Join 3,439 readers in helping fund MetaFilter (Hide)


How Tyler Cowen Would Fix the Current Healthcare Bill
November 20, 2009 2:06 PM   Subscribe

What should we do instead of the Obama health reform bill?
posted by reenum (99 comments total) 5 users marked this as a favorite

 
Hahah. The very first item on the list is already completely infeasible. Republicans and blue-dog Democrats, despite their recent fear-mongering among the elderly, absolutely hate Medicare and Medicaid.
posted by muddgirl at 2:14 PM on November 20, 2009


Yeah, never happen. On the other hand he's right that the currently proposed plan will never work. I have no idea what's going to happen over the next decade if this bill passes, but I can pretty much guarantee it will be great. And by great I mean terrible.
posted by Justinian at 2:17 PM on November 20, 2009 [1 favorite]


I don't understand most of this. this caught my eye, so I'd appreciate someone who understands it better explaining it to me:
4. Make an all-out attempt to limit deaths by hospital infection and the simple failure of doctors to wash their hands and perform other medically obvious procedures.

5. Make an all-out attempt, working with state and local governments (recall, since the Feds are picking up the Medicaid tab they have temporary leverage here), to ease the spread of low-cost, walk-in health care clinics, run on a WalMart sort of basis. Stepping into the realm of the less feasible, weaken medical licensing and greatly expand the roles of nurses, paramedics, and pharmacists.
I'm not totally sure I understand how number 4 fits into a bill about paying for health care. is it already mentioned in the current bill in some way? I just don't understand what he's getting at. Of course we want to limit deaths by hospital infection. Why do we need to codify it into law? How many doctors don't actually wash their hands? Is it an epidemic in our hospitals or something? I thought it was SOP for them to do so, and that they were basically rigorous in it.

then, what does he mean by "weaken" medical licensing? as in, make it easier to get one? this seems... weird to me, if that's what he means. further, what would expanding the roles of nurses, paramedics and pharmacists do for our health insurance problem?

like I said, I don't understand most of what he's writing here, but this stuff in particular seems to me like it's shifting blame onto doctors in weird ways to deviate from the actual problem with health insurance. maybe that's my ignorance that gives me that impression, though. help would be greatly appreciated.
posted by shmegegge at 2:22 PM on November 20, 2009 [3 favorites]


How about you start by listing things that can get the support of a majority of Representatives and 60 Senators, because that's what you need in order for anything to move from idle speculation to actual law. Remember, no administration, ever, has accomplished this.

That being said, it's frustrating that some of these ideas aren't in the bill.
posted by thewittyname at 2:25 PM on November 20, 2009


Independent of whatever else we do, it would save Americans a great deal of money if the FDA were to concern itself with the safety of drugs and not with enforcing regional price controls for the pharmaceutical industry. Allow the import of identical drugs from Canada and Mexico and elsewhere, and stop asking Americans to subsidize on an international scale what would surely count as an antitrust violation if it were writ smaller. This is both free-market and fair trade; I can't think of a reasonable argument against it.
posted by kid ichorous at 2:26 PM on November 20, 2009 [1 favorite]


The real issue with this is calling it the Obama Health Reform Bill. I'm sure if Obama, or Baucus or had their way, things would look a lot different. That's the joy of representative government - for better or worse, no one is going to get things exactly their way.

Fortuanately, the crowd whose idea of healthcare reform involves machette armed gangs roaming the streets is getting even less of their way that Tyler Cowen.

posted by Kid Charlemagne at 2:27 PM on November 20, 2009 [1 favorite]


If Tyler Cowen was King his ideas might be implemented quite well. As it is we have co-equal branches of government and compromise is necessary, including compromise with individuals whose motives have been compromised. The significant but incremental improvements in the current bills are the best realistic possibility, as proven by the astonishing difficulty in even getting 60 votes to _debate_ the bill. Gradual improvements are the only way to get to a single-payer system in decades to come.

Also, the term "stimulus" is not as popular with swing voters as the writer seems to think - it is a swearword. We recently learned that a majority of Republicans believe the 2008 election was stolen by ACORN. With such a misled electorate it's impressive the Senate is getting anything done at all.
posted by East Manitoba Regional Junior Kabaddi Champion '94 at 2:28 PM on November 20, 2009 [2 favorites]


We should give money to everyone and solve peace in the Middle East too. HAY GUISE! STOP FIGHTING!
posted by amuseDetachment at 2:28 PM on November 20, 2009 [1 favorite]


Keep the government's hands off of Medicare, dagnabbit.
posted by mr_crash_davis mark II: Jazz Odyssey at 2:30 PM on November 20, 2009 [3 favorites]


While President Obama set the agenda and priority for access to affordable health care for all, he never introduced a formal BILL, he proposed principles and here are the first three...

IF YOU HAVE HEALTH CARE:
1) If you like your health insurance, you can keep it.

2) No more denials because of pre-existing conditions.

3) No dropped coverage just because you got sick.

Here are the concise list of principles.

Just as the House has a bill, which it passed, the U.S. Senate is undertaking legislation right now.

It's a misnomer to call it "Obama's Bill."
posted by Schultzy at 2:31 PM on November 20, 2009 [7 favorites]


Given a source of flowing water, many males will attempt to dam it.
To this day, my friends and I maintain the dam on the local swimming hole. For fun. We like to move rocks around. It's constructive, destructive, meaningful and meaningless. All at the same time. If a guy sees some water running through a gully, nine times out of ten he will try to make a dam.
posted by Seamus at 2:33 PM on November 20, 2009 [12 favorites]


and solve peace in the Middle East too. HAY GUISE! STOP FIGHTING!

Sadly, you've pretty much summed up the previous president's Middle East peace plan.
posted by EarBucket at 2:33 PM on November 20, 2009


Christ, I can't post in the correct thread to save my life.
posted by Seamus at 2:33 PM on November 20, 2009


I have no idea what's going to happen over the next decade if this bill passes, but I can pretty much guarantee it will be great. And by great I mean terrible.

Rarely does one see complete ignorance admitted in the same breath as a guarentee based upon that very same ignorance.
posted by Ironmouth at 2:36 PM on November 20, 2009 [3 favorites]


then, what does he mean by "weaken" medical licensing? as in, make it easier to get one? this seems... weird to me, if that's what he means. further, what would expanding the roles of nurses, paramedics and pharmacists do for our health insurance problem?

like I said, I don't understand most of what he's writing here, but this stuff in particular seems to me like it's shifting blame onto doctors in weird ways to deviate from the actual problem with health insurance. maybe that's my ignorance that gives me that impression, though. help would be greatly appreciated.
posted by shmegegge at 5:22 PM on November 20 [+] [!]


