"But what I saw were doctors who were set up to provide care in animal stalls ... It was almost-- what country am I in? I just it just didn't seem to be a possibility that I was in the United States."

July 11, 2009 7:20 PM

Bill Moyers Interviews Former Cigna PR Chief Wendell Potter Cigna's former head of Corporate Communications discusses about how Insurance companies have fought against public health care in the U.S, How wallstreet's demands drive up profits, how they do it, and why he quit. transcript
posted by delmoi (129 comments total)

This has been making the rounds in my circle of friends for a few days now. Outside of being outright maddening in confirming all the liberal conspiracy theories, it makes me nervous for his well being as I wonder what they'll try to do to discredit him.

Having said that, after a career of not choosing to do anything, I'm thrilled he's finally found an ability to stand up.

Paints a pretty grim picture for how to mobilize your elected official, though. >_<.
posted by cavalier at 7:23 PM on July 11, 2009

cavalier:

Maybe getting a large number of people to watch the video could help?
posted by leviathan3k at 7:24 PM on July 11, 2009

Well, now. Isn't that a surprise!
posted by contessa at 7:25 PM on July 11, 2009

I weep for this country. I really do. Well, I tell a lie. I weep for those of us who have to pay for the gold rimmed plates of the uberclass while praying our kids don't fall off the monkey bars.

My family lost our insurance last year. We cross our fingers, and hope for the best...because we don't have any other choice.

Obama bowing the medical profiteers and taking single payer out of consideration has probably lost him my support. (Well, the last straw, after the "don't ask, don't tell" thing, and protecting Cheney, and security decisions, and on and on, and now this...it just proves to me that Obama was nothing more than a slick suit and I got really suckered by a conservative with a populist patter.

His massive, MASSIVE turn-around on insurance for everyone just proves (to me) that he doesn't give a rat's ass about the population, any more than any other profit taking professional politician. How have we not been sold into corporate serfhood if we're forced to buy a plan from these companies that have made the plans unaffordable and useless?
posted by dejah420 at 7:58 PM on July 11, 2009 [17 favorites]

this will not wendell
posted by wendell at 8:02 PM on July 11, 2009 [11 favorites]

The insurance companies represent everything that is wrong with our healthcare system in the US today, and on top of that Cigna is one of the better ones. US Health and the Blues are far, far worse.
posted by caddis at 8:06 PM on July 11, 2009

That's some damning shit, there - not that it's anything that hasn't been obvious to anyone that's been paying attention.

We are past the point of no return in a lot of ways. Either it's real reform regarding insurance (and business practices, in general) now, or it's going to be torches and pitchforks in the future.

People can only be squeezed so far before they have to squeeze back.
posted by Benny Andajetz at 8:07 PM on July 11, 2009 [3 favorites]

this will not wendell

eponysterical!
posted by delmoi at 8:08 PM on July 11, 2009 [3 favorites]

The only people left who oppose a robust public option are insurance company shills and crackpots. To the trolls who will doubtlessly run rampant over this with horror stories about Aunt Judy in Canada/Britian/Germany/whereever waiting for her angioplasty because of socialized medicine; please realize that we are on to you. After we implement a robust public option you will either have to reinvent your industry; or you will finally be able to get regular access to your medication. In either case we'll all be better off.
posted by humanfont at 8:09 PM on July 11, 2009 [9 favorites]

To the trolls who will doubtlessly run rampant over this with horror stories about Aunt Judy in Canada/Britian/Germany/whereever waiting for her angioplasty because of socialized medicine;

Uh - haven't those all given up by now, at least around here? I mean, we were going off on how AWESOME single-payer is in a thread just a few days ago.
posted by GuyZero at 8:11 PM on July 11, 2009

Clearly you underestimate the tenacity of the reality-denial on the parts of Faze and gushn, GZ.
posted by dirtynumbangelboy at 8:22 PM on July 11, 2009 [3 favorites]

...The only people left who oppose a robust public option...

Nobody wants this ill-defined "public option." The so-called public option has become a stand-in for the real healthcare reform that Americans want and know is possible, if it weren't for the self-fulfilling predictions by corrupt lawmakers on the take from the insurance industry that single-payer healthcare is "impractical." National healthcare; that's what people are really supporting, when they say they would prefer the table scraps of a public option.
posted by univac at 8:23 PM on July 11, 2009 [3 favorites]

The industry has always tried to make Americans think that government-run systems are the worst thing that could possibly happen to them, that if you even consider that, you're heading down on the slippery slope towards socialism. So they have used scare tactics for years and years and years, to keep that from happening. If there were a broader program like our Medicare program, it could potentially reduce the profits of these big companies. So that is their biggest concern.

Scary, in that this tactic has basically been a roaring success for half our population.
posted by contessa at 8:31 PM on July 11, 2009 [1 favorite]

Awesome link delmoi.
posted by XMLicious at 8:34 PM on July 11, 2009

Nobody wants this ill-defined "public option."

I absolutely want single-payer, but I'll settle for a well-designed public option as a stopgap.

Planned correctly, it would show EVERYONE what a bunch of weasels the insurance companies are. Single-payer would follow.
posted by Benny Andajetz at 8:34 PM on July 11, 2009 [2 favorites]

Uh - haven't those all given up by now, at least around here?

At MetaFilter, yes, but we are the Best of the Web here. In Congress and the Mainstream Media, "single payer" is a dirty word, like "atheist".

eponysterical!

I was just happy to see somebody named Wendell had come back from The Dark Side.

BTW, I'm familiar with all aspects of the Insurance industry; I worked for five years for a so-called "Life Insurance" company (that was built on annuities with well-above-average payouts financed by investments in Junk Bonds in the 80s that inevitably collapsed), AND my father's main adult-life career was as a Liability Insurance Underwriter (among other things, he insured that anyone hit by a foul ball in Dodger Stadium got his medical bills paid, even if the disclaimer on your ticket said otherwise) and we both agreed long ago that Profit-Based Private Insurance Provided by Employers is the WORST possible way to provide health service and exists only because Labor Unions needed another way to have leverage with Big Corporations decades ago. Regrettably, it has become "A Unique American Institution", like driving gas-guzzling cars (and more recently SUVs). And considering how painfully hard it is for this country to give up that other self-destructive institution, it's obviously going to be even harder to give up the Health Insurance thing too.
posted by wendell at 8:38 PM on July 11, 2009 [1 favorite]

I may regret posting this, but I have to throw it out there and ask the question:

I work for an employer whose health and other benefits can charitably be defined as "gold plated." There's no co-pay, deductibles, etc. This is awesome for me and my family, especially since my kid takes a few medications that cost in the hundreds of dollars. In addition, I freely admit I'm a greedy person when it comes to "me and mine."

So, I get that if I lose my job, it can all go poof and disappear. However, I consider that to be like any other risk in life. I try to do well at my job to remain employed there, I have savings in the bank to cover COBRA (going a lot longer courtesy of the gov't discount) and I'm working on being there 10 years so I could stay on COBRA at the discounted rate until Medicare kicks in, which is sometime in the distant future for me.

Knowing all this, why should I be all excited to potentially (likely?) give up this great situation for me and my family? Intellectually, I understand that it will benefit society and it pains me to read the stories I've read here and other places in the media. On the other hand, I would much prefer that my benefits stay the same and others go up to my level, and not have to leave behind what I have which has (pardon the pun) benefited me greatly over the years.

I'm genuinely not trying to be a jerk or to troll.
posted by fireoyster at 8:39 PM on July 11, 2009 [3 favorites]

Oh, and I should also add that my employer is self-insured, though we use a third party benefits admin company to handle the paperwork and access their network of doctors, if that makes a difference in the discussion.
posted by fireoyster at 8:40 PM on July 11, 2009

Well, honestly, I don't think you should, fireoyster. You can keep your gold-plated coverage, but that shouldn't preclude people going without some basic level of health care.
posted by boo_radley at 8:45 PM on July 11, 2009 [1 favorite]

Yeah, I'm with boo_radley. What makes you say you'd have to give that up, fireoyster?
posted by Justinian at 8:47 PM on July 11, 2009

Thanks for including the prominent link to the transcript, too. Much appreciated.
posted by gimonca at 8:49 PM on July 11, 2009 [3 favorites]

boo_radley, the problem is that I don't see any feasible way that will function. Either everyone's in the same pool (single payer) or they're not (what we have now). Assuming a "public option" actually works, how will this be paid for? It's entirely likely it will be paid by taxing employers (like mine) for "excessive" or "gold plated" coverage, which will either increase the cost burden on me--which may or may not be feasible for me to bear, depending on the situation--or cause the benefits to be dropped to a level under the bar for such taxation. Either way, I wind up getting shafted, and I'm not entirely confident--plus I'm getting less confident by the day--that the government will be able to pass a workable solution.
posted by fireoyster at 8:49 PM on July 11, 2009

Fireoyster, there's nothing about a public option - or even about single payer - that would force your employer to take away your gold plated care. The fact that your employer thinks it gets a competitive hiring advantage by offering this coverage wouldn't necessarily change. But right now, you are vulnerable to having your employer change its mind about the value of offering these benefits, and you would have no recourse if your benefits were cut to a level unacceptable to you. Employers are making that decision every day in the current environment. The public option essentally creates a floor beneath which benefits can't be cut, for you or anyone else.
posted by yarrow at 8:57 PM on July 11, 2009 [11 favorites]

Fireoyster, it's pretty goddamn unlikely that your employer would be taxed extra-hard because you have a good insurance plan there. Is the Congress going to institute some kind of super-tax only for companies with robust employee healthcare? Give me a goddamn break.
posted by Optimus Chyme at 8:58 PM on July 11, 2009 [5 favorites]

To the trolls who will doubtlessly run rampant over this with horror stories about Aunt Judy in Canada/Britian/Germany/whereever waiting for her angioplasty because of socialized medicine;

The dumbest thing about this argument is that people usually have to wait here (just to be clear, "here" for me is the USA) in non-emergency situations too. Even the rabid anti-health-care-reform woman in my office gave up on that particular argument after she had to wait two months to get her gall bladder out.
posted by Blue Jello Elf at 9:02 PM on July 11, 2009 [3 favorites]

Knowing all this, why should I be all excited to potentially (likely?) give up this great situation for me and my family?

