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Where do you get your health insurance from?
August 4, 2009 10:25 PM   Subscribe

A simple question shows how complex the issue is. Chris at "Cynical C" asks his fellow citizens where they get thier health care (insurance) from and the incredible diversity of the current options and situations is immediately apparent. Quite spontaneously (but surely not unexpectedly), the question of "How much does it cost you?" becomes an essential part of the answers. Outsiders opine and tell stories and commiserate.

For further information regarding the issue and the forces at work this Canadian has leaned on Bill Moyers and The Daily Howler.
posted by sid abotu (117 comments total) 17 users marked this as a favorite

 
I know this is said every time there's a US health story, but by god it's so tragic for you guys. That poor girl with the tumour and a $130 000 bill. That anyone could be so callous to their fellow citizens really saddens me.

People in Australia complain about our hospitals all the time, but not me. I think they're freaking fantastic, and stories like that just confirm it for me.
posted by smoke at 11:14 PM on August 4, 2009 [4 favorites]


My employer pays my family premium of $100 a month. Beyond that, I just take my health card with me when I go to the doctor or the hospital. Pretty simple here in Canada.
posted by KokuRyu at 11:15 PM on August 4, 2009


People in Australia complain about our hospitals all the time, but not me.

Me neither. The fact that I've never, ever had to trade off health against expense for myself and my family ie. Can I really afford to go to the doctor? Can I really afford to take my son to the hospital? These thoughts have never crossed my mind, but they seem to be common place for many Americans. The fact that, while I have private insurance, I've never had to make a claim on it because everything we've ever needed has been covered under the public system. The more I learn about the US way of doing things, the more tragic it seems.
posted by Jimbob at 11:23 PM on August 4, 2009


The discussion on that link gave me an idea. So many people in the US don't really know what their health care costs unless they're paying out of pocket for their whole premium. Not surprisingly, it tends to be the ones who aren't feeling that pinch who are really repelled by any system other than the current, broken one that we have.

Wouldn't it be interesting in the midst of this debate if the Senate were to require all employers to quantify and disclose health insurance expense information to their employees, on a per-person basis, each year; to include basic everybody-should-know-this data in a generated statement, like:

1) The total annual cost of your insurance (broken down into what they pay, and what you pay).
2) What the same insurance would cost per month if you went on COBRA that year.
3) The additional cost of #1 and #2, to a dependent onto your policy, assuming you're covered singly.
4) Change in annual premium cost from previous year.
5) Pre-existing conditions covered? (a simple YES or NO ought to suffice).
6) Specific benefits that have been ADDED in the plan year.
7) Specific benefits that have been REMOVED in the plan year.
8) Employee's expected out-of-pocket cost per night for a semiprivate hospital room, general medicine floor.

Seems simple enough. There's nothing to hide, after all - right?
posted by contessa at 11:32 PM on August 4, 2009 [43 favorites]


So many people in the US don't really know what their health care costs unless they're paying out of pocket for their whole premium.

I do think that may be a large part of the problem. In Australia, employers (with a few exceptions) don't pay for your health insurance. My workplace does have a deal with an insurance provider where you can get a small discount if you go with them, but there's no great benefit over my current insurer. If you want private insurance, you pay for it yourself, so I think people are much more aware of how things work.
posted by Jimbob at 11:37 PM on August 4, 2009 [1 favorite]


I should say, though, that since business seems to be footing most of the bill for health insurance in the US, there might be more general support for taking the load off employers and moving to a public system. I don't understand why this factor isn't in play.
posted by Jimbob at 11:39 PM on August 4, 2009 [3 favorites]


Why do people always make healthcare out to be a complex issue?

People are sick. They need to be helped not left to die.
posted by Talez at 11:44 PM on August 4, 2009 [6 favorites]


5) Pre-existing conditions covered?

I had never even heard the term "pre-existing conditions" until I moved to the US from the UK. Depressing.
posted by schwa at 11:46 PM on August 4, 2009 [6 favorites]


Why do people always make healthcare out to be a complex issue?

In the US, if you're against reforming healthcare in any meaningful way, highlighting the complexity of the topic is politically advantageous - because then some smarmy Republican senator can get up on TV with a big elaborate chart, boxes and arrows showing the mad chaotic flow of the nightmare scenario they predict. And, omg, the government can't even do an Air Force One photo-op without bungling it mightily, how will they screw up healthcare, nobama socialism, oneoneone!11one.
posted by contessa at 11:54 PM on August 4, 2009 [2 favorites]


Yes, the US has a health care problem -- but there isn't a new insight into the issue offered in this post; there isn't even a story of a particular incident. It's a link to an aimless exchange of viewpoints on another forum, sparking yet another aimless exchange of viewpoints here. I'm not sure we need it.
posted by magic curl at 12:09 AM on August 5, 2009 [10 favorites]


highlighting the complexity of the topic is politically advantageous

Yes. Reality is optional in the USA these days. Since a large proportion of the citizenry are too poorly educated to be able to distinguish fallacy from logic, good science from bad science, or correlation from causation, these issues become propaganda wars. So far, only the neoconservatives have anything resembling a propaganda machine.

Literate, considered analyses of the situation are all well and good, but the people who might benefit from these aren't reading them. It's TL;DR fuck your socialism, USA #1.
posted by Maximian at 12:10 AM on August 5, 2009 [6 favorites]


The more I learn about the US way of doing things, the more tragic it seems.

And the more it horrifies me when right-wing shitbags in places like Aussie and New Zealand seem determined to follow the fuckers down that route so they can ladle out top-backet tax cuts.
posted by rodgerd at 12:13 AM on August 5, 2009 [6 favorites]


The thing I least understand is why Obama isn't pushing for a single-payer system. He supported it in 2003, but has since mellowed in favor of the current reform effort, with a combined public-private system.

I get the thinking behind it -- that it would be more feasible to work for a compromise measure that pleases private and public advocates and could lead to a single-payer system if the public option works well. But I don't see how it works in practice.

By pushing for a complicated, multi-tiered system with a watered-down public option, Obama and the Democrats have made torpedoing the whole thing much easier. It's hard to distill the plan to voters, easy to mischaracterize, and difficult to garner support for. A "Medicare for all"-style plan may have made conservatives livid, but it would be a simple, intuitive, unifying idea. Difficult to argue against, popular and understandable to everyone over 65 (who are the most consistent voters), and replete with international comparisons clearly demonstrating its effectiveness.

But the way things are going down, the whole debate is mired in confusion and misinformation. There's a real chance it won't pass, and even if it does, there's a pervasive sense that what we'll get is an inadequate stopgap, a joke of reform weakened by a spineless legislature swayed by lobbyist cash.

Maybe Obama's right, and even a rudimentary public option will inevitably lead to sane universal healthcare. But it still feels like half-measures and false starts. I mean, when not even a public option is a sure thing, we're definitely in a bad place.
posted by Rhaomi at 12:22 AM on August 5, 2009 [16 favorites]


The thing I least understand is why Obama isn't pushing for a single-payer system. He supported it in 2003 , but has since mellowed in favor of the current reform effort, with a combined public-private system.

I don't think he thought it would be politically feasible. It would mean wiping out those huge corporations, billions of dollars of equity like that. It would mean everyone would "lose" their current coverage, as the companies would go out of business.

Also, France, which lots of people hold up as a model is not a single payer system.

Rightly or wrongly, lots of people like their current healthcare plans.
posted by delmoi at 12:32 AM on August 5, 2009


It baffles me that US businesses aren't screaming at the top of their lungs in favor of a single-payer system. It would save them so much money, time, and effort.

The US healthcare system is a nightmare. I am self-insured. I write a big fat check every month. A few months ago I banged my knee up. No long-term damage, but it hurt like hell and after a few days my foot swelled up and turned purple, so I figured I'd get it looked at. I went to the nearest ER, because I couldn't get in to see a doctor (it was Sunday). I got x-rayed and looked over and was told that when you bruise your knee like I did there's nowhere for that blood to go but down, and so no, my foot wasn't about to fall off. I gave them my insurance card and went on my way, vowing to never combine tequila and ice-dancing again. (not really. Just thought it sounded good.) No drugs received, no splint or bandage, nothing. I was fine. Cool.

Within a week I had a letter saying that because I had gone to the ER with a non-emergency condition, I wasn't covered. Hadn't gotten a doctor's permission to go be sick that day. I got bills from a radiologist I never spoke to, from the hospital, and from some other medical firm that I'm not sure what they do.

I squawked. I raised telephonic hell. Because I can be reasonably persuasive and seem to come across as potentially violently unhinged, the insurance company backtracked and agreed to cover PART of the bills.

So far a bruised knee has cost me almost $500 and a whole day of telephone hell. I shudder to think how much it would have been had there actually have been something wrong that wouldn't heal by itself.
posted by BitterOldPunk at 12:42 AM on August 5, 2009 [8 favorites]


Slightly OT: I used to be a regular reader of Cynical-C until I realized that he just copies many of his posts from MeFi without giving credit. Does that mean he will now post this?
posted by cronholio at 12:48 AM on August 5, 2009


Those of you who are against "socialist" healthcare, how do you justify making a profit on a fellow man's misfortune and ill health?
posted by dearsina at 1:56 AM on August 5, 2009 [8 favorites]


I'm inclined to believe the policy wonks who say the whole current system will implode in a decade or so.

I think this legislation is probably a good lurch in the direction of laying groundwork for answers when that time comes.

Americans feel entitled to health care, so I'm pretty sure we will end up with a single payer system after it is shown that capitalism can't actually fulfill that entitlement.

It would be fun to watch the wildly gyrating process of getting there if so many people weren't getting hurt.
posted by poe at 1:58 AM on August 5, 2009


how do you justify making a profit on a fellow man's misfortune and ill health?

they made a movie on that.

I was thinking about this last week, about the garbage collection cutbacks in Philadelphia (once every other week!) due to city/state budget issues, and it occurred to me that conservative types do have something of an argument on loading up the State as an over-centralized single point of failure.

We're seeing the same thing in California. Oops, out of money, all state parks will be closed!

But make no mistake; I think the main opposition is simply resistance about having to pay for the underclass's healthcare needs. We can marvel at "employer pays my family premium of $100 a month" but the real costs of a world-class healthcare services for a family are more toward $1000/mo not $100/mo on average.
posted by @troy at 2:13 AM on August 5, 2009


I mentioned this peripherally in the last US healthcare thread, but thought I'd add a few more details relevant to this FPP.

One of my buddies, another American ex-pat, is planning to leave England after living abroad since 1988.

He's been in England since 1998, left banking in 2001 or so to acquire and run a hotel. Now that the moneys made they're retiring and as he's a California boy hailing from LA the weather here in the UK simply does not agree with him, hence the move.