There's an idea -- and I have no idea how true this is -- that one of the reasons that health care is so expensive is because the AMA strictly controls the number of doctors who are being trained every year (through making it difficult to open new medical schools, etc.) so that doctors can get paid more money. I don't necessarily trust the people who are throwing this idea around, but that's where that's coming from...
posted by Comrade_robot at 2:38 PM on November 20, 2009


single payer
posted by DU at 2:38 PM on November 20, 2009 [10 favorites]


The Healthcare Bill of Rights:

1. Tort reform: limit the amount of jury awards in malpractice suits.
2. Eliminate rescission.
3. As long as you can pay the premiums, you must be covered.
4. Remove healthcare costs from employers and establish a nationwide option that allows you to sign up for any plan at any time. The plan follows you across employers and cannot be terminated in the case of unemployment.
5. Your choice of any doctor.
6. Limit yearly out-of-pocket expenses to 5% of your 1040. If you make less than the poverty line, you pay nothing.
7. Eliminate co-pay for preventative care.
8. All paperwork standardized and put online for easy submission and approval, from both patient and doctor.
9. Patent reform: all inventions that fall under biotechnology are patentable, however must be licensed to the general public, with the licensing fee being a percentage of all revenue created by that patent.
10. All persons residing in the United States cannot be turned away from emergency care for any reason.
posted by mark242 at 2:40 PM on November 20, 2009 [2 favorites]


Is it an epidemic in our hospitals or something?

Yes, absolutely. MedPAC, the nonpartisan expert organization that advises Congress on Medicare payment policy (which of course Congress never listens to), has estimated that Medicare would receive significant savings if it could reduce the number of rehospitalizations due to infections. If you start looking into this, it will quickly convince you that you should do everything in your power to stay out of hospitals, because they are very infectious places to be. (This article is a really good primer on the problem.)

what does he mean by "weaken" medical licensing? as in, make it easier to get one?

Well, we have a terrible shortage of primary care docs in our system, and according to many policy wonks, waaaay too many specialists. (Some doctors and doctor organizations like the AMA disagree.) Part of the problem is that the very, very smart people who make it into medical school and spend years learning very valuable skills often have an aversion to spending all or most of their time doing very low-level evaluation and management that is the bread-and-butter of family practice, so you don't see a lot of new doctors fighting to specialize in that area. Arguably a lot of the simple cold/flu/strep throat/UTI type stuff could be done cheaper by allowing nurse practitioners or physicians assistants to take it over, which would both save money and free up primary care docs to spend more time on stuff that actually requires an MD.
posted by iminurmefi at 2:40 PM on November 20, 2009 [3 favorites]


Comrade_robot: "There's an idea -- and I have no idea how true this is -- that one of the reasons that health care is so expensive is because the AMA strictly controls the number of doctors who are being trained every year (through making it difficult to open new medical schools, etc.) so that doctors can get paid more money. I don't necessarily trust the people who are throwing this idea around, but that's where that's coming from..."

that's... that sounds like crazy talk. it's crazy talk, right? it's not like it's hard to find a doctor to treat you, provided you can pay. price fixing doesn't work so long as one person within the area being served isn't in on the deal.
posted by shmegegge at 2:41 PM on November 20, 2009


iminurmefi: "Arguably a lot of the simple cold/flu/strep throat/UTI type stuff could be done cheaper by allowing nurse practitioners or physicians assistants to take it over, which would both save money and free up primary care docs to spend more time on stuff that actually requires an MD."

that makes way more sense than the AMA conspiracy version.
posted by shmegegge at 2:43 PM on November 20, 2009


shmegegge, there was a recent story here about doctors not washing their hands. I imagine the USA is similar. The stuff about licenses has a parallel argument here too. The idea is that you shouldn't need a GP (do you call them that too? a doctor in general practice) to, e.g., give someone a flu shot. Nurses could do the job at least as well and certainly more cheaply. Pharmacists could, so the argument goes, do basic diagnoses at the pharmacy (provided they were pharmacologists), etc. The costs savings could increase profitslead to savings.

I don't know enough about it to have an opinion, but the argument gets aired quite often.
posted by GeckoDundee at 2:44 PM on November 20, 2009


I think he's also advocating for loosening the restrictions on what a non-doctor can do for any particular patient.

It's my impression that pharmacy schools and nursing positions are actually harder to get into than medical school - medical school just has a much higher nominal barrier to entry (the MCAT, etc).
posted by muddgirl at 2:44 PM on November 20, 2009


This is how I feel when I follow the health-care """""reform""""":

"Hey look, that train right ahead of us on the track looks like it's facing us... maybe it's going backwards... no, it seems to be getting closer... oh my god, it's heading right at us! The train is accelerating! Don't they know there is another train on the tracks! Someone do something!!!!!!!!"
"Here is a lolly-pop. Trains are complicated"
"NOOOOOOOOOOOOOOOO!"

[Trains collide, twisted metal intersects with bodies in a bloody burning mess, there are no survivors]
posted by fuq at 2:51 PM on November 20, 2009 [3 favorites]


that makes way more sense than the AMA conspiracy version.

Well... usually when you see states that give paraprofessionals almost no independent authority to diagnose and treat medical conditions, it's due to strong physician groups that don't want the competition. I don't know that I'd call it conspiracy so much as a professional interest group acting exactly like any other professional interest group.

And the AMA does control the number of medical school slots, as far as I'm aware. However I'm very skeptical of the argument that opening up a bunch of new medical schools and getting a lot of new doctors would exert downward pressure on prices, because the U.S. has some of the highest prices for a straightforward doctor's visit but does not have a particularly low supply of doctors per capita compared to other countries. Whatever it is that drives high prices, I don't think it's a lack of supply--or not simply a lack of supply.
posted by iminurmefi at 2:51 PM on November 20, 2009 [2 favorites]


Don't. Touch. Anything. Leave things just as they are and consider small, incremental changes on the state and local level, keeping in mind that you're not out to save the world. Healthcare in the US actually works. You guys are going to ruin everything...
posted by Faze at 2:53 PM on November 20, 2009


This list is close to a joke. It's a set of ideas that goes something along the lines of:

1. Make changes to issues I hold as personal hobbyhorses.
2. A miracle occurs.
3. everyone is covered

There are two mindsets here: people, like Cowen, who simply like the aesthetics of a health care system whose laws are conforming to a more market-oriented kind of system, and those whose main concern is ensuring that everyone has health care coverage.

You don't make a few peripheral changes and then expect that everyone gets coverage as a side effect. You start with the premise that everyone should have coverage and work backwards from there.
posted by deanc at 2:55 PM on November 20, 2009 [3 favorites]


there was a recent story here about doctors not washing their hands

Hands are a problem, but even doctors who wash their hands rarely change their lab coat -- or remove their tie.

If you start looking into this, it will quickly convince you that you should do everything in your power to stay out of hospitals, because they are very infectious places to be.

I wonder if more, smaller hospitals and clinics would actually help here. Perhaps -- as with the meat industry -- industrialization/centralization is partly to blame.