First of all, you're in the (very slim) minority. To turn that around on you, why should I care if you lose this magical "gold plated coverage" (i.e. have to pay a fair market rate like everyone else) if that means that that woman whose cancerous tumor grew from 2 cm to 7 cm while she fought with BCBS for tossing her off the rolls right before the hospital demanded their $30,000 to prep the OR for her gets to have her f'ing cancer cut out before it kills her?

Secondly, there are several European models which include an option to pay for "head of the line", "gold plated" coverage. It's not all or nothing.
posted by availablelight at 9:09 PM on July 11, 2009 [5 favorites]

Mmm ... the "I got mine" argument. Yummy.
posted by Auden at 9:09 PM on July 11, 2009 [4 favorites]

Oh, and exactly what yarrow said:


Fireoyster, there's nothing about a public option - or even about single payer - that would force your employer to take away your gold plated care.
posted by availablelight at 9:12 PM on July 11, 2009

His massive, MASSIVE turn-around on insurance for everyone just proves (to me) that he doesn't give a rat's ass about the population, any more than any other profit taking professional politician. How have we not been sold into corporate serfhood if we're forced to buy a plan from these companies that have made the plans unaffordable and useless?

I'm with you, but Obama never promised single-payer. He promised "universal healthcare." That just means everyone has coverage--even extortionate corporate coverage. And with the individual mandate, that's what we're gonna get.

Fireoyster, it's pretty goddamn unlikely that your employer would be taxed extra-hard because you have a good insurance plan there. Is the Congress going to institute some kind of super-tax only for companies with robust employee healthcare? Give me a goddamn break.

Um, I hate to burst your bubble, but a tax on employers who provide expensive coverage is a serious proposal right now, and may be the key to getting health reform through the CBO.
posted by nasreddin at 9:12 PM on July 11, 2009 [1 favorite]

I was hoping Moyers would ask how Wendell would spin his own apostasy, if he still had his old job.

I did like this line, tho: "You hear the companies and their trade groups talking about how we don't want a public option that would put a *bureaucrat* between a patient and his doctor; but you've just described a situation in which a *CEO* is in between the patient and his doctor."
posted by It ain't over yet at 9:14 PM on July 11, 2009 [1 favorite]

Fireoyster, your health insurance is part of the cost of employing you. If your company does not have to overpay for your health insurance, then it has more money to pay you. So with the public plan you get your same health insurance and a higher salary.
posted by Balna Watya at 9:16 PM on July 11, 2009 [1 favorite]

It's times like this I wish I'd done the Metafilter equivalent of Upon reflection, I do not wish to post.

I'm not trying to be a "gold plated" ass, but I feel like it is a legitimate question. Beyond myself, and, hopefully I do this less than "average," a lot of people will be asking the same question. People have this nagging habit of voting "themselves first," even if it doesn't benefit the community as a whole. On an issue as touchy as this, I can only go by history and presume that a good chunk of people will continue to do so. Yes, I am in a slim minority by quantifiable measure, and if the answer is simply "suck it, there's no way around it, and the good of the 99% outweighs the possible impact to the 1%," then I will accept it and do so hopefully knowing that the new system is at least more fair for everyone, even if not arguably "better" for the slim minority.

As for taxing "robust employee health care," yes, it has been proposed, Optimus Chyme: The senators are not suggesting repealing the tax break. Instead, they want to cap the value of benefits that go untaxed. For example, if the tax-free limit is $13,000, an employee with a policy worth $15,000 would pay income taxes on $2,000.

Frankly, and perhaps this is what inspired such an apparently ill-advised question, I'm spooked. Like lots of people, I fear being without health coverage, so I should be championing this. On the other hand, I am not at all confident that our government, in its current configuration, where things the public obviously Would Not Like(tm) exist, will not be able to come up with a system that does more good than harm.
posted by fireoyster at 9:26 PM on July 11, 2009

Crap.

"...will not be able..."
posted by fireoyster at 9:29 PM on July 11, 2009

It seems like publicizing the single statistic (Medicare overhead: 3%, no profits vs. Industry overhead 20%, profits to Wall Street) would go a long way towards opening people's eyes.
posted by CheeseDigestsAll at 9:30 PM on July 11, 2009 [4 favorites]

It's not that I think people in the health insurance industry are bad people. I've worked alongside many of them, at varying levels of the hierarchy, and they were just like people I've encountered in every other industry. Very few of them are the evil scheming capitalist pigs they're so often assumed to be. This video is an example... this guy probably never did any one thing that he realized was evil. To quote Good Omens, he didn't see the big picture for the same reason that people in Trafalgar Square can't see England.

But regardless of their individual beliefs, or their cynical apathy, each of those people is part of a whole, and that whole inexorably favors the capitalist approach to health care. And "the whole" is wrong. There is no doubt in my mind about that. Capitalism is the art of turning short-term thinking into a stable long-term system, and health care ought to be the other way around.

What can we do? All the people with significant power to change this are making out just fine in the current system. Even if the insurance plans for congress weren't excellent, they're all wealthy and powerful enough that they don't have to worry about being bankrupted by a rogue tumor. And the people who vote for those representatives are usually old (in which case they already benefit from socialized medicine, so what do they care), or getting by in the status quo.

These attributes are our inertia, our friction. Have you ever tried to kick a large rock as hard as you can? You just end up hurting yourself, and because of inertia and friction it barely budges. That's what's been happening on health care. Every fifteen years or so we take a big kick at it, and when we change nothing everyone laughs at us while we hop around in pain.

What we need is to start out small; baby steps and compromises. Get our footing, brace ourselves. Establish a public option, and make it efficient enough to compete but not competitive enough to scare anyone. Find the bureaucratic flaws in the system early, before they can become large-scale liabilities.

Then we push. The only difference between a public option and a single-payer system is market share, and we win the market share. We can, because we'll have the fucking United States government on our side.

The government doesn't give two shits about private insurers when push comes to shove. They're just the ones signing the checks right now. If we fix the health care system in this country, there'll be other people signing bigger checks and the private insurers will find their influence withering up and dying and there won't be a damn thing they can do about it.

...and that's if they even wanted to. That's our biggest advantage here. Watch the interview again: the rock WANTS to be moved. Insurance company executives don't want us to have bad health care. They just like their big paychecks and don't know or don't care how bad things are.

So for those of you thinking Obama's copping out on his promises, please reconsider. A public option is the beginning. It's just the beginning. It's not the end, and it's definitely not us giving up the fight. Anything less would be unacceptable, but anything more would be counterproductive.
posted by Riki tiki at 9:33 PM on July 11, 2009 [5 favorites]

Look, I think fireoyster's question deserves to be answered well, and without derision or scorn. There's a ton of misinformation and assumptions that are surrounding the topic, and it doesn't do anyone favors to dismiss people's concerns. And Auden, I think "I Got Mine" is a compelling argument for health care -- it's the nature of the beast: If I get hurt/sick/crippled, I deserve care.

I would expect that a single payer option would be the floor; if you wanted premium coverage, there should absolutely be a market for it. I would like very much for health care to not be linked to employment, especially in its current form. Splitting the cost between employer and employee seems like a distracting shell game to me that can only benefit the insurance companies.
posted by boo_radley at 9:33 PM on July 11, 2009 [2 favorites]

*puts on tin foil hat*

1. Industry plays games to turn profits.
2. These games are at the risk and expense of human life.
3. Therefor the industry risks and spends life to win.
4. Thus would this not be potential manslaughter/murder?
5. And if there are millions uninsured, could this be a potential Health care holocaust?
6. I have stretched this far, but one step more: could there be a person or group of people to point to that purposely just let people like Potter do what they have done? Should they not be held liable? Not talking US congress here, talking private or foreign or international group here potentially.

*tips hat, moves on*

Was also thinking of that other TFH post re: global genocide that brought in michael jackson... :/

Gnight!
posted by JoeXIII007 at 9:34 PM on July 11, 2009

Look at all the posts that happened while I was writing.
posted by boo_radley at 9:35 PM on July 11, 2009

Nobody wants this ill-defined "public option." The so-called public option has become a stand-in for the real healthcare reform that Americans want and know is possible, if it weren't for the self-fulfilling predictions by corrupt lawmakers on the take from the insurance industry that single-payer healthcare is "impractical." National healthcare; that's what people are really supporting, when they say they would prefer the table scraps of a public option.

One of the things I've learned recently about all this is that France, which has one of the best healthcare systems out there, is not single payer. A public option that everyone could sign up for might be more expensive then single payer (the UK's NHS which is nearly a single payer system, is very cheap).

A well designed Public Option would force the insurance companies to use it, otherwise they would

Knowing all this, why should I be all excited to potentially (likely?) give up this great situation for me and my family?

Perhaps because you're not a selfish asshole? Or is that asking too much?

Some people are suggesting that the premiums paid for health insurance be moved from pre-tax to post-tax income, so your salary would go up your premium and you would pay taxes on that. You would just apply your current tax rate to that income (plus whatever marginal bit is in the next tax bracket)

Anyway look; this obviously will be paid for with tax money, so someone's taxes need to go up. Just deal with it. In theory I've got "gold plated" health care, I say in theory because I haven't had any reason to go to the doctor since I've gotten my job. Yet thousands of dollars have gone to insurance companies. I'd have rather had the cash. So for me, paying for insurance is just like paying taxes. I have no choice, I have to do it, and it gets taken right out of my paycheck. And of course, for a family you're probably paying far more then the cost of your kid's medications in premiums.

That's what people need to understand. Employer provided healthcare is just like a tax already it comes out of your paycheck just like a tax, and most people have no choice.

(Meanwhile (if you watch the video) 20¢ out of every dollar you pay goes right to Wall Street or insurance company executives.)