They have the universal, basic coverage NHS coverage here and, like lots of folks in the UK, augments it with a private policy. The private policy gives him and his wife the flexibility that if (when) things happen they can "go private" if necessary, essentially moving to the front of the queue.

He and his wife both have preexisting conditions - a heart problem in his case, and something glandular for her. Both are taking handfuls of pills, for him once every eight hours if I'm not mistaken. They fill these prescriptions on the NHS plan, for her a flat fee of roughly seven pounds per bottle, he's got an annual plan that cots about £100 for as many bottles as he needs. For lots of things the NHS is truly world class, my Dutch wife marvels about it compared to healthcare she received in Nederlands.

In any case they started investigating health coverage back in the United States and the entire process very quickly became very, very complex.

Luckily they have some degree of flexibility about where they might live, because in a large number of US States he simply can't get insurance at a reasonable price. Insurance companies to date have either quoted monthly rates that are obscene, in excess of several thousand dollars, or have provided much lower rates but at the same excluded his existing condition from coverage. Finally, a majority of companies they approached refused to quote at all, apparently preferring to cherry pick the healthiest of the herd. Nice.

While his wife's condition is more a "quality of life" issue, his is effectively a terminal disease if not carefully monitored (periodic blood tests, tweaking some statins, etc). So they the ran the numbers to model paying for his treatment out of pocket while putting her on a plan, and again the costs were substantial, to the point where retirement was no longer an option.

So they narrowed their search down to ten US States which would allow them to form their own group. Apparently then the two of them together could then engage an insurance company, getting coverage at the more reasonable, group rate. Clearly this option isn't available to most Americans, who are effectively rooted (mortgage, kids in school, friends, family, social network, etc) and when they lose their health care coverage, well, I guess they go without.

When approached this way the numbers make do sense, but this exercise has made both him and his wife very nervous about future, as they're retiring and don't have too many more relocations left. Lack of health care for him is a non starter as he'd probably just die.

Now I worked extensively with this guy on the ground in Africa and The Middle East. He's as patriotic as any Reagan Republican you'd ever meet and, like myself, has spent very little time in America since leaving.

Its difficult to be objective if you're immersed. So everytime I go back to the United States I see things - little and not so little things - reinforcing my belief the nation has moved very far to the right and become much more aligned with corporate interests over the past fifteen years or so.

Cost effective health care is one of those not so little things that prove to me something has changed in the soul of America.

My buddy and his wife are so concerned about this strange system that has emerged in The United States that they've started looking towards developing nations. Many offer universal heath care while others have robust private systems that will pick up any issues the state's own system doesn't offer.

Would rather live in The United States than Mexico or India or wherever he ends up. But the way the system has stacked the deck living in The United States isn't the rational option at this point.
posted by Mutant at 2:21 AM on August 5, 2009 [72 favorites]


I very nearly departed this planet a couple of months ago because I was bitten by a fucking spider.

I ended up having emergency surgery with removal of a softball sized lump of necrotic tissue from the center of my back.

Now, since I am self employed, have no savings, and just barely was able to pay for COBRA, I'm only facing maybe $10,000 in medical bills and deductibles. Since I was off work for three months, one of them with a wound pump attached to me ( which had its own $7,000/month bill attached to it for rental), I'm now trying to work out a repayment option for missed mortgage payments on my house, trying to stave off the repo man for my truck, and wondering if I won't in fact, be out of my home on my ass by Christmas.

Nope, the system here is just fucking fine.
posted by pjern at 2:33 AM on August 5, 2009 [63 favorites]


Metafilter: I can be reasonably persuasive and seem to come across as potentially violently unhinged.

Damn, this is not something I do very often but too good to pass up.
posted by i_cola at 2:35 AM on August 5, 2009 [1 favorite]


pjern, where can I get a bunch of those spiders?

I have a plan.
posted by contessa at 3:21 AM on August 5, 2009 [8 favorites]


A public option or single payer seems like such a no-brainer for so many of us, but here are the stumbling blocks I see.

One, the people who vote in every election, without fail, are senior citizens, and in the US those people are covered by Medicare. This should make said seniors want to spread that system to everyone, but I suspect it simply breeds a kind of apathy; they paid their dues, now they're retired and covered.

Two, a fair number of Americans have insurance that they are perfectly happy with. I don't know that percentage (the numbers flying around in this debate make my head hurt; but I'm sure someone on this thread does know the number), but it's pretty safe to say those content people are wealthy and upper-middle class folks who can pay premiums with no problem. This is not the majority of Americans, but they are by and large the educated and successful class with a strong voice in representative government. There is a fair argument to be made that if they vote for a public plan, and even be fully in favor of one, but that it would necessarily decrease their benefits.

Three, the What's-The-Matter-With-Kansas effect, in which middle class people in red states and areas who are against anything a Democrat is in favor of, think that "socialism" is both a real and scary thing, rather than the bogeyman it really is. A govt. option and especially a single payer system would improve the lives of these lower-middle class folks immensely, but there's a lot of bullshit propaganda out there. It's also an extremely complex issue for everyone to wrap their heads around.

Fourth, of those three groups of people (and there's overlap between them), I'd bet my bottom dollar that the vast majority of them have never had a serious health problem or accident. They don't know the daily fear of financial ruin that so many Americans live through. They haven't had to fight against insurance companies, and if they have, the rich folks will just pay up and not think about it again.

It boggles my mind that we let profit get between health care and patients. This, I think, should be the focus; the obscene profits the health industry is making. CEO salaries and bonuses, millions and billions of dollars, and all of it skimmed from the poor in times of dire need. It's so simple and obvious an evil I genuinely can't understand how anyone can defend it. So I say we heap the shame on the profiteers. They are as morally bankrupt as war profiteers (though we seem to be okay with them, too (Halliburton, Blackwater, et al).
posted by zardoz at 3:25 AM on August 5, 2009 [9 favorites]


It's so simple and obvious an evil I genuinely can't understand how anyone can defend it.

I listened to a recent episode of This American Life, where they featured some kind of congressional investigation (is that what you call it?) into the practice of insurance companies reviewing and denying insurance as soon as someone makes a claim. There was a woman who was denied a double mascectomy that was needed immediately, because she had previously had acne. There was another man who had his insurance cancelled, when he needed it, because there was an error on the form for his wife's weight.

The three health insurance CEOs they were questioning admitted that people had died because of this policy. They were asked if they would ever consider changing this practice. They all gave a big fuck you.

Scum.
posted by Jimbob at 3:34 AM on August 5, 2009 [6 favorites]


pjern I'm so sorry. Stories like yours should not be happening, it's unacceptable.

While I've been in Europe for the last 12 years, and can't return to the US in large part due to health care concerns (preexisting condition), I've worked ceaselessly to share how things are here with relatives, friends, my senators and representative (Peter DeFazio, always proud to vote for him). Voting for Obama was, for me, another step towards proper health care for all Americans.

But I also relate to what Mutant says: "Its difficult to be objective if you're immersed. So everytime I go back to the United States I see things - little and not so little things - reinforcing my belief the nation has moved very far to the right and become much more aligned with corporate interests over the past fifteen years or so."

Many Americans claim to have enormous pride in Democracy with a capital D. A "government of the people, by the people, for the people." And then some argue, loudly, that the government — a Democracy — should have nothing to do with helping people, because government is incompetent, can't be trusted, etc.

How does this make any sense? We vote for our mayors, many of our state laws, our representatives, our senators, our president. We implicate ourselves in other countries under the auspices of "spreading democracy" so that the people can govern themselves. Then, we make use of that type of government we claim to be the best in the world, so great that other countries must agree with it, to vote for people... and refuse to trust them once elected??

Is this not a condemnation of democracy? Is the cognitive dissonance between holding a document that begins with "We the People" as saintly, and claiming that our representatives elected by the people are too incompetent to do anything important so deafening that no one wants to face it?
posted by fraula at 3:34 AM on August 5, 2009 [21 favorites]


> they made a movie on that.

Oh dear.
posted by cj_ at 3:35 AM on August 5, 2009


Mutant - I'd recommend your friend consider Australia. It's warm here.
posted by aeschenkarnos at 4:18 AM on August 5, 2009 [2 favorites]


The health care CEOs are remarkably honest about the corporate system. Unless forced to by law, most corporations will do anything to increase profits. Killing people is terrible if it isn't profitable, or if it's bad enough PR to cause financial ruin. Make it profitable enough, and the corporation isn't just going to kill people, they'll claim it is unethical to their shareholders to do otherwise.

You want to persuade the working-class Republican who (like most people) is one serious illness away from bankruptcy? Don't tell him that he's wrong and that Obama isn't that bad, that a socialist program isn't going to give the country over to the ghost of Stalin. You'll only put people on the defensive. Just show a commercial with those CEOs admitting that they killed people, admitting that they have no intention of stopping, then just cut to an idyllic scene with a bearded man in a robe taking care of a sick child, captioned "What Would Jesus Do?"

I'd give it six weeks for the letter writing campaign and email forwarding chains to gain enough momentum to push half of the Republicans in Congress to support a public option.
posted by Saydur at 4:34 AM on August 5, 2009 [1 favorite]


a single payer system would improve the lives of these lower-middle class folks immensely, but there's a lot of bullshit propaganda out there

From a recent Krugman column:

At a recent town hall meeting, a man stood up and told Representative Bob Inglis to “keep your government hands off my Medicare.” The congressman, a Republican from South Carolina, tried to explain that Medicare is already a government program — but the voter, Mr. Inglis said, “wasn’t having any of it.” It’s a funny story — but it illustrates the extent to which health reform must climb a wall of misinformation
posted by Jakey at 4:40 AM on August 5, 2009 [3 favorites]


Texas v. California

Obama gives powerful drug lobby a seat at healthcare table - "As a candidate for president, Barack Obama lambasted drug companies and the influence they wielded in Washington. He even ran a television ad targeting the industry's chief lobbyist, former Louisiana congressman Billy Tauzin, and the role Tauzin played in preventing Medicare from negotiating for lower drug prices. Since the election, Tauzin has morphed into the president's partner. He has been invited to the White House half a dozen times in recent months... Tauzin said he had not only received the White House pledge to forswear Medicare drug price bargaining, but also a separate promise not to pursue another proposal Obama supported during the campaign: importing cheaper drugs from Canada or Europe."
posted by kliuless at 4:44 AM on August 5, 2009 [1 favorite]


From the blog's comments:

I get mine from my job. I absolutely hate the idea of socialized medicine. That’s all.

Ain't that a fucking peach. "I'm covered, so fuck y'all!"