Anyway, this article came off as "I don't like your ideas over there as they are too difficult to implement and uncertain of success, so try my ideas over here which are, well, OK, you got me, difficult to implement and uncertain of success." It's easy to come up with some good ideas, it's hard to make them happen.
posted by dhartung at 2:58 PM on November 20, 2009


Don't. Touch. Anything. Leave things just as they are and consider small, incremental changes on the state and local level, keeping in mind that you're not out to save the world. Segregation in the US actually works. You guys are going to ruin everything...
posted by fuq at 3:00 PM on November 20, 2009 [6 favorites]


Healthcare in the US actually works.

Actually, it "works" the same way the lamp next to my couch works - intermittently and only with great attention and care.

Unfortunately, 99% of sick people are unable to give the health care system, yaknow, attention and care. Since they're sick. The easiest way to "fix" the current health care system would be to assign every single person an advocate to fight for them when they're sick. But that's pretty expensive.

If you research the beginnings of the insurance system in America, it's clear that the sickness has been there from the very beginning, but we were too damned big and gosh-darned independent to change over to a logical system when all the other civilized countries did.
posted by muddgirl at 3:01 PM on November 20, 2009 [1 favorite]


deanc, that's my impression of the list too: none of the ideas are really bad, some of them I actually agree with, but they don't actually represent a comprehensive plan to reform the system. I know around here there's a lot of people who hate Obama's version of a health care reform bill, but it's at least centered around a policy innovation (health insurance exchanges) that are attempting to solve the problems of escalating costs and eroding coverage in a systemic and comprehensive way. You can argue that it won't work, or won't work as well as other systems you'd like to see, but at least it's a well-thought out set of policies that interlock together to produce reform that is more than the sum of its parts.

This? This is pretty much like the sort of list that someone who is a serious dilettante in health care financing issues throws out there, not identifying any particular problem to be solved, just saying "these are my pet issues and thus they must solve the [unstated so no one can quibble with them] problems of our system! voila! I'm an economist, so naturally I'm totally qualified to talk knowledgeably about policy!"
posted by iminurmefi at 3:02 PM on November 20, 2009 [1 favorite]


So is "tort reform" just Republican a euphemism for "arrrgh fucking TRIAL LAWYERS" or are there people who really think folks shouldn't get paid when a doctor accidentally sews his Rolex up in their chest cavity or what?
posted by hamida2242 at 3:05 PM on November 20, 2009


I think it's important to realize that the current "healthcare" reform bill being worked on is not actually about reforming the CARE anyone receives. It's about reforming health insurance.

There's a whole other side to the equation, involving the doctors and hospitals, the sort of care which is given out, how much all that costs, what kind of best practices there are, etc. But this bill seems to be mostly if not entirely about insurance and access to that.

Perhaps in the future we will reform the other side, but I am not holding my breath.
posted by hippybear at 3:08 PM on November 20, 2009


Healthcare in the US actually works.

I agree. The American healthcare system is doing a PHENOMENAL job of killing the poor while enhancing stockholder value! U-S-A! U-S-A!
posted by homuncula at 3:08 PM on November 20, 2009 [10 favorites]


To this day, my friends and I maintain the dam on the local swimming hole.

Watch out for Henry Bowers I hear that guy's pretty mean.
posted by hamida2242 at 3:09 PM on November 20, 2009


1. Tort reform: limit the amount of jury awards in malpractice suits.

mark242:

I think that you created an eminently reasonable list of good ideas.

I just can't get my head around the tort reform idea, though (especially since it's the first thing in your list, implying it's the most important).

How, in any sense, is it fair to limit the amount of money a patient can sue for or be rewarded with? Suing a doctor who has acted wrongly is the only recourse open to the patient. Any accredited professional should fear reprisal if they don't do their job correctly. Doctors are accorded very high status in this country: they operate in an arena with a very high entry barrier, they are strongly organized and represented, they don't have extreme levels of competition, and they are (by and large) paid very handsomely for their skills. Patients have no choice but to put their faith and, many times, their lives in the hands of these doctors. If they are mistreated, they absolutely deserve a way to fight back.

We decided a long time back that a jury of peers is a workable way to referee disputes; I just think that limiting damages beforehand is putting the cart before the horse.
posted by Benny Andajetz at 3:16 PM on November 20, 2009 [5 favorites]


I'm actually kinda sad that we had to go in the "ZOMG we need reform NOW!!!!" direction. Whatever bill got, no matter how shitty, was going to be the all or nothing bet and no other options will be considered. If this bill doesn't go through, everyone will be saying, "Oh well, just like the Clintons. Guess we'll wait another 20 years before trying again. Health care sure is hard to do..."
posted by cimbrog at 3:20 PM on November 20, 2009


I agree. The American healthcare system is doing a PHENOMENAL job of killing the poor while enhancing stockholder value!

Hey look if those poors didn't want to die maybe they should've used some PERSONAL RESPONSIBILITY and not been poor/gotten sick in the first place.

My Rx: take 2 bootstraps and call me in the morning.
posted by hamida2242 at 3:21 PM on November 20, 2009


How, in any sense, is it fair to limit the amount of money a patient can sue for or be rewarded with? Suing a doctor who has acted wrongly is the only recourse open to the patient. Any accredited professional should fear reprisal if they don't do their job correctly. Doctors are accorded very high status in this country: they operate in an arena with a very high entry barrier, they are strongly organized and represented, they don't have extreme levels of competition, and they are (by and large) paid very handsomely for their skills. Patients have no choice but to put their faith and, many times, their lives in the hands of these doctors. If they are mistreated, they absolutely deserve a way to fight back.


You've completely missed it. It's not about people suing doctors who deserved to be sued. It's about people suing doctors who don't. As well as suing everyone else who doesn't have a legitimate reason to be sued.

Defensive medicine has become an accepted and encouraged practice. The number of frivolous lawsuits is incredibly high -- much higher than it used to be, though medicine isn't necessarily worse.. in fact, scientific advancement has made it better. These lawsuits drive costs way up. Insurance companies pass those costs on the doctor in the form of insurance policies that cost well into the six figures per year. Those costs get passed down.

That's just on the doc side. You then have the hospitals and the equipment manufacturers to contend with as well.

Again, no one is suggesting patients shouldn't be able to sue someone who wronged them. Tort reform involves things like enacting better protections for docs/hospitals/etc in certain high risk procedures. It's also the idea that there should be higher penalties on those filing bullshit lawsuits.

IMO we should have a general legal reform to get our lawsuit happy society back in check. It ain't just healthcare that has to deal with it, it's all businesses (small and large)
posted by rulethirty at 3:24 PM on November 20, 2009 [2 favorites]


Healthcare in the US actually works.

There are some 40 million people who would disagree with you.
posted by Doublewhiskeycokenoice at 3:32 PM on November 20, 2009 [5 favorites]


The number of frivolous lawsuits is incredibly high

What are your top 5 most annoying frivolous medical malpractice lawsuits from 2004-present? No copy/paste from overlawyered or reason, tia.