In addition, I freely admit I'm a greedy person when it comes to "me and mine."

Well you know what, screw you ungrateful mooch. I've been forced to pay thousands of dollars in medical premiums to help people like you, and I haven't used a penny of it myself. If you care more about "you and yours" then anyone else, then why should I care about you?

But here's something to think about: What happens when your kid gets too old to be on your policy? What makes you so sure he'll have a "gold plated" insurance plan when he graduates from school? Are you planning on paying for all those medications yourself? How high is the cost going to get? At some point "yours" are going to be out there on their own dealing with the same system that every one else does.
posted by delmoi at 9:47 PM on July 11, 2009 [23 favorites]

Dangit, delmoi.
posted by boo_radley at 9:54 PM on July 11, 2009

fireoyster, you should read this January New Yorker piece by Atul Gawande, "Getting There From Here." It points out that incremental steps are how most Western democracies have implemented their universal health care plans, and just might assuage your - to me, utterly unfounded but perhaps understandable - fears of a sudden removal of your 'gold-plated' plan:

Yet wherever the prospect of universal health insurance has been considered, it has been widely attacked as a Bolshevik fantasy—a coercive system to be imposed upon people by benighted socialist master planners. People fear the unintended consequences of drastic change, the blunt force of government. However terrible the system may seem, we all know that it could be worse—especially for those who already have dependable coverage and access to good doctors and hospitals...

On the left, then, single-payer enthusiasts argue that the only coherent solution is to end private health insurance and replace it with a national insurance program. And, on the right, the free marketeers argue that the only coherent solution is to end public insurance and employer-controlled health benefits so that we can all buy our own coverage and put market forces to work. Neither side can stand the other. But both reserve special contempt for the pragmatists, who would build around the mess we have. The country has this one chance, the idealist maintains, to sweep away our inhumane, wasteful patchwork system and replace it with something new and more rational. So we should prepare for a bold overhaul, just as every other Western democracy has. True reform requires transformation at a stroke. But is this really the way it has occurred in other countries? The answer is no. And the reality of how health reform has come about elsewhere is both surprising and instructive.

Must-reading, really.
posted by mediareport at 9:54 PM on July 11, 2009 [5 favorites]

Er, this New Yorker piece.
posted by mediareport at 9:55 PM on July 11, 2009 [3 favorites]

Nobody wants this ill-defined "public option." The so-called public option has become a stand-in for the real healthcare reform that Americans want and know is possible, if it weren't for the self-fulfilling predictions by corrupt lawmakers on the take from the insurance industry that single-payer healthcare is "impractical." National healthcare; that's what people are really supporting, when they say they would prefer the table scraps of a public option.

Truth.

I have but one hope, that several years from now we have some form of universal access and that means that almost everybody ends up being covered somehow, someway. First we bring the uninsured into the fold, then we worry about the details. The failure to provide coverage for those most in need is one of our country's biggest failings. You know who else fails to give a shit about its poor? That's right, communist China. We are right there with them. Nice.

The structural impediments to reaching this goal are immense. It will cost a lot of money. All these idealists who think it will be cheaper are so amusing and naive. We are not the Netherlands, not even close. Money might get saved a decade in, but not up front. When you are piloting an ocean liner and you plot a radical course such as is US healthcare reform, you are constrained in how fast you can maneuver. Focus on the big goal first, universal access, even universal coverage, then let the economic pain lead to reform of costs sometime later on. There is only so much that can be swallowed at once.
posted by caddis at 10:01 PM on July 11, 2009

delmoi, that is my point exactly. Most people do not care about others, except in the abstract. (For the record, my employer is self-insured and we do not pay insurance premiums) I do not think I am being an "ungrateful mooch," and I resent being called one because I have taken what was offered to me and I have worked hard to ensure I am able to keep it. Yes, it truly sucks that our current system is inequitable, but how does that make me a horrible person for being both relieved that, for the moment, I don't have to face such trials and scared that, in the future, I just might? That is the root of my conflict. I want to be in favor of this because I want everyone to have reliable access to good care, but I'm also fearful that it won't come to pass and then what?

I'm also genuinely sorry that some people here think I'm a roaring asshole for what I've written. I suppose this is what it's like to be on the "wrong" side of a debate, even though I'd love it if quality universal health care came into being in this country. Maybe I just don't trust my government enough.
posted by fireoyster at 10:11 PM on July 11, 2009 [3 favorites]

Wow, I have this really huge 4500 karat diamond on my desk. It's freakin awesome. I love this thing! But I heard that the government wants to give everyone in the country a small lump of coal that they could, with effort, mash into a miniscule diamond if they had access to Superman's hands.

"why should I be all excited to potentially (likely?) give up this great situation for me and my family?"

Because other people having stuff doesn't take anything away from you, that's why. Your employer will be free to pay for all of your medical care if it so chooses. Meanwhile, tens of millions of other citizens who live in fear every day that they or a member of their family might incur disease or injury get some kind of options beyond debtor's prison or death. Sounds like you should be pretty damned excited to me.

Your landscaper, housekeeper, burger flipper, cab driver, hash slinger, street sweeper, barista, and gas station attendant might live long enough and remain healthy and productive enough to continue to provide their inexpensive services to you and those of your privileged class. Unless you have been directly profiting from the medical profiteering situation that has been fundamentally the front line of American class warfare, you should be hopping up and down with glee to have universal health.
posted by majick at 10:12 PM on July 11, 2009 [3 favorites]

Fireoyster:

The scenario: You are driving home from your job with the "gold-plated" insurance. All of the sudden, a dog runs across the road and you skid, over correct and flip your car into a ditch. You break your neck and have a C3 level spinal cord injury. (You are a vent-dependent quadriplegic). You are in the hospital for months. Slowly you get your life back together, but you realize that you have hit your gold plated insurers 2 million dollar lifetime cap...or your employer cannot afford to insure you anymore without going out of business or laying a bunch of people off. You therefore become uninsured. Now, you must spend down all of your life savings to qualify for Medicaid and requisite attendant services and you must live at poverty level to keep these life-saving benefits even if you find that with adaptive technology, there are things you could do to earn an income. Oh, and if you live in certain states that don't support in home care, you will likely end up in a nursing home for the rest of your life, and not one of your choosing.

What interests me about people with "good" employer-based medical insurance is they act like the very thing you really need medical insurance for (catastrophic illnesses) are not mutually exclusive to you keeping your job and your employer continuing to insure you. Anything can happen, you are not immune, you are just as vulnerable as the rest of us.
posted by Bueller at 10:24 PM on July 11, 2009 [14 favorites]

fireoyster, I don't think you're crazy or evil for asking this. I think something like this idea undergirds some of the apprehension about health insurance. I'm in something of the same boat; or a smaller boat of similar design. As an employee of the State of New York, I get very cheap health insurance (~$200/month for me and my family, no matter how big), and the coverage is pretty good with pretty minimal copays. I would not be shocked to find that if we adopted OHIP, my coverage level would be a bit less than it is now.

That said, I'd still rather have universal health care, probably on an OHIP-style model, for a variety of reasons.

The most basic reason that I'll get to in a minute is: Unless your kid has a terminal illness and is basically guaranteed to die before adulthood, in which case you have my honest condolences, you should care about his or her health care in the long term.

Knowing all this, why should I be all excited to potentially (likely?) give up this great situation for me and my family?

You've already given the first and biggest reason: you might lose your job. And then you're responsible for the COBRA fees. Do you know what they are? If they're as gold plated as you say, you might well be on the hook for $2000/month or more for your family. A related reason is that the bit that would let you continue COBRA coverage until your next insurance or Medicare is only a law. It can be repealed at any time.

A second reason is that you should be highly confident that you will not keep that gold-plated coverage, even if you remain with your current employer. The costs of providing that gold-plated care go up and up at shocking rates -- almost certainly far higher than any increase in return for your company, and so unsustainable in the long run. In my boat, I will be shocked if the current health care plans survive the next round of union negotiations.

A third reason is that presumably there are people in this world that you care about who are not your spouse and children, some of who are probably uncovered, undercovered, or looking at being so in the next 10 years. If nothing else, you probably care about your kid. He or she will not be eligible for your health care plan forever, and in not too many years will be thrown into whatever minimal, high-cost plans are available to entry-level employees. Alternately, universal health care.

A fourth reason is that under just about every public health care plan in existence, your employer could still provide gold-plated coverage to you in one form or another. There are still private insurances in Ontario to provide services that OHIP doesn't cover.

A fifth reason is that presumably you like economic growth. Universal health care means economic growth for a host of reasons. Most obviously, it means firms can locate in the US without having to navigate the minefield of health care benefits, and without having to directly worry about the rate of cost increases. The reverse of this is already happening now; plants sometimes locate in Canada to take advantage of NAFTA without having to deal with the US health care system. Secondarily, universal health care at least can mean a flowering of entrepeneurship as people who are currently too responsible to leave their jobs that provide health care to their families are able to strike out on their own and, probably, fail but sometimes succeed gloriously. Thirdly, the substantial mass of uncovered and unhealthy people constitute a nontrivial drag on the economy.

A sixth reason is simple morality, for reasons that hardly bear mentioning.
posted by ROU_Xenophobe at 10:29 PM on July 11, 2009 [21 favorites]

fireoyster, please see these two comments in particular from the recent health care reform fpp.

Excerpts: 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.

and

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.

A single payer plan does not mean you must give up your private coverage. It does not mean you can't pay (a relatively small amount, it seems) for extra-special coverage if you like. It does not mean that your employer can't continue to offer coverage.

