped pay for."
posted by chunking express at 7:47 AM on July 9, 2009


I've always paid my taxes. And I would like to pay less in the future rather than more.
posted by gushn


Let's go back to the tax structure under Reagan, right?
posted by Optimus Chyme at 7:52 AM on July 9, 2009


The free-market mentality is so deeply rooted in our psyche that it is automatically used as the yardstick by which every endeavor should be designed and measured.

I wish. If this were true, we wouldn't be in this situation. The root problem is that gummint gummed up any hopes for a free market in healthcare, and now we're like Br'er Fox trying to get free of the tar baby. The government got us into this mess, and their solution is: more government. Isn't the definition of insanity the obsessive repetition of an unsuccessful strategy? "Cap'n, the stimulus isn't working!" "Hmmmm... More stimulus!"
posted by Faze at 7:55 AM on July 9, 2009


Funny, you never hear the whole "don't tax me, bro!" argument getting trotted out when the government gives your kid a Stafford Loan or Pell Grant to pay for college. Or when the government has to pay tens of millions to widen a highway because you'd rather drive to work than mix with the proles on the bus or subway. Or when the government gives a multi-billion no-bid contract to Halliburton. The mental gymnastics must be painful.
posted by contessa at 7:56 AM on July 9, 2009 [9 favorites]


http://www.metafilter.com/82314/All-fur-coat-and-no-knickers#2598692

caddis: "The overall tax burden in the US is among the lowest in the world:"

And that's why you need to be careful with statistics. That charts the total tax revenues against GDP. But it ignores Social Security taxes and the effects of productivity on GDP. Is that a list showing that the US pays too little in taxes, or that the other countries have anemic economies precisely because they are taxed too much? I notice that we are right in line with Korea and Japan, two other powerhouse economies. And I notice that China isn't on the list at all.

In fact, this article makes clear that once you take into account the vagaries of taxation in the two countries, the US and Netherlands have roughly the same tax burden, even though on your list the Netherlands is much higher. Furthermore, it's not clear if your list includes or excludes corporate tax revenues, capital gains taxes, etc. VATs and sales taxes, etc.
posted by Pastabagel at 7:59 AM on July 9, 2009


I don't want to shut anyone out, but at the same time I'd rather people keep their hard-earned money and spend it as they please.

Yeah, but as I understand it, they are. We're not talking single-payer at this point in the U.S., although this particular thread has become that debate.

As I understand it right now, people are to be given the option of a publicly owned and operated insurance plan, similar to Medicare or the Congressional plan, that they may buy into, not receive as an entitlement. Or, at their sole discretion, they may opt to stay with their existing private insurer. Of course, a public option would require some public cost, as anything public does, and that's currently the real trick as far as the Congressional debate goes.

But aside from that, I don't see what the big problem with it is. At first glance, it appears to be very similar to the way Germany handles healthcare, and the Germans seem to be pretty content with their system. I honestly don't see how the 'Socialized Medicine' labels can be thrown at it with any degree of honesty. But I can absolutely see why the private insurance lobby in the U.S. is firing nukes at it.
posted by spirit72 at 7:59 AM on July 9, 2009


Let's see if I have this straight:

If you get sick, it's your own damn fault

Let the weak die

The pursuit of profit is more important than the illusion of "public good"

I prefer to pay way more money for private health insurance than I would through taxes if there were a system like the rest of the developed world because for some reason I think that gives me freedom of choice when in reality it traps me

I'll never understand the problems with the system until the day it fucks me over

Does that cover it?

Oh I forgot

"Are there no prisons? Are there no workhouses?"
posted by jokeefe at 8:00 AM on July 9, 2009 [22 favorites]


The root problem is that gummint gummed up any hopes for a free market in healthcare

Yeah, by capitulating to their corporate buddies.

Isn't the definition of insanity the obsessive repetition of an unsuccessful strategy?

Yep.
posted by Benny Andajetz at 8:00 AM on July 9, 2009


The root problem is that gummint gummed up any hopes for a free market in healthcare, and now we're like Br'er Fox trying to get free of the tar baby. The government got us into this mess, and their solution is: more government.

"The 'government' didn't stop the insurance companies from screwing over Americans, so we should be content to be screwed by insurance companies for the rest of the country's existence, regardless of who is actually President or serving in the Congress, because 'government' is a completely static entity at all times and in all ways."

— Faze, The Dumbest Things Ever Written on the Internet, Vol VII
posted by Optimus Chyme at 8:03 AM on July 9, 2009 [6 favorites]


Pastabagel, I've totally lost your point as well.

I don't think private or public insurance affects people's choices in in life. Private insurance certainly doesn't make people any healthier.

I don't think public insurance will make the country healthier either. Some people might stay fat asses drinking their way to their smoking grave, public health coverage is not going to stop that no matter what people like hrbrmstr think.

But maybe some people will get that ache checked out before it kills them. Maybe my dad wouldn't suffer everyday from an aching forearm from doing god knows what at his construction job, which he never got checked out because he couldn't afford it and I can't afford it and how shitty does that make me feel?

This is about giving everyone an equal chance at having a humane quality of life. How's that for pursuing a little happiness?
posted by like_neon at 8:04 AM on July 9, 2009 [2 favorites]


Oh Mister Metafilter, how you do go on!
I wanted a government-administered health-care system when the Republicans were in office.

The roads that are now in shitty condition, the USPS's discounts on junk mail... these things are vestiges of once-great public works. Hell, the interstate highway system was installed by a Republican general as an investment in national defense.

I want some of those Republicans back.
posted by Rat Spatula at 8:05 AM on July 9, 2009


Pastabagel:

I think the "taxes are too high or too low" is a damned-if-you-do, damned-if-you-don't argument.

First, if our taxes are approaching European levels, why are we not getting the health care they are. Priorities, maybe?

Second, "their economies are anemic compared to ours" is a bit hyperbolic, no?
posted by Benny Andajetz at 8:08 AM on July 9, 2009


And I would like to pay less in the future rather than more.

Well, so would I. Who wouldn't???

But the facts on the ground are these:

-50 million Americans have no coverage at all. When they do get care, in an ER or elsewhere, we pay for it through higher costs, higher premiums, and higher taxes. They generally take more time off from work due to illness, and are generally less productive when they are at work. This is not good for the American economy. In Republicanese, it is Bad For America.

-By some measures, as many as 25% of Americans who are insured postpone care and prescriptions, or forego them entirely, due to cost. I happen to be one of them, from time to time. This is similarly bad for the American economy, and Bad For America.

-Over 50% of all personal bankruptcies in America are caused by medical costs. Perhaps more than both of the above facts combined, this is bad for the American economy, and Bad For America.
posted by spirit72 at 8:10 AM on July 9, 2009 [3 favorites]


But maybe some people will get that ache checked out before it kills them. Maybe my dad wouldn't suffer everyday from an aching forearm from doing god knows what at his construction job, which he never got checked out because he couldn't afford it and I can't afford it and how shitty does that make me feel?

This is about giving everyone an equal chance at having a humane quality of life. How's that for pursuing a little happiness?
posted by like_neon at 8:04 AM on July 9


if your dad was able to get his arm checked out in a single payer system then gushn and pastabagel would have to download one less song from iTunes every year so clearly it is unacceptable
posted by Optimus Chyme at 8:10 AM on July 9, 2009 [5 favorites]


if your dad was able to get his arm checked out in a single payer system then gushn and pastabagel would have to download one less song from iTunes every year so clearly it is unacceptable

Well, so much for honest debate. Please resort to screaming SINGLE PAYER NOW!!! and NOBAMA SOCIALISM!!! in alternating turns for the rest of the thread.
posted by electroboy at 8:13 AM on July 9, 2009 [1 favorite]


Pastabagel - actually, the numbers I posted do include social security etc. Here is the source. I am going to trust these over the musings of some op ed writer in the NYT with no apparent financial background.
posted by caddis at 8:18 AM on July 9, 2009


There was no honest debate here on the part of Faze, Pastabagel, and gushn before I got here, so why should I be any different?

• gushn's argument is simply that he doesn't want to pay more taxes, forgetting that the total cost of healthcare is higher for pretty much everyone, rich and poor alike, than if we had a single-payer system.

• Pastabagel is spouting weird theories about the founding fathers not liking taxes and something about cubicle drones that neither he nor anyone else has been able to explain. After that, he claimed that taxes were too high for mysterious unstated reasons and also something about how if we raised taxes for any reason we would be like . . . China? I don't know, I honestly think he is getting old and weird or something.

• Faze claims that the failures of the privately run, for-profit insurance companies are in reality the failures of "the government," a monolithic, unchanging entity that has ruled over us from its dark minaret for the last two centuries.
posted by Optimus Chyme at 8:21 AM on July 9, 2009 [13 favorites]


Do we actually have any hard economical/quantitative evidence that a single-payer system would result in my paying less overall taxes?

I sat down with another mefite via email a couple of years ago and we figured out how much of my paycheck was going towards health insurance and how much towards taxes. A LOT of my check goes to insurance: roughly $400 a month. For just me. My employer pays about $300 a month towards a policy with a $1000 deductible and a whole bunch of other weird deductibles that I know for a fact covers hardly anything and if I got catastrophically sick, would disappear like the morning dew. Basically, with a starting gross salary of 28K a year (yeah I am poor) I take home about 19K. The majority of that is my portion of health insurance cost. The other mefite lives in the UK. He makes considerably more money than I do, gross - say about twice as much. He is also single with no children. I have one dependent child. Therefore, you would expect him to be paying proportionally more in taxes, right? Well, guess what? He nets a higher proportion of his gross because he is not paying that $400 a month health insurance and he can go to the doctor any time.

I suggest that those of you who are complaining about how it's all going to cost you way way more perform a similar experiment with a mefite from another country. You may find it quite eye opening. A single payer option will almost certainly be less expensive than what those Americans who do luxuriate in health insurance have now.

Oh and the waiting times thing? Who are you people who have no waiting times in the USA? If I called my doctor - an OB/GYN - today with something dire, I'd be lucky to get in to see her in a week to ten days. If I complained, they would tell me to go to the ER. If I called looking for a checkup, I could probably make an appointment in, ummm, late September. When I make appointments for my 80 year old aunt or my 17 year old son with their doctors, I know it's going to take at least several weeks before they can get in to see them unless it's a really serious emergency and even then they'll tell you it will be 24 hours. Here in Asheville, where we do have a shortage of medical care (partly due to all the glowing articles in the early 2000s about how this was the best place in the US to retire and the subsequent glut of senior citizens) if you do not already have a doctor, it will be six to eight months before you can make your first appointment with any doctor. Until then, good luck with the doc in a box clinics that will see you for $200 a pop.
posted by mygothlaundry at 8:23 AM on July 9, 2009 [10 favorites]


i_am_joe's_spleen: "Kadin2048: I can only say that supporting the healthcare for feckless numbskulls annoys me too, but it turns out to be cheaper than going it on my own. But if it comes to that, there aren't even that many of them, relative to the average person, and the best suffferers from chronic, lifestyle-related conditions can hope for is treatment, not cures -- they're not really getting away with much."

That's fine, but the problem isn't you or me, it's how do you convince everyone else to adopt this sort of tolerant attitude too? Because tolerance isn't something the United States does well.

I mean, a lot of people can't resist the urge to tell other people how to live when they have no reason to care at all. And now we're going to give them what appears on its surface to be a huge financial incentive to get into their neighbor's business?

I'm not sure if he's trolling or in earnest, but the person you need to convince is someone like Faze (or the argument he's repeating), because I think that's representative of a huge slice of America. If somebody's paying, however indirectly, for their neighbor's medical care, suddenly everything he puts in his mouth is very much their business, and some people are going to go after anything that costs them money with a vengeance.

The fat slob who costs the taxpayer money because of his Haagan-Daaz consumption is going to be the "welfare queen" of the single-payer era; it's the sort of thing that just infuriates people. The idea that somebody might be taking advantage of the system is more than enough reason, to a lot of people, to just rip the system apart and let everyone pound sand on their own. (Cf. welfare reform.)

Or, even worse, arguments like Faze's could actually win, and you'd end up with a system where individual liberty was stunningly reduced in the name of healthcare costs. Probably not all at once, but you could make a good incrementalist argument for just about everything Faze is suggesting. Not overnight, but in time; a sort of "creeping dystopia" driven by penny-pinchers and authoritarians.
posted by Kadin2048 at 8:30 AM on July 9, 2009 [1 favorite]


Please resort to screaming SINGLE PAYER NOW!!! and NOBAMA SOCIALISM!!! in alternating turns for the rest of the thread.
The thread's over 300 comments, it had to break out sometime. ;)

I don't know what kind of "socialized healthcare" is the right kind. From my understanding, it comes in a lot of different flavors. Everyone seems to have a different idea of what it means and so it's easy to see how those against it can imagine their very worst possible scenario (ie after stopping by the atm and personally escorting a morbidly obese person to liposuction) and then react accordingly.

But instead of making up fantastical scenarios where people are robbing you of your hard earned money, seriously look around you. There is a VERY good chance you personally know and care about someone who's life is negatively impacted because of their inability to afford health care. And I'm not talking about fancy-pants cancer treatments, but like basic health care.

Rather than turning it around to be somehow their fault why don't we use our collective brains and will to do something about it? Are you really ok with people suffering from unpreventable health issues because you're vindictive against those who have preventable ones?
posted by like_neon at 8:32 AM on July 9, 2009 [3 favorites]


Everyone seems to have a different idea of what it means and so it's easy to see how those against it can imagine their very worst possible scenario (ie after stopping by the atm and personally escorting a morbidly obese person to liposuction) and then react accordingly.

Incidentally, that woulda made a terrific Python skit.
posted by spirit72 at 8:35 AM on July 9, 2009


Implicit in pursuing happiness is not having someone else take the fruit of your labors.

Implicit in living is not being denied basic medical care so that someone else can afford to live in Palm Beach.
posted by oaf at 8:47 AM on July 9, 2009 [2 favorites]


If somebody's paying, however indirectly, for their neighbor's medical care, suddenly everything he puts in his mouth is very much their business, and some people are going to go after anything that costs them money with a vengeance.

I get where you're coming from, but what Faze et al. refuse to recognize or admit is that we're already paying for our neighbor's medical care. Right now. As the system currently stands, as broken and hideous as it is.

Arguments that start with "[XYZ] doesn't live the perfectly regulated life that I do and I don't want to pay for the consequences of that life," are equally broken and hideous, flowing as they do from a place that's irrational, illogical and thoroughly out of touch with how the world (and the humans in it) actually operates. Arguments that begin from such an embarrassingly stupid premise should be ignored - there are enough complicated decisions to be made without considering the what-ifs and I-don't-wannas of people who choose to not recognize reality.
posted by rtha at 8:49 AM on July 9, 2009 [2 favorites]


Implicit in pursuing happiness is not having someone else take the fruit of your labors.

No, it's not.
posted by dirigibleman at 8:58 AM on July 9, 2009 [3 favorites]


Ugh, there is a very high tax rate on cigarettes in Canada which people don't mind because it helps offset the extra healthcare costs. Faze's red herring is starting to stink up the place.
posted by Space Coyote at 9:04 AM on July 9, 2009


The pursuit of profit is more important than the illusion of "public good"...

The pursuit of profit leads to public good. I wish this were taught in school.
posted by Faze at 9:05 AM on July 9, 2009


One of the less-discussed burdens on the Canadian health care system is Americans who sneak in to make use of it.
Is there any evidence that this is a significant burden?


It can't possibly be a significant burden, but it's a fair bit assholic. Still, better than having them die due to their own country being incapable of operating a good healthcare system.
posted by five fresh fish at 9:06 AM on July 9, 2009


The single biggest issue with reform now seems to be that the US population is aging rapidly. None of the public health systems are in good shape in that sense, they are all going to fare poorly as their populations age and, as a result, their expense grows year by year without end. This is a problem for Canada, France and everyone else.

By doing US reform now, we are basically ensuring that the program will start off in the mud and likely be an easy magnet for cost overruns and other criticism. Realistically, most health spending is on the elderly, regardless of their lifestyle choices. Unless something is done to reign in the spending there (and especially on terminal diseases and near end of life care) any medical system is basically doomed. We are extremely reluctant to do that.
posted by rr at 9:07 AM on July 9, 2009 [1 favorite]


ValkoSipuliSuola wrote: As the daughter-in-law of a surgeon, I know that malpractice insurance eats up a HUGE portion of a doctor's income.

That would be the insurance companies once again charging ridiculous sums far out of proportion to what they actually have to pay out. Most malpractice suits are settled for completely reasonable sums directly related to the cost of ongoing care needed due to the doctor's negligence.

Every once in a while you get these $10 million payouts and then everybody assumes that when you sue a doctor, the insurance company has to pay out ten million bucks, which couldn't be farther from the truth.
posted by wierdo at 9:09 AM on July 9, 2009


There is no such thing as a "Free Market".
posted by Artw at 9:12 AM on July 9, 2009


The pursuit of profit leads to public good.

Whatever you say, Mr. Gekko.
posted by oaf at 9:13 AM on July 9, 2009


The overall tax burden in the US is among the lowest in the world

Only if you do not count the burden of purchasing private health insurance. Otherwise you are comparing sharks and bunnies.
posted by five fresh fish at 9:14 AM on July 9, 2009 [8 favorites]


The pursuit of profit leads to public good. I wish this were taught in school.

Yeah, well, there's that Church/State thing to respect.
posted by @troy at 9:14 AM on July 9, 2009 [5 favorites]


The pursuit of profit leads to public good. I wish this were taught in school.
posted by Faze at 9:05 AM on July 9


Maybe this is a bit too internet detective, but I found Faze's high school graduation photo.
posted by Optimus Chyme at 9:15 AM on July 9, 2009 [3 favorites]


I also think "the Faze argument" is ridiculous but I don't think ignoring it is right. It represents a LOT of people's opinions.