Makes me want to track people like that down and do them harm in such a way that they'll find out exactly what it's like to go broke trying to get well again.
posted by splice at 4:46 AM on August 5, 2009 [3 favorites]


So many people in those comments, and so many people in this thread, are making a fundamental mistake that I hate to see:

No one in the United States has good health insurance.

Oh sure, your employer has given you a nice piece of paper that says great things, but you can be goddamn sure that when those literally unbelievable medical bills come calling, as they will for <1% of the population, you will be out on your ass and poor.

Whenever someone says, "Most people can have good, economical insurance if they try," (as someone in the linked thread was) they simply have no idea what they're talking about.
posted by TypographicalError at 4:54 AM on August 5, 2009 [17 favorites]


And when I say no one, I mean: no one who isn't a politician or hyper-rich, of course.
posted by TypographicalError at 4:55 AM on August 5, 2009


A fair number of Americans have insurance that they are perfectly happy with...

I keep hearing this point tossed-about by those (including the insurance industry reps) who are dead-set against changing the system. It makes me wonder what, exactly, were the questions that were asked of people to get this answer?

Most people, if they have insurance, are going to like having it, no matter what form it takes, because anything short of the more scam-ish policies, is going to be helpful. Somehow, though, I don't think the followup question was asked, namely, "Are you satisfied with the cost of your insurance?" Or, "What percentage of your household income are you paying for your insurance?"

Somehow, I think the pollsters are ignoring the other side of the "Do you like your insurance?" coin.
posted by Thorzdad at 5:01 AM on August 5, 2009


I know it's always so strange and shocking to people outside of the United States. "Why do they put up with it?" they ask. "Why don't they fix it?" It just seems so crazy from the outside, so let me explain:

The national religion of America is capitalism.

It isn't some snake-handling Southern Baptist cult or dour, pleasure denying Puritans in the chilly northeast corner of the country. No, we worship capitalism, and not just any kind, but the kind that involves enormous bailouts and non-tangible entities called corporations.

Every so often, a man or a woman is chosen to be blessed by the corporation, which rides him or her. We call that person a CEO, and they are the living embodiment of the corporation. They speak for it. We give them great gifts and whatever they desire. Occasionally, a CEO must be sacrificed and is thrown off of the pyramid wearing a golden parachute. The wise old council (the board) may call for a sacrifice when the crops fail to be bountiful or the profit margins do not increase as they have increased in quarters past.

We pay our tithes and our premiums for past errors called pre-existing conditions. We show our devotion to the great idols by giving them everything they ask before, because if we do not, they will become angry. They will take away our Choice, and we have it So Good. We are the Chosen People. Other people in other lands do not worship as we do, and they are in miserable thrall to terrible, cruel religions (like socialism) we have been commanded to defy and slander. If we donate large portions of our labor, the idols will ensure our health, but not in certain circumstances, for reasons we mortals cannot understand.

Many treatises can and have been written about the stations of office, the elaborate rituals, the prognostications, and how the corporations bless this land; my intent here is not to go into that, only to say: being religious means that certain things must not be questioned and attitudes need not be rational, only strongly and hotly held.
posted by adipocere at 5:09 AM on August 5, 2009 [58 favorites]



And the more it horrifies me when right-wing shitbags in places like Aussie and New Zealand seem determined to follow the fuckers down that route so they can ladle out top-backet tax cuts.

I agree, and Kiwis and Aussies should be on the lookout for the changes coming down the pike.
I live in the US and Australia, but go to the doctor in Australia. I have no insurance in either place, but if I went to the doctor in the US, I would pay about $200 for an appointment a month away, and whatever it was that I was going to the doctor for would be on my permanent record, a potential pre-existing condition.
In Australia, I make an appointment with the GP, usually within a day or two, at most within a week. Costs me $55. No insurance, no government health card. Thats just how much it costs.
The last time I went to the doctor there, the receptionist and I got into a discussion about the comparative systems of the US and Aus. She told me that over the last few years there has been more and more pressure (from the insurance companies? I cannot recall the exact details right now) for the Australian system to become more like the US, and that it seems inevitable that eventually this would come to pass, with private insurance companies playing a more central role as the national health system gets reduced.
I truly hope the Aussies and Kiwis have more sense and more motivation than Americans and actually do something to prevent this disaster from happening.
posted by newpotato at 5:16 AM on August 5, 2009


pjern, where can I get a bunch of those spiders?

I have a plan.


My plan is to stay the fuck away from those spiders. Yikes.
posted by Horace Rumpole at 5:31 AM on August 5, 2009


...the Australian system to become more like the US, and that it seems inevitable that eventually this would come to pass, with private insurance companies playing a more central role as the national health system gets reduced.
I truly hope the Aussies and Kiwis have more sense and more motivation than Americans and actually do something to prevent this disaster from happening.


If your system works anything like the US, you won't have any say in the matter. It will simply be a done-deal by the insurance cartels and the legislators they've paid handsomely for. In the US system, the voice (or needs) of the people will rarely be allowed to come between corporations and their profits. So, if that's on its way to Australia...well...welcome to the club, mate.
posted by Thorzdad at 5:38 AM on August 5, 2009


My favorite comment on that blog so far:

"I’m from Europe. You know the rest…"
posted by KevinSkomsvold at 5:52 AM on August 5, 2009 [1 favorite]


I have a question about all these example of gigantic medical bills stacking up. Under any system, someone has to pay them. That is money owned to the hospitals, doctors, etc. after all. Unless the plan involves capping what doctors and hospitals charge, which is going to have obvious downstream effects on medical innovation and the like, who do you propose should pay for this?

If your answer is "the government," please explain to me how a government that was already broke before the current economic meltdown is going to cover these expenses without something that results in massive inflation or raising personal income taxes to the point where it becomes economically worthwhile to figure out how to legally avoid paying those taxes?

I don't think people realize that the government is just as broke as they are. If your plan for paying for healthcare relies solely on the government's power to confiscate the property of other individuals, you might want to rethink things.
posted by Pastabagel at 6:10 AM on August 5, 2009 [1 favorite]


Oh sure, your employer has given you a nice piece of paper that says great things, but you can be goddamn sure that when those literally unbelievable medical bills come calling, as they will for <1>

If the problem we are trying to solve affects less than 1% of the population as you suggest, then both single payer and the actual plans being discussed are idiotic. Better to have a plan that allows those 1% to apply to the government for some special relief given their circumstances than changing the system for everybody to accommodate that 1%.

posted by Pastabagel at 6:16 AM on August 5, 2009


I have a question about all these example of gigantic medical bills stacking up. Under any system, someone has to pay them. That is money owned to the hospitals, doctors, etc. after all. Unless the plan involves capping what doctors and hospitals charge, which is going to have obvious downstream effects on medical innovation and the like, who do you propose should pay for this?

What would happen is exactly what happens now. Given a fee-for-service system (which isn't given, I hope), doctors/hospitals aren't capped on what they charge, but what they get reimbursed is capped.

It works like this: You receive a medical procedure. The doctor/hospital charges their fee for that service to your provider. They can charge anything they want, but the provider has a fee schedule for every service and will only pay a set amount for that service. They pay what they pay, and the doctor/hospital writes-off the remainder of what they charged.

This is, in part, why doctors/hospitals will charge $5,000 for a certain procedure. They know that they won't get $5,000 paid to them. The insurance company might reimburse $1,500 for the procedure (after milking the patient for all they can with deductibles), but the doctor/hospital must charge more than the provider's reimbursement for that procedure; if they charge less, then the insurance company won't pay the full $1,500 that they're willing to pay.

So why don't the doctors/hospitals just charge exactly what they will be reimbursed? They deal with dozens or hundreds of insurance providers. Each provider has its own fee schedule. They can't charge different amounts for the same procedure (charging the "good" providers more than the "bad" providers), so it's easier to crank up ALL their fees and get back whatever the insurance companies will pay them.

This is just one aspect of the current system, and why even a one-doctor clinic generally has an employee dedicated entirely to coding and billing.
posted by cyclopticgaze at 6:38 AM on August 5, 2009 [10 favorites]


There are so many moving pieces involved, so many unspoken hidden agendas and subconscious neuroses, so many code words, so many un-thought-out slogans, it does lead one to despair.

One 'adult' problem when debating the issue (in contrast to all the very, very childish problems) is that the U.S. is actually trying to solve two problems at once: how to cover everyone, and how to get costs down. The first problem was solved by most civilized nations long ago. With the second one, my understanding is that this is a problem in many places--health care costs have been rising in European countries, too, for example.

Countries like France or the Netherlands don't have to worry so much about problem #1, they can concentrate on #2. The U.S. should have solved #1 back in the 1960s or 1970s -- now after decades of 'deferred maintenance', we're being forced to solve everything at once.
posted by gimonca at 6:54 AM on August 5, 2009 [4 favorites]


Keith Olbermann Special Comment On Health Care Reform.

Someone on metafilter wrote "you can power a small town with Keith Olbermann's nightly indignation", but I think his special comment here rings true...
posted by kolophon at 6:57 AM on August 5, 2009 [1 favorite]


The insurance issues are only half the problem here. The other huge problem that is often overlooked in US healthcare debates is the creation of the for-profit hospital (now "health system") and the fee-for-service billing model. Hospitals and practices are looking to perform relatively expensive imaging studies and procedures on people who have coverage for these services, whether there is medical evidence supporting the use of these expensive technologies or not.

A couple of prime culprits are over-use of expensive imaging studies like MRI and CT, and elective surgeries. Every year, insurers (including US citizens via Medicare) pay for many millions of dollars, maybe billions even, for surgery to relieve back pain, even though there is no evidence that most pain-relief surgeries (eg, herniated disc surgery) offer better results than non-surgical management. Lower back pain is a doozy, by the way, because you tend to get tens of thousands of dollars worth of imaging studies before you get your very expensive surgery, and insurers are pretty good about covering this. I don't mean to suggest that there's never an appropriate time to operate for a disc problem, but rather, the financial pressure of the system often pushes the decision toward surgery prematurely, without a proper trial of non-surgical treatments, and the insurers are compelled to pay for this extremely expensive care, leading to higher premiums across the board and encouraging overly-aggressive reviews of claims.

Here is a write-up on a joint guideline from the American College of Physicians (ACP) and the American Pain Society (APS) for the management of low back pain in primary care. It's encouraging to see the emphasis on non-pharmacologic and non-surgical care in the new guideline. Spinal manipulation, acupuncture, massage, and other techniques are mentioned as potentially worth a trial, but–and this is a big but–most insurers in the US won't cover these interventions.