Please don't listen to the scaremongering shills from the insurance industry. It is in the best interests of their bottom line to keep you (or your employer) paying as much as they can squeeze out of you while giving you the bare minimum in return. Their concern is profit, not your health. Remember that.
posted by rtha at 10:47 PM on July 11, 2009 [4 favorites]

delmoi, that is my point exactly. Most people do not care about others, except in the abstract. (For the record, my employer is self-insured and we do not pay insurance premiums) I do not think I am being an "ungrateful mooch,"

Well, I don't know where you work, but you understand is paying for the medical problems of you and your co-workers, right? If you're not paying "premiums" that money is coming from somewhere. If the company stopped paying for medical care and distributed the money to the employees, and you didn't have any medical expenses, you would have more money to spend. Just as if the government lowered taxes. (alternatively, the company could just give raises to the CEO or give the money to shareholders)

Anyway, the purpose of insurance is to protect against unlikely horrible things. You could get fired, your company could decide to cut the program or go out of business, and then that gold plated insurance would go away. Or you could get sick and find out, like many Americans that you have a lot less insurance then you thought.

The purpose of a public option, for me, is that it decreases risk. With a public option, you don't need to worry about those things. Right now I don't have any reason to have health insurance at all, but at the same time, I wouldn't want to be financially ruined by getting hit by a bus. With the health insurance I have, I don't have to worry about that. With ta public option, I don't have to worry about losing my job and then getting hit by a bus.

So a public option is like a better form of insurance (that is, it offers greater protection against risk) at a higher cost (higher taxes)

And by the way, the choice isn't "what I have now" vs. "a private option" It's whether or not mandatory health insurance has a public option or not. A public option actually reduces the costs ($150 million dollars, according to the Congressional Budget Office). So you would actually pay more without. Your taxes would go up more without it.

But in the end, if you don't care about anyone else, then why should anyone else care about you? Why do you think anyone should care if you care or not? I have never understood this.

Meanwhile, tens of millions of other citizens who live in fear every day that they or a member of their family might incur disease or injury get some kind of options beyond debtor's prison or death.

Oh don't get hysterical. This country doesn't have debtor's prisons. They'll just have to die. (Along with 20,000 other Americans who die every year for lack of health insurance)
posted by delmoi at 10:50 PM on July 11, 2009 [1 favorite]

Even though I took a drubbing for it, I appreciate the links and insight, and I'm reading through the former now. I'm really not a member of the landed gentry with 200 serfs (cab driver? landscaper? might be nice to not drive myself back and forth to work), and I'm sorry if it came off like that. I guess I'm more paranoid that what I have will be yanked away and replaced with something that simply doesn't work. That's not meant to be an indictment of universal care; it's a statement of mistrust in our federal government. Maybe I just need a better perspective on this topic, and to not be so "greedy" (as I wrote earlier) or just focused on my little world.
posted by fireoyster at 10:56 PM on July 11, 2009 [3 favorites]

I may regret posting this, but I have to throw it out there and ask the question:

I'm unemployed and my health insurance runs out in 3 weeks. This sucks for me and my family especially since my kid takes a few medications that cost in the hundreds of dollars. Luckily, if I stay poor enough my state government will provide health insurance coverage for my kid but if I'm lucky enough to be gainfully employed with a job that doesn't provide gold plated benefits, I will be spending all of my paycheck up to the insane deductible and hoping my employer doesn't drop me because I drive up the health insurance cost too much. In addition, I freely admit that I'm a greedy person when it comes to "me and mine."

Knowing all this, why should I give a flying fuck if someone is scared that a wealth and business-friendly political elite is going to take their "gold-plated health insurance" and give it to me.

p.s. really?
posted by geos at 10:57 PM on July 11, 2009 [3 favorites]

I have savings in the bank to cover COBRA (going a lot longer courtesy of the gov't discount) and I'm working on being there 10 years so I could stay on COBRA at the discounted rate until Medicare kicks in, which is sometime in the distant future for me.

The other problem here is that you don't know what you're talking about. It dosn't matter how long you've been working, COBRA only lasts 18 months. Then you're on your own. Unless "a distant future" is a year and a half you're going to be uninsured if you don't get another job in 18 months, and your next job may not come with "gold plated" coverage. And of course, medicare doesn't pay for your kids.

The basic problem here is that in the United States your health insurance can go away. With the new plan (whether or not it includes a public option) the insurance can't go away.

Some form of that plan is going to be passed no matter what, and if it includes a public option, it will cost less for you and me and everyone else. Except for insurance companies and their shareholders, of course.

Not including a public option simply means free taxpayer money for insurance companies.
posted by delmoi at 11:01 PM on July 11, 2009

No one has "gold-plated" insurance. Your insurance is just one terrible injury from going away forever and ever, and unless you can afford to sink millions into your healthcare, you're in the same boat as the rest of us. You just don't know it, you schmuck.
posted by TypographicalError at 11:02 PM on July 11, 2009 [8 favorites]

I used to be one of those people who was against nationalizing health care. I lived in England for a couple of years as a teenager and my family had bad experiences with the NHS that supported the kinds of charges that Republicans and insurers make about "government-run healthcare". My mother was given a medication she was allergic to (but fortunately didn't take it) and my father's blood pressure medication was changed with the result that he became seriously ill. But my father's employer had a private insurance plan and we were able to leave the NHS doctor who'd done so badly by us and receive private care.

I'd already changed my mind on single-payer, but damn, reading that transcript would have done it if I hadn't already. There's no way you can run an insurance company and guarantee increasing profit percentages every reporting period without doing some really skeevy things. I wish the world were such that the former executives at the health insurance company to which I pay premiums wasn't talking about denying lifesaving treatments and dumping patients to increase the percentage of income investors take as profit by .1%.
posted by immlass at 11:06 PM on July 11, 2009 [2 favorites]

Great link, delmoi.

One thing I didn't understand though was the assertion made at the end of the video that health insurance companies want the government to enforce coverage, despite the earlier comment that purging customers is a way to minimise payouts.
posted by teem at 11:33 PM on July 11, 2009

fireoyster, please visit the Netherlands (and France). We've got the same gold-plated coverage as you do.

Except we *all* do. And we're spending less on it that you do. So please, steal every part of our system that works, and fix the atrocity you've got now.
posted by DreamerFi at 11:35 PM on July 11, 2009 [8 favorites]

Haha! We're not going to get any "public option", whatever the hell that even is. This was the Obama administration's opening bid! And they've already backpedalled from that!

At "worst" the Fazes and the gushns of the world will have to worry about a bill like Bush had with prescription drugs (does that sound familiar, Obama's plan is like Bush's?): Namely that 10's of millions of free dollars will be going to insurance companies to keep doing what they've always been doing. The Libertarians can go to bed secure in the knowledge that none of their money will go towards helping someone else.

We live in the Libertarians' fantasy. Corporations are literally more powerful than the government or the will of the people.
posted by dirigibleman at 11:48 PM on July 11, 2009 [1 favorite]

"Great link, delmoi.

One thing I didn't understand though was the assertion made at the end of the video that health insurance companies want the government to enforce coverage, despite the earlier comment that purging customers is a way to minimise payouts.
posted by teem at 1:33 AM on July 12 [+] [!]"

1. Some of the 50 million uninsured are healthy and likely to remain so.
2. Some of the 50 million uninsured are unhealthy and likely to get worse.
3. The insurance companies will set claim policy to exclude the latter group from making claims the same as they have with the currently insured.
4. Profit!
posted by vapidave at 12:25 AM on July 12, 2009 [3 favorites]

As vapidave says - consider that some of the uninsured are twenty-somethings for whom in practicality health insurance is almost certainly a losing bet. Which means that forcing them to buy health insurance, even though it will in the end benefit the twenty-somethings who have bad luck, is going to be a total goldmine for the insurance companies because the premiums they pay will be almost pure profit. So they'll maneuver to get those customers and foist off the less profitable ones on their competitors or on the public somehow.
posted by XMLicious at 1:05 AM on July 12, 2009

"I'm more paranoid that what I have will be yanked away and replaced with something that simply doesn't work."

I'm not going to mince words, here. What millions of your fellow citizens have already doesn't work. They go into unbearable debt to cover their medical costs, or just avoid treatment as much as possible, or in the worst cases die. I don't advocate in any way reducing the level of service you receive from your medical service providers, but you don't suppose there's some middle ground between having your health and wellbeing fawned over by the entire medical establishment and dying from lack of insurance do you?

"My mother was given a medication she was allergic to (but fortunately didn't take it) and my father's blood pressure medication was changed with the result that he became seriously ill."

There are private medical outfits which have just as much incompetence to them if not more. I've seen similar incidents in my own family with large HMOs as well as at ostensibly fancy-pants Catholic hospitals. Government bureaucracies don't have a monopoly on incompetent morons -- in fact there are plenty of them operating for profit.
posted by majick at 1:21 AM on July 12, 2009 [1 favorite]

fireoyster, although you may have gotten a bit of a drubbing from it, I'm glad you asked the question, because it helps get the discussion going. Now I have so much more to say to people who only get the talking points version of why nationalized health care is awful and scary. For me, the reasoning is clear. I love working for small employers: They're flexible to business needs, they're exciting to work for, and it's always a new challenge. But small employers generally can't provide health insurance. And so I'm stuck working a dead end job for a dead end industry because it at least has some level of health insurance available, although in recent years it has pretty steadily dropped from decent to OK to marginal to we're actually buying supplemental insurance to fill in the gaps. And we're paying more every year for a reduction in service. And yet, I cling to this job for dear life because it has insurance.

My stepdaughter doesn't have any, and because she makes too much (I think the line is set at $24k/yr to give a sense of scale), my grandson has no insurance whatsoever. Last September, she took a spill and went to the ER to have it checked out. A couple of x-rays and she was sent home. We're sort of glad her bill was only $847, but my wife and I live in constant fear that some day something major will happen and she'll have a five figure hospital bill garnishing her limited wages. Blech.
posted by Kyol at 1:28 AM on July 12, 2009 [1 favorite]

I've dished out a bit of said drubbing myself, and I want to state for the record: you're not evil for asking the question you're asking. It was clear that it's out of a sincere quest for knowledge and not merely to take your monocle and cane out for a constitutional. Your concerns are legitimate, particularly when considered from your own perspective.