I would rather try to drill it into their heads:

- You are already paying for Joe Lardass' health care. This is how insurance works, regardless if it's the US government or Kaiser Permanente. The difference is that Jane TriesHerBest shouldn''t have to go bankrupt if she ever gets breast cancer. Or breaks her leg.

- Under the current system, people who can't afford health care are driven to worsening conditions (preventable or not) and you are again paying for it (see Spirit72).

- Seriously, talk to someone without health insurance or with inadequate health insurance. It's easy, you'll probably see them at Christmas. Put a face to this issue, it might make you more human about it.
posted by like_neon at 9:16 AM on July 9, 2009 [1 favorite]


I like all the folks pretending that what makes large systems corrupt and wasteful is the involvement of the government, like deregulated utilities and countries without public infrastructure are paragons of efficiency.

"Quick, there must be some way to blame the government for Enron!"
posted by klangklangston at 9:16 AM on July 9, 2009 [1 favorite]


if your dad was able to get his arm checked out in a single payer system then gushn and pastabagel would have to download one less song from iTunes every year so clearly it is unacceptable
posted by Optimus Chyme at 11:10 AM on July 9


Maybe part of the reason I can afford health insurance is that I don't spend money on useless shit like iPhones and music for iTunes.

You missed my point? Here is my point:

1. There is no such thing as single payer. There is single buyer, which is economically inefficient. There are multiple payers under a single buyer scheme - those people are the people who have to pay more in taxes. My guess is that not a single one of the people advocating for single buyer in this thread would have their taxes raised to pay for it.

2. The problem is not with health care, it is with health insurance. The problem with health insurance is that under a single buyer scheme just like now people don't pay more or less for their insurance based on their particular circumstances. Now, everyone in your workplace pays the same for their insurance regardless of their particular health circumstances. The only reason it is done this way now is because it is in the economic interests of the insurance companies and corporations to do it this way. Single buyer would make this worse, not better. Furthermore, the way health insurance is priced is the opposite of how insurance is priced for home, auto, life and anything else you'd every by insurance for. Those things are priced uniquely for you based on your circumstances.

3. Yes, people would change their behavior if they were economically incentivized to do so. If obese people could save 50% on their insurance (of if they suddenly had to pay 50% more), then some of these people would lose the weight.

4. I'm not suggesting the system is fine the way it is. But a single payer system would be worse.

if your dad was able to get his arm checked out in a single payer system then gushn and pastabagel would have to download one less song from iTunes every year so clearly it is unacceptable
posted by Optimus Chyme at 11:10 AM on July 9


Maybe the reason I can afford health insurance is because I don't throw my money away on overpriced shit like iPhones and music from iTunes.
posted by Pastabagel at 9:19 AM on July 9, 2009


Implicit in pursuing happiness is not having someone else take the fruit of your labors.

First off, *life* is the first thing in that list, and many people here die for want of effective medical care. But I digress.

Implicit in *everyone* being able to pursue happiness not just *you*, is not being an asshole and stepping on your neighbor's dick to keep him down in your "pursuit".
posted by notsnot at 9:20 AM on July 9, 2009 [1 favorite]


"The pursuit of profit leads to public good. I wish this were taught in school."

Don't kids already get enough lies in school?

But I'm surprised they're letting Bernie Madoff comment from prison.
posted by klangklangston at 9:21 AM on July 9, 2009


Faze: "The pursuit of profit leads to public good. I wish this were taught in school."

Oh, so you *are* 22. I was just joking before.

Go re-read Atlas shrugged, or jack off to your picture of Ayn Rand, or whatever it is you do when you're not working out.
posted by notsnot at 9:23 AM on July 9, 2009


That wasn't a dig at your dad, like_neon. It was a response to the ridiculous assumption from OC because I have insurance, it must also mean that I spend money frivolously, and that raising my taxes would only affect me in a trivial way. The reason I can afford insurance is because I don't waste money. Raising my taxes would directly affect my children's future, as it would mean less spending on their education now and in the future.

But presumably the government would step in eventually to absorb the costs of those things, so fuck it, maybe I should just transfer all of my money to whatever company makes the shiny, trendy shit of the moment.
posted by Pastabagel at 9:26 AM on July 9, 2009


There is no such thing as single payer. There is single buyer, which is economically inefficient.

If you're starting from an incorrect premise, of course you're going to end up with skewed conclusions.
posted by oaf at 9:28 AM on July 9, 2009 [1 favorite]


Pastabagel: " There is single buyer, which is economically inefficient.
Like Walmart.
There are multiple payers under a single buyer scheme - those people are the people who have to pay more in taxes. My guess is that not a single one of the people advocating for single buyer in this thread would have their taxes raised to pay for it.
If it meant not having to pay the premiums I pay a share of and my boss pays the rest of, I'd love to. In fact, if every penny that me or my boss paid to healthcare went to taxes instead, I'd bet it would cover the cost for two other people, too, over my lifetime.
posted by notsnot at 9:29 AM on July 9, 2009


It seems very unlikely to me that a nation that is populated by citizens who don't give a flying fuck for one another is a nation that can maintain a first-world living standard, let alone survive as a country.
posted by five fresh fish at 9:30 AM on July 9, 2009 [7 favorites]


THIS CANNOT POSSIBLY WORK IN SPECIAL-LAND!
posted by Artw at 9:30 AM on July 9, 2009 [5 favorites]


My guess is that not a single one of the people advocating for single buyer in this thread would have their taxes raised to pay for it.

Remember when you were wrong about "no one in this thread" advocating for national healthcare under a Republican, and I pointed out that I did, and you were wrong, and you just pretended it didn't happen?

Well, you're wrong again. I would be fucking thrilled to have my taxes raised so we can all have healthcare. Shit, make it another ten percent across the board, gross. But I'm sure you'll ignore this, because you have displayed an astounding, embarassing amount of intellectual dishonesty today. Goalpost-moving, bizarre tangents about the founding fathers and cubicle-drones that you have yet to explain, these "bets" and "guesses" that are immediately disproved - I am honestly, genuinely concerned about you, because even when we disagree, I don't normally think something is actually wrong with you cognitively.
posted by Optimus Chyme at 9:33 AM on July 9, 2009 [9 favorites]


The problem with the insurance system now is that individuals don't internalize the additional costs their own risky behavior imposes on the system.

I agree entirely - as long as you mean (which you didn't, of course) "going without healthcare because you can't afford it," which is the most costly risky behavior for society. Our current system ensures that un- and under-insured people who do end up getting injured or sick are a huge burden, both because they use services they will never be able to pay for (heading straight to the emergency room, for example, with a wound gone septic or complications from untreated diabetes) and because if you don't have access to regular health care, you're more apt not to risk paying for the doctor until things are already pretty bad. Oh, and then there's the lost productivity due to ill health, the problems caused by health-related bankruptcies...

Most of my US peers have been without insurance for some periods of time - sometimes short, sometimes long. They wish they could "internalize the risk", and act on it: because they (unlike Faze!) realize that anyone can get injured, or hit by a car, or end up with cancer, they want to pay a regular, reasonable fee for tightly-regulated German-style insurance, or for an English-style NHS, or really anything that will be vaguely affordable and result in access to health care. But when they get rejected by insurance companies because of pre-existing conditions, or are offered only high-deductible insurance that would still cost a third or more of their meagre paycheck every month, or can only get access to catastrophic insurance that won't cover preventive care and probably won't cover much if they do end up in an accident...

Well, they end up having to do the risky thing: go without insurance and healthcare now, and hope that they won't get sick or injured and incur the greater costs to self (bad health, possible bankruptcy) and society (the fee for all the treatment they couldn't pay for, lost productivity, etc.) Far too often, they lose the bet, and we all pay. We pay so much, in fact, that we pay more than everyone else in the first world!

Even ignoring the greater efficiency of everyone else's regulated, nationalized, or single-payer systems (which you are, and blindly so), preventive healthcare will lower many costs to society. The number of fat people may not change, but what will change is the number of people who can't afford a doctor and wait far too long - and then end up needing very expensive treatment for advanced cancer, or untreated diabetes. Similarly, there should be a change in the number of people who work inefficiently because they are ill, or because they are trapped in a job they don't like in order to get health insurance.
posted by ubersturm at 9:34 AM on July 9, 2009 [3 favorites]


"There is no such thing as single payer. There is single buyer, which is economically inefficient. There are multiple payers under a single buyer scheme - those people are the people who have to pay more in taxes. My guess is that not a single one of the people advocating for single buyer in this thread would have their taxes raised to pay for it."

Well, no. First off, your semantic jiggery-pokery is easily inverted—if there are multiple payers under a single buyer plan, then there are multiple buyers. You can't substitute one phrase for a synonym and claim that makes a difference. Second off, our multiple payer system is also inefficient, and Canada's single payer is more efficient in the amount of health care delivered per dollar. So, instead of arguing from theory, you might confine yourself to the facts or be branded an ideologue. Third off, ignoring that there exists evidence to the contrary of your assertion, your assertion isn't even theoretically correct—single buyers aren't inefficient when it's a public good, and health care is a public good. It eliminates rent-seeking, and public utilities are organized for good reason.

"The problem is not with health care, it is with health insurance. The problem with health insurance is that under a single buyer scheme just like now people don't pay more or less for their insurance based on their particular circumstances. Now, everyone in your workplace pays the same for their insurance regardless of their particular health circumstances. The only reason it is done this way now is because it is in the economic interests of the insurance companies and corporations to do it this way. Single buyer would make this worse, not better. Furthermore, the way health insurance is priced is the opposite of how insurance is priced for home, auto, life and anything else you'd every by insurance for. Those things are priced uniquely for you based on your circumstances."

Wrong and wrong. The problem is health care, in that it's prohibitively expensive to buy it, and it's a rare good. That's why insurance schemes exist at all. Second, for someone arguing against single payer, you're not doing a very good job at all—how would it be worse to continue the same system of pooling risk? Further, that's how health insurance works. By separating out folks based on risk factors, you get plenty of folks who are uninsurable, who we then have to provide health care for out of public monies already. The folks who are most profitable are the ones who don't need health insurance. Can you not see that profit distorts the incentives against the public good? Are you an idiot or a liar?

"Yes, people would change their behavior if they were economically incentivized to do so. If obese people could save 50% on their insurance (of if they suddenly had to pay 50% more), then some of these people would lose the weight."

Given the mixed science regarding the ability of people able to lose weight, wouldn't this essentially be a tax on poor genetics? Further, while people will change behavior given incentives, this is not a magic bullet—if it were, we'd have no crime save white-collar crime. Hell, not even weight-loss programs instituted by health insurance companies have a record of long-term success.

Perhaps you should leave off commenting until after your free-market orgasm. Your profit lust is clouding your rational thinking.
posted by klangklangston at 9:34 AM on July 9, 2009 [6 favorites]


About three months ago I was taken to hospital in the UK with suspected meningitis. I have insurance through my work but didn't see the need to use the service and relied entirely on the NHS. As a result, not only did I get a lovely free ride in an ecnalubmA but I also got two days of completely free medical care including a CAT and lots of delightful bags of antibiotics.

I paid (drumroll) ffffffffffffffffffuck all for any of it other than the piddly amount that I pay for National Insurance contributions each month out of my paycheque. Not only that but when I phoned up my insurance company and said "Hey guys, I just spent two days in an NHS hospital" they mailed me a cheque for £300 three days later for not using their service.

You guys are fucking nuts.

p.s. meningitis is shit. Don't get it.
posted by longbaugh at 9:35 AM on July 9, 2009 [15 favorites]


The pursuit of profit leads to public good.

No, the inclination for one person to respect and assist the other persons around them leads to public good.

Profit-seeking can lead to good or bad. It generally doesn't give a shit one way or the other.
posted by Benny Andajetz at 9:35 AM on July 9, 2009 [6 favorites]


"The reason I can afford insurance is because I don't waste money. Raising my taxes would directly affect my children's future, as it would mean less spending on their education now and in the future."

But by raising your taxes here, you would avoid paying for insurance or health care individually. How come you can recognize economies of scale everywhere but here? Don't you get that you'd pay less in the long run?
posted by klangklangston at 9:37 AM on July 9, 2009


The pursuit of profit leads to public good. I wish this were taught in school.

Love Canal. Triangle Shirtwaist Factory. The last round of unrecalled defective pacemakers. "New" drugs that actually aren't any more effective than "old" drugs except the drug company can charge "new" drug prices for them, and the "old" ones are generic. Enron. Madoff.

My guess is that not a single one of the people advocating for single buyer in this thread would have their taxes raised to pay for it.


Your guess is incorrect. I would love to have my taxes raised. A family friend - an American - who's lived in France for the last 30 years has something approaching 40-45% of her income taxed (and she's not supermegawealthy; she's a translator). You know what she gets for that? Extraordinarily good healthcare. Free/cheap childcare. Free/cheap university for her kid. If she gets hit by a taxi walking to work (because the Metro is on strike), she won't go bankrupt paying the deductible and out-of-pocket costs, and she won't have trouble getting health insurance to cover any taxi-accident-complications if she changes jobs (she's self-employed, so that point is kind of moot). If I could get all that shit from having my taxes jacked up some, you're goddamn right I'd vote to have my taxes raised.

If the single-payer system is so much worse than ours, then why aren't all the Canadians in this thread moving to the U.S. for the awesome health coverage? Can I get an informal, nonscientific show of hands? Canadian mefites, who among you wants to move to the U.S. because your healthcare system is so much worse than ours?
posted by rtha at 9:40 AM on July 9, 2009 [4 favorites]


Are you an idiot or a liar?

I guess I'm an idiot then. So, are your taxes going up too?
posted by Pastabagel at 9:41 AM on July 9, 2009


Also, all you people who would love to have your taxes raised should know that you can actually pay more any time you want. Just cut a check to the Treasury, that's where your tax money would go.

So I assume you will all be paying 20% more than you have to this year?
posted by Pastabagel at 9:43 AM on July 9, 2009


And I, too, am happy to pay more in taxes if it means an actual healthcare system, though if we're reforming the system, I suspect the extra money in taxes would be compensated for by the decreased spending on insurance! Maybe my parents raised me wrong, but I really don't mind putting money towards covering hypochondriacs and fat people and people who play extreme sports, and welfare queens don't scare me. Healthcare is a human right - and is recognized as such in most first-world countries - and a healthier society is better for everyone.

It's also rather disingenuous to say "we pay less in taxes in the US" and then ignore the costs in the US that are unavoidable, even if they aren't listed under "taxes." Add healthcare (and local and state taxes), and for most people, the numbers end up in the range of the taxes paid by people in European countries. The big difference, of course, is that we get much less for the money we pay in terms of health (and infrastructure, and education, but those are different problems.)

Even ignoring the basic right to health care, and the fact that we're paying out the nose for meagre results, being able to freely choose your job (not being held captive due to needing health care for yourself and possibly your family too) would be incredible too: in oh-so-capitalist America, acting as a free agent who can easily choose a better job carries the rather punitive risk of losing healthcare access. Having to handle healthcare for employees also sucks for businesses (who don't have to do it, or do it to this extent, in the rest of the first world.) I've never understood why advocates of health care reform don't push that more; it would seem to be an angle that might get the attention of of conservative types.
posted by ubersturm at 9:48 AM on July 9, 2009 [1 favorite]


Also, all you people who would love to have your taxes raised should know that you can actually pay more any time you want. Just cut a check to the Treasury, that's where your tax money would go.

So I assume you will all be paying 20% more than you have to this year?


C'mon,man. Now you're not even trying to make sense.

It's not how much taxes everyone pays, it's the value everyone gets in return. That's really what this country sucks at.
posted by Benny Andajetz at 9:52 AM on July 9, 2009


Also, all you people who would love to have your taxes raised should know that you can actually pay more any time you want. Just cut a check to the Treasury, that's where your tax money would go.

So I assume you will all be paying 20% more than you have to this year?


Too bad there is nowhere my extra 20% can currently go that will fund the sane healthcare system I'm hoping to pay for! Seriously, man, that's a really intellectually dishonest argument. Paying extra taxes towards a sane healthcare system is contingent on such a system existing. Randomly throwing extra money at the Treasury now, before such a system exists, would do fuck-all.
posted by ubersturm at 9:53 AM on July 9, 2009 [2 favorites]


Also, all you people who would love to have your taxes raised should know that you can actually pay more any time you want. Just cut a check to the Treasury, that's where your tax money would go.

This is what I'm talking about. You're having a meltdown like a toddler instead of addressing the points brought up by me and klangklangston and rtha and everyone else. When you are proven wrong by we proles begging for this system and willing to help pay for it, you just go into denial and produce the shameful bullshit you posted above.

So I assume you will all be paying 20% more than you have to this year?

Sure, if we actually get a single-payer system this year.
posted by Optimus Chyme at 9:55 AM on July 9, 2009 [4 favorites]


I haven't yet seen anything that says taxes will even go up. Is this a given?

Since other countries with socialized healthcare pay less than the US, why do people assume that taxes would go up?

Also, wouldn't having less people go bankrupt due to health issues would be a benefit to the economy?
posted by ODiV at 9:58 AM on July 9, 2009


Oh awesome, Pastabagel has played the FUCK YOU I GOT MINE card and just pulled out the "nonsensical argument that has nothing to do with anything card". With only a few minutes left in the game, can he pull off a hat trick? Perhaps there's a "contorted analogy" card in his deck?!
posted by cmonkey at 9:59 AM on July 9, 2009


rtha: "Arguments that start with "[XYZ] doesn't live the perfectly regulated life that I do and I don't want to pay for the consequences of that life," are equally broken and hideous, flowing as they do from a place that's irrational, illogical and thoroughly out of touch with how the world (and the humans in it) actually operates. Arguments that begin from such an embarrassingly stupid premise should be ignored - there are enough complicated decisions to be made without considering the what-ifs and I-don't-wannas of people who choose to not recognize reality."