Insurance companies pass those costs on the doctor in the form of insurance policies that cost well into the six figures per year.

A doctor having to lease a cheaper Benz seems a reasonable level of "collateral damage" to give patients meaningful recourse but I don't know?
posted by hamida2242 at 3:35 PM on November 20, 2009


Malpractice awards are not up. Malpractice insurance rates, however, have skyrocketed in the last couple of decades, because insurance companies are one and all scumfucks.
posted by Pope Guilty at 3:35 PM on November 20, 2009 [7 favorites]


What should we do instead of the Obama health reform bill?
posted by ford and the prefects at 3:36 PM on November 20, 2009 [2 favorites]


So on a 2,000+ page bill 'we' are supposed to have an informed and wise response as to 'what could be done instead' so we'd be able to judge Tyler Cowen's POV?

The Congress critters claim they don't read the bills. Even laugh about it when Micheal Moore puts a camera in their face. And that is, in theory, their jobs.

Again, no one is suggesting patients shouldn't be able to sue someone who wronged them.

And yet, the vaccine makes have exactly that immunity. So yes, some one is suggesting exactly what you have claimed is not suggested.
posted by rough ashlar at 3:41 PM on November 20, 2009


We can trust Moe Greene to run the Tropicana and go in with Tattaglia on the heroin business. None of this has anything to do with Barzini and Carlo is a good kid we know we can trust. Anyway, the Don is never going to die and even if he does, all we have to do is put Fredo in charge of the family.

Seriously – wha? “Construct a path for federalizing Medicaid and put it on a sounder financial footing…”
All we really need to do is go back to the end of world war two before all the screwy changes in health care took hold. I’ve got some ideas for that. 1. Construct a time machine and set it to go back to 1945….

What the hell is an “all out attempt”? We go into hospitals and aim rifles at doctors who don’t wash their hands? What’s the oversight mechanism?

Boost subsidies to medical R&D – how? I mean – hell yeah I agree in principle. But where’s the money come from? And how would the subsidies be structured? Just hand money to people in the street if they fill out the right form or would there be some sort of grant structure program? And if it’s the latter, who gets that? Schools? Corporations? Non-profits?
Jesus, has this guy ever actually executed anything in the real world? Hey, you guys want to win in Afghanistan? Just drop a neutron bomb on ‘em dood!

“Establish the principle that future extensions of coverage, as done through government, will be for catastrophic care only.”

And everyone will follow this principle. Because it’s the principle of the United States.
I’ve got some wonderful ideas on the space program. I should pick up the phone and straighten out NASA – ‘Hey, you guys should figure out how to colonize space! Then we could get people off planet and that would solve overpopulation and a lot of other stuff. Get on it. …what do you mean ‘budget’? Just increase that. …make the senators give you more money then. Establish the principle that we need to get out into space….’ Etc.

Changing the culture for doctors such that it’s easier for them to wash their hands, change lab coats – it’d be nice if they didn’t wear ties at all – would be swell. And they should. ‘How’ is a whole other animal. And the resistance to change alone (much less outright opposition) in putting forth any concept for action has to be incorporated into the 'how.'

Course, I'm back of the napkin arguing his back of the napkin ideas. But my criticism of his criticism is that the bill proposal isn't a failure of ideas (and anyone can have an idea). That it is, rather, a failure in our system of government to be responsive to what our people want such that there is more resistance than necessary to even elemental ideas based on entirely fair dealing.
Hell, we've got many examples of what works and what does not work so well in other governments health care systems, so it's not like we're lacking in a knowledge of best practices.

What under contention -and I think Cowen fails to recognize a bill is, inherently, contentious - is money. Lots and lots of money.
posted by Smedleyman at 3:49 PM on November 20, 2009 [1 favorite]


I'm stiil searching for the 'right thread' for Seamus's post on damming water. I just mulled it over here and assumed it was in the right thread -- maybe it is some kind of zen koan for any number of threads ...
posted by Surfurrus at 4:00 PM on November 20, 2009 [1 favorite]


kid ichorous: Independent of whatever else we do, it would save Americans a great deal of money if the FDA were to concern itself with the safety of drugs and not with enforcing regional price controls for the pharmaceutical industry. Allow the import of identical drugs from Canada and Mexico and elsewhere, and stop asking Americans to subsidize on an international scale what would surely count as an antitrust violation if it were writ smaller. This is both free-market and fair trade; I can't think of a reasonable argument against it.

What you're describing is called "price discrimination" in the economic literature. The point is debated, but I think the mainstream view is that "perfect" price discrimination is efficient. I haven't studied the question in a while, but I bet some googling would turn up reasonable arguments.

Looking at the problem from another point of view: what do you suppose will happen to Mexican and other poor-country patients when their drug prices equalize with the US? (Off-hand I think the equilibrium will be higher than the dollar-weighted average price, because high prices will drive poor-country consumers out of the market.)
posted by grobstein at 4:14 PM on November 20, 2009


A huge variable that makes us different from other countries is that we are the most litigious society on earth, and the party trying to enact health care reform has as its biggest donor the trial bar. Until the Democrats are willing to bite that hand, the cost issue will not be resolved.
posted by mattholomew at 4:20 PM on November 20, 2009 [1 favorite]


Malpractice awards are not up.

Got a citation?
posted by mattholomew at 4:21 PM on November 20, 2009


blah blah blah mcdonalds hot coffee lawyers blah blah blah
posted by bepe at 4:37 PM on November 20, 2009


blah blah blah mcdonalds hot coffee lawyers blah blah blah
I certainly can't stand up to a nuanced argument like that. I stand down, sir or madam.
posted by mattholomew at 4:41 PM on November 20, 2009


Got a citation?

You can start with citations 16 through 19 in the first Google result for "medical malpractice". Then you might want to check out The Medical Malpractice Myth.
posted by designbot at 4:42 PM on November 20, 2009


Truths and Myths about Malpractice
posted by Benny Andajetz at 4:43 PM on November 20, 2009


"Now, I recognize that it will be hard to make some of these changes if doctors feel like they're constantly looking over their shoulders for fear of lawsuits. I recognize that. Don't get too excited yet. Now, I understand some doctors may feel the need to order more tests and treatments to avoid being legally vulnerable. That's a real issue."
--Barack Obama, June 15, 2009
posted by mattholomew at 4:45 PM on November 20, 2009


Mathowie's recent experience with being asked to make life-changing decisions while in no condition to do so makes me wonder if more needs to be fixed than the financial mess. What would any of us do in a similar situation with no family member available to speak for us? Especially when, as in mathowie's case, one is far from one's own physician and local facilities.
posted by Cranberry at 4:46 PM on November 20, 2009


Benny Andajetz - Um...that site is written by a trial lawyer. I'll bet there are also websites sponsored by insurance companies stating that the insurance industry is not the issue.
posted by mattholomew at 4:48 PM on November 20, 2009


A doctor having to lease a cheaper Benz seems a reasonable level of "collateral damage" to give patients meaningful recourse but I don't know?