But down here in steerage we really just cannot expend time and effort to worry about how your deck chairs are arranged up there. We're too busy bailing water and scrambling for air while the insurance companies ram the entire United States economy into their healthcare cost iceberg over and over again.
posted by majick at 1:39 AM on July 12, 2009 [6 favorites]

A real life example of what happens when you don't have insurance. If anybody has any ideas on how to help my brother, feel free to contribute.
posted by Avenger at 3:17 AM on July 12, 2009 [2 favorites]

The government doesn't give two shits about private insurers when push comes to shove.

I must have a different definition of one or more of the words you used there. From where I sit, the private insurers are the only ones the government is really listening to. For instance, none of the Congressional dog-and-pony shows have even allowed single-payer to be mentioned.


Insurance company executives don't want us to have bad health care. They just like their big paychecks and don't know or don't care how bad things are.

Exactly. Which is why that rock does NOT want to be moved. I do wish that your version of reality were true. Sadly, it isn't.
posted by Kirth Gerson at 5:27 AM on July 12, 2009

I don't know of a single country with a universal health care plan that does not also have private health insurers. The way it works here in Australia is, your private health insurance covers things that the public health system (Medicare) doesn't, and it reduces your out-of-pocket expense and waiting times on things that the public health system does cover.

We can take out loss-of-income insurance, which pays out if the holder becomes unable to work for a significant length of time. That has a similar relationship to government-paid disability pensions and sickness allowances that the private health system has to the public system.

We also have a pharmaceutical benefits scheme, which subsidizes the cost of medication for everyone where that medication is particularly expensive, and also for pensioners, the unemployed, and low-income earners (ie, "health care card holders"). Usually doctors bulk-bill (ie, no patient payment) health care card holders, although the Medicare rebate has not kept pace with increasing costs of living--a deliberate decision by our obnoxious previous government--and as such, most doctors charge people who do not hold health care cards a "gap fee". In my experience this gap fee isn't too onerous, around $30 for a visit, and most doctors I've ever gone to on a long-term basis have bulk-billed me for any followup visits.

In my experience neither Medicare nor private health insurers in Australia are particularly reluctant to pay out substantiated claims, nor do they interfere in medical decision-making. You could do a lot worse than copy us. In fact that would be easy, since all you have to do to do worse, is do nothing.
posted by aeschenkarnos at 6:05 AM on July 12, 2009 [1 favorite]

I may regret posting this, but I have to throw it out there and ask the question:

I work for an employer whose health and other benefits can charitably be defined as "gold plated." There's no co-pay, deductibles, etc. This is awesome for me and my family, especially since my kid takes a few medications that cost in the hundreds of dollars. In addition, I freely admit I'm a greedy person when it comes to "me and mine."

So, I get that if I lose my job, it can all go poof and disappear. However, I consider that to be like any other risk in life. I try to do well at my job to remain employed there, I have savings in the bank to cover COBRA (going a lot longer courtesy of the gov't discount) and I'm working on being there 10 years so I could stay on COBRA at the discounted rate until Medicare kicks in, which is sometime in the distant future for me.

Fireoyster, you seem to be under the impression that doing a good job will keep you employed. For your sake, I hope you are never disillusioned. I lost my job when my company was sold to another and there was no need for my services. I now commute almost four hours a day to a temporary freelance job with zero benefits, paid COBRA rates of nearly $1,000 a month to cover two people, reduced to $600+ until the TEMPORARY subsidy ends in December, and have no prospects for a decent job. I am 57 years old and work in a dying industry. So I wish you well but I think you're out of touch with the reality many of us are facing.
posted by etaoin at 6:11 AM on July 12, 2009 [5 favorites]

If American healthcare is the hell on earth it is advertised as being, why don't fewer people smoke? Why are so many Americans overweight? Why do people eat steak and barbecue and french fries, and never exercise? Why do they drive fast and ride bikes and motorcycles without helmets? Why do they take drugs, play with guns, and practice unsafe sex? I don't think Americans hate their healthcare system. I think they're loving it to death.
posted by Faze at 6:14 AM on July 12, 2009 [1 favorite]

On the subject of employer-provided health insurance in Australia, some large employers and some industries or sectors (eg the police) have their own "in-house" private health insurers (also credit unions); generally speaking these give a slightly better deal than those private health insurers who are open to the public. Generally speaking a certain minimum number of sick leave days per year is a mandatory employment condition for full-time or part-time permanent employees, and under awards where these do not accumulate or pay out on end of employment, "taking a sickie" is common practice. Employers can legally require doctor's certificates from employees, and generally do from those who take more than a day or so in a row.

Long-term illnesses do impact employability in Australia of course, but this is not due to insurance concerns, more a natural consequence of the illness itself. While not an illness as such, pregnancy is a special case; because it's obviously stupid to expect an employer to employ a woman more than six months or so pregnant for any long-term job, if she is single or partnered and the couple are earning a low enough income, and is a casual worker or otherwise unemployed, she can receive a government benefit. (Caveat: my knowledge on that topic is about ten years out of date.)

Social security is highly relevant to a discussion of health insurance, as the two interact to a great extent. You'll probably find your lack of a decent social security system will become more noticable, when and if you replace your ludicruously inefficient shit parade of a health system.
posted by aeschenkarnos at 6:20 AM on July 12, 2009

Faze If American healthcare is the hell on earth it is advertised as being, why don't fewer people smoke?

One of the defining characteristics of a hell, is being trapped in it.
posted by aeschenkarnos at 6:21 AM on July 12, 2009 [7 favorites]

If American healthcare is the hell on earth it is advertised as being, why don't fewer people smoke? Why are so many Americans overweight? Why do people eat steak and barbecue and french fries, and never exercise? Why do they drive fast and ride bikes and motorcycles without helmets? Why do they take drugs, play with guns, and practice unsafe sex? I don't think Americans hate their healthcare system. I think they're loving it to death.

Sinners!
posted by srboisvert at 6:21 AM on July 12, 2009 [1 favorite]

The government doesn't give two shits about private insurers when push comes to shove.

As the chair of the Senate Finance Committee, Sen. Max Baucus is at the center of the congressional effort to craft health care reform legislation, a top priority of President Barack Obama. The Baucus-headed Finance Committee has been singled out by advocates and news organizations as the toughest obstacle for the President’s health care priorities. Containing more moderate and conservative members may not be the only reason. The committee is packed with lawmakers who have close ties to the health care and insurance industries, receiving large campaign contributions as their former staffers turn around to lobby for the very interests whose issues — in this case health care — they previously worked on. Baucus, as chair, stands out in particular.

Lobbying disclosure filings for the first quarter of 2009 reveal that five of Baucus’ former staffers currently work for a total of twenty-seven different organizations that are either in the health care or insurance sector or have a noted interest in the outcome. The organizations represented include some of the top lobbying organizations in the health sector: Pharmaceutical Manufacturers and Researchers of America (PhRMA), America’s Health Insurance Plans (AHIP), Amgen, and GE Health Care. link

posted by rtha at 6:22 AM on July 12, 2009 [2 favorites]

If American healthcare is the hell on earth it is advertised as being, why don't [yadda yadda yadda]

Because people are often very, very bad at eschewing short term pleasures for long term gains. Also, many of your examples have dick-all to do with the real health problems that befall people due to genetics or fate.

You may choose to live in a padded box eating oat bran for the rest of your life. Most people won't make that choice.
posted by maudlin at 6:23 AM on July 12, 2009 [1 favorite]

If American healthcare is the hell on earth it is advertised as being, why don't fewer people...

If you had no insurance, would you stop eating fresh spinach and tomatoes because you might get E. coli? Would you stop exercising because you might get injured and need medical treatment?

The answer to your question is that people don't operate the way you seem to think they do, or should. People don't do risky things because they have good insurance. They do them because they're addicts or they like it or it's fun or because their options are limited. In short, because people aren't rational robots like you. Good on ya.
posted by rtha at 6:27 AM on July 12, 2009

guess what faze got for his birthday
posted by caddis at 6:31 AM on July 12, 2009

If American healthcare is the hell on earth it is advertised as being, why don't fewer people smoke? Why are so many Americans overweight? Why do people eat steak and barbecue and french fries, and never exercise? Why do they drive fast and ride bikes and motorcycles without helmets? Why do they take drugs, play with guns, and practice unsafe sex? I don't think Americans hate their healthcare system. I think they're loving it to death.

This is possibly the most incoherent thing I've read in the past week, and I read through the Plan B thread without ignoring jsonic.
posted by oaf at 6:44 AM on July 12, 2009 [6 favorites]

Faze continues to be the master of the absurd. So entertaining.

Faze, I live under a universal health care system. Why don't I smoke? Why do I exercise 4 to 5 days a week? Why do I rarely drink? Why do I commit myself to a better than average diet? Why do I do all the things that presumably others shouldn't also and yet still, I have to go the doctor. I've torn muscles from exercise and sport. I've been t-boned in an automotive incident and my neck hascn't been the same since. I suffer from periodic bouts of intense depression. Like many Americans, I've taken my destiny into my own hands and work for myself, as in freelance, and if I was in the States non of my medical needs would be addressed as I couldn't afford coverage despite my commitment to my health. There is also the factor of age and genetics, which can affect the health of individuals even if they live healthy lifestyles. Fear to generate healthy lifestyles is not a great model, and even if you're committed to your health it doesn't mean you won't need service, expensive or otherwise.
posted by juiceCake at 7:28 AM on July 12, 2009 [1 favorite]

Fireoyster, I don't think you're a terrible person for asking the question. I think it's still really difficult for the shrinking set of people for whom our current health system does work well to wrap their heads around just how terrible it is for huge numbers of their fellow citizens - and how vulnerable they are to winding up part of that pool of people through no fault of their own. It's so bad that it's hard for people who aren't experiencing it first hand to really grasp how bad it is. In some ways that's really what this interview was about - Wendell Potter had a huge vested interest in thinking the system wasn't that bad, and it took a lot to get through to him, and Bill Moyers does a good job of exploring how that process worked for him.