That strikes me as self-defeating. I'd estimate, conservatively, that about 60-75% of American political discourse is "irrational, illogical and thoroughly out of touch with how the world (and the humans in it) actually operates." That doesn't seem to actually stop anyone.

Hell, there are whole sections of US law that seem to have been based on premises that are irrational, illogical and thoroughly out of touch with objective reality. Yet they're still law.

Ignoring people who you disagree with or think are complete morons won't make them go away. Rather, it seems to me that refusing to engage with them only empowers them — they get to play the "I'm being oppressed" card and retreat deeper into consensus-based reality with people who agree with them. You're not solving the problem, you're just letting it fester.

I know people who take a similar line with homophobes. They just think it's such a stupidly offensive worldview that they refuse to enter into any sort of discussion with anyone who feels that way. Which is fine in the short run, but it can lead to nasty surprises down the road — things like Prop 8, where suddenly those assholes come out of the woodwork and use the political system to advance their agenda.

The problem with democracy is that even morons get to vote, and there are a lot of morons. I think you choose to ignore them at your peril.
posted by Kadin2048 at 9:59 AM on July 9, 2009 [2 favorites]


If I cut a check to the Guvmint right now, you know where it will go? To the wars. Not to health care. Or is that not incredibly obvious? Or are you just really that disingenuous?

If, on the other hand, we have a system like Canada's, the extra tax will go to health coverage.

Here's some personal anecdata: A friend just had a baby. It was a complicated pregnancy, a complicated birth, and the kid's going to be in NICU for at least three months and have at least two surgeries. You think, by the time he's of age, he'll have any hope of getting private insurance? He's going to have every pre-existing condition under the sun. His mom, my friend, is fortunate to have a job at the moment that has excellent insurance. Gosh, I sure hope she doesn't have to change jobs (she's a public school employee, so I'm sure she'll never get laid off or anything).

So the kid will either end up with Medicare/Medicaid coverage - which we all already collectively pay for - or he'll end up underinsured, which means if he needs medical care for a "pre-existing condition" we'll end up paying for it anyway, because he won't be able to afford to cover all of it, resulting in bankruptcy, lost productivity, and a bill at the hospital that will end up being paid for by us anyway in the form of higher fees, fewer services, or both.

Awesome.
posted by rtha at 10:02 AM on July 9, 2009 [1 favorite]


Before we create a huge new government single-payer bureaucracy to deal with the healthcare "crisis,"


You know, the scare quotes in that sentence tells me that pretty much the rest of what you have to say on the matter is going to be horseshit. Some of us have experienced, first-hand, the grim horrorshow that is US health care insurance madness.

If you can't see and wholeheartedly affirm that we legitimately have a health care crisis in this country, then how in the world can your opinion on how to solve it be given any weight, whatsoever?
posted by darkstar at 10:03 AM on July 9, 2009 [1 favorite]


If I cut a check to the Guvmint right now, you know where it will go? To the wars. Not to health care. Or is that not incredibly obvious? Or are you just really that disingenuous?

If, on the other hand, we have a system like Canada's, the extra tax will go to health coverage.


Speaking of disingenuous...

You don't really get a say where your taxes go. It all goes into a big pot (with some exceptions) and how it's apportioned according to the budget that your elected representatives create. So if we did have a system like Canada's (which I think we should), guess what? Your money still goes to paying for wars and farm subsidies and yes, health care, but don't pretend it's magically going to pay for only good things.
posted by electroboy at 10:10 AM on July 9, 2009


I guess I'm an idiot then.

this burns me - why should society be taking our intelligence and our rationality to benefit incapable idiots like you?
posted by pyramid termite at 10:22 AM on July 9, 2009


I guess I'm an idiot then. So, are your taxes going up too?

Oh, come on Pastabagel. Are you gonna take your pail and shovel with you?

For you, and all who have shared your opposition to a public option in this thread, I mentioned a few facts up the page a bit about the realities of the healthcare situation in the US, and how they are bad for America, economically and otherwise.

I am amazed that after all the long posts you guys have made about this and that, that none of you have even addressed these facts from your perspective.

So, in case you just missed it, I'll repost:


-50 million Americans have no coverage at all. When they do get care, in an ER or elsewhere, we pay for it through higher costs, higher premiums, and higher taxes. They generally take more time off from work due to illness, and are generally less productive when they are at work. This is not good for the American economy. In Republicanese, it is Bad For America.

-By some measures, as many as 25% of Americans who are insured postpone care and prescriptions, or forego them entirely, due to cost. I happen to be one of them, from time to time. This is similarly bad for the American economy, and Bad For America.

-Over 50% of all personal bankruptcies in America are caused by medical costs. Perhaps more than both of the above facts combined, this is bad for the American economy, and Bad For America.

Now, this is not politics, nor is it ideology. These are incontravertible facts. This is what is happening in America...right now, today, as we type.

Forget about single-payer. To hell with it. I'm not even convinced that it's the right solution.

But if a completely voluntary public option is not a solution for you guys, what is wrong with it in your opinion? What, in your opinion, is the right solution? What, really, is 'socialized' about it?

Really, guys. Please. I am willing to learn here. But what I'm seeing---and not just from MeFi-ers, but from damn near everyone who opposes a public healthcare option, is that they're willing to point to strawmen and red herrings all day, but when pressed, they can't seem to propose a better solution, or really do anything but shrug and admit that something does need to change.
posted by spirit72 at 10:22 AM on July 9, 2009 [4 favorites]


"Also, all you people who would love to have your taxes raised should know that you can actually pay more any time you want. Just cut a check to the Treasury, that's where your tax money would go."

I'm going to go with "idiot" too, seeings as how you can't understand why rational self-interest would mean being willing to pay a little more up front for a massive benefit down the line. Would I pay 20% more if it meant free health care? Fuck yeah, because that would easily offset the amount I paid in insurance (including employer matching and the tax credits).
posted by klangklangston at 10:24 AM on July 9, 2009


My guess is that not a single one of the people advocating for single buyer in this thread would have their taxes raised to pay for it.

Don't make that bet when there's a Sicilian Georgist in the room.
posted by @troy at 10:27 AM on July 9, 2009


That wasn't a dig at your dad, like_neon.
posted by Pastabagel at 9:26 AM on July 9 [+] [!]


I know you didn't mean for it to be a dig at my dad, but it is. Your self-righteous attitude implies that it's my dad's own damn fault he can't afford health care. He was just throwing money around on frivolous shit like my college education. Oh but as long as you and yours are taken care of, carry on.
posted by like_neon at 10:28 AM on July 9, 2009 [3 favorites]


Speaking of disingenuous...

You don't really get a say where your taxes go. It all goes into a big pot (with some exceptions) and how it's apportioned according to the budget that your elected representatives create.


Pastabagel's snark was meant to point out that, automagically, if I say I want my taxes raised in order to pay for a single-payer system, then I should be happy to send money to the Treasury right now. As others have pointed out, we don't currently have a single-payer system. If we did, then yes, I'd be happy to be taxed an extra Y% to pay for that.

I know that I don't get a say in where my taxes go. That's why Pastabagel's remark was disingenuous.
posted by rtha at 10:32 AM on July 9, 2009


1.) Ban the eating of meat or dairy products.

and of course there are no meat or dairy product manufacturers (or those who invest in them) in your investment portfolio

2.) Enforce a 35 mph speed limit.

and of course, you are currently driving just 35 mph - and there are no car manufacturers (or those who invest in them) in your investment portfolio

3.) Enact and enforce helmet laws for automobile drivers as well as motorcyclists.

and of course, you actually wear a helmet when you drive a car, right? and you have been busy advocating on the net and in real life that this and the 35 mph law be passed, right?

4.) Ban smoking.

and of course, there are no tobacco companies, (or those who invest in them) in your investment portfolio

something tells me that for all the ranting you do about milk, dairy, fast cars and tobacco, you've actually made some money from them over the years - you're willing to take the profit and someone else can take the loss, is that how it works?

unless you can prove to me that you've never made a penny on the things you disapprove of, you're a trolling hypocrite

which increases other people's blood pressure - that alone is justification for taxing you
posted by pyramid termite at 10:33 AM on July 9, 2009 [2 favorites]


Second, it is a certainty that "less overall" is code for some people will pay less, and a few people will pay a lot more, which is what is happening. I don't want to pay more, even if it means someone else has to pay less. Maybe this makes me a bad person? If so, it also makes the people receiving the benefit bad people for not thanking those who have to pay more so they can pay less, by the way.

(sigh)
It *will* take the Plague, won't it.
posted by emeiji at 10:41 AM on July 9, 2009


It *will* take the Plague, won't it


If that flu virus hits hard this fall, or mutates, we may very well GET the plague.

So, we'll see.
posted by spirit72 at 10:48 AM on July 9, 2009


There is single buyer, which is economically inefficient.

Bull fucking Shit. If you are a single buyer with a shit load of money because you represent a shit load of people, you're going to get some good deals. You will have serious negotiating power. As pointed out about, this is why the LCBO in Ontario can buy Wine and what have you for cheap. (And then tax it like taxes were going out of fashion.)
posted by chunking express at 10:48 AM on July 9, 2009


Also, all you people who would love to have your taxes raised should know that you can actually pay more any time you want. Just cut a check to the Treasury, that's where your tax money would go.

And this is why one should always wear a helmet when riding. Head injuries are no laughing matter.
posted by five fresh fish at 10:52 AM on July 9, 2009 [8 favorites]


I am in the top tax bracket here in Canada, and I have never felt I wasn't getting my money's worth. I know some of it goes to waste, but fucking hell, I'd hate to have to live like you do down in the States. Thinking twice about going to the doctor because you can't afford it? Because you might have to declare bankruptcy? I can't even imagine. Our socialized system means far less disparities in other areas of our lives as well. This leads to far less crime. Far less worry. It's just a far better way to live, fuck.
posted by gman at 10:56 AM on July 9, 2009


Faze... dude... If you're on a group (company) health insurance plan, you're ALREADY subsidizing the "fat-asses", smokers, old people, and breeders. It's rolled into the group plan, and you're paying a higher rate than you would if you were evaluated on just your own ultra-healthy merits. They're probably costing you $150 a month or more. Stew on that for a minute.

With that in mind, shouldn't you run around at work snatching burgers out of people's mouths and constantly berating their unhealthy lifestyles? Do you stand outside the obese woman's cubicle chanting "fatty-fatty-fat-fat!!" and physically threaten the young couple who has decided to have their first child? Or is this just a generalized hatred towards country-mates that you DON'T work with? Serious question -- I want to explore this notion.

My obvious point is that yeah it's NOT fair that you have to pay for somebody else's unhealthy habits. I agree! But guess what -- you're already doing that! Expanding the risk pool to include the entire country wouldn't change this one bit. If you're angry about the possibility of unfairness, then to maintain any logical consistency you should already be an angry person indeed.
posted by LordSludge at 10:59 AM on July 9, 2009


now we're like Br'er Fox trying to get free of the tar baby

That was Br'er Rabbit.
posted by albrecht at 11:01 AM on July 9, 2009 [1 favorite]


If you're angry about the possibility of unfairness, then to maintain any logical consistency you should already be an angry person indeed.

anger has adverse health consequences - i don't see why we should have to pay for the medical consequences of his anger issues
posted by pyramid termite at 11:02 AM on July 9, 2009 [2 favorites]


The pursuit of profit leads to public good. I wish this were taught in school.

Helping other people helps you. I wish this were taught in school.

From In search of the Swedish soul:

Four years ago his first born baby was diagnosed with a dangerous heart ailment. She was treated by a Libyan doctor in one of the world's top children's heart clinics in Sweden and has now recovered, a happy little girl. "Then I realised what went on inside the system I had rather derided. I saw what the tax system did with our money and how effective it was. The treatment did not cost me a kronor. More than anything this changed my attitude."
posted by shetterly at 11:06 AM on July 9, 2009 [1 favorite]


I'll keep this thread bookmarked so that in 1.5-3 years I can do an "I told you so" (via a FPP) when there is regulation/taxation/fines passed on U.S. citizen consumption of "X" since it has a theoretical remote correlation to health problem "Y" which may end up costing the government insurance program more money.
posted by hrbrmstr at 12:15 AM on July 9


This is true, although I think you're expecting it to be really significant, whereas in countries with public healthcare, it's just little incremental costs like, for example, cigarettes cost something $10/pack in Nova Scotia vs the $3/pack they cost in Tennessee. That's a significant cost if it happens all at once, but that $10/pack price was reached by increasing the price by a few dimes every year or every few years. So, yeah, there will probably be (more) sin taxes because of public healthcare. I think that's inevitable. I also think paying $7 more for a pack of cigarettes is way cheaper than paying thousands of dollars for a hospital stay. I don't think sin taxes are a reason not to have public healthcare, especially given that the U.S. already has sin taxes.

It's freedoms in general, not necessarily health care freedom.
posted by hrbrmstr at 12:15 AM on July 9


I know you mean, losing freedoms. But here's the thing: citizens of countries with public healthcare have significantly more freedom to change jobs (because it won't mean their kids will go uninsured), and to start new businesses (because you can get people to work for you without offering any health insurance at all, and because supplemental insurance - for drugs and dental and eyeglasses, if those aren't covered by the public system - is way cheaper than regular insurance that covers those things plus basic health, and because, again, they don't have to worry about their kids going uninsured).

Citizens of countries with public healthcare also don't go bankrupt from medical costs - which account for half of all U.S. bankruptcies. So the people who get sick, and then get well, and simply go on with their lives instead of being dragged through bankruptcy, have more freedom to do all the things that bankruptcy would have prevented, like buying a new house or getting a small business loan. And there's a spinoff economic benefit for everybody.

Public healthcare systems translate into a greater degree of personal freedom for their participants.

The overall tax burden in the US is among the lowest in the world:
posted by caddis at 10:24 AM on July 9


Now add the amount you pay in private insurance premiums for something people elsewhere get in return for their taxes.
posted by joannemerriam at 11:25 AM on July 9, 2009 [4 favorites]


Expanding the risk pool to include the entire country wouldn't change this one bit.

A single-payer system isn't about pooling risk. It's about eliminating risk. I had dinner last night at a restaurant with a bunch of people. When the check came, I was the single payer. Everyone else sat on their wallets. There was no risk involved. That's a single-payer system. I pay, you eat. Of course, I was happy to buy dinner for my delightful friends. But if, say, Dennis Kucinich (a vegan, by the way, and not an unfamiliar figure in this restaurant) had grabbed my credit card and forced me to pay the checks of the 300 pounders sitting next to us washing down their steaks and fries with pie and milkshakes, that would be like single-payer health care.
posted by Faze at 12:00 PM on July 9, 2009


Bullshit.
posted by klangklangston at 12:03 PM on July 9, 2009


A single-payer system isn't about pooling risk. It's about eliminating risk. I had dinner last night at a restaurant with a bunch of people. When the check came, I was the single payer. Everyone else sat on their wallets. There was no risk involved. That's a single-payer system.

That may be the biggest load of horseshit I've ever read.

Unless you used your exemplary genius and incredible buying power to renogiatiate the dinner tab, that most certainly is not a single-payer system.

Either you are exceedingly misleading on purpose, or you are exceedingly ignorant.
posted by Benny Andajetz at 12:05 PM on July 9, 2009 [3 favorites]


uh, renegotiate

sorry, hard to type and shake my head in disbelief at the same time
posted by Benny Andajetz at 12:07 PM on July 9, 2009


Please. I am willing to learn here. But what I'm seeing---and not just from MeFi-ers, but from damn near everyone who opposes a public healthcare option, is that they're willing to point to strawmen and red herrings all day, but when pressed, they can't seem to propose a better solution, or really do anything but shrug and admit that something does need to change.

We all need to listen to each other, kudos to you.

I like FreeMarketCure, which even contains a few articles by the previously mentioned David Gratzer.
posted by gushn at 12:11 PM on July 9, 2009


That's a single-payer system. I pay, you eat.

No, my friend. This is called "Your Treat".

In a single-payer system, everyone else at the table would have previously paid you. You just negotiated the price and handled the transaction.
posted by spirit72 at 12:15 PM on July 9, 2009 [2 favorites]


No, my friend. This is called "Your Treat".

Yeah, I admit that was a pretty stupid analogy. Maybe I been on this thread too long.
posted by Faze at 12:19 PM on July 9, 2009


Yeah, I admit that was a pretty stupid analogy.


I didn't say it was stupid, just incorrect.:)
posted by spirit72 at 12:21 PM on July 9, 2009


Heh, Faze, I figured you were just making a pun on "single payer"...

Please answer my question, btw, on why you're okay with pooling risks with comparatively unhealthy company-mates but not with unhealthy country-mates.

You don't... hate America... do you?? ::puppy-dog eyes::
posted by LordSludge at 12:21 PM on July 9, 2009


...if, say, Dennis Kucinich ... had grabbed my credit card and forced me to pay the checks of the 300 pounders sitting next to us washing down their steaks and fries with pie and milkshakes, that would be like single-payer health care.

No, it wouldn't. If he'd grabbed the credit cards of everyone eating in the restaurant and charged an equal share of the total cost of all the meals to each card, that would be more like single payer. But it is a stupid analogy.
posted by Kirth Gerson at 12:29 PM on July 9, 2009 [2 favorites]


My guess is that not a single one of the people advocating for single buyer in this thread would have their taxes raised to pay for it.

*raises hand* I'll gladly pay higher taxes so I don't have to watch people slowly die every day due to lack of access to health care.