The other thing to keep in mind is that no one is going into primary care in the US. The burden of primary care is falling increasingly on non-physician staff like NPs, because, again, financial pressures push most medical school graduates into more lucrative specialties. With a glut of specialists and a dearth of primary-care docs, medicine has shifted sharply toward specialty-focused care.
posted by Mister_A at 7:04 AM on August 5, 2009 [5 favorites]


Under any system, someone has to pay them.

Well, in the U.S., many of those people go to an emergency room that is required by law to treat them regardless. The patient gets billed, can't pay, may declare bankruptcy or linger on in bad debt for years. The hospital puts this into their budget as "uncompensated care". What's the effect of that? Either higher costs passed on to the shrinking pool of people who are able to pay, or scaling back or eliminating other services.
posted by gimonca at 7:05 AM on August 5, 2009 [2 favorites]


Also, what cyclopticgaze said.
posted by Mister_A at 7:07 AM on August 5, 2009


The national religion of America is capitalism. - adipocere

Best post ever.
posted by Hugh2d2 at 7:07 AM on August 5, 2009


Last year I was diagnosed with thyroid cancer. On 08-08-08 I had my thyroid (which was more than 50% engulfed by a tumor) removed, along with 16 lymph nodes. A month later I had radioactive iodine treatment and two body scans. Over the course of my diagnosis and treatment, I also had four ultrasounds, a CAT scan, a biopsy, and too many to count blood tests. So far, everything looks good.

The total amount I paid out of pocket was about $400, mostly for office co-pays and prescriptions. I am in the US and my employer (an international humanitarian non-profit) pays the entire cost of my health insurance.

And I still support substantive health care reform. I was fucking lucky, kids. 18 months prior I was between jobs and had opted not to pay for COBRA. I was uninsured for 5 months. My doctor say I had the cancer at that time.

And even having awesome insurance, I still had to 1.) wait for care, 2.) compromise on doctors. I had to wait 4 weeks for my first ultrasound and 3 weeks for my biopsy. And this was after raising hell to get them moved earlier. Then, my first, second, and third choice of surgeons refused to take my insurance (Oxford). I had to move to an entirely different hospital to find a highly rated surgeon who would take it. And then I had to wait another 5 weeks for surgery.

I should be a shining example, I guess, of how great the system is. But all I can think about is the pressure of keeping insurance for the rest of my life. My plans to relocate to another state in a couple of years are now much more complicated. Like one of the commenters in the original thread, I am hoarding levothyroxine (which I will be on for the rest of my life), just in case something really bad should happen.

Even when the system "works" it's a joke. Fuck. The stigma of cancer itself is NOTHING compare to the stigma of pre-existing condition.
posted by kimdog at 7:16 AM on August 5, 2009 [13 favorites]


Jimbob: "I should say, though, that since business seems to be footing most of the bill for health insurance in the US, there might be more general support for taking the load off employers and moving to a public system. I don't understand why this factor isn't in play."

Because the employers aren't paying... the employees are. Your employer-provided insurance is a benefit that you receive instead of a higher wage. The employer takes cash that you would otherwise be receiving in your paycheck and uses it to pay the insurance company for your health insurance; your employer is merely the middle man. You just don't see that transaction because it happens before you are ever even offered a job; it is factored into the salary offer that you receive. The expense that your employer carries is the labor cost of administering the program, but they do not actually pay for your insurance. No for-profit company in America could afford to carry that nut (and certainly not a publicly-traded one).

If we received that money in our wages up front instead, and wrote a check each month to our employer for the equivalent expense, and actually saw that money going out of our pockets, maybe Americans would better understand who is truly paying, and how much. Maybe then we could compare that to the health coverage we actually receive, and see that something is really seriously broken.

I think we'd also be more realistically equipped to participate in discussions about how "socialized medicine" is going to screw us all into the poorhouse via taxes. We're still paying, and much more than is necessary, because of the current profit-based health system. Why is it somehow preferable to pay that money to Big Medicine for a system we know is broken, than to the government?

Also, I confess that I cock my head in Nipper-style confusion at the "socialized medicine" bogeyman. Is our compulsory American education system also "socialized"?
posted by pineapple at 7:29 AM on August 5, 2009 [9 favorites]


Even when the system "works" it's a joke. Fuck. The stigma of cancer itself is NOTHING compare to the stigma of pre-existing condition

Not long ago there was one of these threads about health care, and there was a person who opposed any kind of reform in part because he had really super ++good insurance through his job. People pointed out how precarious that is (what happens if he loses the job from getting sick?) and I missed my chance to chime in but will now. kimdog mentions that she didn't have the money for her COBRA premiums so was uninsured for five months.

When my partner was laid off from a job, we opted to get COBRA coverage. One problem with the COBRA system is that you can only opt to pay for the insurance the company you worked for gave you. We had had really super ++good insurance through his employer, and the monthly COBRA premiums for our family of (then) four were $1438 a month. And no option to choose less insurance for less money.

We paid it, because we didn't want to risk a period of not being insured; both of us have minor but chronic conditions that we get treatment for, and we didn't want a lapse in insurance to lead to the "pre-existing condition" problem. I guess I just wanted to chime in with how not-functional COBRA is in some ways.
posted by not that girl at 7:33 AM on August 5, 2009 [3 favorites]


Pastabagel: "If the problem we are trying to solve affects less than 1% of the population as you suggest, then both single payer and the actual plans being discussed are idiotic. Better to have a plan that allows those 1% to apply to the government for some special relief given their circumstances than changing the system for everybody to accommodate that 1%."

There are several problems we are trying to solve. However, truly incredible and crushing medical costs which result in being dumped by insurance companies affects a fairly small percentage of the population. My point, however, is that a truly great insurance policy would not even have a 1/1000 chance that you would be dropped and uninsurable for life.

But this is by far not the only problem. Much more frightening are the masses of people who are actually uninsured for various reasons. They incure staggering, life-changing costs for treatments which are fairly routine, and would not really hurt an insurance company.

But my issue is with people in the US who think they have good insurance. They don't.
posted by TypographicalError at 7:35 AM on August 5, 2009


If your answer is "the government," please explain to me how a government that was already broke before the current economic meltdown is going to cover these expenses without something that results in massive inflation or raising personal income taxes to the point where it becomes economically worthwhile to figure out how to legally avoid paying those taxes?

The UK government is broke as well. If any Minister (liberal or conservative) even dared to mention cutting back on health services, it'd be political suicide.

I pay more taxes here in the UK than I did in the US. I'm at the top tax rate too. And if my money is going to grant other people in the country what I consider a basic human right, then I am happy to do so. Here, take my stupid money.

I had, by any standards, great healthcare when I was in the US. Not only that, my GP was a personal friend of mine. Before I left, I decided I would take care of a hernia I had been told long ago that I should take care of "sometime." So, no emergency, really. My surgery was scheduled a week after I asked for it - in one of the best hospitals in the country. So, I should be one of the last to complain about US healthcare right?

Not really. I have too many friends, close friends whom I have seen suffer in this rotten system. I have suffered myself. In the late 90's I was raising money for my own startup and had no health insurance. It was then that I stupidly fell off a small height and severely twisted my ankle. I didn't go see a doctor because I couldnt afford it then. I borrowed crutches from a friend's dad. Lucky for me, the ankle healed itself eventually. I'll really never forget that time.

I guess that yes, "I got mine" but I'm not really satisfied until everybody also gets theirs. All these financial arguments are just lame excuses.
posted by vacapinta at 7:43 AM on August 5, 2009 [1 favorite]


"Unless the plan involves capping what doctors and hospitals charge, which is going to have obvious downstream effects on medical innovation and the like, who do you propose should pay for this?"

Americans are already paying something like twice as much per capita for health insurance compared to Canadians and something like 15-20% of Americans have no insurance at all. Restructuring to remove profit and bookkeeping expenses from the system would pay for universal care.
posted by Mitheral at 7:54 AM on August 5, 2009 [2 favorites]


I have a question about all these example of gigantic medical bills stacking up. Under any system, someone has to pay them. That is money owned to the hospitals, doctors, etc. after all.

As noted earlier, some nontrivial amount of the bills are simple bullshit; fictional made-up numbers with no relation to marginal cost that exist only as a token initial bargaining position.

Unless the plan involves capping what doctors and hospitals charge, which is going to have obvious downstream effects on medical innovation and the like

This isn't obvious. Existing fee and pay levels might (or then again might not) represent rents. Reducing rents, more or less by definition, doesn't alter the underlying productive behavior.

I'm not claiming that they are rents, only that it isn't immediately obvious that capping fees would reduce "medical innovation and the like."

If your answer is "the government," please explain to me how a government that was already broke before the current economic meltdown is going to cover these expenses without something that results in massive inflation or raising personal income taxes to the point where it becomes economically worthwhile to figure out how to legally avoid paying those taxes?

Step one: Require all employers, public and private, to pay their employees the full amount of any health care contributions they had been making. Or even, shit, just 80%.

Step two: In the aggregate, tax that amount away again with any of a variety of taxes.

I'm not sure what specifically you mean by figuring out how to legally avoid paying those taxes. Frankly, it's not that difficult to make that infeasible. You could just structure it as a VAT + kickback for poorer people, for example. Or just make a separate income tax with few/no exemptions and deductions.
posted by ROU_Xenophobe at 8:06 AM on August 5, 2009


I hear arguments that going single payer or any other government health system will take away a person's "choice" in regards to their health care.
But from what I understand from posts like these, people don't get much choice in the insurance they get (the employer does), and once on a plan, the insurance company makes all the decisions - not only what doctor or specialist or hospital you can go to, but even if you can go at all.
I really don't get why a more expensive system that doesn't cover you any way, and doesn't let you actually make health decicions beyond "can I afford this? Y/N", is better than government run healthcare. I really, really don't.
posted by sandraregina at 8:13 AM on August 5, 2009


Related: what if health insurance companies ran the DMV?
posted by emjaybee at 8:14 AM on August 5, 2009 [6 favorites]


Also, I confess that I cock my head in Nipper-style confusion at the "socialized medicine" bogeyman. Is our compulsory American education system also "socialized"?

Yep. You've heard about the whole "School Choice" thing to allow private schools who exclude special needs students to compete in the educational market, right?
posted by stet at 8:15 AM on August 5, 2009


It is worth noting that health care in America is one of the only marketplaces wherein market forces have no effect whatsoever.