There are a lot of things wrong with your assumptions, but let's start with the basics: with the exception of a few specialists, most doctors make significantly less than you'd think. Yes, it used to be that physicians were baronially wealthy, but that was back in the days when 4 out of 5 doctors endorsed Camels, treated heart attacks with bed rest and thought lobotomies were a pretty swell idea.

Anecdotally, where I am (a large medical center), the docs seem to live pretty modestly, and the parking lots are full of Hondas and Volvos. Late model, yeah, but still. You do see the odd Benz or Porsche - the midlife-crisis-mobiles / angsty cries into the abyss of hard-charging, atherosclerotic subspecialist surgeons and misanthropic radiologists (my favorite example, a bright red Jaguar, has a personalized plate reading "CMPSSN") - but these are very much the exception rather than the rule.
posted by killdevil at 4:54 PM on November 20, 2009


Aw, shucks, mattholomew, ya got me! Barack Obama said that it's an "issue" that "some doctors" "feel the need" to "avoid being legally vulnerable."

That definitely proves that capping awards in malpractice suits is the most effective way to cut health care costs. I can't imagine any other way to address the issue.

If you're looking for some more recent citations, you can try the Washington Independent article "Tort Reform Unlikely to Cut Health Care Costs."
posted by designbot at 5:07 PM on November 20, 2009


Just to throw out some random income stats, according to this 2006 survey, it looks like an internist makes around $176,000 and a general surgeon makes around $291,00. According to Wikipedia's summary of some US census data, median personal income for adults working full time is around $39,000.
posted by Staggering Jack at 5:07 PM on November 20, 2009


The number of frivolous lawsuits is incredibly high

How high? What fraction of malpractice suits are "frivolous"? What are the criteria for a "frivolous" malpractice suit? How often do plaintiffs actually win "frivolous" suits and claim money? How does this compare historically?
posted by dirigibleman at 5:07 PM on November 20, 2009 [1 favorite]


grobstein: Looking at the problem from another point of view: what do you suppose will happen to Mexican and other poor-country patients when their drug prices equalize with the US?

You're right; Mexico has a very reasonable argument for price discrimination. But I don't think it's necessary that the US close the price gap with Mexico, or even India. If we could only bring prices in line with the UK, Switzerland, or Canada, I think we'd be making a difference for millions of people, and doing so independently of how we resolve the problems of insurance regulation and the single-payer option. Nudging the FDA to allow a kind of free trade between certain developed countries and the US seems like the most forward approach, but it's all uphill. We're in the unenviable position of 1) asking other first world countries to step up and pay a more equal share, and 2) challenging a set of market rules designed by and for the pharmaceutical industry.

Prescription drug prices in the United States are the highest in the world. "The prices Americans pay for prescription drugs, which are far higher than those paid by citizens of any other developed country, help explain why the pharmaceutical industry is — and has been for years — the most profitable of all businesses in the U.S. In the annual Fortune 500 survey, the pharmaceutical industry topped the list of the most profitable industries, with a return of 17% on revenue." [...] Prices of brand name drugs in the United States are significantly higher than in Canada, India, the UK and other countries, nearly all of which have price controls. [...] As an example of the extremely high U.S. drug prices, consider the cholesterol drug Lipitor, one of the best selling drugs in the world. At CVS, a leading U.S. pharmacy, Lipitor (40 mg/90 tablets) costs $361.99. At Drugstore.com, another U.S. pharmacy, the same drug costs $335.97. While in Canada at CanadianOnlineRx.com pharmacy, the cost is $215.46, and in India at licensed pharmacy InternationalDrugMart.com, the identical generic drug costs $120.94 (Source: All costs in US$,19 May 2008, from the respective pharmacy websites). [wiki]

Not to change gears to something trivial, but the first parallel that comes to mind is regional lockout, and just what goes into creating the street price of a DVD.
posted by kid ichorous at 5:08 PM on November 20, 2009


D'oh - the 2006 survey is here.
posted by Staggering Jack at 5:09 PM on November 20, 2009


U.S. health care professionals (specialists, general practitioners, and nurses) are among the highest paid health professionals in the world. 2007 Congressional Research Service report [via NY Times Economix blog]
posted by designbot at 5:24 PM on November 20, 2009


D'oh - the 2006 survey is here.

Those numbers look about right.

U.S. health care professionals (specialists, general practitioners, and nurses) are among the highest paid health professionals in the world.

True. But remember that in many of the other advanced Western countries for which an apples-to-apples comparison is most valid, medical education ranges from heavily subsidized to completely free, and most if not all doctors are salaried and indemnified by their respective national healthcare systems.
posted by killdevil at 5:34 PM on November 20, 2009


Linked article is disappointing. I thought it would be "Go to Mars, like, 15 times, with a nuclear propulsion system" or something.
posted by RobotVoodooPower at 5:51 PM on November 20, 2009


Benny Andajetz - Um...that site is written by a trial lawyer. I'll bet there are also websites sponsored by insurance companies stating that the insurance industry is not the issue.

I picked that one because he mentions all the studies that the other pages do but all in one place, more or less.

( BTW, whenever I see the term "trial lawyer", it resonates just like "activist judge". It usually is used more to denigrate than illuminate.)
posted by Benny Andajetz at 6:05 PM on November 20, 2009


Why do we need to codify it into law? How many doctors don't actually wash their hands? Is it an epidemic in our hospitals or something? I thought it was SOP for them to do so, and that they were basically rigorous in it.

Having spent six weeks of my summer voluntarily coaching a design team of students who were following health care professionals around an Intensive Care Unit of a lovely hospital, I can tell you that if hospitals have a 30% hand hygiene compliance rate, they feel that they are doing relatively well compared with all US hospitals.

30%. Just 30% of what they are SUPPOSED to be doing. Can you imagine many other settings where you could get away with complying with something only 30% of the time and not being immediately booted?

As mentioned up thread, we can't even get doctors to switch from long ties to bow ties in order to slow the spread of C Diff, MRSA and other hospital acquired infections. Or clean stethoscopes between patient rooms. Or just give each patient their own damn stethoscope.

How much does all of this neglect in simple hygiene changes cost us? Plenty, in dollars AND lives.
posted by jeanmari at 6:25 PM on November 20, 2009 [1 favorite]


Let all health care providers have a giant dose of de-socialized medicine by eliminating their supply-side rationing of preventive medicine that benefits them them most. All state and federal agencies should immediately STOP enforcing medical licensing requirements, and discontinue all patent enforcement on medications that were developed with the help of government funded research.
posted by Brian B. at 6:55 PM on November 20, 2009


I am currently in medical school and have spent the last year working in hospitals in the Philadelphia area - one of the most "medicalized" cities in the country - and yet with some of the poorest health indicators. The problem with health care in America is multi-faceted, that is for sure, but the 10,000 pound gorilla in the room that no one really wants to talk about is HOW we spend our health care money.