That having been said, I'm going to go cry for a while after reading this thread.
posted by threeturtles at 12:35 PM on July 9, 2009 [4 favorites]


Wait. You know what? You could TRIPLE my income taxes if I didn't have to pay for care not covered under my husband's crappy private insurance.
posted by threeturtles at 12:37 PM on July 9, 2009


But if a completely voluntary public option is not a solution for you guys, what is wrong with it in your opinion?

The ideologues are against it because it "gets the government involved".

The powerful are against it because it might show up the private insurance companies. At best, it would put downward pressure on prices (and profits), and,at worst, it would drive private insurers out of business.

It's funny that they argue out of one side of their mouth that " government botches everything they touch", and, out of the other, "private insurance can't compete with the government". Seems they want it both ways.

Honest competition is the last thing the monied interests want.
posted by Benny Andajetz at 12:38 PM on July 9, 2009


He doesn't hate America, just his fellow Americans.
posted by five fresh fish at 12:43 PM on July 9, 2009


Most malpractice suits are settled for completely reasonable sums directly related to the cost of ongoing care

But if the insurance company does not need to pay out anything directly related to the cost of care because of government health coverage the premiums would be much lower. According to this: "The annual malpractice fee for family physicians who practice obstetrics is $1,560 in Canada,12 and averages $11,389 in the United States. For family physicians who do no obstetrics, the annual fee is $760 in Canada,12 and averages $6,037 in the United States. (11) All monetary figures have been converted to US dollars to facilitate comparison.)"

The point upthread about this being a bad time demographically to change health coverage in the US is apt. Won't the bulge of boomers soon be covered under government care anyways, creating a burden to the government coffers regardless? (Sorry, I can never remember which is Medicare and which is Medicaid). However, perhaps boomers will agitate for their precious millennial/echo boom children that keep coming back to their parents and draining the boomers retirement saving to pay for health care for their thirty-something children and grandchildren.
posted by saucysault at 12:49 PM on July 9, 2009


The fat slob who costs the taxpayer money because of his Haagan-Daaz consumption is going to be the "welfare queen" of the single-payer era; it's the sort of thing that just infuriates people. The idea that somebody might be taking advantage of the system is more than enough reason, to a lot of people, to just rip the system apart and let everyone pound sand on their own. (Cf. welfare reform.)

Or, even worse, arguments like Faze's could actually win, and you'd end up with a system where individual liberty was stunningly reduced in the name of healthcare costs. Probably not all at once, but you could make a good incrementalist argument for just about everything Faze is suggesting. Not overnight, but in time; a sort of "creeping dystopia" driven by penny-pinchers and authoritarians.


Those are plausible worries, but surely you can put them to rest by looking at other countries that have had nationalised health systems for most of a century? Where is the persecution of the self-indulgent, or the dystopian intrusion into daily life? Not where I live, even though we've run things the scary way since WWII.

Here's something you might like to consider. In my country, in the years between 1984 and 1991, a succession of governments with neoliberal policies implemented a near complete monetarist reform of our economy. Floated the currency, abolished all duties and tariffs, broke the unions, liberalised the financial markets, and turned New Zealand into one of the most lightly regulated economies in the Western world. More so than the US, according to the OECD. Yet there were two things they did not touch beyond reform around the edges, and those are nationalised healthcare, and compulsory nationalised accident/injury insurance -- because even in those years, when the population was kind of convinced that deregulation was necessary, that would have been political poison. Nationalised healthcare is that popular. The way that Americans defend their system produces bewildered headshaking. It's just so... obvious.
posted by i_am_joe's_spleen at 12:53 PM on July 9, 2009


My guess is that not a single one of the people advocating for single buyer in this thread would have their taxes raised to pay for it.

The fact that you can write something like that and not know it's ridiculous is one of the reasons you aren't being taken seriously.

Here's my situation. I'm a minister in a tradition that has no denominational hierarchy, and therefore no group health plan, retirement, etc. You have to go find your own insurance and start an IRA if you want health coverage and retirement income. My wife has a pre-existing condition, which means that no one will offer her an individual plan. When we married, she was a teacher and had good insurance, but when our daughter was born, she wanted to stay home. She kept her school insurance for a long time through family leave time and COBRA, but eventually it was going to run out. We were scrambling to figure out what to do. It looked like there was no way around either her going back to work or me trying to switch denominations. I guess neither of those was necessarily objectionable, but I find it very difficult to breastfeed, no matter how hard I try, and a denomination switch at this point would involve a lot of different kinds of adjustments, and almost certainly a move to a different town--there are only so many churches looking for preachers at any given time. Or I guess I could find something else to do with a Doctor of Ministry degree, but that really pretty much sets you up for one career path.

Fortunately, just when we were about to have to make some critical, life-disrupting decision, I found out that I could get into the group plan of a related denomination that was graciously allowing their ecclesiastical cousins to piggy-back into their system. Their health plan was quite literally the only one that we could get without a major career change on my part, or my wife going back to work with a toddler at home and, by then, a baby on the way. When you only have one option, you take it, and we did.

I write a check every month for $1000 to cover our family. There's no vision or dental coverage, so I write more checks for dental trips and for my contact lenses. My wife sees her specialist once a month, so I write $150 checks for that until her deductible is fulfilled, and then I write $60 checks. Her meds are around $80 with our prescription plan. Our son was born four months ago and spent two weeks in NICU with complications. Insurance came through pretty well for us. I only had to write a $2500 check for that. Another $1500 for my wife's delivery and hospital stay. By the time you add all of this up, plus whatever care my daughter and I will need, we're looking at something like $18,000 to $20,000 out of my pocket for health care. With insurance.

To be honest, as clergy members go, I get a pretty generous salary. Lots of my colleagues are not too far above the poverty line. But $20,000 a year is still a big chunk of money. And even a less eventful year will run us a minimum of $16,000.

If there were a public option, would we take it? In a heartbeat. Would I mind having my taxes raised for it? As long as we stay under the 53% bracket, I'm still coming out ahead.
posted by Pater Aletheias at 12:59 PM on July 9, 2009 [12 favorites]


Yes, it's a bad analogy and an incorrect one.

If Faze in this scenario is the single payer, he's not using solely his own money to pay the bill. Everyone has already given him some money. He has put some of his own money into the pot. Other people's money subsidizes some of his organic salad; his money subsidizes some of somebody else's glass of wine or steak. And he's negotiated a good price for the whole group.

The FreeMarketCure site that gushn linked to above is...interesting. I'll give it a more thorough read when I have a bit more time, but what struck me right off (from here) was this: When people perceive that someone else is paying for something, they tend to over-use it. In a single-payer health care system, people over-use health care. This puts strain on government health care budgets, and to contain costs governments must ration care.

As they say on Wikipedia, cite please. Is there an epidemic of frivolous and wasteful use of health care in systems that are single-payer?
posted by rtha at 1:00 PM on July 9, 2009


Is there an epidemic of frivolous and wasteful use of health care in systems that are single-payer?

I would infer from the fact that I have 5years longer life expectancy than an American man, despite my country spending way less per capita or as a percentage of GDP than the US, that it is the US that has a frivolous and wasteful system.
posted by i_am_joe's_spleen at 1:05 PM on July 9, 2009 [3 favorites]


"Also, no one here advocating for a government consolidation of the insurance industry would be doing so if a Republican were in the White House. Implicit in calls for single payer healthcare is the notion that they would be administered by a Democratic administration."

I've been calling for public health care in the states since at least Bush the Elder. But it could be I have an unreasonable expectation that government will be free from wide spread corruption; I know lots of people in the states don't feel that way and think the government wants to force them to marry their bowling buddy and other crazy shit.

"Who are you people who have no waiting times in the USA? If I called my doctor - an OB/GYN - today with something dire, I'd be lucky to get in to see her in a week to ten days. If I complained, they would tell me to go to the ER. If I called looking for a checkup, I could probably make an appointment in, ummm, late September."

AskMe is overflowing with stories starting "I know you're not my doctor but I can't see them until next week".

"Yes, people would change their behavior if they were economically incentivized to do so. If obese people could save 50% on their insurance (of if they suddenly had to pay 50% more), then some of these people would lose the weight. "

Sure, they could choose between eating and getting that leg set after it got broken by a hit and run.

"Also, all you people who would love to have your taxes raised should know that you can actually pay more any time you want. Just cut a check to the Treasury, that's where your tax money would go. "So I assume you will all be paying 20% more than you have to this year?"

Can you actually do this in the States? Revenue Canada would just return your cheque.

For those who are against a universal system because it would raise taxes; why doesn't self interest over ride this? How much are you willing to pay to increase the chance your barber doesn't have tuberculosis, your nurse doesn't have hepatitis, your green grocer or chef doesn't have typhoid, your booty call doesn't have syphilis? Service industry workers after all tend to have the worse benefits and shitty pay.
posted by Mitheral at 1:06 PM on July 9, 2009 [1 favorite]


Here's a page with a nice graph of life expectancy vs per capita healthcare spending.
posted by i_am_joe's_spleen at 1:23 PM on July 9, 2009 [4 favorites]


Can you actually do this in the States? Revenue Canada would just return your cheque.

You can do it in Canada too, you just have to do it explicitly and check off the right boxes. Well, you can do it in Ontario at least - the Ontario Opportunities Fund.
posted by GuyZero at 1:28 PM on July 9, 2009


I would infer from the fact that I have 5years longer life expectancy than an American man, despite my country spending way less per capita or as a percentage of GDP than the US, that it is the US that has a frivolous and wasteful system.

No, no, joe! Haven't you been reading this thread? I mean, all the people objecting to a single payer system have presented overwhelming and really correct evidence of how broken and awful and wasteful such a system is!

Hang on, I'll link to some comments.

The sound you hear is crickets, because there haven't been any comments that show that.
posted by rtha at 1:33 PM on July 9, 2009 [1 favorite]


Faze = Gordon Gekko?
posted by Saxon Kane at 1:37 PM on July 9, 2009


Something that strikes me about the arguments of people like Faze, et al, is that they seem based in a fundamental belief that life is fundamentally about competition. "I don't want to pay for someone else's healthcare, education, etc., because doing so does not directly benefit me. In fact, it probably hurts me, because then I am not spending money directly on my own healthcare, education, etc." What they forget is that collaboration is often more successful than competition. It is to everyone's benefit to have a healthy population. It is to everyone's benefit to have a well-educated population. Do you not see how those things will help not only you, but your friends, family, and offspring? It seems like there's almost this pathological fear that any sort of social safety net is going to come back to bite you in the ass because your taxes may go to pay for the blood transfusion for the kid who is going to get a government scholarship to get a degree so he can steal your job and fuck your wife, so you better try to get them out of the picture now.
posted by Saxon Kane at 1:44 PM on July 9, 2009 [10 favorites]


Here's what the President has advocated so far:
"...a market where Americans can one-stop shop for a health care plan, compare benefits and prices, and choose the plan that's best for them, in the same way that Members of Congress and their families can. None of these plans should deny coverage on the basis of a preexisting condition, and all of these plans should include an affordable basic benefit package that includes prevention, and protection against catastrophic costs. I strongly believe that Americans should have the choice of a public health insurance option operating alongside private plans. This will give them a better range of choices, make the health care market more competitive, and keep insurance companies honest."
Single payer isn't being discussed as an option, except by Kucinich, who's a longtime advocate. People covered by employer health insurance will continue to be covered, with the exception that the employer contribution will be taxed as a benefit.

The pre-existing conditions thing is important, but I'm not sure the reforms proposed are going to be much of an improvement for those already covered. As for those who aren't currently covered, they'll still have to find the money to pay for a plan. And people will still be afraid to leave jobs and lose their insurance if the government plan doesn't provide good service.

Whether this is supposed to be the beginning of incremental reforms, I don't know. My biggest concern is that all these halfway, compromise reforms will be disastrous and the government option will become the insurer of last resort, making costs skyrocket (see Medicare). Once the pendulum swings back the other way, conservatives will dismantle it and use it as evidence that government run health care doesn't work.
posted by electroboy at 1:46 PM on July 9, 2009 [1 favorite]


Seriously, grow up. If you don't like opinions other than yours, maybe you shouldn't be on a discussion forum.

The difference is that my opinions are on a speaking basis with facts and reality. Yours? Not so much.

Because when O'Reilly does it, it is to silence things like 'facts' and 'reality'. advance his agenda.

When Kucinich does it, it is to ensure that those two things are heard. advance his agenda.

Fixed that for you.
posted by electroboy at 9:36 AM on July 9 [+] [!]


Uh, wow. That was just sad. Are you really trying to say that O'Reilly and Kucinich are the same? You are ... wow. You are just not in touch with reality. Facts scare you, don't they?

The overall tax burden in the US is among the lowest in the world:

Alright... now factor in the cost of healthcare, if you would be ever so kind.

Aw, y'know what, fuck it. There's little point in trying to get anti-healthcare demagogues to come to this planet and actually deal with reality. Good luck, USA. You're going to need it.
posted by dirtynumbangelboy at 2:17 PM on July 9, 2009 [1 favorite]


Uh, wow. That was just sad. Are you really trying to say that O'Reilly and Kucinich are the same? You are ... wow. You are just not in touch with reality. Facts scare you, don't they?


God you're an idiot. The point is that it's wrong when either of them do it.
posted by electroboy at 3:07 PM on July 9, 2009


The overall tax burden in the US is among the lowest in the world

Only if you do not count the burden of purchasing private health insurance. Otherwise you are comparing sharks and bunnies.


Ok, so let's actually compare.

While living in the UK, my husband and I earned about the same amount we earn here (taking the exchange rate in to account). Our tax rate in the UK was 23%. Here, it's 25%. Hmmm... so far it's not looking too good.

From that 23% tax rate in the UK, I enjoyed unlimited visits to the doctor (yes, I got to choose which one I wanted to see) and any prescription I wanted was £6.85. Since I take maintenance meds for allergies and stuff like that, I opted to prepay for my prescriptions. That means a flat £9.84 per month was automatically deducted from my bank account, regardless of how many scrips I got that month. My husband opted to do the same. So... 23% tax rate and a grand total of £19.68 per month in out of pocket expenses. That's relying entirely on the NHS with no supplemental private insurance whatsoever.

Here we're paying 25% in taxes. In the past THREE MONTHS we have spent $3,540.59 out of pocket for doctor's visits and prescriptions, and that's with insurance.

So yeah, we're still comparing sharks to bunnies
UK=bunnies US=sharks
posted by ValkoSipuliSuola at 3:14 PM on July 9, 2009 [8 favorites]


Around 10%of my income goes to National Insurance, funding the NHS among many other contributory benefits I will enjoy at some point in my life (pension, bereavement - yes! every partner in the UK receives a couple of thousand pound when their partner dies, regardless of other life insurance - incapacity benefit etc etc). Through the NHS I get to see a doctor whenever I'm sick, pay £6 for prescriptions (oh! unless it's for contraception or I'm pregnant or disabled or a number of other exclusions, then they're free), I see specialists and have tests and surgery conducted at a world-class teaching hospital (my nearest) whenever necessary, the day after they've been ordered so far. What proportion of American income goes to health care and you still have to fucking worry?

Oh, and as a smoker, I also fund the NHS through the taxes on my cigarettes - around half the cost of each packet.If I cost the NHS later on due to smoking-related illness I don't give a fuck, because I've well and truly paid for it already.

Your system is broken, America. Why on earth do you put up with it?
posted by goo at 3:18 PM on July 9, 2009


Heh - snap, ValkoSipuliSuola!
posted by goo at 3:21 PM on July 9, 2009


Oh for crying out loud:

My guess is that not a single one of the people advocating for single buyer in this thread would have their taxes raised to pay for it.

That doesn't mean "if you had the choice you would have your taxes raised", it means "you will have your taxes raised to pay for it whether you want them raised or not". I really am sorry that people don't have access to health care or that their insurance is massively burdensome. I know full well that this happens to people, thank you very much.

There is already a government plan in the works to provide health coverage only for people who don't have it now (not a single payer plan), and congress is talking about raising taxes on a certain group of people to pay for it. My comment was intended to be a less blunt phrasing of: are any of you people now advocating the single payer system going to be in the class of taxpayer whose taxes are being raised now.

In other words, you are a saying you'd much rather have your taxes raised a little if it means paying less (or none) for private insurance. Obviously you would do this. That isn't what I'm talking about.

I'm talking about having to pay BOTH private insurance in the same amount you are paying now AND having your taxes raised. Get the picture?

So really what this thread comes down to, what everyone has admitted, is that they will pay more in taxes if it results in a net decrease of (taxes + health care expenses). Color me unsurprised. So self-interest dominates? What should I do, then, being faced with the non-hypothetical reality of paying twice?

Also, I'm going to spare everyone the stories of my life without insurance, and the considerable pain I am still in on an hourly basis because of it, because it is not relevant to the story. Yes, everyone should have healthcare coverage, and access to care. THIS IS NOT THE WAY TO DO IT.
posted by Pastabagel at 3:27 PM on July 9, 2009


You know what'd be really cool? If we could compile a list of the valid concerns about universal health care and address them one-by-one, rather than arguing with particular people about it. Then compile the concerns and answers into a FAQ. (Hmm... surely somebody has done this already?) And source the answers from somewhere other than the typical liberal outlets. I'm a raging liberal myself, and would be happy to kick a bit more into the pot to make sure my friends are taken care of, but we gotta meet conservatives on their own ground.

Something like... (I'm just pulling the numbers from my ass, and we universal health care supporters may even be *gasp* wrong on a few points!)

Q: I'm worried that my taxes will go up.
A: They will, but less than you're currently paying for private health insurance. On average, your yearly taxes will increase $3000, but the average health insurance premium is $3800/year, so the average insured person will save $800 per year. (source: blahblahblah)

Q: I'm worried that quality of care will decrease and there will be longer waits.
A: In 9 out of 10 westernized states, the wait lists are actually shorter. (source: pretty chart from foo) Quality of care is similar, slightly better in some categories, slightly worse in others... (source)

Q: What if I'm happy with my current private health care insurance?
A: Great! You can opt out of the single payer system and your taxes will be unaffected. If you change your mind later, we'll be here.