I also don't blame you for worrying about the federal government's capacity to implement something like this. FEMA, SEC - we have plenty of recent examples of the feds demonstrating incompetence. I guess I have two rejoinders for that; first, the current administration has a profound commitment to practical competence that reassures me in terms of getting this thing set up; and second, the very fact that it is such a vital service creates constant public pressure for competence. Once this thing exists it becomes the third rail in the same way that Social Security currently is. You yourself mentioned Medicare as part of your backup plan, implying that you do have confidence in some federally-administered health care.

The group that Potter talks about that was running the health fair in Virginia is interesting - they were started to provide health care in remote areas of South America but then saw the need in the US as well. Their schedule for 2009 is on their site.
posted by yarrow at 7:29 AM on July 12, 2009 [1 favorite]

Right now I am sitting on my throne. Scarlett Johannsen is naked, rubbing my feet while I drink the finest libations out of a solid gold, jewel-encrusted goblet and the London Symphony Orchestra performs for me alone. Isn't it great that everybody gets to enjoy this level of luxury and it comes at a cost to nobody else? I love American Capitalism!
posted by Legomancer at 7:40 AM on July 12, 2009 [1 favorite]

There are private medical outfits which have just as much incompetence to them if not more.

I was one of those lucky people who didn't encounter incompetent doctors and shuffling with losing paperwork until a bit later in life. Until I was in my mid 30s, my GP was the partner of the doctor who attended at my birth, so he was a valuable health care adviser across a lot of issues. It was only dealing with specialists (and moving across the country) that drove home to me how bad the current US system is even if you're insured.

One of the ways my GP in my hometown managed, by the way, is by refusing to deal with insurance paperwork. He took a check for the full amount of the office visit and I requested reimbursement from my insurance company. Because he didn't have to pay to manage the paperwork, and because his compensation didn't depend on it, he was able to spend more and better time with his patients.
posted by immlass at 7:41 AM on July 12, 2009

What ROU_Xenophobe said.

I have excellent health insurance in my current job, but with a family there's no way I'd take the risk of starting my own business, or joining a startup, both things I've considered in the past. I know many, many co-workers who stay in the job for similar reasons.

Also, I grew up in the UK. The psychological difference in never worrying about healthcare there is hard to describe. I know every country has a degree of exceptionalism, but I wonder sometimes if in the US it means that, by definition, many believe that the US has nothing to learn from other countries.
posted by idb at 7:49 AM on July 12, 2009 [3 favorites]

I can't believe how little those who claim they've "got it good" realize how fragile that situation is. A corporate take-over or a year of bad management could turn them either unemployed or employed with copper-plated coverage rather than gold. And should you be so unfortunate as to develop a "pre-existing condition" before you switch jobs, you're at serious risk for being financially drained the rest of your life.
posted by CheeseDigestsAll at 8:34 AM on July 12, 2009 [2 favorites]

Scarlett Johannsen is naked, rubbing my feet

ur doin it wrong
posted by ROU_Xenophobe at 8:46 AM on July 12, 2009 [1 favorite]

American exceptionalism is nothing new, unfortunately.

In 1908, Dr. Alice Hamilton published a paper on "industrial diseases"—the first paper on the topic published in the U.S. Europe was far ahead of the U.S. in this (Hamilton had to begin by convincing employers that really did have an obligation to make sure their workers weren't poisoned or injured as they performed their jobs) but then as now, neither employers nor legislators wanted to hear about how they did things in Yurrup.

Is it sensible to assume that what is American is necessarily wisest and best, or even that it is unchangeable? Surely we should have enough humility to reexamine our national ways and decide quite objectively if they are the best possible for us. Personally, I am very loath to accept the verdict that a dependence on the benevolence of the uppermost class toward the lowest class is the only possible American way of solving the problem of the poor, or even that it makes for a healthy state and contentment at the bottom of society.
posted by dogrose at 8:47 AM on July 12, 2009 [1 favorite]

If I were fireoyster I'd be concerned that the creation of the public option would give incentive to the insurance industry to cut services and jack up costs to fireoyster and his employers even if there is no reason for them to do so. Of course, if the insurance companies are successful in fighting this, they're likely to do it anyway to pay for their success by rewarding their 'leadership.'
posted by wobh at 8:52 AM on July 12, 2009

I can't believe how little those who claim they've "got it good" realize how fragile that situation is.

One of the things I've learned in my 49 years is that a lot of Americans that have it good have a healthy dose of entitlement, also. I've met so many upper-management types who actually believe they got where they are through their talents only. They make the big bucks because they deserve the big bucks; luck and fortune played no part in it. Make no mistake, the upper-class that constantly bitches about entitlements for the less fortunate is a constant (and largely ungrateful) recipient of entitlements. Unfortunately, since they are the last in line to suffer when things go bad, they are also the last in line to learn any useful lessons.

This country, and especially the fucks who have a deathgrip on the reins of power, needs an empathy overhaul.
posted by Benny Andajetz at 8:55 AM on July 12, 2009 [11 favorites]

I guess I'm more paranoid that what I have will be yanked away and replaced with something that simply doesn't work.

Very shortly after your first major health crisis, your insurance will be yanked away and replaced with something that bankrupts you.

Your gold-plated health insurance is sunshine and roses until you actually use it.
posted by five fresh fish at 10:00 AM on July 12, 2009 [2 favorites]

"We are strongly opposed to a government-run health care plan in America. We are committed to providing the best possible care for our members at the lowest possible prices, and we believe that any attempts to change this will be detrimental to all Americans. Premiums will rise, treatment options will be greatly reduced, and you'll have a government bureaucrat telling you what care you can and cannot receive. The sun will slowly go dark. Water will turn to dust, grain to sand, and trees to rocks. The notion of love will be a distant memory and demons will roam the landscape, eating the flesh of any human unlucky enough to remain living."

- National Association of Health Insurance Plans Spokeswoman Amy Pullman
posted by hamida2242 at 10:11 AM on July 12, 2009 [12 favorites]

If American healthcare is the hell on earth it is advertised as being, why don't fewer people smoke?

One of the defining characteristics of a hell, is being trapped in it.

There's a scene at the end of Garth Ennis's run on Ghost Rider where a demon is trying to...not console, but offer some perspective at least, to Ghost Rider about having to go back to hell. He tells him: "Son, I'ma give you a bit of advice that I got when I first got to the pit. First: the first billion years is the worst. Second: You gotta take yore pleasures where ya can."
posted by Doublewhiskeycokenoice at 10:12 AM on July 12, 2009

I have excellent health insurance in my current job, but with a family there's no way I'd take the risk of starting my own business, or joining a startup, both things I've considered in the past.

This.

This should be a reason even conservatives should appreciate.
posted by cosmac at 10:17 AM on July 12, 2009 [2 favorites]

Fireoyster, it's great that you said out loud what lots of people who have decent coverage are thinking but won't admit.

That said, you are misinformed. If Obama's plan would take away good insurance from people who already have it, IT WOULD NEVER NEVER NEVER IN A MILLION YEARS pass Congress. All the current version does is potentially make you pay taxes on benefits over a certain amount-- it doesn't force you into anything but it does give everyone else the opportunity to have decent health care.

If a public option is added, that would mean that basically, there's a new entity like Medicare that will compete with insurers and might well drive some out of business because of the sheer economy of scale of having that many people and not having to make a profit by denying care to pay people to not answer your calls and make extra paperwork and delay and to pay executive salaries and shareholders.

What I find funny is that the insurers freak out at having the government compete with them and call it unfair-- at the same time as they say the free market will always do better than government. Can't have it both ways, dudes: if you can't compete with the slow, bureaucratic evil government's cost lowering strategies, that's your problem.

If the public option eventually shrank the insurance industry significantly, you might have to worry-- but that's not going to happen any time soon if ever.

If you are making over 350,000 as a family, you are also at risk of higher taxes in general, but you know what, if you are making over that amount, you can afford to pay more taxes and you should be thanking God that people with pitchforks aren't at your door or that you aren't in bankruptcy like many who once made that are.

In the UK, there's a public system and if you want "gold plated" you can pay for private insurance on top of that. I think Canada is the only place where private insurance is not allowed-- and no one has even proposed anything like that here.
posted by Maias at 11:11 AM on July 12, 2009 [3 favorites]

Ugh, I know. I had the most horrible experience at the hospital last month. I mean, it was like the freaking U.S.A. in there!
posted by Eideteker at 11:17 AM on July 12, 2009

If American healthcare is the hell on earth it is advertised as being, why don't fewer people smoke?

Fewer people are smoking.
posted by vibrotronica at 11:39 AM on July 12, 2009

And the song remains the same...
posted by Vindaloo at 12:01 PM on July 12, 2009

Because no one in Europe or Australia ever smokes, amirite?

Fireoyster, I'm sorry that your kid has health problems. I'm sure if I were in your situation I'd be really scared, too. But it would take so little for you to be down here with the rest of us. Business failing, getting a new manager who hates you, mergers, you having a catastrophic health problem.

I'd never be able to get insurance on my own through the current system for various reasons, including a genetic condition that I apparently should have thought about before I was born. Right now, I have excellent insurance, but only through the auspices of my husband's job. And even with excellent insurance there are insane costs. I went to the emergency room a couple of weeks ago. I stayed for a couple of hours and got an ultrasound on my leg -- I thought I had a blood clot. I left with a diagnosis of "left leg pain." Even AFTER my insurance paid the hospital, I ended up $250 out of pocket. For us right now, that wasn't too difficult to pay, but we have no children and a middle-class income. For many, many people, $250 is devastating.
posted by sugarfish at 12:03 PM on July 12, 2009

However, I consider that to be like any other risk in life. I try to do well at my job to remain employed there, I have savings in the bank to cover COBRA (going a lot longer courtesy of the gov't discount) and I'm working on being there 10 years so I could stay on COBRA at the discounted rate until Medicare kicks in, which is sometime in the distant future for me.