Ever tried actually comparison shopping for a medical procedure? Nobody at the front desk of a doctor's office knows how much anything costs. Even the billing department doesn't really know how much something costs, because of the "name a high price and hope for good reimbursement" game outlined earlier in this thread. And even then, within some healthcare networks, getting treated for something may require services from several different departments or offices, each of them will have its own billing nonsense. The end result is, even if you want to try to find the best value-for-dollar, you cannot. It's a completely opaque system, designed to confuse and obfuscate, because god forbid that Insurance Company B might discover that Insurance Company A is paying $5 less for that procedure. If they knew it was offered at that price, well EVERYONE would want it at that price.

I've lived without insurance for about 15 years now, and thank goodness I have never had anything actually serious happen in that time. Right now I'm undergoing treatment for an infected sebaceous cyst which I could not get to "come out" after a week of hot compresses. By the time I did go to the doctor, the infection was apparently nearly an inch in diameter under my skin, and all three of the staff at the clinic said they had "never seen so much drainage".

The entire thing is costing me $300, which includes the follow-up visits to get the wound packed and dressed. The doctor waived the office visit fee (which would have been $120, up from $60 about a year ago) and gave me antibiotic pills out of his sample case so I wouldn't have to pay for a prescription. When I go in today it will be the 6th time I've been in for this, thank goodness I'm not having to pay for each visit.

Having insurance would have allowed me to seek professional treatment much sooner, rather than my home remedy attempts. Having active market forces in play would likely mean that the cost of an office visit would not have doubled in a year. Having BOTH would result in better value for money for everyone concerned.
posted by hippybear at 8:15 AM on August 5, 2009


stet: "Yep. You've heard about the whole "School Choice" thing to allow private schools who exclude special needs students to compete in the educational market, right?"

Absolutely and I'm wholly opposed to it. I regularly reach out to public officials and express my opposition to vouchers and any other similar "school choice" legislation here in Texas, because I believe it's an end-run at getting public taxpayer money diverted to private schools.

Much like with the health insurance system, to me a perfect world offers multiple choices. Let the private product providers do their business, but insist on a public product option as well for those who can't afford the private one. Then let the market sort it out.

If I can afford a better [school/doctor/fundamental human need], then I have the right to pay the premium for it. But don't make me go without any [school/doctor/fundamental human need] so that the private providers don't have to stop taking baths in gold bullion.
posted by pineapple at 8:45 AM on August 5, 2009 [2 favorites]


The doctor waived the office visit fee (which would have been $120, up from $60 about a year ago) and gave me antibiotic pills out of his sample case so I wouldn't have to pay for a prescription.

I just want to note that this happens ALL THE TIME, especially in primary care practices. My experience is mostly with primary care physicians. I've known many who welcome every single drug rep who shows up. Not because they want free lunch (they don't have time for that), but because they want the stacks and stacks of sample cases of medication. They give these out to their patients who cannot afford to buy meds, and for primary care doctors, that's a lot of patients.
posted by cyclopticgaze at 8:50 AM on August 5, 2009 [1 favorite]


"Those of you who are against "socialist" healthcare, how do you justify making a profit on a fellow man's misfortune and ill health?"

I don't know. I'm against hunger. How can we justify making a profit on food? I'm against homelessness. How can we justify making a profit on shelter?

How can we justify a doctor getting paid for their labor? After all, these people would die! How anyone could be so cold to a fellow citizen is disheartening.

What we should do is ban all profit industry where people's needs are being met.
posted by TheFlamingoKing at 9:30 AM on August 5, 2009 [1 favorite]


You know, reducing dearsina's whole point to hyperbole like that is pretty silly, TheFlamingoKing.

As a society, we need to be having more realistic discussions about health care, not fewer. It's immature to casually diminish the argument that, if Americans want to continue to consider ourselves leaders of the free world and a model for other nations, we have to stop viewing health care strictly as a for-profit business, and the human consequences be damned.
posted by pineapple at 9:43 AM on August 5, 2009 [1 favorite]


I don't see it as hyperbole as they are legitimate questions posed sarcastically, but if I need to be more clear, here's my realistic point about health care.

Why is health care a "right" and freedom from hunger is not?
Why is health care a "right" and shelter is not?
If health care is a "right" then who grants that right? Why don't we have that right today?
posted by TheFlamingoKing at 9:51 AM on August 5, 2009 [1 favorite]


Why is health care a "right" and freedom from hunger is not?
Why is health care a "right" and shelter is not?


My philosophy is that there should be universal access to that which is required to become and remain a productive member of society without regard to ability to pay. I care not if this is public initiative or private charity, thought the latter generally has too many holes in its implementation to be taken as a serious policy choice.

Rights are abstract and arguable since there is no universal morality, what is not arguable is that governmental interference with the free market works better for more people than laissez faire approaches so that's where I'd argue why guaranteed health care is good policy..

But every dollar we subsidize food & shelter will go right into ground rents. Churchill argued this 100 years ago now:

"And a friend of mine was telling me the other day that, in the parish of Southwark, about 350 pounds a year, roughly speaking, was given away in doles of bread by charitable people in connection with one of the churches, and, as a consequence of this, the competition for small houses, but more particularly for single-roomed tenements, is, we are told, so great that rents are considerably higher than in the neighbouring district.

All goes back to the land, and the landowner, who, in many cases, in most cases, is a worthy person utterly unconscious of the character of the methods by which he is enriched, is enabled with resistless strength to absorb to himself a share of almost every public and every private benefit however important or however pitiful those benefits may be."
posted by @troy at 10:08 AM on August 5, 2009 [2 favorites]


I should say, though, that since business seems to be footing most of the bill for health insurance in the US, there might be more general support for taking the load off employers and moving to a public system. I don't understand why this factor isn't in play.

I think there are two reasons for this. First, when your employer controls not only your salary, but whether or not your wife and children can see a doctor when they're sick, they have much more leverage over you. Employer-based health care literally gives your boss life-or-death control over your body, so you are much more flexible in salary "negotiations" and when they ask you to work off-the-clock overtime, you're much more likely to do it. That's precisely what happened to me in my last job. I held onto the job for much longer than I would have had there been no health insurance for me or my wife involved, even though it would have been better for me, career-wise, to go freelance. So when I got laid off, I was doubly fucked. The fact that the health insurance companies are now in such a position of power that they are draining the life from many small businesses (and not-so-small businesses like GM, too) is just now sinking in. As I was being laid off on the day before election day, my hardcore, small-business Republican boss told me she hoped Obama won and fixed the health care system.

The second reason is that the rich have much more class loyalty than the poor in America. They're afraid to come out in favor of health care reform because of what the other people in the country club will think.
posted by vibrotronica at 10:12 AM on August 5, 2009 [1 favorite]


and we didn't want a lapse in insurance to lead to the "pre-existing condition" problem. I guess I just wanted to chime in with how not-functional COBRA is in some ways.

FWIW, I ~think~ it's possible to easily move from employer to self-insured during this window after losing work. That's what I did, moving from a gold-plated COBRA alternative of $500/mo to a $200/mo good-enough PPO.
posted by @troy at 10:14 AM on August 5, 2009


FlamingoKing, I assume you agree that in a democracy rights are granted by the will of the people, enshrined in their constitution and laws? Because I'm pretty sure no one here is positing some sort of divinely-granted rights to anything.

Most of those who want healthcare to be an actual right know that there's a many times better chance of getting healthcare access via reform (as we're doing now) than actually trying to change the Constitution. If the Constitution were written today, it might be worth considering if access to healthcare should be included. But that's not the situation we are in.

Some people don't actually mean a "right" so much as "so easily accessible that in practice no one is excluded from obtaining it", that's true. For most who want healthcare reform, that's good enough.

As for rights to shelter and food, well, there are people who do argue exactly that. But those are red herrings in this discussion, since it's nonsensical to say that you must be for those things in order to be for healthcare rights or reform.
posted by emjaybee at 10:15 AM on August 5, 2009


Unconscionable Math:
If the top 5% is the absolute largest population for whom rescission would make sense, the probability of having your policy cancelled given that you have filed a claim is fully 10% (0.5% rescission/5.0% of the population). If you take the LA Times estimate that $300mm was saved by abrogating 20,000 policies in California ($15,000/policy), you are somewhere in the 15% zone, depending on the convexity of the top section of population. If, as I suspect, rescission is targeted toward the truly bankrupting cases – the top 1%, the folks with over $35,000 of annual claims who could never be profitable for the carrier – then the probability of having your policy torn up given a massively expensive condition is pushing 50%. One in two. You have three times better odds playing Russian Roulette.
posted by ryoshu at 10:16 AM on August 5, 2009 [5 favorites]


I'm against hunger. How can we justify making a profit on food?

You should be able to make a profit on supplying people with food. You should not be able to make a profit off of starving people to death.

How can we justify a doctor getting paid for their labor?

Doctors should be paid handsomely because they provide a very valuable service and they work very hard and are very highly educated. Insurance companies only stand between doctors and their patients and collect a toll. They are not providing a valuable service, they are merely extortionists.
posted by vibrotronica at 10:17 AM on August 5, 2009 [14 favorites]


"what is not arguable is that governmental interference with the free market works better for more people than laissez faire approaches"

Actually, that's precisely the argument. I argue that what we have today is a system that prevents the market forces from working. There literally is no market, because there's no competitive pricing and there's no opportunity costs. Why get 1 test when you can get 10 and bill them all to insurance? Why care at all what things cost when someone else is fitting the bill? And I question that the solution to the problem is just to move that same system over to the government's control instead of fixing the issue.

I know I'm already ignored or vilified by most people here for expressing that opinion. I'm cruel and callous, and probably an evil Republican hellbent on getting the largest profits for those evil corporations. I'm not, but that's apparently the discourse in America right now. You're either with us, or you're with "the mob".

Every conversation on this that focuses on what the rich want, or what the poor get, or what the GOP says, or what middle America wants, takes away from a rational argument on what works and what doesn't. And that's the real shame here.
posted by TheFlamingoKing at 10:26 AM on August 5, 2009 [1 favorite]


And, omg, the government can't even do an Air Force One photo-op without bungling it mightily

Bungle a whole lotta things. 2+ trillion in accounting can't be accounted for and 20+ million spent to deliver sub $10,000 in LP gas are 2 "bungles". And what's the penalty for that bungling?

Why JUST the "focus" on "bungling" from Jan 20th 2009 when history is so rich with others bungles?

Many Americans claim to have enormous pride in Democracy with a capital D. A "government of the people, by the people, for the people."

'Cept America is "a Republic". There is even a pledge thing where you are reminded of it.
posted by rough ashlar at 10:35 AM on August 5, 2009


"FlamingoKing, I assume you agree that in a democracy rights are granted by the will of the people, enshrined in their constitution and laws? Because I'm pretty sure no one here is positing some sort of divinely-granted rights to anything."