Q: Will all this govt involvement have a negative impact on economic growth?
A: Exactly the opposite. Countries reported an average boost of 6% GDP growth within 5 years of implementing nationalized health care, compared to 4% growth in countries that did not. (source blahblahblah2)

Q: Won't people abuse the system, say go to the ER for a hang-nail?
A: A study in 2007 shows that this is not the case... (source foobar)

etc. etc.

We're not going to convince people to care about their fellow countrymen, or not to be racist... just ain't gonna happen. (Hmmm, or could we...: "Jesus says we need to care for the sick, and elderly..." heh) But the more good information we can show that it's in their own financial and health interests to push for universal health care, the more pressure there will be from all angles to MAKE THIS HAPPEN.
posted by LordSludge at 3:42 PM on July 9, 2009 [2 favorites]


I'm talking about having to pay BOTH private insurance in the same amount you are paying now AND having your taxes raised. Get the picture?

If there was a public option, you wouldn't have to pay for private insurance. Get the picture?
posted by vibrotronica at 3:42 PM on July 9, 2009


"There is already a government plan in the works to provide health coverage only for people who don't have it now (not a single payer plan), and congress is talking about raising taxes on a certain group of people to pay for it. My comment was intended to be a less blunt phrasing of: are any of you people now advocating the single payer system going to be in the class of taxpayer whose taxes are being raised now."

A certain group of people? You mean negros? Oh, no, you mean top income brackets, but are reluctant to say so because, well, you know, those terrible undeserved class resentments of hoi polloi.

So, wait, your position is that because you make more money, it's better to not change the system because you're likely to be disproportionately taxed? Aside from your abysmal failure top present anything like a credible case above, it seems like what you should do is advocate an expansion of the system to make sure that it covers you as well, thus lowering your overall costs. Since this is one of those places where you do best with the biggest plan, second-best with the smallest plan, and worst with the medium plan, and given that the smallest plan is morally reprehensible and ends up costing everyone more than the bigger plan, well, you know, I'm again at the point where I think it's your ideological commitment to a lot of libertarian handwaving that prevents you from realizing your best option.
posted by klangklangston at 3:52 PM on July 9, 2009 [7 favorites]



Well said, Pastabagel. I don't want to shut anyone out, but at the same time I'd rather people keep their hard-earned money and spend it as they please.
posted by gushn at 7:25 AM on July 9 [+] [!]


Hey, Mr Works in New York Finance, when are you returning your porion of the trillion-dollar bailout that underwrites your job to the federal government?

The pursuit of profit leads to public good. I wish this were taught in school.

Love Canal. Triangle Shirtwaist Factory. The last round of unrecalled defective pacemakers. "New" drugs that actually aren't any more effective than "old" drugs except the drug company can charge "new" drug prices for them, and the "old" ones are generic. Enron. Madoff.


You forgot Thalidomide, Bhopal...

There is single buyer, which is economically inefficient.

Economies of scale must be sending Wal-Mart broke.
posted by rodgerd at 4:11 PM on July 9, 2009 [1 favorite]


I would infer from the fact that I have 5years longer life expectancy than an American man, despite my country spending way less per capita or as a percentage of GDP than the US, that it is the US that has a frivolous and wasteful system.

Using life expectancy to compare the effectiveness of health care across boundaries is extremely treacherous.

Observe the exchange between libertarian economist Tyler Cowen and liberal blogger Ezra Klein chronicled in the economist. The conclusion presented shows that the U.S. is more productive in care, although wasteful administratively. (relevant book source)

Other wonky life expectancy statistics may baffle you too:
Japanese Americans have the longest measured life expectancy on this planet. Mormons live 10 years longer on average than Europeans.
posted by gushn at 4:22 PM on July 9, 2009


From Pastabagel's "certain group of people" link: As discussed in the tax-writing House Ways and Means Committee, the surtax would apply to individuals with adjusted gross income of more than $200,000 and couples over $250,000, they added.

Some numbers: In 2006, there were approximately 116,011,000 households in the United States. 1.93% of all households had annual incomes exceeding $250,000.[5] 12.3% fell below the federal poverty threshold[6] and the bottom 20% earned less than $19,178.[7]

So, that's 1.93%, but it's actually fewer households than that, because that's not adjusted gross income.

If I made more than $200K/yr, then yes, I'd be fine with being taxed more if I got fewer uninsured people out of it. I'm never going to make that much money (and I'm fine with that, or I would've decided to do something other than be an editor), but I'd be fine with being taxed more right now if that meant more of a safety net for those without, for me and my family when we need it. But I'd prefer a single payer system (in case I haven't made that obvious!).

What should I do, then, being faced with the non-hypothetical reality of paying twice?

Advocate for a single payer system. Obviously.
posted by rtha at 4:29 PM on July 9, 2009 [2 favorites]


Perhaps you're thinking the NHS numbers I posted earlier are a fluke, so let me give you another example.

In Finland, we made significantly more and paid a whopping 32.5% in taxes. As with the UK numbers, I'm working from old paystubs here. In exchange for that 32%, I could go to the doctor for free any time I wanted, but I would have to wait a couple of days to get an appointment (assuming it wasn't an emergency). If I wanted an immediate appointment and opted to go to a private physician, it was still subsidized by Kela and I paid between 28€ and 52€ depending on the type of appointment. I paid out of pocket for my meds, but what costs me $96.87 a month here cost me 8.05€ there. Also, they have an annual out of pocket limit of 650€. Once I hit that limit I didn't pay for meds anymore. Nice, huh?

Having a baby? In addition to the 18 weeks of paid maternity leave, here's a nifty box of free stuff for you. Need to take a leave of absence to care for your sick child? Not to worry. Kela will pay your salary for up to 60 work days, 90 if your child's doctor says he still needs additional care. Add in child care subsidies (they pay for daycare or give you cash if you're a stay at home parent) and a monthly child benefit (cash paid to you as a parent just to help you raise and care for your child).

Americans are getting screwed. More accurately, Americans are screwing themselves.
posted by ValkoSipuliSuola at 4:50 PM on July 9, 2009 [1 favorite]


We all need to listen to each other, kudos to you.

I like FreeMarketCure, which even contains a few articles by the previously mentioned David Gratzer.


Can someone explain what the free market solution is for people who are uninsurable, like the leukemia survivor in the Kos diary? I'm not trying to be snarky. I looked over the FreeMarketCure site and I'm seeing a lot about "encourage competition between insurers." I can't see how that helps when insurers are doing everything they can to avoid covering people like her. I can't imagine greater competition among insurance companies making it more likely for them to take on patients with serious illnesses, but maybe I'm missing something.
posted by creepygirl at 5:13 PM on July 9, 2009 [5 favorites]


More accurately, Americans are screwing themselves.

It's not the first time. You recall our 2004 Presidential election?
posted by darkstar at 5:15 PM on July 9, 2009 [2 favorites]


In Finland…

Yeah, but we have more aircraft carriers.
posted by Civil_Disobedient at 5:21 PM on July 9, 2009


Yeah, but we have more aircraft carriers.

They're hard as hell to fit through the door at the doctor's office, though. Still - aircraft carriers!
posted by rtha at 5:31 PM on July 9, 2009 [2 favorites]


Maybe part of the reason I can afford health insurance is that I don't spend money on useless shit like iPhones and music for iTunes.

I can't say much about iPhones, but a life without music is no life at all, to my mind. And perhaps the question here is a larger one: what do you want your life to be? A race where you let the wolves take the stragglers and you, the glorious individual, triumph? Do you really see yourself on your deathbed croaking out that at least nobody ever got undeserved health care on your precious dime? The price of everything and the value of nothing, indeed....
posted by jokeefe at 5:46 PM on July 9, 2009 [4 favorites]


If Americans don't want to subsidize one another's healthcare, I don't see why the Third World and developing countries should - thanks to the machinations of the IMF and World Bank - continue subsidizing America (or, more accurately, American businesses).
posted by turgid dahlia at 5:50 PM on July 9, 2009


I can hardly talk though, I guess. Whenever I come across a hobo with a freshly self-amputated leg, I tell them that laughter is the best medicine. Then I tickle them. You should see them smile! Then I tell them that prayer is also another best medicine. People tell me "But turgid dahlia, medicine is actually the best medicine" but what would they know? One guy set his dog on me, and I remembered something about music soothing the savage beast, but I couldn't get it to wear the headphones from my Walkman. So here we all are. Also I got a racecar. Is any of this getting through to you?
posted by turgid dahlia at 5:56 PM on July 9, 2009 [6 favorites]


Clearly, we should send some aircraft carriers over to Finland and demand that they turn over their health-care system to us. Or else.

Do something useful with the damn things.
posted by Kirth Gerson at 6:00 PM on July 9, 2009


One thing that isn't mentioned, and needs to be borne in mind by those outside of America, is that the United States was born as a result of a Revolution, and that Revolution essentially began as a tax revolt.

Yeah, the colonists were a bunch of freeloaders who'd gotten used to being protected by an army which the British Isles paid for, and then when asked to contribute (and to tolerate Catholicism in Quebec, and let the Native Americans have the Ohio Valley), decided that this was INTOLERABLE and had to have a revolution about it.
posted by jb at 6:07 PM on July 9, 2009 [1 favorite]


Pastabagel, if you would just say "fuck you, got mine," it would save a lot of typing on your part. Because that's what your position boils down to. Same goes for you, gushn. If that's the way you feel, great, but don't try to say that our current system is the best for America, or for most Americans, or try to handwave away the real ethical implications of this system by saying "we're not France." Lazy, pathetic, cowardly euphemizing. It's best for you - or at least you think it is - and you don't give a fuck about anyone else. Got it.
posted by Optimus Chyme at 6:08 PM on July 9, 2009 [2 favorites]


Please identify for me a single government service that is inarguably superior to an equivalent provided by the public sector.

Fire, police, military are obvious. And as a university student and teacher who has been in the public and private systems - the public university system is on the whole better than the private. The private can be good, but cannot serve the vast majority of students; same goes for private elementary and secondary.

Also mail - USPS rocks, Royal Mail is a national treasure. Canada Post sucks in comparison to these two, but it's still better than any private alternative for low cost delivery to anywhere in the country.

The Brits could tell you that gov't maintenance of railway lines is much better than private, though some only acknowledged this after people died.

And as someone who has been in Canadian public health care, the British NHS and the American system: the gov't service is better.
posted by jb at 6:18 PM on July 9, 2009 [1 favorite]


i_am_joe's_spleen: "…Or, even worse, arguments like Faze's could actually win, and you'd end up with a system where individual liberty was stunningly reduced in the name of healthcare costs. Probably not all at once, but you could make a good incrementalist argument for just about everything Faze is suggesting. Not overnight, but in time; a sort of "creeping dystopia" driven by penny-pinchers and authoritarians.

Those are plausible worries, but surely you can put them to rest by looking at other countries that have had nationalised health systems for most of a century? Where is the persecution of the self-indulgent, or the dystopian intrusion into daily life? Not where I live, even though we've run things the scary way since WWII.
"

This is the typical response and I find it less than reassuring. In most of the countries where socialized healthcare seems to work, lots of "hot button" issues in the US are non-issues. I don't see a successful movement to disenfranchise gay people in the UK or Canada, nor a well-funded and well-organized bunch of pro-life slut-punishers hell bent on denying access to reproductive services by whatever means happen to be effective. (And with a long track record of being successful in it; e.g. the Hyde Amendment that I mentioned earlier, which if not repealed as part of a single-payer system would effectively ban abortions in the US by ending insurance coverage for them.)

If anything, I strongly suspect that taxpayer funding for healthcare would increase, not decrease, anti-abortion and anti-contraception efforts, since suddenly they would have an opportunity to use this new system to their advantage, and would able to make the "your tax dollars are being used to pay for abortions!" argument. That argument is what got the Hyde Amendment passed — it clearly works. It will be several more generations before these issues are settled, and before I'd begin to trust a healthcare system that was at the end of the day responsible to the voters.

I accept that socialized, single-payer systems seem to work in civilized countries. By any reasonable measure, the US is not a civilized country. It is a rich country. There is a big difference.
posted by Kadin2048 at 6:19 PM on July 9, 2009 [4 favorites]


oh, apparently you think those aren't good enough. Which is a moot point, since the private wouldn't be any better.
posted by jb at 6:22 PM on July 9, 2009


One might note that if the US didn't spend most of its budget on wars past and present, it could have a stonking good universal healthcare system.
posted by five fresh fish at 6:35 PM on July 9, 2009 [1 favorite]


Faze: "The health care "crisis" is being driven by a populace being driven mad by the scent of a government handout"

Holy shit! You were serious? This has to be on of the most retarded things I've ever read on MetaFilter. Considering the vast heaps of shit, you're shiny little turd floats effortlessly to the top.

Apologies in advance if this is just some elaborate performance piece. Hats off to you. You win. Something tells me though that it's not and it's frightening to think that there's more of you out there. As much as it pains me to say, I hope at some point you taste the pain of not being able to cover your medical expenses. I hope you get to see the fear in someone else's eyes as they stare down a six figure medical bill. I hope you taste the stench of a society that has turned into "every man for himself." Feel free to hit me up with some stats, reports, graphs, etc., to back you position but I must warn you; it will be a complete waste of time. We have a crisis on our hands. Let us do the big work.

gushn: "This exchange is quite shameful. It's not a "pwning" at all; it's not even a civilized debate. If you prefer to praise clips in which one person is bullied, not allowed to talk, and is interrupted at every turn, well I guess you've found it."

Oh boo hoo. If Kucinich had jumped over the table, caved his head in and started eating his brains, I would have considered it reason debate compared to what we're up against here. Either you are too insulated and ignorant to get his point or your silently sitting on your porch steaming mad about all those fat people walking by.
posted by KevinSkomsvold at 6:43 PM on July 9, 2009 [5 favorites]


One might note that if the US didn't spend most of its budget on wars past and present, it could have a stonking good universal healthcare system.

No. The USA is already spending much more on healthcare than any other country, per capita, yet getting next to nothing in return.

The problem is not lack of money. The problem is that no-matter how much money you throw at healthcare in the USA, most of it "leaks" before any actual healthcare gets purchased.

THe USA can have healthcare AND get to keep its wars and toys, it just needs to reform the healthcare to a system that spends the healthcare money on (gasp) buying healthcare, instead of a system that steals the money through corruption and fraud and bureaucratic inefficiency, and delivers next to nothing in return.
posted by -harlequin- at 6:45 PM on July 9, 2009 [2 favorites]


(However, from my experience, countries that forgo having endless wars do offer working healthcare systems AND lower taxes.)
posted by -harlequin- at 6:52 PM on July 9, 2009


-harlequin-: "The problem is not lack of money. The problem is that no-matter how much money you throw at healthcare in the USA, most of it "leaks" before any actual healthcare gets purchased.

THe USA can have healthcare AND get to keep its wars and toys, it just needs to reform the healthcare to a system that spends the healthcare money on (gasp) buying healthcare, instead of a system that steals the money through corruption and fraud and bureaucratic inefficiency, and delivers next to nothing in return.
"

Amen.

I worked in managed care and was either directly responsible for or indirectly responsible for denying care based on dollars. I've cut of treatment stays and kicked people out of detox centers because of their inability to pay or their insurance "ran out." It was an absolute horrible position to be in and I lost a lot of sleep and probably a lot of hair over the decisions I made but the staff got paid and upper management was happy with a capital fucking H. To this day, it sickens me to have been involved in treating health care as a commodity.
posted by KevinSkomsvold at 7:03 PM on July 9, 2009 [3 favorites]


The most outrageous thing to me is that anyone thinks that tying health care to what kind of job you have is normal, preferable or fair in any sense. No surprise that the people who think so were fortunate enough to be able to have a job where they currently believe they have good insurance (of course, anything can happen, as the main link in this thread goes to show).
posted by agregoli at 7:04 PM on July 9, 2009


Please identify for me a single government service that is inarguably superior to an equivalent provided by the public sector.

Let me compare the UPS and the USPS in my area. First, UPS refuses to leave anything at my house because they say that packages get stolen in my neighborhood. So I have to drive down to the customer office which is this poorly marked, ugly, dirty, cramped little windowless room staffed by grumpy clerks who yell at you if you haven't called ahead. And you have to get there on a weekday because they aren't open on Saturday.

The Post Office by contrast is very clean, well lit and open on Saturdays and as far as I can remember, the clerks have always been pleasant and helpful. But I seldom have to go there because my postal carrier, Lisa, asked me one day if it would be OK for her to leave packages on the side porch so that I didn't have to go pick them up at the office.

I'm always sort of amazed when people trot out the post office as an example of a bad government program; I'd much rather deal with them than any insurance company that I've ever dealt with.
posted by octothorpe at 7:58 PM on July 9, 2009 [8 favorites]


No. The USA is already spending much more on healthcare than any other country, per capita, yet getting next to nothing in return.

You're right. I forgot the US spends twice as much as the rest of the civilized world to get less.

What a drag on the economy it must be. For that reason alone, ignoring all the humanitarian reasons, you'd think the dipshits would be in support of it.
posted by five fresh fish at 8:03 PM on July 9, 2009


Canadian mefites, who among you wants to move to the U.S. because your healthcare system is so much worse than ours?