Maybe I'm not reading this correctly, but there seems to be a little misunderstanding of COBRA--you can't stay on it indefinitely or try to stretch it into something else unless you time it exactly right and your age is just right. It tends to end after 18 months. And again, the federal subsidy ends in December, it doesn't go on forever. What bothers me most in this posting is the presumption that we all control our fate and we can have perfect lives if we just plan it right. Does not work that way at all.

Let me say that, although I have great issues with some things Obama has failed to do since becoming president, getting the COBRA reduction for a few months is a huge, huge benefit without which I probably would have no coverage. I am eligible to join a freelancers' group that offers expensive but really piss-poor but better than nothing coverage that may have to take as my next step.
posted by etaoin at 12:07 PM on July 12, 2009

When I was laid off, my COBRA lasted 3 months. I tried to sign on to the extension, but because I worked for a small magazine, they didn't let me. I went to an insurance broker that was recommended to me by my wife's employer and bought an insurance plan with BCBS, the same company that I was insured with at my old job. My new insurance, which I am paying for out of what passes for my savings (It was my share of the proceeds from the sale of my grandparents farm, BTW) has a very high deductible.

Here's where I should note that I had the choice of two health insurance companies: United and BCBS. I had been insured with both companies in the past. While I was with United, my doctor went from being in-network and covered to being out-of-network and not covered at all. Only no one told me, and I got stuck with a huge batch of bills that screwed up my finances for an entire year. While I was with BCBS, they literally denied every claim I sent them and made me call and contest it. I guess I got them to pay out maybe half of the time. I allegedly had dental insurance with them when I was at my old job, but the one time I tried to use it, the billing people at the dentist's office told me the procedure the dentist recommended was pre-approved, and then BCBS turned around and stuck me with the entire bill, which I fought until it eventually went into collections after I lost my job and I was forced to charge it on a credit card that I had managed to pay down to almost nothing while I had my job. So I was forced to choose between two companies that had screwed me over in the past and which I had no doubt would screw me over in the future. In fact, my wife went to a doctor two weeks ago and has another appointment this week. The doctor told her that she accepted her insurance, and from my reading of the policy materials BCBS sent me when I signed up, these doctor visits should be regular co-pay visits. We haven't received the benefit statement from the insurance company yet. I bet you five dollars they deny it. And yet, those were my choices in the "free market".

I still haven't found a job. I got incredibly excited when I thought I had landed three piddly freelance jobs, but one of those has already fallen through and the other one is not being communicative. When the insurance company drains the last of the farm money, either by monthly attrition or by fucking me over again, I'm totally fucked.
posted by vibrotronica at 12:37 PM on July 12, 2009

At the risk of starting the landslide all over again, I was reading an old version of the American Recovery and Reinvestment Act: Turns out the COBRA-for-tenured-employees bit was not in the final bill.

And, back to homework.
posted by fireoyster at 1:16 PM on July 12, 2009

Great post, delmoi, thank you. Potter's is a classic Coversion Experience, and I hope he writes it down.

Previous posts to the Blue have revealed my general opposition to Single Payor and Universal Healthcare and variations on theme, and like most Dogma, that opposition is based upon tenets that are fundamental to me: 1. that cool innovations happen with the profit motive, and 2. that I know the Aunt Judy scenario happens.

I'm not posting any conversion narratives here or anything, but I have appreciated reading (and sometimes getting knocked around in) the discussions on this topic. My industry (hospitals) has thrown its hat over the wall and accepted a reduction of $150B over 10 years to pay for the plan. There is a long way to go, but this plan could work...
posted by njbradburn at 2:36 PM on July 12, 2009

The number of people who stay in jobs they hate, not because they need the money but because they need the health care... well, it's sickening.
posted by rokusan at 4:47 PM on July 12, 2009 [1 favorite]

Fireoyster, for the record, we once had "gold plated coverage". Then I got in a (tragic but funny)Bauhaus accident that severed both my acl tendons, crushed my knees, and had a whole bunch of other injuries.

Physical therapy was denied by the insurance company. I developed a deep vein thrombosis from not moving, and the week in the hospital from it were denied. Pain meds were denied, blood thinners were denied.

My company fired me "because I couldn't return to work" in two weeks. My husband worked for the same company, so we switched me over to his plan, and lo and behold, he was laid off in the next round of layoffs.

I was left with more than 80,000 dollars in medical bills, and I HAD gold plated insurance the day I had the accident. Almost a decade later, and I'm still in constant pain every day from all the work that should have been done, but was denied.

I can go whole days where I can barely feel my left leg. I cut the bejebus out of myself last week because I hadn't realized I'd run into something sharp, and it was only when the kids starting freaking out about the blood that I realized I was hurt. All because the insurance company denied coverage that would have put me back together correctly in the first place. (For the record, I cleaned it and butterfly sutured it together, because I didn't feel like dealing with the emergency room...especially without insurance. Girl Scout first aid to the rescue!)

Insurance is a racket. Don't expect it to actually pay for anything, if you really ever need it.

What you have is an illusory security blanket that will disappear like fairy gold if you ever really test the limits of it. You can wrap yourself in the belief of your gold-plated safety net...but it is no safer than anyone else. You could lose your job tomorrow. Gods forbid you or your family could be in an accident, you could actually try to *use* your insurance...and then, my toasty bivalve friend, you will find yourself up the oyster bed without a paddle...just like the rest of us.

Or to put it more succinctly, as Thomas Paine so brilliantly said: “If we do not hang together, we shall surely hang separately.”
posted by dejah420 at 5:38 PM on July 12, 2009 [20 favorites]

I'm going to keep my response short.

Canada has a health-care system that works far, far better than ours. As a first step, we should discard what we've been doing and adopt Canada's system.

After 10 years of this experiment, we can frame new hypotheses and do other experiments to see if we can improve it.

Those who don't like science can buy into whatever snakeoil they like -- outside the system.
posted by Twang at 6:55 PM on July 12, 2009

Jesús, dejah, what happened to put you into such a state?

Canadian Healthcare Story:

So we're toodling down the backroad on our motorcycles when a kid in a farm truck blows a stop sign because he's busy watching me with a kid on the back of the bike, instead of looking the other way to see if there is oncoming traffic. My wife is right. fucking. there.

The truck nips the front tire, throwing the bike down hard to the left. My wife is pitched forward. Her right shoulder slams into the front driver corner of the truck, breaking the ball joint in three. She is thrown backward and under the truck. The front tire and rear dualies run over her left elbow, pulverising it.

A paramedic happens to live right there. The volunteer fire hall is one block away. Cops are there pretty quick. Ambulance is there in about twenty minutes.

She goes through hospital triage pretty damn quick. By the time I make it to the hospital, she has been x-rayed, specialist reconstruction surgeons is on their way, they're doping her up and getting her ready. Within the hour she is in surgery, with an amazing surgeon reconstructing her elbow from the little bits he can salvage and a fair bit of titanium rod and plate, miraculously avoiding damage to the nerve that runs to her left hand. Another amazing surgeon works on her shoulder, dealing with the highly unusual break, pinning the three parts back together.

Some four hours (maybe it was six? Time stood still.) she's in the recovery ward. IV drips and pins sticking out of her limbs and nurses and all. I'm still freaking, I stay the night despite ward policy. There's just no way to get me out of there.

Over the next few days it's a lot of drugs and a lot of x-rays on the rest of her banged-up limbs and fingers and hips, and twice-daily visits from the surgeons. Nurses finally get me out of the ward for hours at a time.

By day four or five she's woozily mobile, with a occupational therapist (?) getting her up out of bed and around the ward, doing exercises up and down mini staircases, testing her grip strength, looking for tissue injuries. A day or two later I've got home care setting up a hospital bed in our living room and assisted living devices for the tub and toilet and all that jazz.

She comes home on day five or six (yay!) and we've got a homecare nurse coming in daily to check on her wound care and pain meds.

No insurance to claim or negotiate. Nothing but pure support and superlative care. None of it directly cost us a dime.

That's Canadian healthcare, in my experience.
posted by five fresh fish at 7:42 PM on July 12, 2009 [10 favorites]

AskMe
posted by haltingproblemsolved at 7:43 PM on July 12, 2009

The post-hospitalization/rehabilitation services were superlative, too. That was covered by the automobile insurance company. My wife was rehabilitated to an amazing degree and I have only great things to say about ICBC's dedication to rehabilitation.

They were, however, complete and utter assholes when it came time to settle out the claim vis-a-vis lifetime loss of income and disability. But, still, at least they did the healthcare aspect right, which is entirely unlike anything that happens in the USA.
posted by five fresh fish at 7:48 PM on July 12, 2009

There isn't nearly enough money to pay for all of the health care that people want--that's the sad reality. In our lifetimes, for sure, there will always be tragic stories of people being denied health care--not because of bad people, but just because there literally is not enough money in existence to pay for it all.

People have to come to grips with that.
posted by mpls2 at 7:53 PM on July 12, 2009

I work for an employer whose health and other benefits can charitably be defined as "gold plated." There's no co-pay, deductibles, etc. This is awesome for me and my family, especially since my kid takes a few medications that cost in the hundreds of dollars. In addition, I freely admit I'm a greedy person when it comes to "me and mine."

I don't think you should have to give this up. I have the same. No co-pay, no deductible, go to any doctor I want, any hospital I want and have whatever treatment the doctor and I decide are appropriate without needing anyone to pre-approve. I wouldn't give it up either.