No, I don't agree with that statement at all. Because rights that are granted by the will of the people can be taken away by the people. That's contradictory to the concept of a "right". I think gay marriage proponents, for one, would not be willing to argue that their right to marry should be granted by the will of the people.

What is written by the people into law are not rights, but temporary privileges that can be revoked at will.

I always come back to this quote on this matter:

"I think that people who are backers of the First Amendment and anti-censorship have to realize that when you jump on the First Amendment, what you're doing is trying to use the system's tool, the Constitution, to defend you. We need to just get away from that and just say, 'Yo, I can make this record because I have grounds to make this record. I have human rights, so fuck the First Amendment, we have human rights to speak. I don't need your Constitution to give me that right.' As long as you use their laws, they'll twist that law against you. I think that sooner-or-later we've gotta realize that this Constitution is something that can be bended, folded, spindled and mutilated to serve their system. We have to turn it around and say, 'Yo, we don't need the Constitution.' I think that's the new way we should go about our speech instead of using them, because they'll always get us with that First Amendment. They'll twist it and say, 'well, it didn't mean this.' You don't need any law to let you say that. That's a much stronger grounds to speech."
- Ice-T, on free speech and "Cop Killer"
posted by TheFlamingoKing at 10:36 AM on August 5, 2009 [1 favorite]


Okay, TheFlamingoKing, I'll bite and assume you are truly and sincerely asking. So here's how I see it, and why I see your argument as not germane to a solution:

Freedom from hunger is a right that humans deserve. Freedom to have shelter is a right that humans deserve. (As emjaybee pointed out, those aren't constitutional rights or divine rights, and neither is health care -- but if we are truly a leading first-world nation, we shouldn't have to boil every human need down to, "We should only provide that if required by a law." And, I'll assume you aren't making that assertion anyway.)

I personally have the wherewithal to go and feed myself. I can walk into a store and spend a dollar and obtain a food item and put it in my mouth and eat. Or I can buy a packet of seeds and plant something that will grow into a piece of food that I can use to feed myself. The core reason that hunger happens is when someone doesn't have the dollar to begin with, and our society does in fact offer public options to change that situation. BUT, that I don't have the dollar does not correlate to whether affordable food is out there for purchase. Affordable food is out there; I can solve my hunger problem with the tiniest amount of money, and in fact people do that everyday.

Same for shelter. I personally have the wherewithal to pay $10 for a flophouse bed in a YMCA; I merely have to walk into the building, hand over my tenner and voila, I have sheltered myself. And again, if I don't have the $10 to put a roof over my head, it's not for a lack of the availability of affordable shelter. It's that I don't have the $10, and I therefore need to take steps to solve that problem.

Whereas, I cannot provide my own health care. I cannot walk into a store and simply buy an antibiotic, or a biopsy, or a blood panel. The barrier to entry for consumers is both high and expensive. Health care is a heavily regulated and licensed system, run by professionals who have obtained extended educations and training. And those who run the system set the prices, and I do not get to choose the most basic or most affordable option for myself. Only those who have resources in the upper tiers of income are guaranteed access to the health care that they might need, because they can afford to just write a check for what they owe the doctor or hospital.

The rest of us are forced by the present system to roll the dice.
Are we employed? Y/N
If Y, will the employer insurance cover our dependents too?
If Y, does our employer offer insurance from a company that believes my family is already healthy enough to cover us? Y/N
If Y, can we afford what isn't covered by the employer policy?
If Y, how long can we afford what isn't covered, in the event of calamity or serious illness?

At every point in that decision tree, every single day, Americans fall out of the health care circle. And we cannot simply write a check, because health care costs have grown so exorbitantly high thanks to those who run the system.

The idea that, in the United States of America, someone will simply be allowed to die if he doesn't have the financial means to pay hundreds of thousands of dollars for the health care he needs, is appalling to me.

If you don't see why that's not equivalent to a food/shelter dilemma, I might not be the one who can help. Surely someone else can articulate it better than me.

>> I know I'm already ignored or vilified by most people here for expressing that opinion. I'm cruel and callous, and probably an evil Republican hellbent on getting the largest profits for those evil corporations. I'm not, but that's apparently the discourse in America right now. You're either with us, or you're with "the mob".

Weak. We're merely having a discussion here, and no one is vilifying you. Your "health care = food = shelter?" comment was throwaway and sarcastic as you acknowledged yourself, and people responded in kind.

If you have a minority opinion at MetaFilter, have the huevos to defend it... but don't drop a shitbomb into a thread and then jump back and say, "YOU'RE SILENCING ME, YOU'RE JUDGING ME, I'M JUST TRYING TO SPEAK TRUTH TO POWER."

>> Every conversation on this that focuses on what the rich want, or what the poor get, or what the GOP says, or what middle America wants, takes away from a rational argument on what works and what doesn't. And that's the real shame here.

How have your comments in this thread contributed to the "rational argument" that you are advocating? I'm not trying to be flippant. I'm seeing you say, "we should be talking about it like this," and then not doing it.

I am asserting, as are many many people, at MetaFilter and elsewhere, that Problem #1 is that the present system doesn't work. If you disagree, I'd love to hear why.
posted by pineapple at 10:37 AM on August 5, 2009 [18 favorites]


I argue that what we have today is a system that prevents the market forces from working

talking about the free market "working" for universal health services is similar the free market for fire prevention and disaster relief. It's really nonsensical since the entire field if rife with rent-seeking and asymmetrical relationships.

Good health is something people will pay a lot of money for. Unfortunately, most people don't have a lot of money, but the guilds and service industries limit the supply of their services such that they control the market at the cost of limited availability.

IOW, your argument is empirically crap.
posted by @troy at 10:38 AM on August 5, 2009 [1 favorite]


pineapple: "if we are truly a leading first-world nation, we shouldn't have to boil every human need down to, "We should only provide that if required by a law." And, I'll assume you aren't making that assertion anyway.)"

Well, never mind. I now see that that is exactly the argument you are making. Right, then.
posted by pineapple at 10:38 AM on August 5, 2009


I am asserting, as are many many people, at MetaFilter and elsewhere, that Problem #1 is that the present system doesn't work. If you disagree, I'd love to hear why.
posted by pineapple at 1:37 PM on August 5


I agree completely the present system does not work. However, as I've said here many times before, the reason it does not work is precisely because there is not a free market for health insurance. You get your insurance from your employer. Your employer negotiates with the insurance company to their mutual benefit. But the benefit to you is not part of the negotiation and not part of the transaction.

Consider how you buy every other kind of insurance - home, auto, life, etc. You pick the terms, you have coverage choices etc. You negotiate with the company. Not so with health insurance. If the comment above is true that the doctors charge amounts of money that are largely fictituious to establish a bargaining position with insurance companies, then an uninsured person getting a $5000 bill in the example given upthread should be able to immediately renegotiate it down to $1500, because that's really what the hospital needs to recover.

If health insurance were truly a free market, if insurance companies actually competed with each other to directly get your business, then I would have no problem with the government coming in as another participant, even if it meant raising taxes.

But single payer is broken for a whole host of different reasons, and the plans on the table do not address the underlying problem of the lack of a real open market for health insurance.
posted by Pastabagel at 11:31 AM on August 5, 2009


talking about the free market "working" for universal health services is similar the free market for fire prevention and disaster relief.

Actually, I think the point is that our CURRENT system is completely outside market forces. There is no way to shop around competitively to find best value-for-dollar pricing of medical services, and the insurance industry's closed-door negotiation process with health care providers stands as a barricade between the consumer and real information about the cost of care.

And it is worthy to remember -- major cities used to have private fire houses supported by subscription, and they would let your house burn if it didn't have the correct fire house shield on it. We no longer have that system because it was finally realized that it made no fucking sense.
posted by hippybear at 11:35 AM on August 5, 2009 [1 favorite]


But single payer is broken for a whole host of different reasons

LOL. Nothing that can't be fixed with public money. :) Chances are I'm going to be moving to a single-payer system in the not-too-distant future, so you can take your "host of reasons" and shove 'em one by one.
posted by @troy at 11:39 AM on August 5, 2009


We no longer have that system because it was finally realized that it made no fucking sense.

yeah, that was what I was getting at. When you've got an illness all this "consumer choice" BS fades quickly. You want to get better, you gotta pay the man.
posted by @troy at 11:41 AM on August 5, 2009 [2 favorites]


So my wife went to the hospital for surgery a few weeks back. We got her checked in, and the attendant said, "OK, your health insurance has a ten percent co-pay." We knew that, and that was OK by us.

The attendant asked how much we wanted to pay, and I said "Well, you said ten percent, so what does that come to?" She was completely unable to tell us how much the surgery would cost, at all. No idea whatsoever. Not even a ballpark figure.

How can this be?
posted by boo_radley at 11:47 AM on August 5, 2009 [1 favorite]


I agree with the people who have said that the current US health care system is not a free market, and I see the simple appeal of the reasoning that a transparent "open market" for insurance would drive down costs and show how much people are willing to pay for different levels of care given the choice. However, when I think further I realize that at my core I don't believe that the free market is the best way to provide for the basic needs of people. With limits and regulation, it's a great way to foster ingenuity and healthy competition for producing the best car, or the best luxury good, or the best-tasting sandwich, but it's pretty sad to me if we're saying that the market is the most important component, or the only component, of creating a better society. Capitalism and free markets are tools but they aren't the only tools in the drawer.

And of course, I imagine all the deceptive advertising, mergers to *reduce* choice, and lobbying to reduce regulation that would occur in this "free" market of health care options, and I am just not convinced it's the way to go. Going further, I strongly disbelieve that any kind of actual textbook-like free market can realistically exist in the world at any kind of macro level, and that even if it could, it wouldn't be the best way to build a meaningful future for the human race. So, uh, I guess I'm in favor of a health care model that guarantees basic access for everyone. And I'm willing to get taxed more so that other people can have it.
posted by freecellwizard at 12:26 PM on August 5, 2009 [1 favorite]


I think it's the height of defeatism to say that a public run healthcare system would be a nightmare, as if these anecdotal (and as often as not, unverifiable) horror stories from other countries should be reason enough for us not to even bother.

What happened to American exceptionalism? We sent human beings to the moon, but for some reason we don't have the balls or the brains to manage an equitable healthcare system? Yet somehow these tiny little E.U. states can do it, with a fraction of our GDP, and we can't?

I call bullshit. And I'm calling it to the face of anyone who tells me we can't or shouldn't pursue public healthcare in this country.
posted by wfrgms at 12:32 PM on August 5, 2009 [15 favorites]


However, as I've said here many times before, the reason it does not work is precisely because there is not a free market for health insurance.