I work in an industry that has me in the USA about 5 months of the year & I could make at least twice as much money if I was there full time. That's an option I will never take for a variety of reasons, but right at the top is the health care situation. I choose who my doctors are, I get timely appointments, I get top notch care, I have the freedom to change jobs & move to other cities, I don't worry about getting sick, plus I can sleep at night knowing that my fellow citizens are similarly protected. It goes against every fibre of my being to only look out for Number One, in no small part because it's illogical. If everyone else is doing worse than I am, eventually that's going to have a negative impact on me.
posted by zarah at 8:21 PM on July 9, 2009 [8 favorites]


Numbers to think about, since I'm lucky enough to have 'em. I'm a white-collar employee of a fairly successful company. I'll do it in percentages, because you people don't care what I earn at my job. Note all percentages are off by a teensy bit, but let's not sweat it. I'm also assuming a cost for Medicare that makes sense to me, but might not to you. Here we go.

My total financial "rewards" per year:

- Salary, including paid days off, incentives, and bonuses: 84.5%
- Statutory (medicare, FICA): 4.7%
- 401K match: 0.4%
- Health and Welfare (aka what they pay for my benefits): 10.4%

So: I only see (pre-tax) 84.9% of what my company is actually paying me. The rest goes to Medicare/FICA (4.7%) and the insurance companies (10.4%.) In that Medicare/FICA number, 22% of that (or approximately 1.4% of my income) goes to Medicare.

Let's say Medicare gets expanded to cover everyone, and they say that I have to take the Medicare number and multiply it by five, so that my family of four is paying their fair share even if we don't use it. That's an extra 5.6% (roughly.) That seems like a reasonable number to start with.

So, presumably, my choices are to keep my private insurance, or not. So, options:

1. I keep my private insurance, and my company pays the extra medicare without reducing my salary. They're out 5.6% of my total cost and I'm unaffected.

2. I keep my private insurance, and have to pay for it out of pocket, because my company will no longer foot the bill since we have Medicare. I'm out 10.4% of my salary (presumably pre-tax), and my company saves 4.8% of my total cost.

3. I take the Medicare, and my company bumps my salary the difference. I get an extra 4.8% (presumably post-tax) and my company is unaffected.

4. I take the Medicare, and my company does not bump my salary the difference. My company saves 4.8% of my total cost, and I am unaffected.

Three of the four scenarios do not impact my finances. Under two my company gains, and under one they lose. The most likely scenario, then, is one in which neither of us loses, and at least one of us gains. So, scenarios 3 and 4 are most likely, and so for us the only thing to do is figure out who keeps the bounty. In a perfect world we split it, but odds are it'll be scenario 4.

So, under this theoretical construct, who loses?

The insurance company: the most likely outcomes that hurt neither myself nor my employer both stop paying the private insurance company.

Me, maybe: if Medicare-for-all turns out to be a disaster, and the coverage is crap, I'll either have to suck it up or pay for the private insurance for a net loss of 10.4% of my salary.

By this reckoning, if you put aside all the emotional "I don't want to pay for other people"/"everyone deserves health care" rhetoric, The best-case scenario for me is a 4.8% salary bump, the worst-scenario for me is a 10.4% salary drop, and arguably the most likely outcome is no change for me other than who pays for my health care.

Add your personal feelings and it gets more interesting:

- I might be risk-averse, and don't want to risk being in a position to get a 10.4% salary drop. Then again, if I'm risk-averse, I might consider that risk of a 10.4% salary drop to be reasonably-priced insurance against the risk of being out of work and having no health insurance;

- I might hate the idea of paying for other people who I don't think deserve it, but I'm already doing this for Medicare, so I might be able to get used to it -- or Medicare may frustrate the crap out of me on a daily basis, so there's no winning and I'll hate this;

- I might believe that a risk of a 10.4% salary drop is worth it to bring insurance to the masses -- or may see that number and realize I'm not as selfless as I once thought, and so I'll hate this;

- I might be risk-seeking, and don't think the risk of a 10.4% salary drop is a big deal, but then I also probably don't see anything wrong with being at-risk of having no health coverage.

It's no wonder people have such a hard time with this. Still, the bottom line (once you get past the emotional stuff) is this:

1. What's the risk that Medicare-for-all will suck balls?
2. What's the risk that I will be unemployed?

The only logical thing to hope for is this: minimize both risks by giving us Medicare-for-all, but let people continue to have the option for tax-free private insurance if they prefer it. Worst case, I'm either jobless but insured or I'm employed but spending around 7% (post-tax) of my income on private insurance because I don't like the public option.

also: FICA is a lot of money per month, huh? no wonder so many people hate social security. me, I don't mind it; I like to think of it as the money I would be giving to my mother right now each month if she wasn't on social security.
posted by davejay at 8:22 PM on July 9, 2009 [1 favorite]


...no change for me other than who pays for my health care.

Make that other than who pays my health care providers at the end of the month.
posted by davejay at 8:25 PM on July 9, 2009


Just read my own comment and realized something:

1. What's the risk that Medicare-for-all will suck balls?
2. What's the risk that I will be unemployed?


A stereotypical republican will assume that Medicare-for-all will suck balls and they'll never be unemployed because they work hard, so they'll assume the worst case scenario of losing money overall.

A stereotypical democrat will assume that Medicare-for-all will be as good as private options (or better) and they'll likely be unemployed because people sometimes end up unemployed despite working hard, so they'll assume the worst case scenario of being covered no matter what.

And that's the whole argument in a nutshell.
posted by davejay at 8:28 PM on July 9, 2009 [4 favorites]


A stereotypical republican will assume that Medicare-for-all will suck balls and they'll never be unemployed because they work hard, so they'll assume the worst case scenario of losing money overall.
posted by davejay at 11:28 PM on July 9


An awful lot of people are discovering what it's like to be unemployed this year. Some of them have to be Republicans.
posted by joannemerriam at 8:34 PM on July 9, 2009


Friends in France just posted about their experience: Healthcare and the Quality of Life in the South of France
posted by shetterly at 8:52 PM on July 9, 2009


Apologies in advance if this is just some elaborate performance piece. Hats off to you. You win.

I've enjoyed Faze's absurdist masterpieces for years. Just go through the comments to see that Jarry and Ionesco, two master absurdists held in high regard, don't hold a proverbial candle to the works of Faze.

If Metafilter is the Stuart Sutcliffe of Blogs, and it's not, but if it were, the works of Faze would guarantee that it would never be forgotten, or perhaps that's in the reverse.

Regardless, as a devotee of the theatre of the absurd I applaud, loudly.
posted by juiceCake at 9:04 PM on July 9, 2009 [2 favorites]


joannemerriam: "
An awful lot of people are discovering what it's like to be unemployed this year. Some of them have to be Republicans.
"

Oh indeed, there are plenty of now unemployed Republican Congressmen. Norm Coleman, for example.
posted by pwnguin at 9:15 PM on July 9, 2009 [1 favorite]


Been thinking about how to frame this issue in terms that a typical conservative or libertarian might understand. Any pro-government-plan argument that centers around "helping ourselves by helping others" (which is a high-minded and collective approach to the problem we face) just gets shouted down by the OMG SOCIALISM knee jerk reaction that the right has been constantly drilled to dish out.

So, I'm going to give it a shot. I'm going for it, buzzwords, dog whistles and all. Feel free to hear these in your head as being voiced over with the same foreboding storminess as a swiftboating ad:

A: Insurance companies tell you "you're covered!" - so why do they want to take away the money you work hard for by putting you in a special interest1 category, even if you've never been sick? Hardworking Americans deserve to get what they pay for. Isn't your family worth it? [image of crying six year old girl standing in front of an American flag.]

B: Small businesses and entrepreneurs take on personal risks to provide jobs for Americans. They make our country strong. But the insurance industry doesn't like risk. They prey on the men and women who carry the true spirit of our forefathers by denying them coverage, or by taking an unfair share of business owner's rightful profits! Insurance companies just don't understand the American Dream. [image of shark eating a tiny fish, Jaws music.]

C: America's history has been a fight for freedom. For ourselves, and for others. Our liberties are what we hold dear, and nobody will take them away from us. But insurance companies will try. Bill Jones just found a better job - one that will make it possible for him to send his son to college, and maybe even get that fishing boat he's been dreaming of. But his family won't be covered by insurance for six months if he makes the move. If something terrible happened before he got covered, Bill might have to give up those dreams. Is this really life, liberty, and the pursuit of happiness? [image of unmoored rowboat, drifting toward a gloomy darkening sky.]

1: Of course I mean special risk, but 'special interest' is still holding on to its post-08 campaign glow.
posted by contessa at 9:51 PM on July 9, 2009 [11 favorites]


"I don't see a successful movement to disenfranchise gay people in the UK or Canada"

There is a movement in the States to remove the right of gay people to vote?

"nor a well-funded and well-organized bunch of pro-life slut-punishers hell bent on denying access to reproductive services by whatever means happen to be effective."

Canada has had public health care for about twice as long as legal abortion and three times as long as gay marriage so when it was adopted these weren't dead in the water issues. Besides, isn't this sort of shifting the blame for crappy health care system onto gay people?
posted by Mitheral at 10:00 PM on July 9, 2009


Everyone here seems to love the single payer option. The thing is, that is not even on the table now. Get over it. The reason Obama is the man is that he moves beyond the daydream to the practical reality. He's a pragmatist, not an idealist. That is the most effective form of politician usually.

What do we need? Well, I have a short list:
-Cover everybody somehow.
-Eliminate the ability of the insurers to deny coverage because of pre-existing conditions or to drop you for getting sick.
-Put everyone into a large group rather than let the insurers pick off the weak.
-Cover things that should be basic like mental health.
-Address cost and pay the primary care physician more and the person who performs a procedure less. This is actually a huge point that has been tried before but the politics are brutal.
-Make preventative care cheap (free?) and easy to use.

What are our big problems now? Very many people are not covered, those who are don't get care they need, there is terrible waste and overhead in the system all in the name of reducing payouts to the insured, and part of all that is the drive by the insurers to deny coverage for whatever: pre-existing conditions, calling treatments experimental, games with reasonable and customary, and just the general incentive to be slow to pay.

You know that problem employee you have who when something gets tough instead of facing it just throws it into the bottom drawer and forgets about it? They just let those problems mount and fester and everything goes all to hell on those issues in that bottom drawer. Everyone knows one of these people. They often otherwise look like your best employee, but in reality they are your nightmare. Well, if you are an insurer they are your best employee. You just put them into your claims department. Every claim in that bottom drawer is money in your pocket. We need to eliminate that.

Most of the bureaucracy revolves around what should and should not be covered. I think, hope at least, that we could expand what is covered, and eliminate some of that ambiguity, by eliminating that bureaucracy. One would hope at least, but this may be the hardest part of keeping the private insurer.
posted by caddis at 10:07 PM on July 9, 2009


Contessa, the libertarian reply would probably come in two forms:

1) Obviously the healthcare industry is sick. But is to rid ourselves of socialist tools like employer run health care and replace it with a free market private insurance system. The question is, do you mandate the purchase of heath insurance by the young to help defray the costs of insuring the elderly? Can a government run plan discriminate by age?

2) Secondly, healthcare is expensive because medicine is highly regulated and there's too many barriers to enter the medical field. Remove the medical license boards and FDA!

*facepalm*

The way to address these people, I might suggest, is to mention that society exists to defend everyone's right to Life, Liberty and the Pursuit of Happiness. Medicine is not a commodity you can easily concoct a standard contract for and operate from a clearing house. And as the past year has shown, neither is insurance. Emergency medicine doesn't have time for consumer price shopping, and individuals can't compete with the army of actuaries employed in the grim business of pricing insurance. Liberty isn't synonymous with survival of the fittest, and leaving the sick to die is incompatible with Life.
posted by pwnguin at 10:59 PM on July 9, 2009


I had dinner last night at a restaurant with a bunch of people. When the check came, I was the single payer. Everyone else sat on their wallets. There was no risk involved. That's a single-payer system. I pay, you eat.

let me guess - they all had to eat cucumber and alfalfa sprout sandwiches

cause i know you didn't let them order anything with meat or dairy in it - right?
posted by pyramid termite at 11:25 PM on July 9, 2009 [2 favorites]


I'm trying to imagine why a libertarian would even have health insurance. It would drive them mad in the same way paying taxes seems to.
posted by maxwelton at 11:52 PM on July 9, 2009 [4 favorites]


Mitheral: "There is a movement in the States to remove the right of gay people to vote?

Don't be obtuse. Disenfranchisement involves taking away someone's rights; it does not necessarily have to be their right to vote. I can wait while you go look it up if you wish.

Canada has had public health care for about twice as long as legal abortion and three times as long as gay marriage so when it was adopted these weren't dead in the water issues.

And that's well and good, but right now we have achieved a fair bit of progress against the best efforts of the anti-choicers and anti-contraceptionists; essentially the only place they still have traction with the public is over how tax dollars get spent. Right now, lots of people have access to contraceptives and abortion services because they're funded by private insurance. No currently-existing public plan — including Medicaid and Tricare, which are frequently used as models for a 'public option' — covers elective abortions, because the anti-choicers have been very successful when the debate is framed over the use of tax dollars for abortions.

A move to a publicly-funded system might very well be a huge step backwards, and put the availability of services at the mercy of irrational ideologues. It would be trading the tyranny of the balance sheet for the tyranny of the opinion poll and ultimately the voting booth, and I think we need to have a pretty long national discussion about what that will mean before we jump out of the frying pan and into the fire. Given the option, I'd personally rather try to argue with an insurance underwriter than with someone from the Crazies for Christ camp; at least the insurance companies are driven by logic, cold as it may be.

Besides, isn't this sort of shifting the blame for crappy health care system onto gay people?"

I never implied anything of the sort and I'm not sure how you could have gotten that from what I wrote. The problem is on the other side; it's all the frothing-at-the-mouth homophobes and anti-abortionists who will stop at nothing and use any power they're given to enforce their social agenda on everyone else. There is a very deep, very nasty streak of authoritarianism in the American psyche, and I'm uncomfortable handing such an important lever of power over to We The People before we take a long, hard look in the mirror.
posted by Kadin2048 at 12:24 AM on July 10, 2009


Regarding the coverage of abortion in any theoretical plan:
My mother is in pants-shitting fear of the very idea of even moderately socialized medicine. She's also a rabid pro-lifer. Because she made a Michelle-Bachman-style-crazy-eye face at the mere mention of socialized medicine, I wasn't able to probe her rationale, but I imagine that abortion is a large part of it: "I don't want MY tax dollars paying for abortions!!! OR birth control!"

My solution: a little check box on tax forms; "Check yes to pay an extra 0.5% income tax to cover 'Conscience Clause' [or whatever verbiage] medical care." I'd check that box with ten thousand sharpies.
posted by notsnot at 4:47 AM on July 10, 2009 [1 favorite]


"Check yes to pay an extra 0.5% income tax to cover 'Conscience Clause' [or whatever verbiage] medical care." I'd check that box with ten thousand sharpies.

no that is impossible you are not being a rational actor

i do not understand hu-man altruism //// ERROR FAULT 9FA618E
posted by Optimus Chyme at 5:35 AM on July 10, 2009 [5 favorites]


Optimus Chyme: "
i do not understand hu-man altruism //// ERROR FAULT 9FA618E
"

Hey, what can I say, my parents raised me right.
posted by notsnot at 6:49 AM on July 10, 2009


Want to talk about wait times? Once again, I have (by most people's standards) very good private insurance. I pay extra for the best coverage I can get.

I have a chronic back condition that has random flare-ups. I had one last December, the week of Christmas. I went to the local health clinic, staffed by a nurse practitioner, because it was the only place I could get into that week. I got some pills. When I called back four days later to tell them I still couldn't walk, I was told they wouldn't see me again, and I needed to go to a specialist (who I had seen before). (This was New Years week.) I called the specialist's office and was given an appointment 14 days away as the soonest "emergency appointment." I called the NP back and said the specialist couldn't see me for 14 days and could someone please help. I was told to go to the ER. I waited 14 days and went to the specialists office, where I saw a Physician's assistant, not the doctor. He sent me for an MRI and told me they would schedule me for the doctor's next appointment.

When they called me with the appointment, it was for March 9. Two full months away. And at the time, I couldn't work, could barely walk at all.

Now, needless to say I never went back to either of those offices. Luckily, I got into another doctor in only a month's time. But I don't want to hear about how great our private system is because we don't have to wait to see doctors. Because it's just not true.
posted by threeturtles at 7:15 AM on July 10, 2009 [2 favorites]


But I don't want to hear about how great our private system is because we don't have to wait to see doctors. Because it's just not true.

Just to play devil's advocate, you did have the option of trying other doctors. Just because the particular doctor you wanted to see was booked, that doesn't mean no doctors were available.
posted by electroboy at 7:39 AM on July 10, 2009


Can someone explain what the free market solution is for people who are uninsurable, like the leukemia survivor in the Kos diary?

creepygirl, there can be a competitive market for high-risk patients, and the government can provide tax credits & vouchers to assist payments. More here and here.

If I made more than $200K/yr, then yes, I'd be fine with being taxed more if I got fewer uninsured people out of it.

rtha, how could you be arguing that the single-payer system costs less when you keep talking about higher taxes being acceptable? Clearly it will cost more for some people, and not support all the 'IT WOULD COST LESS MONEY OVERALL FOR EVERYONE!!!!' screaming that we've seen. Well, unless we plan on just totally soaking the rich because, well, 'from each according to his ability', right?

And really, why does this I'm-okay-with-something-therefore-everyone-should-be-okay-with-this-too argument keep coming up? Do you not see the utter absurdity of this? I'm sure I can bring up many, many examples of this line of thinking from the religious right which we'd both disagree with.

I didn't have time to look up the ex-ante moral hazard stuff in health insurance, rtha, but you are probably right that it is less of an issue than in, say, auto insurance.

Yeah, I just couldn't resist the Marx quote... hehe.
posted by gushn at 8:03 AM on July 10, 2009


No currently-existing public plan — including Medicaid and Tricare, which are frequently used as models for a 'public option' — covers elective abortions, because the anti-choicers have been very successful when the debate is framed over the use of tax dollars for abortions.