Of course I'm in Canada and get all this from a single-payer system. Why not create a single-payer system with no deductibles and co-pays? Why assume that the insurance offered by a single-payer insurance would be as crappy as most private insurance plans?
posted by If only I had a penguin... at 7:59 PM on July 12, 2009 [1 favorite]

In other words, instead of asking "why should I give this up?" why not ask yourself "Why shouldn't everyone have this?"
posted by If only I had a penguin... at 8:00 PM on July 12, 2009 [6 favorites]

There isn't nearly enough money to pay for all of the health care that people want--that's the sad reality.

mpls2, have you been paying any attention at all to the previous 100+ comments or the linked video or any of a number of earlier posts on MeFi, or are you being deliberately obtuse?
posted by barnacles at 8:04 PM on July 12, 2009 [3 favorites]

Previous posts to the Blue have revealed my general opposition to Single Payor and Universal Healthcare and variations on theme, and like most Dogma, that opposition is based upon tenets that are fundamental to me: 1. that cool innovations happen with the profit motive

If I can address this, you're mistaken if you think that single-payer removes the profit motive. Most healthcare providers are private companies operating for profit (e.g. doctors are in private practice). It's not the health *care* that is public, it's the health *insurance*. A medical facility that can do it better and cheaper and attract more patients will make more money. A drug company that developes a better drug will sell more of it. That's your profit motive, right? There's your profit motive. Of course the difference is that rather than making more money by competing to make insurance companies happy, healthcare providers make more money by competing to make patients happy. Once patients have truly free choice about where to go and what healthcare to receive I would think the profit motive would operate all the more efficiently. How many doctors did I dislike when I lived in the states that I had to keep going to because they were the ones my insurance covered? Doesn't happen here. Treat me right or I'm going elsewhere.

As for Aunt Becky, sure she exists. But I'm guessing there are a shitload more Aunt Becky's with private US health insurance than with single-payer insurance in other countries.
posted by If only I had a penguin... at 8:13 PM on July 12, 2009 [2 favorites]

Faze--shut up.

The rest of you--terrific conversation. This is one of the reasons I never truly stay away from Metafilter, even when some threads make me want to stab people through the internet.

dejah420--it was Benjamin Franklin, not Thomas Paine, but that's okay, I'm just nitpicking.
posted by tzikeh at 9:34 PM on July 12, 2009

mpls2 there literally is not enough money in existence to pay for it all.
That's not how money works. See, you don't have to pay for it all at once. What happens is, you pay the doctor for your health care. That's outgo for you, income for the doctor. The doctor does not destroy the money, he does not roll it up and smoke it, he does not sew it up in the wounds of the next patient, and he does not throw it in the sea - he spends it. At that point it becomes outgo for the doctor, and income for others: the landlord of the surgery, the grocer near the doctor's house, etc etc.

The fallacious idea that spent money is destroyed by the recipient is responsible for a lot of "conservative" financial misunderstandings, misspending and mal-spending. If money is given to people, they have an overwhelming tendency to spend it.

(Of course if you give out too much everyone jacks up their prices and then you get inflation--or they just do that anyway--but that's not as bad as a liquidity crisis, as has been recently demonstrated.)
posted by aeschenkarnos at 11:30 PM on July 12, 2009

There isn't nearly enough money to pay for all of the health care that people want-

Doesn't the US government already spend/waste more on health care, per capita, than many nations with free/universal health care?
posted by rokusan at 11:48 PM on July 12, 2009

there literally is not enough money in existence to pay for it all.

The US spends more on health care per capita than any other nation on earth - more than nations like France, Canada, Britain, Switzerland, and others that manage to provide coverage for all of their citizens and generally experience better overall results.

Why is health care so expensive in America? I'm sure we'd all love to believe it's because we receive far superior health care than everybody else, but why then are our infant mortality rates (it's over twice as bad for African American babies) and life expectancy rates so much worse than most industrialized nations?

The administrative costs for private health insurance runs in the neighborhood of 20% of the total cost, while Medicare is closer to 2%. Middlemen, corporate executives, and profits add up.

Upwards of 30% of every hospital bill charged to an insurance company goes to offset the hospital's costs of treating patients who have no insurance. Our taxes cover some of the rest.

Since you'll be paying for it one way or another, which bill would you prefer to subsidize: 1) $4,500 to cover emergency room care, labs, and hospitalization to treat a case of pneumonia that could have been prevented with cheap antibiotics; or 2) the $100 doctor's visit and $20 worth of antibiotics that would have prevented the pneumonia?

Right now we're all forced to subsidize option #1. Some of us would prefer to pay for option #2, not only because it's more humane for those who become sick but also because it's far more affordable.

Finally, you used the word "literally". I do not think it means what you think it means. (hint: it doesn't mean "figuratively").
posted by Davenhill at 1:16 AM on July 13, 2009 [3 favorites]

Doesn't the US government already spend/waste more on health care, per capita, than many nations with free/universal health care?

It's important to separate "the government" from "the economy" The U.S. spends a ton of money on oil, but that doesn't come from tax dollars.

The question about scarcity is really a question of resources, not money. Do we have enough doctors, enough MRI machines, etc to cover every medical procedure that everyone wants?
posted by delmoi at 2:04 AM on July 13, 2009

(But of course, there is a huge difference between what "everyone wants" and "everyone needs" Obviously we have the capacity to provide basic care to everyone)
posted by delmoi at 2:06 AM on July 13, 2009

what about the insurance company executives wont somebody please think about the insurance company executives
posted by hamida2242 at 2:06 AM on July 13, 2009

hey i don't know about you buddy but if i don't run the risk of bankrupting my entire family in the event that an unforeseen medical disaster happens to me resulting in my insurance company dropping me in order to protect its profits then that's just not freedom.

free market rules, socialism drools.
posted by hamida2242 at 2:08 AM on July 13, 2009

There isn't nearly enough money to pay for all of the health care that people want--that's the sad reality.

Even if you were right - which you aren't - surely it's better to ration the health care based on who needs it the most, not who's got the most spare cash?
posted by harriet vane at 4:59 AM on July 13, 2009 [1 favorite]

Americans generally have no idea what gold-plated healthcare really looks like.

It's a common bennie in Europe - medical benefits programs, paid for by your employer. It lets you have:

Housecalls.
Housecalls from specialists and physical therapists.
Private convalescence "suites" that are more like upscale hotel rooms instead of a curtained stall in a hospital ward.
Accommodations for family members near your hospital.
Travel expenses paid for so you can see top-flight specialists anywhere in the world.
Minor cosmetic surgery and dentistry.

I don't care how nice your Made-in-the-US health plan seems to you, it's just not that nice compared to countries with social medicine. The bar is set higher to begin with.
posted by Slap*Happy at 5:53 AM on July 13, 2009 [2 favorites]

There are, imo, two big factors that work very strongly against Americans:

1) Most Americans are extremely ignorant of what goes on in other countries.
2) Americans are brainwashed with "We're Number One!!1!eleventy1!!"

Those two combine to make it nearly impossible to convince many Americans that there are better ways of doing things.

And the end result is what we see in American healthcare: a huge population of citizens being fucked over the barrel by corporate health and insurance companies, yet absolutely convinced that this is the best possible system of healthcare.

It is remarkably similar to what goes on in North Korea, except that instead of a god-like human dictator, it's god-like corporate oligopolies.

Obviously, most MeFi citizens aren't part of this categorization, because most MeFi citizens are not so ignorant nor so brainwashed as the rest of the population.
posted by five fresh fish at 9:02 AM on July 13, 2009 [1 favorite]

Do we have enough doctors...?

Unfortunately not.
posted by njbradburn at 9:20 AM on July 13, 2009

Doesn't the US government already spend/waste more on health care, per capita, than many nations with free/universal health care?

It's important to separate "the government" from "the economy" The U.S. spends a ton of money on oil, but that doesn't come from tax dollars.

Of course it is. So let's. If you look at the wikipedia article on US healthcare, citation #2 is a spreadsheet with all sorts of WHO healthcare stats. From that spreadsheet, US government spends $2862 per capita on healthcare in 2005. The Canadian government spent $2410 (all figures in US dollars), and the UK government spent $2668 per capita. So yes, the US government spends/wastes more on health care per capital than nations with universal coverage.

Now if you want to look at all spending and not just government spending, the amount being paid to leave so many people without needed care. According to the OECD, (via the Kaiser Foundation) Americans (government + others) spent a total of $5711 per capita on healthcare in 2003. For te UK the number is $2317 and in Canada it's $2998.

This has been reposted all over the web, so you've probably all seen it, but just in case, this article is one of the few accurate/fair descriptions of Canadian healthcare that I've seen from a US source. 10 Myths about Canadian Healthcare

Oh, and I've lived in the US and Canada and had serious interactions with the heathcare systems in both countries, including care with "good insurance" in the US. I never paid a co-pay or deductible while there either. Nonetheless Canada wins hands down for the greater choice and the lesser bureaucracy involved in getting care.
posted by If only I had a penguin... at 9:27 AM on July 13, 2009 [1 favorite]

And of course, a third big factor comes into play, but it applies to all our countries:

3) Corporate media tells us endless lies, paid for by corporate interests, keeping us misinformed, ignorant, and passive.
posted by five fresh fish at 9:41 AM on July 13, 2009 [2 favorites]

Thinking about it, humans are a natural resource, to be consumed by corporations as raw material for the generation of profit. Humans are a sustainable, renewable resource, and from a corporate point of view, as much emotion should be given a human as one would give a tree or fish. The only thing that mediates in our favour is that humans are also involved in the operation of a corporation, and thus might rule in the favour of fellow humans instead of in the favour of the corporation's best interests. Of course there are endless examples where human lives are sacrificed or harmed because other humans care more about the corporation than humanity.
posted by five fresh fish at 9:58 AM on July 13, 2009 [9 favorites]

five fresh fish: I could favorite your "humans are consumed by corporations" paragraph a thousand times and it wouldn't be enough.
posted by hippybear at 1:46 PM on July 13, 2009

Here is a perfect illustration of 3) Corporate media tells us endless lies. The population is being deliberately kept ignorant.
posted by five fresh fish at 7:01 PM on July 13, 2009 [1 favorite]

Potter on Democracy Now.
posted by homunculus at 4:34 PM on July 16, 2009

Tracking the influence of Frank Luntz’ obstructionist health care memo.
posted by homunculus at 8:28 PM on July 16, 2009

So for Frank Luntz, it's not a matter of what is best for America, but what is best for the GOP — even if that means causing harm to America.

Is that not a form of traitorous behaviour?
posted by five fresh fish at 7:06 AM on July 17, 2009