Do you have evidence to support this? Can you point to a fully free-market health care system that works? Or is it merely a blind faith in the free market that leads you to this conclusion?

After a decades-long journey through many political philosophies, I now describe my political beliefs as "pragmatic." That is, I reject any argument which attempts to derive public policy from high-level principles as if it were a geometric proof. Perhaps this is what you're doing here. Perhaps not. It's a sincere question.

I observe that most developed countries have health care systems that work, while not perfectly, significantly better than the US system, and at a lower overall per capita cost to boot. Thus, I conclude that the US should modify its health care system to be more like [one or more of] those countries. Not because I have some axiomatic belief about whether one form of health care is better than another, but because I look at those countries and see that it's better there.
posted by DevilsAdvocate at 12:44 PM on August 5, 2009 [8 favorites]


Re: free markets and basic needs.

The food supply in the US isn't immune to some governmental hand holding. USDA gives farmers (and more and more, agribusiness) subsidies to grow certain crops or to refrain from growing others. Food is inspected and graded. It's not a free-for-all and market forces are not 100% at play, unless you count the effects of commodities trading.

Neither is housing outside of government influence. Interest rates on loans are set by the Fed, which technically is outside government but as we've seen in the last 18 to 24 months, inextricably linked with the success of governmental policy. HUD and FHA help secure financing for people who would otherwise have difficulty finding a mortgage product.

Nowhere in the Constitution or the Bill of Rights does it say Man has the right to housing or food - but in the background the government is working in its way to do just that: make these basic necessities of life safe, affordable, and accessible.

So,once more I ask: The government isn't bungling our food supply or contributing to the scarcity of affordable, decent housing. How exactly are they going to cock up health care again?
posted by contessa at 12:45 PM on August 5, 2009 [2 favorites]


Is our compulsory American education system also "socialized"?

Yes, although the official term is 'government schools'. They teach about evolution 'n' global warming 'n' stuff, so they must be avoided.
posted by lukemeister at 1:00 PM on August 5, 2009


It's curious to me that the topic of the United States' largest private employer and its health care policies seldom, if ever, comes up in these discussions. I think it's relevant, given that the vast majority of insured Americans get their health coverage from either their employer or from government programs.

For many years GM was the largest private employer. Employees were unionized, paid a living wage, and provided with very good health benefits. Now GM is in serious financial trouble, and a significant portion of the reason why is the growing cost of providing those health benefits to their employees.

Over the last couple of decades, WalMart has replaced GM as the nation's largest private employer. Unions are absolutely taboo, a significant (and growing) portion of employees are limited to part-time status, and the health care benefits are expensive and of poor quality in comparison to GM's, once one passes the hurdle of 6 months to 2.5 years to get covered. WalMart relies on public programs to cover employees and their families more than any other employer, passing the costs on to us. "Wal-Mart leads the list of companies with the most employees and dependents enrolled in state-funded health care programs [i]n all states that have released such data."

If U.S. employers were consistently like GM and could afford to be so and were becoming more likely to provide health care coverage to employees that was affordable on the wages they paid, effective immediately, provided coverage without regard to condition, we wouldn't need public coverage nearly so much as we do. The rising costs of health care, the growing for-profit sector of the health care industry, the rising profits for the insurance companies and policies they have to enforce to ensure that condition, the accelerating physical decline of the baby boomer generation, combined with the nation's largest private employer's shameful approach to covering employees mean that we are overdue for a sensible system that offers at the very least basic and catastrophic coverage for everyone.
posted by notashroom at 1:04 PM on August 5, 2009 [4 favorites]


Rural Medical Camp Tackles Health Care Gaps
posted by homunculus at 1:17 PM on August 5, 2009 [2 favorites]


FK: what?

"FlamingoKing, I assume you agree that in a democracy rights are granted by the will of the people, enshrined in their constitution and laws? Because I'm pretty sure no one here is positing some sort of divinely-granted rights to anything."

No, I don't agree with that statement at all. Because rights that are granted by the will of the people can be taken away by the people. That's contradictory to the concept of a "right". I think gay marriage proponents, for one, would not be willing to argue that their right to marry should be granted by the will of the people.

What is written by the people into law are not rights, but temporary privileges that can be revoked at will.


And then you follow it with a beautiful Ice-T quote, and sure I love Ice-T, but unless a right can be protected...which takes law and law enforcement...does it exist?

This is getting way OT so I won't go much further than that, but you seem to be arguing for some sort of universal, obvious, all-encompassing rights, that come from...where? Out of the sky? The rights we grant ourselves and each other flow from our reasoning and empathy and millennia of observing what does and doesn't work to allow human freedom and safety to coexist. Not from the Universal Fountain of Rights. And then we make laws that prevent those rights from being trampled or that state plainly that they exist, if enough of us perceive the need for those laws and demand it.

The gay marriage thing proves my point. Marriage is a civil contract; until a government actually makes a law stating that it is a valid civil contract, gay civil marriage does not exist as as right.

Like I said, though this is way into the weeds, sorry for the OT. A lawyer-type could probably say this a lot better than I could.
posted by emjaybee at 1:54 PM on August 5, 2009


More ‘Town Halls Gone Wild’: Angry Far Right Protesters Disrupt Events With ‘Incomprehensible’ Yelling
posted by homunculus at 1:58 PM on August 5, 2009 [1 favorite]


Two observations:

I'm self-employed and live in Silicon Valley. Housing is expensive here, but my monthly healthcare payments are more than my mortgage. ($2K for Kaiser with 2 adults, 3 children, through the Episcopal Church).

My mother in the UK recently had major brain surgery, but is now back in her house. My friend in Florida is basically bankrupt after his wife had the same brain surgery.

Something smells rotten.
posted by mdoar at 2:33 PM on August 5, 2009 [2 favorites]


@troy: "FWIW, I ~think~ it's possible to easily move from employer to self-insured during this window after losing work. That's what I did, moving from a gold-plated COBRA alternative of $500/mo to a $200/mo good-enough PPO."

I can't get self-insurance. No one will take me; I've had a preexisting condition from birth, and individual insurance plans don't have to give me coverage, even though I've never let my insurance lapse - ever. The requirement that a preexisting condition not be held against a patient? Only applies to group insurance plans.

I'm just about to leave college and enter the workforce. Once I'm no longer on my parents' insurance, I have to be employed or pay for COBRA. There is no safety net like that "good-enough PPO" you mentioned. Not for me. And not for the millions like me.
posted by spaceman_spiff at 4:26 PM on August 5, 2009 [1 favorite]


If health insurance were truly a free market, if insurance companies actually competed with each other to directly get your business, then I would have no problem with the government coming in as another participant, even if it meant raising taxes.

Individual health insurance is such a market. By most accounts such plans are even worse than employer-provided group plans. Individual plans are also primarily what the public option is targeted towards.
posted by dirigibleman at 6:06 PM on August 5, 2009


After a horrible day working, I made the mistake of reading this thread. God, we're totally fucked, aren't we?
posted by maxwelton at 10:30 PM on August 5, 2009


I was a single mother of 2 for almost 10 years. My kids have been covered by the state health system since they were born, mostly (the time when I had full-time work with benefits, we also had some insurance problems; it's very likely I'm biased), so over a decade now, and still are, because my new husband and I are both state employees. I'm thankful. They have been cared for very reasonably when scary things have happened. They've actually been better covered by the state than when I had them on my private insurance, honestly.

I've only got insurance coverage now because I got married and then my husband got the full-time with benefits package. I'm still afraid to go to the doctor even though I have chronic pain issues. The dreaded lower back problems mentioned above because I've got pretty bad scoliosis, discovered after I'd quit growing, so it was back surgery and chronic pain or "deal with it" and chronic pain. When I was 16, and my parents didn't have insurance (dad's been a teacher at a little private school as long as I've been on the planet), I was the one who chose to deal with it. I wasn't going to burden them with the costs of surgery and then questionable results. Exercise and massage and NSAIDs help a lot most of the time, but some days, I'm just in a fog from pain. I still make it to my part-time job, do it well, raise my kids successfully, and maintain my home with occasional super bad days when I just can't.

I'm not even sure what is happening with my spine in terms of long-term damage; I still manage to work and have a life; and I'm scared to go to the doctor because of what it might cost my family now in the long run thanks to pre-existing conditions and opportunities we might have in the future. Do I want to limit us because I'm broken?

When I was single, I also got rental assistance and food stamps. I was grateful to be educated and able to deal with the bureaucracy.

What I found about the food stamps is that, if you are a smart shopper and can cook from scratch, you can easily feed a lot of people on what you're given every month. You can buy in bulk, can get good fresh vegetables, do some happy work, and feed quite a few extra people without ever committing fraud. I only ever declared my household, but we sure gave a lot of people happy bellies when they needed it without ever straining the food budget.

I still live in the same apartment, but without the assistance. Where I live isn't fancy, but if they didn't have the folks here who got help, there'd be a lot more empty units and the complex would end up looking like a ghost town or worse. It's run by a non-profit organization, I got elected as an alternate on the board, and have to go to some training and meetings. It's gonna be a pain, but I'm going to do it anyway.

For what it's worth, I also put the shopping carts back into the corrals.

After reading the lovely MeTa threads yesterday and today, I guess what I'm mostly wondering at my cynical age of 40-ish is, dammit, people, why can't we be more kind to each other as a country and help each other be more healthy?
posted by lilywing13 at 1:01 AM on August 6, 2009 [3 favorites]


I guess what I'm mostly wondering at my cynical age of 40-ish is, dammit, people, why can't we be more kind to each other as a country and help each other be more healthy?

Because there are an awful lot of people who believe that they should get everything they want, right when they want it, but everyone else's money should pay for it.
posted by oaf at 5:12 AM on August 6, 2009


I found it interesting that we almost had universal health coverage thanks to...Nixon?

"Harry Truman (1949) In a nation as rich as ours, it is shocking fact that tens of millions lack adequate medical care.

That was 1949. Again, the American Medical Association, with Republican support, beat the effort."
...
Richard Nixon (1974): Turning now to the rest of the agenda for 1974, the time is at hand this year to bring comprehensive, high quality health care within the reach of every American. I shall propose a sweeping new program ….

Nixon’s Comprehensive Health Insurance Act is the closest the nation’s come to universal health care. All the key players were talking. But in the end, it was organized labor that wouldn’t compromise. They thought if they held out just a bit longer their plan for government-run insurance would win. But the moment of opportunity was lost.
(source)
posted by vacapinta at 5:57 AM on August 6, 2009 [1 favorite]


Reading this thread makes me so happy that I married a Canadian. Now if only I can convince them to let me enter their country.