Ummm...I hate to break it to you, but I've had untold numbers of employer-provided private insurance policies and not one of them covered elective abortions. Hell, over half of them wouldn't cover contraception. So, I still don't see how a public plan is any worse....
posted by ValkoSipuliSuola at 8:26 AM on July 10, 2009


Well, unless we plan on just totally soaking the rich because, well, 'from each according to his ability', right?

[...]

Yeah, I just couldn't resist the Marx quote... hehe.
posted by gushn 39 minutes ago


hehe why don't you ever respond when i ask if you want to go back to the tax brackets of Saint Reagan
posted by Optimus Chyme at 8:42 AM on July 10, 2009


CSPAN video of a House subcomittee hearing on single payer healthcare.
posted by electroboy at 8:46 AM on July 10, 2009


hehe why don't you ever respond when i ask if you want to go back to the tax brackets of Saint Reagan

Here's the historical tax rates, please just make your point and get it over with.
posted by electroboy at 8:54 AM on July 10, 2009


Everyone here seems to love the single payer option.

Well, that might also be because metafilter is in an international website, and many of the posters are currently living under a single payer option which they think works great. (And it does.)

I agree that it might not be the most politically feasible option for the US right now, and that's why the administration is pushing the line, "no one will touch the insurance you have now if you like it" - they don't want people to feel threatened.

But that's not a good reason to exclude the option from the discussion. In fact, the administration could try to play this to their advantage - let the single payer advocates talk, and then "compromise" by offering the public/private system they are pushing for right now.
posted by jb at 8:57 AM on July 10, 2009


Here's the historical tax rates, please just make your point and get it over with.
posted by electroboy


I think his silence on the issue makes my point quite well, thanks.
posted by Optimus Chyme at 9:04 AM on July 10, 2009


True, much easier than having to make a coherent argument.
posted by electroboy at 9:11 AM on July 10, 2009


rtha, how could you be arguing that the single-payer system costs less when you keep talking about higher taxes being acceptable?

Because it would still cost less than what it costs now. Between what the employee and the employer contribute toward the premium and the deductible the employee has to clear before coverage kicks in, it would cost less. See here and here, for instance. It would cost less for the vast majority of people, and it would cost less for our society as a whole. The system we have now is fucked - we spend a truckload of money and don't get the return we should. How would making it more profit-oriented make it better? And, of course, if you have great coverage at one job, well, too bad, you can't take it with you.

Look at this chart*, which shows the rise in premium costs for single and family coverage for employer-sponsored plans over the last 10 years. Short version: Single coverage in 1999 - $2196; in 2008, $4704. Family coverage in 1999 - $5791; in 2008 - $12,680. Did wages increase by that much? Family coverage costs more than doubled in that time. Wages most certainly did not.

And of course the people who make more should contribute more, percentage-wise. When I was a cheese monkey at Whole Foods making 12 bucks an hour, we had insurance, but the cost was high and most folks picked the lowest cost option, which had the highest deductible, which meant that a lot of people put things off because they didn't have the financial flexibility to spend a $100 on an office co-pay and prescription. Now I make more money, and my employee contribution is higher (and so is my employer's), but I also get more for that - like a $5 co-pay and $5 prescriptions.

Check this out:
Between 1979 and 2005, the mean after-tax income for the top 1% increased by 176%, compared to an increase of 69% for the top quintile overall, 20% for the fourth quintile, 21% for the middle quintile, 17% for the second quintile and 6% for the bottom quintile.[21] For the same time span the aggregate share of after-tax income held by the top percentile increased from 7.5% to 14%.[21]

* My usual disclaimer: I work for the organization that produced this report, but I do not work in the policy area and do not write or research any of the reports, charts, fact sheets, issue briefs, etc.
posted by rtha at 9:22 AM on July 10, 2009 [3 favorites]


gushn, that quote is from Louis LeBlanc, not Karl Marx. /pedant
posted by shetterly at 9:31 AM on July 10, 2009


It's just Louis Blanc, shetterly. TRIPLE PEDANT MAXIMUM OVERKILL FATALITY
posted by Optimus Chyme at 9:44 AM on July 10, 2009 [6 favorites]


I just read this link form gman's post and I think I'm going to puke. From my understanding, insurance companies want you to pay for health care insurance, and then take out a second policy on your health status. IOW, you need to take out insurance on your insurance. This illustrates quite nicely why the for-profit health insurance provider paradigm is fundamentally flawed.

Now that it is commonly accepted that $N-$n = profit instead of set-aside, risk is reintroduced into the system. It should come as no surprise that people are again clamoring for risk mitigation. People, for whatever reason, are not focused on forcing insurance providers to revert the paradigm shift or develop new alternatives that would compete with said companies. Much of this owing to FUD from these same companies. At any rate a given company can go two ways with this:
  1. stop taking all of $N-$n as profit by dropping anyone who is actually at-risk and sell to the same customer base
  2. develop a new product to mitigate this second-order risk
Surprise!

The system isn't broken, we just need to purchase a new, additional policy to cover this inexplicable second-order risk that has reared its ugly head. Not to mention, who is to say that once it becomes generally accepted that companies can profit take from your second-order risk coverage until you actually need it, some kind of third-order risk coverage is required?

From their perspective it's policies all the way down.
posted by Fezboy! at 10:05 AM on July 10, 2009


I'm totally firing my copyeditor. Doing better work than gushn's is not good enough.

If he was a Superman villain or love interest, his name would've been Louis LeBlanc.

Okay, my bad.
posted by shetterly at 10:06 AM on July 10, 2009


err, and sell tot he same customer base should have been appended to the second list item. D'oh!
posted by Fezboy! at 10:07 AM on July 10, 2009


ValkoSipuliSuola: "Ummm...I hate to break it to you, but I've had untold numbers of employer-provided private insurance policies and not one of them covered elective abortions. Hell, over half of them wouldn't cover contraception. So, I still don't see how a public plan is any worse...."

Depending on which states you've lived in, they may have had restrictions on whether insurers could provide coverage for abortions. There's currently a split between various states as to whether this is allowable or not (there was a case in Rhode Island where the state restriction was struck down as a violation of the state constitution, but a statute in Missouri that was upheld; I don't know if it's been challenged at a Federal level), but it's a minority of states. Far more states restrict abortion access via publicly-funded state level plans (12 states) than via private insurance (5). And of course the Federal plans, which are the ones that really provide a model for national healthcare, are restricted to rape/incest/life-threat and this seems unlikely to change.

The vast majority (86.9% is the Guttmacher Institute number frequently cited) of typical employer-based private health insurance plans in the United States cover abortion.

From a perspective of an insurance company, it makes sense to cover abortions, since they are cheaper in most cases than mandatory prenatal care and a live birth. That's why you have Kaiser, in the link above, opposing any effort to limit it, and why the insurance companies are frequent targets of pro-lifer hate. They're not supporting a right to choose for philosophical reasons, they're doing it because the numbers work out tremendously in its favor.

That some states have tried to limit private insurance's coverage of abortions (or, in some states, push it out of the 'default' plan and into a rider) is unfortunate, but they've obviously had far less success at doing that than at eliminating it from public plans.

And it's not like the possibility of using healthcare reform as a vehicle for imposing pro-life views has escaped the authoritarians:
[In late June 09,] 19 antiabortion Democrats in the House sent a letter to Speaker Nancy Pelosi, warning that they ‘cannot support any health-care-reform proposal unless it explicitly excludes abortion from the scope of any government-defined or subsidized health-insurance plan.’ … If an explicit ban on abortion coverage were imposed…it could have much further-reaching implications than the Hyde Amendment ever did. It could, in fact, have the effect of denying abortion coverage to women who now receive it under their private insurance plans. Nearly 90% of insurers cover abortion procedures, according to a 2002 survey by the Guttmacher Institute… [source]
This isn't just a hypothetical threat; the anti-choice camp is already lining up to take advantage of it.

But abortion is only one example of way that a national healthcare system, if not properly insulated from the political realm, could be used to oppressive ends. We are proposing a system that would in all likelihood last generations, and would need to deal with threats not even possible to envisage right now. I'm not saying that it's impossible to create a national healthcare system that would be resistant to political manipulation, but it seems unlikely: it would require the system's implementors — probably the current crop of Democrats — to swear off using it to affect their own kind of social change as well. Politicians, as a rule, seem totally incapable of resisting that type of temptation.
posted by Kadin2048 at 10:35 AM on July 10, 2009


See here and here, for instance.

rtha keep in mind that those examples neglect employer contribution and VAT taxes, both of which are usually quite high (15-20% or so on VAT).
posted by electroboy at 10:42 AM on July 10, 2009


Ah, and apparently there's an additional 11% or so explicitly for the National Health Service.
posted by electroboy at 10:51 AM on July 10, 2009


People keep asserting without back-up that it will cost less. Where is the proof? Perhaps I missed it in the volume of posts here so if I did would someone kindly point it out to me? We will add 50% or so to the rolls of insured and it will cost less? This sounds like politicians saying that they will solve our budget troubles by eliminating fraud and waste in the budget. That's a lot easier said than done.
posted by caddis at 11:04 AM on July 10, 2009


People keep asserting without back-up that it will cost less. Where is the proof? Perhaps I missed it in the volume of posts here so if I did would someone kindly point it out to me?

BECAUSE IT COSTS LESS PER CAPITA IN EVERY COUNTRY IN THE WORLD.

My god, how many times does this point need to be made.

America, the world has run an experiment to check to see if universal care will lower your costs. It's our gift to you. And, like the hotel bibles keep telling you, there's good news.
posted by GuyZero at 11:06 AM on July 10, 2009 [4 favorites]


caddis, one element of that would be expanding the risk pool to cover otherwise healthy people who typically go without insurance. They would pay in to the system, and presumably not use the benefits as much as older or sicker people. Whether or not that balances out the baby boomers, I don't know.
posted by electroboy at 11:07 AM on July 10, 2009


caddis, because people don't have health insurance still generate health costs. And if they are unable to pay for the costs, they get passed on to the people who can -- you and me -- in the form of higher procedure costs, more expensive hospital stays, and higher insurance premiums to cover the average.

And don't forget, the middleman is tacking on a profit margin.
posted by contessa at 11:08 AM on July 10, 2009


And don't forget, the middleman is tacking on a profit margin.
And don't forget, the middleman is tacking on a profit margin.
And don't forget, the middleman is tacking on a profit margin.
And don't forget, the middleman is tacking on a profit margin.
And don't forget, the middleman is tacking on a profit margin.

See: Blood Money
posted by Benny Andajetz at 11:15 AM on July 10, 2009 [1 favorite]


lots of speculation, where is the proof, a study, something....
posted by caddis at 11:38 AM on July 10, 2009


Why do I get the feeling that if the Angel of the Lord came down, sucked you off, and farted out "It will cost less!" while doing so, you'd still doubt?
posted by notsnot at 11:57 AM on July 10, 2009 [2 favorites]


This is the best accounting I've seen for the reasons why American health care is so expensive. Here's a quick rundown:

1. GDP per capita. When you look at the raw dollars, the contrast is pretty stark, but when it's adjusted for GDP, the US is still high, but not quite so high.

2. Distribution of Market Power and Prices Medical personnel such as doctors and nurses are typically highly compensated in a labor intensive industry. Lack of collective bargaining and oversight further increase prices.

3. Capacity of Healthcare Systems The US has one of the lowest growth rates of new doctors in the world, and a significant number of the new doctors are foreign educated. Nurse to patient ratios are also lower. Medical school capacity has not grown since the 1970s. The US has significantly fewer hospitals per capita than Europe.

4. Administrative Complexity and Cost Inefficiency in payment systems, multiple buyers, etc lead to the administrative costs being about 2.5 times higher in a private system.

5. Unwillingness to Ration Care This was interesting because of this graph, showing the relative costs to extend life. It suggests that a significant expense is life extending therapies that are extremely expensive and ultimately don't have significant benefits.
posted by electroboy at 11:57 AM on July 10, 2009


Don't embarrass yourself by being obtuse, caddis. The proof is plain if you would choose to see it.

Healthcare costs for every nation in the world that has a national system are less expensive per capita than healthcare costs in the US. This is a fact.

A larger risk pool with all members paying into a single system, by virtue of its enormous size, will have the affect of every member paying less for health services than if they were separated into smaller pools, or no pool at all. Not only is this painfully obvious purely from a logical standpoint, it is a provable fact, supported by the statement above.

A system in which uninsured people still have demand for health services has an impact on the cost of those services to others, if the uninsured are unable to pay for them. Those costs don't just vanish by magic, or get paid "by the government," nor are they simply given away as charity. They raise the costs to everybody who can assume the burden of them, e.g. healtchare consumers who have insurance. This isn't some abstract notion; that's exactly how it works. Which would make it a fact.
posted by contessa at 12:00 PM on July 10, 2009 [1 favorite]


A larger risk pool with all members paying into a single system, by virtue of its enormous size, will have the affect of every member paying less for health services than if they were separated into smaller pools, or no pool at all. Not only is this painfully obvious purely from a logical standpoint, it is a provable fact, supported by the statement above.

This is not quite true, if the overall number of people receiving healthcare increases. I.e., right now we let a fair number of people just die from lack of treatment. Unless we're going to continue that (and apparently we are to some extent — the current plans exclude illegal immigrants), you could get a cost increase due to increasing the number of people receiving services at all.

Most advocates assert that this would be offset by cost savings due to increased availability of preventative care, but in the short run when you wouldn't have nearly enough GPs to offer everyone preventative care, it's not impossible to envision a cost increase as you start to get people going to the hospital and the hospitals actually treating them rather than stabilizing and pushing them out the door as fast as they possibly can. (This sort of comes back to one my earlier issues with current plans, which is that they focus far too much on universal insurance coverage and don't seem to do much about increasing the actual capacity for medical services.)
posted by Kadin2048 at 12:11 PM on July 10, 2009 [1 favorite]


After looking over electroboy's accounting, a few thoughts come to mind:

Alot of these discrepancies, IMO, come directly from our profit-driven system -

1. Profits are protected by limited supply: The high cost and high entrance-barriers to becoming a doctor act much like a labor union, without the union. School admissions are highly configurable.

2. Lack of real competition: In most areas, including where I live, you can't just open a competing hospital. You need the green light from local government. The existing players are very powerful and influential citizens. 'Nuff said. (I've actually heard Sentara - the biggest hospital owner in this area- argue that increased competition would drive prices up as hospitals competed for the best talent.)

3. Hospitals and doctors want to be businesses, but there is no real incentive for them to act like businesses. Hospitals will get patients no matter what they do. They don't have to really compete (see above), they don't have to advertise, they don't have to have sales; they just open the doors and the patients come. Pretty sweet "business".

4. And if that wasn't enough, hospitals and insurance companies have learned how to "tag-team" patients. Do you really think that the bill you get and the bill the insurance company gets are the same? Patients are welcome to the retail pricing for which they are responsible, but the insurance companies and hospitals carry on a wholesale business between themselves.

It's pretty sordid when you think about it.
posted by Benny Andajetz at 12:24 PM on July 10, 2009 [1 favorite]


Eh, you can view it through that lens, if you like. I'd prefer to see it as a problem that needs to be solved, rather than some sort of conspiracy. But the fact is that doctors and nurses are highly trained professionals that spend a lot of money and time pursuing their chosen profession. The monetary costs can be helped with government subsidies, but the time committment has to be rewarded as well, or people just won't pursue medical careers.

As for lack of competition, you need the green light from local government to open a hot dog stand, let alone a hospital. Opening any institution as large as a hospital is going to require a lot of capital and support from local government, regardless of its purpose. It's like saying "not just anyone can open a transmission factory or a chip fabrication plant"
posted by electroboy at 1:33 PM on July 10, 2009


Also, it's basically impossible for consumers to comparison shop between hospitals, giving little pressure to keep "retail" prices down. Even if consumers knew what services would be provided -- which quite often the highly trained doctors don't even know that ahead of time -- there's no place you can go to see consumer ratings, price comparisons for various procedures, etc.

You get whatever services they decide you need, and you're stuck with whatever they decide to bill you. $800 for one Lortab pill is normal in Hospital Land.
posted by LordSludge at 1:38 PM on July 10, 2009


I'd prefer to see it as a problem that needs to be solved, rather than some sort of conspiracy.

I agree. I'm not willing to call it a conspiracy (other than to point to the lengths the AMA and insurance companies have shown they're willing to go to keep the status quo). I just think that a profit-based sytem is probably not the best model for providing health care. No system works when one side has all the power.
posted by Benny Andajetz at 1:47 PM on July 10, 2009 [1 favorite]


electroboy: rtha keep in mind that those examples neglect employer contribution and VAT taxes, both of which are usually quite high (15-20% or so on VAT).

electroboy
: Ah, and apparently there's an additional 11% or so explicitly for the National Health Service.

My numbers DID include the 11% NHS deduction. For all intents and purposes, VAT is comparable to sales tax, so I consider it a wash. As for employer contributions, you're right. I didn't include them in the foreign summaries, nor did I include the stateside employer paid insurance premiums which are anything but cheap.

I stand by my previous statements. The return on investment in the US sucks big sweaty donkey balls.
posted by ValkoSipuliSuola at 2:14 PM on July 10, 2009


I know I'm a little late to an EPIC THREAD, but I wanted to run some ideas by the crowd. I think I have a solution that could make a lot of people happy(ish/er). And by "I" I mean "We". And by "We" I mean me and my dad. First, some background:

My father pulled himself up by bootstraps from grocery clerk to VP of HR for a large regional hospital system. He's been a Six-Sigma black belt for years; has been since before all the cool kids were doing it. My dad is a pragmatic sort of guy who has made quite a career out of gently guiding stupid people away from wasteful practices. The hospital system he helps run is successful, non-profit, and is capable of servicing upwards of a million lives.