One of the biggest causes for exploding costs in health care is the vast amount of medical care we all collectively use. It is a problem of our culture in general, where "please do everything necessary" means that, on average, we spend 80% of our lifetime health care dollars on the last 2 weeks of our lives. We Americans, in general, have always made a big deal about our "freedom" that is our hard-fought and earned right - a mindset that seems to direct a lot of our governmental decisions if you think about it. I don't mention this to disparage that idea - i think it is a uniquely american attitude that makes me proud to live here. But this mindset trickles down to health care decisions, as well. It is our freedom and our right to have every test we want; to get that second, third, or fourth opinion; and to keep taking that $100,000 chemo treatment even though several experienced physicians have said there is no hope for cure.

Doctors are not innocent in this, either. I have seen so many unnecessary tests and procedures done this year, so many medications not really necessary or even warranted, and generally a use of health care with no real understanding or care for the costs of such things. If you come to the hospital with a nasty flu, maybe your chest hurts from coughing so much, and you just feel crappy. Before you've even talked to a doctor, the ED will have ordered a portable chest X-ray ($500), a round of routine blood tests ($200), cardiac enzymes for your chest pain ($300), and an EKG ($100). Then maybe the doctor looks at you and thinks you've probably just got a flu, but they remember that one time 3 years ago that they didn't think of this random one in a million bug and a patient got really sick, so they run the special expensive test for that ($1000) even though they really don't think you have it, but you know, "just to be safe." They have to send out that test to another hospital in another state (which has a patent on the test and has an exorbitant monopoly) for results, so they keep in the hospital to "monitor" you ($3000/night) when you probably would be just as good at home with some clear instructions about how to convalesce.

Did you know that for a disturbingly large amount of maladies, knowing EXACTLY what is the cause for your cough, your UTI, or your whatever is not necessary to provide accurate or effective treatment? A lot of American medicine, it is my experience, is spent in finding out definitively what is wrong, when symptomatic or empiric (ie "best guess") treatment is often all that is necessary. Doctors are trained in a culture of scientific inquiry - always curious for that final answer. Too often, though, the final answer comes at an enormous cost with questionable to even possibly harmful results for the patient.
posted by i less than three nsima at 6:55 PM on November 20, 2009 [15 favorites]


Healthcare in the US actually works.

If, and only if, you have money.

I know, I know, don't feed the troll.
posted by dirtynumbangelboy at 7:28 PM on November 20, 2009 [1 favorite]


All state and federal agencies should immediately STOP enforcing medical licensing requirements

Not enforcing licencing requirements is good for patients how, exactly?
posted by dirtynumbangelboy at 7:30 PM on November 20, 2009


Re: Stopping frivolous lawsuits. Seems to me that a cap on damage awards is a blunt tool that will lead to some really unjust results. Is anyone really willing to set a number on pain and suffering? Would you really say, arbitrarily, that $250K is enough for every person permanently disfigured / injured by gross malpractice?

Seems to me the fairest and simplest way to enact effective tort reform is have a "loser pays" system as in England and the commonwealth countries. The person filing a tort claim must pay court costs and legal fees of their opponent should they lose. Incentives are now properly structured to avoid frivolous lawsuits, without having to tell someone who got the wrong leg amputated that $250K is all they get for a life permanently fucked up.
posted by ScotchRox at 7:43 PM on November 20, 2009


A frivolous lawsuit is one that I don't like.
posted by Pope Guilty at 8:38 PM on November 20, 2009 [1 favorite]


killdevil: "(my favorite example, a bright red Jaguar, has a personalized plate reading "CMPSSN") - but these are very much the exception rather than the rule."

Someone should tell the guy 'compensation' is spelled with a 't'.
posted by alexei at 8:53 PM on November 20, 2009 [1 favorite]


Healthcare in the US actually works.

If, and only if, you have money.


Yes, that's what he meant.
posted by dirigibleman at 9:03 PM on November 20, 2009


Not enforcing licencing requirements is good for patients how, exactly?

The public becomes aware of how much control they really have. It rethinks the idea of medical rationing through legal barriers we've made, and how hard we've made it for ourselves to control our costs, which then becomes part of the negotiation over socializing medicine.
posted by Brian B. at 9:52 PM on November 20, 2009


Uhh... right. Or any two-bit quack who bought a lab coat could suddenly claim to be a doctor. Or actual (former) doctors who have lost their licences due to malpractice, inappropriate behaviour with patients, etc...

There is nothing about your suggestion that is actually good for patients. It's more free-market handwavy nonsense.
posted by dirtynumbangelboy at 9:56 PM on November 20, 2009


There is nothing about your suggestion that is actually good for patients. It's more free-market handwavy nonsense.

Well, handwavy or not, it was point number five in the linked suggestions, but you were asking me about it like you've never heard of it, so maybe you missed it:

5. Make an all-out attempt, working with state and local governments (recall, since the Feds are picking up the Medicaid tab they have temporary leverage here), to ease the spread of low-cost, walk-in health care clinics, run on a WalMart sort of basis. Stepping into the realm of the less feasible, weaken medical licensing and greatly expand the roles of nurses, paramedics, and pharmacists.
posted by Brian B. at 10:03 PM on November 20, 2009


What you said and what that paragraph says are vastly different things. You know this, of course.
posted by dirtynumbangelboy at 10:05 PM on November 20, 2009


What you said and what that paragraph says are vastly different things. You know this, of course.

No. My intention was to hardball it for the same results. Both myself and the link blatantly assumed it was a very difficult proposition. Same exact suggestion precisely.
posted by Brian B. at 10:13 PM on November 20, 2009


Keep Get the government's hands off of Medicare, dagnabbit.

FTFY
posted by _paegan_ at 10:16 PM on November 20, 2009


Except, y'know, not.

The paragraph is suggesting a weakening of licencing requirements in order to allow a download of traditionally MD-only skills to nurses, PAs, etc.

You advocated a total removal of all licencing requirements (via lack of enforcement).

These are two very, very different propositions.
posted by dirtynumbangelboy at 10:17 PM on November 20, 2009


You advocated a total removal of all licencing requirements (via lack of enforcement).

These are two very, very different propositions.


May they stay forever apart in your mind.
posted by Brian B. at 10:23 PM on November 20, 2009


Good lord.

Proposition A: let's look again at how we licence medical professionals, and who is allowed to do what.

Proposition B: let's not enforce anything. Anything goes.

You do not see the difference here? Or are you trolling?
posted by dirtynumbangelboy at 10:24 PM on November 20, 2009


let's not enforce anything. Anything goes.

Fondling my balls prevents breast cancer.
posted by dirigibleman at 11:56 PM on November 20, 2009 [1 favorite]


Can you imagine many other settings where you could get away with complying with something only 30% of the time and not being immediately booted?