I speak French! I like poutine! I watched the whole first season of Ice Road Truckers! Please let me in! Those were misdemeanors, not felonies!
posted by BitterOldPunk at 7:27 AM on August 6, 2009 [1 favorite]


I guess what I'm mostly wondering at my cynical age of 40-ish is, dammit, people, why can't we be more kind to each other as a country and help each other be more healthy?

Because there are an awful lot of people who believe that they should get everything they want, right when they want it, but everyone else's money should pay for it.


Wow. I would have gone the exact opposite way with that, and said that there are an awful lot of people who believe that if life's circumstances mean you cannot provide for yourself, you need to stop expecting others to provide, buck up, find a better job, or else just fucking do without because here in America we only succeed by our own bootstrap tugging.
posted by hippybear at 8:58 AM on August 6, 2009


I would have gone the exact opposite way with that, and said that there are an awful lot of people who believe that if life's circumstances mean you cannot provide for yourself, you need to stop expecting others to provide, buck up, find a better job, or else just fucking do without because here in America we only succeed by our own bootstrap tugging.

We're probably talking about the same people.

The ones I'm talking want the government to do all sorts of things, like provide police and fire protection, a military, paved roads, and such, but they don't want to pay a penny in taxes for it—the same ones who are horrified by the thought that a single cent of their tax dollars might go to pay for someone else's health care, because, hey, after all, that person could get what they wanted if they just worked harder.
posted by oaf at 9:34 AM on August 6, 2009


oaf: indeed, we ARE talking about the same people. I just didn't recognize them from what you wrote. Maybe between the two of us, we have painted a more complete picture. :)
posted by hippybear at 9:36 AM on August 6, 2009


As I've said here many times before, the reason it does not work is precisely because there is not a free market for health insurance.

The market for health insurance works pretty well! The job of an insurance program is to distribute risk among many people. If I have a 1% chance of needing $100,000 in treatment per year, I should be able to pay a private company $1,000 per year, and come out spending the same amount on average -- but without the ups and downs of paying for it directly. And indeed, I can pay $X per year in anticipation of needing $X coverage on average over many years, with only a very small percentage going to the insurance company's profits.

The problem is that we want redistribution of the cost of health care, not just lower risk. That means healthy young people should be paying some of the cost of insuring sick older people, and people without kids should be paying some of the cost of caring for kids, and people with no genetic conditions should pay some of the cost of treating people with genetic conditions. And, of course, the employed should pay for some of the cost of insuring the unemployed.

The free market works great for providing insurance, but redistribution is something only the government can do.
posted by miyabo at 10:27 AM on August 6, 2009


miyabo: where do you live that you can comparison shop for health insurance, find the provider with the lowest rate, and then know you're going to be granted some kind of maximum value-for-dollar for what you buy? Everywhere I've ever lived, the choices have been, go with the one and only plan offered by my employer, if they even offer such a thing as health insurance anymore, or else find the market for private insurance is far too expensive to participate in?

As others have stated up-thread, buying health insurance is not like buying car insurance. It should be, but it isn't.

And that doesn't even begin to address the problems (I will continue to harp on) with how the insurance industry causes the health care providers to create false pricing schemes in order to mask the true value-for-dollar they provide. It's a situation where basic checks-and-balances do not apply, and nobody even knows how much anyone is paying for anything.

Except for people like me, who pay the maximum possible at time of service, because I pay cash, have no insurance, and have no way to bargain for the lower costs which insurance companies get charged for the same services.
posted by hippybear at 10:35 AM on August 6, 2009 [1 favorite]


re: nixon - yea after watching frost/nixon i was fascinated to learn that he was quite the progressive (to the left of most 'movement conservatives' and current mainstream republicans)...
Nixon believed in using government wisely to benefit all, supporting the idea of practical liberalism. During the Nixon administration, the United States established many government agencies, including the Environmental Protection Agency (EPA) and the Occupational Safety and Health Administration (OSHA). In addition, the Post Office Department was abolished as a cabinet department and reorganized as a government-owned corporation: the U.S. Postal Service.

Nixon impounded billions of dollars in federal spending and expanded the power of the Office of Management and Budget. He established the Consumer Product Safety Commission in 1972 and promoted the Legacy of parks program. He implemented the Philadelphia Plan, the first significant federal affirmative action program. Nixon authorized the Clean Air Act of 1970, which has been called one of the most significant pieces of environmental legislation ever signed. In 1971, Nixon proposed the creation of four new government departments superseding the current structure: departments organized for the goal of efficient and effective public service as opposed to the thematic bases of Commerce, Labor, Transportation, Agriculture, et al. Departments including the State, Treasury, Defense, and Justice would remain under this proposal. In his 1974 State of the Union address, Nixon called for comprehensive health insurance. On February 6, 1974, he introduced the Comprehensive Health Insurance Act. Nixon's plan would have mandated employers to purchase health insurance for their employees, and in addition provided a federal health plan, similar to Medicaid, that any American could join by paying on a sliding scale based on income.
btw...
White House Affirms Deal on Drug Cost - "Pressed by industry lobbyists, White House officials on Wednesday assured drug makers that the administration stood by a behind-the-scenes deal to block any Congressional effort to extract cost savings from them beyond an agreed-upon $80 billion."
You Do Not Have Health Insurance

A Jumble of Health Care Related Points
posted by kliuless at 10:40 AM on August 6, 2009


hippybear: The problem with comparison shopping for health insurance is adverse selection.

Imagine a world of 3 people. Each person knows about how much his or her health care costs and keeps it secret.

A needs about $100 of health care a year
B needs about $200 of health care a year
C needs about $300 of health care a year

An insurance company decides to offer insurance with a premium of $200 a year. Only B and C decide to buy insurance, since A can get a better deal on his own; at the end of the year, the insurance company has earned $400 but spent $500. So the next year, the insurance company raises has to raise premiums to $250. Now only C decides to buy insurance, and the company loses $50. Costs keep rising, and the number of people insured keeps falling. Everyone (including the insurance company) is unhappy.

You're B. You would benefit from insurance, but adverse selection keeps you from getting it.

There are two ways to stop adverse selection:

1) Prevent information asymmetry -- make A pay $100, B pay $200, and C pay $300. Insurers do this as much as they can get away with already, by not covering preexisting conditions, and charging differently based on your sex and age. They could copy homeowners' insurance and make a shared national database of everyone's exact claims. But it is impossible to prevent information asymmetry for many types of medical care, for example pregnancy and elective surgery.

2) Prevent people from making choices based on information asymmetry -- make everyone buy insurance at a cost of $200. This is what a health insurer is doing by creating group plans for employers: since everyone is required to enroll, it doesn't matter if you have information your insurer doesn't. This isn't too different from car insurance, where we've just decided to make everyone who owns a car buy a certain minimum level of coverage.

The high cost of individual insurance isn't because there's no free market, it's because comparison shopping on the free market lead to adverse selection. Requiring everyone to buy a minimum level of insurance would help, though as I said previously I'd prefer an effort to redistribute health costs through taxes.
posted by miyabo at 12:49 PM on August 6, 2009 [3 favorites]


miyabo: how does car insurance coverage figure into what you have stated?
posted by hippybear at 2:25 PM on August 6, 2009


Imagine a world of 3 people. Each person knows about how much his or her health care costs and keeps it secret.

And, not meaning to sound snarky, but in what piece of America do any insured persons know how much their health care costs actually are, per annum? The disconnect between what a person pays in insurance and co-pays and what the health care providers collect can be light-years, and is NEVER revealed to the consumer unless they purchase health services without insurance. Even then, it is not an accurate measure of what the insurance companies pay for those same services.
posted by hippybear at 2:27 PM on August 6, 2009


The high cost of individual insurance isn't because there's no free market, it's because comparison shopping on the free market lead to adverse selection. Requiring everyone to buy a minimum level of insurance would help, though as I said previously I'd prefer an effort to redistribute health costs through taxes.

I understand what you're saying, and it sounds logical. Except that, in the private health insurance market here in Australia:

(a) You can comparison shop. There are dozens of insurance companies, and purchasing health insurance isn't much different than purchasing car insurance. In fact, the forms you have to fill out are significantly shorter.

(b) Insurance companies generally do charge a standard fee based on the sort of coverage you require - it seems to vary slightly with age and location, but there's certainly no crap about "preexisting conditions" - I recently changed health insurance companies, and I can't recall there being any questions on the form that were even medical in nature.

Yet, somehow it works. Perhaps because there's a general pressure towards having insurance - people generally don't say "Oh insurance is too expensive, I'll just insure myself and put that money under my mattress until I need it" - there are real benefits of having insurance, no matter what the actual empirical cost. What did they call that in that one economics class I took? Elasticity of demand? Insurance is like heroin - you'll pay whatever it costs. And all this seems to work in Australia where we have universal health care anyway and having insurance just gets you a private room with flowers on the bedside table, and shorter waiting times for surgery.
posted by Jimbob at 4:00 PM on August 6, 2009


And for anyone who thinks that individual health insurance is some sort of panacea for those who don't have access to employer-sponsored plans: try imagine having to pay $22,000 out-of-pocket for having a baby. (via Consumerist)</small)
posted by shiu mai baby at 6:11 AM on August 7, 2009


And this quote from that article was just staggering:
[A] new report from the American Journal of Medicine found that in 2007, 62 percent of declared bankruptcies were by people with staggering medical bills—even though 80 percent of them actually had health insurance.
Yep. The American health system fucking rocks.
posted by shiu mai baby at 6:16 AM on August 7, 2009 [2 favorites]


...try imagine having to pay $22,000 out-of-pocket for having a baby.

True story. The expense of having me (in a hospital in San Diego) so shocked my parents financially that, shortly before my younger brother was born, my mom went down to Mexico to have him there.

My father stayed behind to keep working. His job and the money they saved allowed them to finally make a down payment on their first house.
posted by vacapinta at 6:36 AM on August 7, 2009


Interesting op/ed on the astro-turfed town-hall protests, from someone with first-hand knowledge of how these campaigns work.
posted by saulgoodman at 10:29 AM on August 7, 2009


Are Republicans and their thugs killing off the Town Hall as a democratic forum?
posted by homunculus at 1:59 PM on August 7, 2009


Frank Schaeffer calls out the Republican / lobbiest astro-turfers as "Brown Shirts" on Rachel Maddow.
posted by hippybear at 9:36 AM on August 8, 2009


Grrr. that was entirely the wrong segment.

This is the correct link for the Frank Schaeffer interview on Maddow. (Interview begins at approx the 8 minute mark.)
posted by hippybear at 9:42 AM on August 8, 2009


The View From Your Sickbed
posted by homunculus at 11:34 AM on August 9, 2009


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