Lives. I use that term because I, on the other hand, work for a software company that sells a complete provider management platform to health insurance companies. Payers. Big ones. BCBS's in multiple states. Private, for-profit companies on the scale of CIGNAs. I've been on-site many times at these companies and have helped them develop the systems they are using to alleviate the insane administrative costs they've cursed themselves with. I think most of the numbers you hear about administrative waste are actually pretty conservative, but that's another post.

So my father and I come to the table with lots of industry experience, pragmatism, and jaw slackening horror stories. He sees how screwed up it is from the provider side, and I see all the waste from the payer side. We try not to talk shop and compare notes, but... c'mon. We're both passionate about fixing this kinda stuff. We do it because we enjoy it, it's not really work for us. Anyway, last time we went down this path, I had a bit of an epiphany.

I realized that together, my father and I could form VOLTRON.

I was sharing some horror stories with my dad about the quality of the software systems at one of the BCBSs we work with. Turns out, this is the same company that my fathers hospital systems uses to insure their employees, and the arrangement used to provide that healthcare makes them what is known as a "self-insuring" hospital. Basically, the hospital eats the cost of all the healthcare for its employees, as long as that care is administered within the system. A hospital system isn't just the hospital. It's a bunch of them. It includes GPs, clinics, radiology/imaging centers. Tons of stuff. Everything you would need for a health-care co-op, but at a scale that is big enough to allow effective risk-pooling. So this self-insuring hospital system doesn't pay premiums to it's BCBS like a conventional employer would, because BCBS isn't paying for the care.

The hospital pays regular, contracted administration fees to the payer. That's it. Lots of hospital systems nationwide do this, and they are all dying to cut out these "administration fees". Because it is waste, pure and simple. There is little value being added by the payer... it's basically a healthcare network that the payer manages that represents the entire hospital system.

Kinda got me to thinking about how archaic the very nature of an insurance company is anymore. They collect revenue, and pay out claims for service. Then they pocket the leftovers. Most of what they do is paperwork, which we are eliminating with modernized systems. I'm putting people at the payer out of work, and reducing the cost of what they provide to my dad. All so he can provide healthcare for his employees. Theoretically, they should be in an ideal situation as far as employers go, since they provide healthcare at cost. The care being provided is well tracked in their EMR systems.

What kinds of systems would a hospital need to handle self-insured employees? They'd need to manage their network of providers, the insured lives (employees), and track payments back to the providers that render the service. It's all record keeping and accounting, and the hospitals have well established IT and billing departments already. They've invested heavily in admin systems of their own just so they can deal with all the payers that their patients use, why not manage their employees the same way?

All the pieces are already there, they just need to be stitched together. Problem is, this never works unless the hospital employs (and therefore covers) enough lives to spread the risk out into a viable insurance pool. Hospital workers, despite being surrounded by germs, tend to be younger and healthier than the average citizen.

Not only are many of the necessary pieces already in place, but a large scale hospital has many other advantages that the payer doesn't, but cannot leverage in the existing scenario. Right now, all healthcare providers that have an EMR are reproducing data when they file claims. A self-insured hospital should be able to bill based on the EMR data, not on duplicative claim data. So the entire claims processing system goes away.

I think a hospital system of sufficient size, servicing a large enough risk pool could provide it's own insurance-like equivalent to its employees. Eventually, after the kinks get worked out, I don't see it being to difficult to scale upwards. It wouldn't even be that much of a leap to allow local businesses to pay into this pool, and enroll their employees in as well. This could eventually be a health co-op for the region the hospital services.

I just don't see the value that these insurance companies claim (ha!) to provide. My dads hospital already manages a network of providers. It already tracks the services it renders through its EMR system. It already processes payment into and out of the system, and those billing departments spend most of their resources fighting the payers. The hospitals have the pieces already, they just don't integrate them together very well. That is the same problem the payers have, and our software solves that for them. We can sell that same platform to the hospitals.

This doesn't work for everyone. Lots of hospital systems of sufficient size to pull this off are for-profit. In those cases, you may run the risks of reproducing the same problems we have now with for-profit insurance companies. Non-profit hospitals however, could completely change the game in very fundamental ways. The payments come in, and if young healthy people like me are encouraged to join the risk pool, then the entire community benefits. What isn't spent is not "profit" when talking about a non-profit hospital. It gets re-invested. Additional beds. More doctors. More nurses. Non-emergency facilities like nursing homes and community clinics. Expensive but effective preventative health programs would actually start appearing since these incentives get re-aligned. A non-profit hospital tries to maximize outcomes, not profits. Not only could you have more, better doctors, but you'd eventually get less need for them. All the profit taking in the current system ends up being invested in the health of the community.

As you can tell, this idea is a little bit new. I've only been chewing on it for a few weeks. I wouldn't be surprised if I'm not the first person to think of this, so if anyone has any suggestions on how I can better direct my thinking towards this goal, I'm willing to listen. There are a lot of problems to solve here, but I think they are in fact solvable. And the reason this concept appeals so much to me is that it is scalable... so it's testable. Iterable. We can start small with the employees and once we can prove that the hospital can render care without the "administration" of the plan, then it's just a matter of increasing the money payed into it.

There is a ton of upside here, and I'm not really seeing a whole lot of downside.
posted by butterstick at 2:21 PM on July 10, 2009 [5 favorites]


Kadin2048: Depending on which states you've lived in, they may have had restrictions on whether insurers could provide coverage for abortions

We're both right. Just because the law says they can pay for them doesn't mean they have to. Texas has lovely laws like this:

§ 1454.052. REIMBURSEMENT FOR ABORTION NOT
REQUIRED. This chapter does not require a health benefit plan
issuer to provide reimbursement for an abortion, as defined by the
Family Code, or for a service related to an abortion.

Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005.

posted by ValkoSipuliSuola at 2:29 PM on July 10, 2009


Why do I get the feeling that if the Angel of the Lord came down, sucked you off, and farted out "It will cost less!" while doing so, you'd still doubt?

That's not the way I remember it. Did Kushner really write that?
posted by oaf at 2:31 PM on July 10, 2009


I kinda forgot where I started with that ginormous comment, so let me clarify. Not only is the idea scalable, but I also don't really see any ideological arguments against it. It should thrill libertarians, because this just ends up being another choice for the consumer. No freedoms are being impinged. No tax subsidies are needed. It's local, community oriented. Shit, municipalities could eventually choose to pay tax revenues into it and cover their residents; nobody ever said this had to happen at the national level.

Liberals should like it because it re-aligns the incentives in the system to encourage better care and outcomes, and it directs resources most efficiently towards those ends. It also greatly reduces the impact of the profit motive on outcomes.

Conservatives... I have no idea how or why conservatives should like it. Maybe for the same reasons the libertarians do? Maybe because it could easily be applied by for-profit hospitals as well? I'm a little fuzzy on what a conservative platform/ideology is anymore these days ;).
posted by butterstick at 2:53 PM on July 10, 2009 [1 favorite]


Why do I get the feeling that if the Angel of the Lord came down, sucked you off,

loser spouting
posted by caddis at 6:04 PM on July 10, 2009


so, caddis, what alternative explanation do you offer for the fact that the universal health care countries in the rest of the world are paying less per capita than we are, and generally, have a healthier population?
posted by pyramid termite at 6:25 PM on July 10, 2009 [2 favorites]


According to today's The New Republic the preliminary CBO score on a public option plan would net 150 billion dollars in savings over ten years.

Let's see how the people who were lauding the CBO's previous bad (and incomplete) numbers around will spin this.
posted by Benny Andajetz at 8:29 PM on July 10, 2009 [1 favorite]


Everyone seems to just want to accept on faith (which makes the snotty comment above so deliciously ironic) that a universal care system would lower costs. I remain unconvinced that just because costs are lower in other countries that we would be able to achieve the same results and that our costs would go down. There are many reasons. One big one is that we would dramatically increase the number of insured and almost all of that will be at public expense. We should do this, we need to do this, but I don't think it is going to come without great cost. Long term we should see savings in administrative costs, more efficient care by not waiting until the last minute to treat long term conditions etc. Nevertheless, we don't do bureaucracies well in the US. Also, much of the lower cost in other countries comes from paying doctors less, medical device companies less, pharm companies less and in denying expensive care such as newly available treatments and end of life care. Politically this country is not ready to do those things. The funny thing is that as a percentage I think the US is only slightly behind most of the other countries being discussed in the overall percentage of care being funded publicly versus privately. Something like 70% of our care already falls under medicare, medicaid or public employee health plan. The other countries have significant private components. For all that money we spend we still don't have universal care. That is the tragedy. Anyway, a single payer system is not on the table now, nor will it ever likely be for the US. It's not going to happen. Rather than focus on this faith based fantasy, it would be better to focus on a reality based idea more like what is practiced in France or Switzerland.
posted by caddis at 5:59 AM on July 11, 2009


Also, much of the lower cost in other countries comes from paying doctors less, medical device companies less, pharm companies less...
Well, between Canada and the US there is is a difference in doctor's pay but I wouldn't define it as huge ($116 vs 135 for Family Doctors) especially considering the much higher administration and malpractice insurance costs (plus the cost of their own health insurance) that US doctors pay out of their salary. Yeah it sucks the companies make less profit per item but with a wider market wouldn't they end up making more profit overall?
...and in denying expensive care such as newly available treatments and end of life care.
Now that is just being silly. UNNECESSARY items like plastic surgery are not covered but health care under single payer is hardly "here's a free band-aid for your brain tumour". The people I know that have had crazy health problems have all been happy with the level of care they have recieved and the studies they have been enrolled in to get the cutting-edge drugs and treatment for free.

The other countries have significant private components.
Well, in Canada at least, there is private health insurance on top of the provincial health care that covers items not considered medically necessary that can be purchased individually or part of a compensation package at work. For my family of five the cost is $500 a year (75% paid by my employer, if I worked full time it would be 100% paid by them) that gives me free dental care (we spent $5000 last year at the dentist - bad year for teeth!), free pills (my husband's pills are several hundred dollars a month), $250 per person for eyeglasses/contacts, orthopaedic shoes up to $900 each, 52 massages a year, chiropractic care, various forms of therapy and I am sure a bunch of other stuff I am not even aware of since we are pretty healthy and have not had to use it very often. If I didn't have the private insurance I would be still be able to maintain my health with minimal cost to my own pocket. Having benefits at work is a bonus but I don't know anyone that made career decisions based on what benefits they get. THe private care supplements the provincial care but doesn't even try to replace it.

I see a contradiction in your assertion that the US can't afford to offer universal health coverage because it would "dramatically increase the number of insured and almost all of that will be at public expense" when "Something like 70% of [US] care already" is paid by the US government. That doesn't look like too much of a jump to me, especially if overly generous plans (like what the Congesspeople get) is scaled down. Not to mention the cost savings in eliminating the middlemen that are just there to skim profits.

I agree that politically, the US is not ready to make such a change. And that is a real shame.
posted by saucysault at 10:17 AM on July 11, 2009 [1 favorite]


caddis, you may wish to read about economy of scale, a concept that capitalists grasp when talking about private enterprise, but which seems to baffle them as soon as the government enters the picture.

Also, France has a single-payer system. You're right that Switzerland does not.
posted by shetterly at 10:32 AM on July 11, 2009 [1 favorite]


Nevertheless, we don't do bureaucracies well in the US.

Nonsense. We do bureaucracies just fine, except when people who don't believe government can do anything right are in charge. Then everything goes to Hell. What a surprise.
posted by Kirth Gerson at 10:37 AM on July 11, 2009


Nevertheless, we don't do bureaucracies well in the US.

Right. Because there's no paperwork in the US military. Give me a break.
posted by GuyZero at 11:07 AM on July 11, 2009


I went to the local health clinic, staffed by a nurse practitioner, because it was the only place I could get into that week. I got some pills.

Hey, I gotta say that the nurse practitioner thing is great, and something we need to do (more of?) in Canada. I had a really bad bronchial thing a few months back while in the USA. Nurse prescribed appropriate antibiotics. Whole thing worked wonderfully for me, and was reasonably cheap to boot (well, free, once I got back home and submitted the bills to be paid back for expenses.)

I'd guess 90% of my doctor's visits would be perfectly served by a nurse. Hell, 90% of them would be perfectly served by myself: it's not rocket science.
posted by five fresh fish at 12:57 PM on July 11, 2009 [1 favorite]


That doesn't look like too much of a jump to me, especially if overly generous plans (like what the Congesspeople get) is scaled down.

See, you are already cutting back benefits. No wonder people are afraid of the government plan.
posted by caddis at 7:35 PM on July 11, 2009


Yep, and that ties into the attidtude of of "fuck you, I got mine". I wonder if that attitude would translate into many Americans abusing a universal health system because they felt entitled to see the doctor every week for every little thing since "their taxes dollars are paying for it"; leading to cost overruns and its eventual collapse.

I never really understood how terrible the American system was until AskMe came along and suddenly there were so many questions where the answer "go see a doctor" wasn't even an option to the OP. (that last one hit me particuarly hard - if losing motor control, speech and waking hours later on your front step covered in blood and drool doesn't indicate medical involvement I don't know what does).
posted by saucysault at 6:36 AM on July 12, 2009


saucysault, the fear of "entitled" people abusing the system reminds me of people who think women get abortions for fun. Only hypochondriacs are quick to go to the doctor, and you're going to have them under any system.

People don't abuse other single-payer systems. People from the States really aren't as different as US-lovers or US-haters like to think. We're just people. If we get a sensible health care system, we'll use it sensibly.
posted by shetterly at 8:31 AM on July 12, 2009


From PBS: Former insurance insider Wendell Potter speaks with Bill Moyers about health care reform.

Also, I think this thread has made me stupider.
posted by chunking express at 6:14 AM on July 13, 2009


Oh wait, there is a Mefi thread about that video already. See, it did make me stupider.
posted by chunking express at 6:39 AM on July 13, 2009 [1 favorite]


My numbers DID include the 11% NHS deduction.

Unless I'm misunderstanding, which is certainly possible, UK income tax is 10%, 22% and 33%, with an additional 11% for NIC.

For all intents and purposes, VAT is comparable to sales tax, so I consider it a wash.

Not really a wash. It's comparable in the sense that it is a sales tax, but it's much higher. UK VAT is about 15%, and the highest local sales tax is about 10% or so, with the norm being around 7-8%, or half of what UK VAT.
posted by electroboy at 10:23 AM on July 13, 2009


First off, no one's gonna go broke.

I can tell you right now in all seriousness that if my husband and I hadn't been able to afford insurance, we'd be entirely bankrupt right now and would have lost our house... all because my baby decided to arrive early. And that's just a little early (six weeks), not a lot early like some babies. Aaaand I'm a clean-living, non-smoking, pro-exercise vegetarian with a low-stress lifestyle.

I really don't get what you're saying about no one going broke. A $27,000 NICU stay? What would I have done, put it on a credit card? Passed the hat when friends came to visit the baby?
posted by Never teh Bride at 8:52 AM on July 14, 2009


$10 baby viewing fee, heh...

A close friend of mine is a doctor at a public clinic, and she insists that there are plenty of programs and public clinics to handle any uninsured contingency. Oh, and therefore there is no need for any sort of national medical reform because everybody is already well cared for. Yep, she is adamant in this position. She is fond of saying, "Health care is like food -- everybody deserves to eat, but they don't deserve filet mignon." Yeah, chaps my hide, but I've given up arguing with her on the matter -- it's maddening and depressing and ultimately unproductive.

A lot of these programs are not well-publicized, of course, but for example my uninsured student friend who recently had an $8,000 bill for a do-nothing overnight ER stay was able to get it knocked down to $800 by contacting the hospital's business office. It's still a huge amount for her, as she seldom has more than $20 in her bank account, but it was a ten-fold decrease at least.

So it's not a great solution, but it would help if programs such as these were better publicized so that people knew that they, you know, EXISTED.
posted by LordSludge at 10:22 AM on July 14, 2009


LordSludge, that is a truly shocking attitude. So not everyone deserves the best care? The best care is ok only for those who can afford it? Puhleese. I can see why you would be frustrated.
posted by agregoli at 3:02 PM on July 14, 2009


I'd guess 90% of my doctor's visits would be perfectly served by a nurse. Hell, 90% of them would be perfectly served by myself: it's not rocket science.

Unfortunately, the AMA campaigns against letting nurse practitioners do all kinds of things. They're afraid of losing the magical status that MDs have.

I've always been a huge supporter of nurse practitioners, being the daughter of a nursing instructor. However, after my most recent NP misdiagnosed my husband's ulcerative colitis, costing three weeks of suffering and finally hospitalization, and then brushed me off when I needed help by telling me to go to the ER, I'm driving 40 miles farther to go to an MD.
posted by threeturtles at 3:27 PM on July 14, 2009


She is fond of saying, "Health care is like food -- everybody deserves to eat, but they don't deserve filet mignon."

OMG, if anybody I knew said something like that I'd be so filled with rage I'd have to consciously hold myself back from decking them. And I'm like the least violent person ever.

You know what I'd ask her, "How about if you paid for filet mignon, the waiter brought over a hamburger on a stale bun, and the bus boy took it out of your hands when you were half way through eating it?" That's essentially what health insurance companies do.
posted by contessa at 4:49 PM on July 14, 2009 [9 favorites]


Why don't you tell her that once med schools stop artificially depressing the # of qualified doctors that she'll have to compete like everyone else. Also, if your best argument is to compare yourself to a cut of beef you have no rational arguments.
posted by GuyZero at 4:54 PM on July 14, 2009


"Health care is like food -- everybody deserves to eat, but they don't deserve filet mignon."

The idea that anyone "deserves" a luxury is the basic problem with capitalism.
posted by shetterly at 6:02 PM on July 14, 2009 [1 favorite]


contessa, I am favoriting your analogy so hard.
posted by agregoli at 6:23 PM on July 14, 2009


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