A .300 batting average is pretty good.
posted by box at 8:53 AM on November 21, 2009


And the lesson from that, I suppose, is the current healthcare bill needs to have something in it about steroids.
posted by box at 8:57 AM on November 21, 2009


I was really struck by what i less than three nsima said. Has everyone taken a look at this article, which makes very similar points? It bothers me that none of the health care reform ideas being bruited about right now seem to zero in on this problem of very high costs, egged on by subsidized demand, and not justified by the results.
posted by bearwife at 6:33 PM on November 21, 2009 [3 favorites]


Did you know that for a disturbingly large amount of maladies, knowing EXACTLY what is the cause for your cough, your UTI, or your whatever is not necessary to provide accurate or effective treatment? A lot of American medicine, it is my experience, is spent in finding out definitively what is wrong, when symptomatic or empiric (ie "best guess") treatment is often all that is necessary. Doctors are trained in a culture of scientific inquiry - always curious for that final answer. Too often, though, the final answer comes at an enormous cost with questionable to even possibly harmful results for the patient.

To hear this come from a med student brings an unimaginably large comfort to my life.

I have epilepsy. That doesn't show up on an EEG. I have had two bouts of 24 hr. monitoring, 3 regular EEGs, 1 sleep deprived EEG, and one portable EEG that I got the joy of wearing at home for 48 hrs. Nothing. Not a damn thing.

On the other hand, I had my first observed seizure at 9 mos. of age. I had periodic seizures in childhood related to fever/vaccination. (I'm allergic to the P variant in the DPT vaccine, which is known to potentially cause seizures in children. So please, if you have pertussis, back the fuck off.) When I was six, I got viral meningitis. With, y'know, plenty of seizures. After I was released from the hospital, my pediatrician decided that if I had another seizure again - ever - he'd diagnose me with epilepsy and put me on Dilantin. (They didn't want to do this to start with since Dilantin is a harsh drug and I was 6. Being the mid-80s, it was also the only drug available - I'm also allergic to phenobarbitol which was the other commonly used anti-convulsant.)

I had my next seizure at 19. 13 seizure free years!

You would think that with this medical history, it would be OBVIOUS that I have epilepsy. Indeed, from my symptoms and history, I was told by an epileptologist that my condition was "textbook" and he practically creamed his pants imagining using me as a case study and got way ahead of himself talking about experimental brain surgery. And then. The monitoring.

After the monitoring showed nothing, I was told that I didn't have epilepsy. That my problem was all in my head, so to speak. I was given a preliminary diagnosis of pseudoseizures and told that a possible cause was repressed psychological trauma. Can you imagine that? I was told that something awful may have happened to me in my life that I couldn't consciously remember, but that was causing my seizures. I was told flat out that I may have been abused, but was blocking the memories.

Can you even imagine how awful and disconcerting that is to hear? FROM A DOCTOR?

My history matched the disease. My symptoms matched the disease. But rather than giving me treatment based on these, my doctor ordered extensive testing to "confirm" and when that confirmation didn't happen, he dumped me.

It took five years after this to get a diagnosis. Five. Years.

FIVE. YEARS.

During those five years, I was given psychiatric evaluations (which say that there's nothing wrong with me and that the seizures do not fit any psychiatric qualifications for pseudo seizure and no, this can't be a form of panic disorder since I'm actually the least anxious person alive and during an evaluation, I actually had a psychiatrist tell me that MORE anxiety would be healthy), psychiatric medications (which did nothing), years of therapy (which did nothing), and was generally told that I was crazy. Do you know what this did?

IT MADE ME CRAZY. Literally. I went through several Major Depressive Episodes and anytime I had a seizure, which was often, I wondered if I was faking it. Several times, I told myself that I WAS faking it and resolved to stop. That didn't work.

Finally, five years later, a neurologist looked at my history and said "Yeah, you have epilepsy." She ordered an EEG, but when the results came back normal, she said "Well, it would have been nice to see something to pinpoint seizure location, but this will not change your treatment in any way."

Five years of "ruling out" pseudoseizure to get to a point where a doctor put me on a course of treatment THAT WORKS based on history and symptoms alone. Just because one very famous doctor ordered one test that didn't give him the answer that he wanted. This man died recently and the Epilepsy Foundation has a tremendous endowment in his honor - his research truly helped a lot of people, I can see that, but I also know that there must have been other patients like me whose lives were RUINED when he dumped their cases when the tests didn't show what he wanted to see. To tally up the unnecessary expenditures of ER visits, psych evals, drugs that didn't work for my case alone is tens of thousands of dollars. That the insurance company paid when they totally wouldn't have had to do so had he just gone with the obvious diagnosis.

And as for insurance? My condition being pre-existing, I have to pay half my month's salary to afford insurance and even then, the insurance company doesn't always pay for ALL of my meds being that they're expensive and whatnot. I can't ever afford to not have insurance, and if I go off my meds, I run a not-insignificant chance of spontaneously dropping dead.

I would vote for a tomato that would provide universal coverage. I don't care if that tomato also sent a nuclear bomb to a town solely inhabited by koalas, universal health coverage is my One Issue issue when it comes to how I vote.

(Yeah, way TL, I imagine most of you DR. That's ok.)
posted by grapefruitmoon at 5:30 AM on November 22, 2009 [40 favorites]


"I would vote for a tomato that would provide universal coverage. I don't care if that tomato also sent a nuclear bomb to a town solely inhabited by koalas, universal health coverage is my One Issue issue when it comes to how I vote."

I find it incredibly sad the number of people that would agree with you. You've basically said, in as many words, that it doesn't matter to you what kind of violence is required to maintain it, you want other people to pay for your health care and will vote for whatever individual, no matter how power crazed or incompetent that individual is, in order to get it.

(Before someone misinterprets my words, no statement is being made as to the power-craziness or incompetence of actual current, past, or future leadership...)
posted by TheFlamingoKing at 1:23 PM on November 23, 2009 [1 favorite]


thewittyname : "How about you start by listing things that can get the support of a majority of Representatives and 60 Senators, because that's what you need in order for anything to move from idle speculation to actual law"

This is the frustrating thing about the political system we have (both in the US and Australia, where I live). It's hamstrung and geared to prevent any radical changes. Which is often helpful, but other times - when radical change is needed - it leaves us high and dry.

What kind of bills might get bipartisan support, and sail through the house and senate?
- The 'Be Kind to Kittens' bill
- Pay rises for politicians

.... that's about all I can think of... depressing.

"Democracy is the worst form of government except for all those others that have been tried." - Winston Churchill
posted by joz at 3:56 PM on November 23, 2009


you want other people to pay for your health care

No. They want everyone to pay for everyone's healthcare. You know, the way most of the rest of the world does it. Successfully, I might add.
posted by dirtynumbangelboy at 7:20 PM on November 23, 2009 [20 favorites]


Finally, five years later, a neurologist looked at my history and said "Yeah, you have epilepsy." She ordered an EEG, but when the results came [...]

grapefruitmoon, your story is creepily my story too... left temporal lobe epilepsy since toddler, undiagnosed until early thirties, after a handful of years having top neurologists tell me I merely had pseudoseizures after cursory exams and EEGs that showed nothing. ("Merely" seems pretty arbitrary when it's destroying your life, but, after a while, one begins to believe what the 'experts' say.) Well, until I had a three day status epilepticus - yeah, then I had epilepsy. A few months later my first Rx gave me systematic organ damage, including brain, after being prescribed at nearly 4x the recommended dose. Yeah, fun times; I'm still in recovery five years later.

My search for adequate health-care and coverage during all of this time has been quite the trial. In the meantime, I lost everything; my home, my car, my job, my credit, my family, and I ended up homeless for a while. I'm now covered by the only true health insurance in the US, Medicare, which I've been very happy with my treatment. I've got mine now and I hope everyone else gets their coverage now, too! Without having to almost die first.

I'd vote for that tomato. Because one day, seriously, it is actually going to be lupus.
posted by _paegan_ at 10:52 PM on November 23, 2009 [4 favorites]


You've basically said, in as many words, that it doesn't matter to you what kind of violence is required to maintain it, you want other people to pay for your health care and will vote for whatever individual, no matter how power crazed or incompetent that individual is, in order to get it.

Ok, two problems with this: #1) You're putting words in my mouth, #2) You didn't read the bulk of my comment, or if you did, you didn't fully absorb what I've gone through.

To put it this way: I have a choice right now, I can afford health care OR rent. NOT BOTH. The only way I can afford to buy insurance AT ALL is that my partner owns our apartment outright. If I had to pay rent, I couldn't afford health care.

Let's say that again, shall we? I pay half of my month's salary for health insurance. HALF OF IT.

I am not asking for anyone else to subsidize my healthcare. I am asking that we, as a collective, pool together our resources so that everyone can have access to care. I am G-DDAMN LUCKY that I'm in a situation where I can afford care. Not everyone is. (See, for example, _paegan_ who has gone through a similar - and actually MORE horrific - ordeal and ended up homeless - this SHOULD NOT HAPPEN.) For years, I wasn't able to afford to pay the bills and pay for insurance. For years, I paid for health care out of pocket. Just FYI: neurologists aren't cheap. An MRI isn't cheap. Anti-convulsants aren't cheap. It is flat out wrong for insurance companies to decide that because you have a pre-existing condition, you need to pay MORE for health insurance that you desperately need BECAUSE OF YOUR CONDITION.

I want everyone to have blanket coverage to adequately deal with conditions - such as my own - so that crippling medical debt is not a fact of life and so that people such as myself and _paegan_ (not to put words in her mouth, but she seems on board with the Health Care Providing Tomato) aren't faced with the decision "Hm. Should I pay my phone bill this month, or buy my medication?" A decision I myself have faced, and it has led to THOUSANDS of dollars of credit card debt.

Many, many people are "One Issue" voters: some choose abortion. Some choose gun control. For me, it's health care because I believe that the system that we have is actively doing harm to people such as myself who are already dealing with the difficult reality of chronic conditions.

This isn't about subsidizing MY treatment; this is about doing the right thing and providing access to care to anyone, regardless of medical history.

As for violence? We've got that going on already, for the love of fuck. I thought that nuclear bombs and koalas was a fairly obvious HAMBURGER type hyperbole. And yeah, other people have their One Issue being ending the wars we have going on in the Middle East, and I'm totally supportive of that, but I'd vote for someone who provided health care over someone who said "I will pull out of Iraq TOMORROW!" THAT is my priority. Ideally, I'd like someone who did both if I had my druthers, but in an either/or situation, I put providing health care over ending our current wars. That is the higher priority for me.

And what the hell is a druther?
posted by grapefruitmoon at 5:07 AM on November 24, 2009 [24 favorites]


you want other people to pay for your health care and will vote for whatever individual, no matter how power crazed or incompetent that individual is, in order to get it.

Hey guess what? We're already paying for it, genius. If the uninsured or under-insured folks right here in this thread get sick/have seizures/get cancer etc. and their insurance (if they have it) won't pay (because it's a pre-existing condition), guess who pays? We do. Collectively. In the form of higher taxes, fewer services, higher treatment costs from your local hospital that get passed on to people who can pay.

I mean, what the hell.
posted by rtha at 9:09 AM on November 24, 2009 [8 favorites]


(Before someone misinterprets my words, no statement is being made as to the power-craziness or incompetence of actual current, past, or future leadership...)

Then what the fuck are you talking about?
posted by YoBananaBoy at 11:43 AM on November 24, 2009


I would vote for a tomato that would provide universal coverage. I don't care if that tomato also sent a nuclear bomb to a town solely inhabited by koalas

Way to throw the baby out with the bathwater, there.

A town solely inhabited by koalas would be in Australia, where we've had universal health insurance since 1975.
posted by UbuRoivas at 12:23 PM on November 24, 2009 [1 favorite]


I find it incredibly sad the number of people that would agree with you. You've basically said, in as many words, that it doesn't matter to you what kind of violence is required to maintain it, you want other people to pay for your health care and will vote for whatever individual, no matter how power crazed or incompetent that individual is, in order to get it.
You are being willfully obtuse, and it makes you look like a moron.

What she wants, and in fact what almost everyone who is advocating for universal healthcare wants, is for everyone to pay for everyone's healthcare. You, and people like you, seem to inhabit some bizarro world where, in order to have universal healthcare, someone has to "lose". Not only is your position unsupported by the actual evidence, it's unsupported by actual reality.

While we're at it, let me lay a little SCIENCE!! on you, Einstein: we're all already paying for the uninsured, in higher premiums, in higher costs, in higher everything. This is straightforward fact. You know, those things that, unlike opinions pulled out of your glibertarian ass, are represented by actual data gathered over, in this case, decades.

If you can't debate the merits of healthcare reform intelligently, kindly shut up while the adults are talking, because we are tired of explaining reality to you again and again.
posted by scrump at 1:18 PM on November 24, 2009 [5 favorites]


What she wants, and in fact what almost everyone who is advocating for universal healthcare wants, is for everyone to pay for everyone's healthcare.

Yes, exactly. And it bears repeating as long as people are of the mistaken opinion that universal coverage means that the people who have the conditions somehow don't pay into the system but just "milk" it.

It's not a zero-sum game.
posted by grapefruitmoon at 1:28 PM on November 24, 2009


We do. Collectively. In the form of higher taxes, fewer services, higher treatment costs from your local hospital that get passed on to people who can pay.
Don't forget the nice little kicker that most businesses are probably underpaying wages because of the rising overhead in healthcare premiums for employees.
posted by scrump at 2:10 PM on November 24, 2009


« Older Merriam-Webster's Ask the Editors blog...  |  CERN has successfully circulat... Newer »


This thread has been archived and is closed to new comments