Obama's healthcare proposal... just posted at the White House website: http://www.whitehouse.gov/health-care-meeting/proposal
Any thoughts? I imagine Mike may have some!
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Here's the lead from Jonathan Cohn's summary:
Cohn has a good executive summary of the proposed changes too...
It's a testimony to the dominion of vested interests over the popular will. Tinkering at the periphery to deal with some of the most glaring short-comings but not daring to do anything which might cut the flow of campaign contributions or increase those to rivals or provoke negative advertising.
The other frightening aspect of this is the effectiveness of the campaigning of the America's emerging Tea Bag Fascist movement and it's shock jock champions.
What (politically feasible!) improvements would you have preferred then, bigC?
Not really for me to prefer Thomas. I am not American. But all polls have shown that a majority of Americans would favour health care which would at least have public provision as an option.
The waters have been muddied by mis-representation of the original proposals by the media ( eg the ludicrous death selection committee slur) and by organised public meeting disruption by the tea baggers.
I don't disagree with you... but good poll numbers don't show political feasibility (though clearly they count towards it). As the last year has shown, the Republicans have ample power to throw up roadblocks to even popular proposals... most individual parts of the Senate bill poll well (although the whole package polls badly, which just goes to show the limits of polling).
Thomas, there are very good arguments for a public option—and it’s much cheaper. The Democrats never tried this, they had hoped that the insurance companies wouldn’t sabotage their plans if they didn’t propose the public option. In this they were terribly wrong.
The original proposal was a compromise between having health care for everyone and the interests of the insurance companies. Now they have a version that’s watered-down even more. They are wondering where the supporters are, though. It’s not politically feasible because it’s too much watered-down. You can’t expect somebody to campaign passionately for something that is only a slight progress, but you still have to cope with the people who are opposed to it just because it’s “Obama-care”.
This plan is about the same that our FDP wants and we all fight against here! It’s worse than everything other developed countries have for a health care system. Only for the US it’s a tiny bit of progress, ironically.
I really don't think it's fair to say they never tried it - even after it was omitted from the Finance Committee bill, Harry Reid proposed it again, at the cost of protracted negotiations which bled support for the whole package. In the end, it was killed by the intransigence of a few self-proclaimed 'moderates' like Joe Lieberman, who promised to support the filibuster of any bill with a public option (or even the 'Medicare buy-in' alternative that was floated at the very end of the debate). I don't think you can blame Democrats as a whole for this.
I agree with your last paragraph though...
Thomas, public option for a very small minority doesn’t count. It only works if you have it for a considerable percentage of the population. We have it for 90%, and that’s working, although I don’t know why we must have private health care at all.
The tea-baggers claim that public health care is more expensive. Have the Democrats ever disputed this? No, they never intended to spoil the profits of insurance companies.
If our health care in Germany was privatised, it would cost 20-35 billion Euros more to maintain the same standard—per year. For the US you can use the factor 2,5: public health care would be cheaper by up to 87,5 billion Euro per year, if it was implemented for a considerable percentage of the population, not only for bad risks.
The Democrats could have pointed these facts out, but they haven’t. Their proposal is a gigantic subsidy for insurance companies. Small wonder that under these circumstances they can’t afford to make sure everyone gets affordable health care.
You might get argument on the superiority of public health care from Mike, but not from me. We (in the UK) have it for 100% of the population, and I wouldn't want to change that. (Where I do disagree is when you question the availability of private health care - banning it seems profoundly illiberal, and if you let the well-off spend their money on swimming pools or schools, forbidding them for paying for treatment for bad backs seems unreasonable.)
But as for your last paragraph - while you could argue it's never been properly tried, I'd be amazed if the Democrats (struggling even to deliver the current watered down reform) could get universal state healthcare just by 'pointing out' its virtues. Surely you accept America isn't a debating club where the side with the best argument wins?
If the Dems went down your route they'd have to combat huge amounts of misinformation, filibusters from the GOP and moderate Dems, hysterical cries of 'socialism' (albeit slightly more accurate ones than those we're hearing from the tea partiers right now), etc. And it's not like no one has ever talked about socialising medicine in the US before. Michael Moore's movie was essentially a feature-length paean to the systems in Europe (and Cuba!)
A misunderstanding. What I mean: I don’t want 10% opting out of public health care, and I want this public health care to be funded by all sorts of income (by taxation).
I don’t see why the treatment of bad backs shouldn’t be part of public health care, it should include everything that makes sense from a medical point of view. The only thing left to private insurance would be luxuries such as a single room in hospital and so on. I have no issue with that, if people want to pay for it. But the medically necessary: no way.
Of course I am aware that the Dems would have to combat all sorts of misinformation, but that’s their job, isn’t it? What else are parties good for? They must represent (and campaign for) their point of view, try to convince as many people as possible, and in elections they can see if they are successful with this. This can be put the other way round too: what a party campaigns for is their point of view. I conclude that the Dems aren’t interested to dispute the “hysterical cries of 'socialism' “.
Do you believe that the health care systems in Germany or Britain were implemented by socialists? I think the average US American voter is intelligent enough to grasp the fact that Bismarck was not identical with the author of the Communist manifesto, if the difference was only pointed out to them.
Understood... I'm not that familiar with the German system, though I have read Ezra Klein's summary of it.
I'll respond to your other points when I get a mo...
"I think the average US American voter is intelligent enough to grasp the fact that Bismarck was not identical with the author of the Communist manifesto, if the difference was only pointed out to them."
I think some of them would have difficulty grasping that Benjamin Franklin wasn't a communist Momo (http://crooksandliars.com/jon-perr/tea-baggers-strange_brew).
Right BigC, but you aren’t saying they are the average, are you?
My point is that the Dems haven’t got convincing arguments for their compromise of a compromise. They leave the momentum to the tea-baggers. If they had some real improvement to offer, they could campaign very much differently.
Thomas, Ezra Klein is a bit inaccurate. The main fault of our system is that it’s only funded by a percentage on wages. For unemployed the money comes from the unemployment insurance, but it’s less of course, because unemployment benefits are only 63-68% of the wage. Every rise of the unemployment-rate has a very direct impact on our health care. Other sorts of income don’t play a role, which is simply unfair: people with the same income pay very different sums for health care.
I don't think they're average Americans Momo but they're certainly well represented among those who vote. Which is where you are right of course. If the the Dems had the guts (or perhaps the will) to be a bit more radical then they could win the participation of the disillusioned in the US electoral system. Or maybe that is exactly what they are afraid of. I suspect it is.
In lieu of of a proper response, here's something to get you excited for today (well, maybe):
(Not necessarily safe for work!)
Just my luck, I find myself stuck in a location without internet access, only to have something interesting pop up here. Oh well. Much to my surprise, a week off the grid was relaxing, even if a bit disconcerting.
But on the issue of healthcare, I am not convinced that a socialized healthcare system provides a better standard of care or meets the needs of most people. Ask the Canadian premier getting his surgery in the US why he'd rather pay from his pocket in the US. Or perhaps you are a fan of the Dems proposal to prosecute people who fail to purchase a government controlled commodity. Sounds pretty fascist.
If you want a 2-tier system of healthcare, go ahead implement socialized medicine. The rich and politically connected (often one and the same) will always get the best care and the poor will die waiting in line--having their babies on the sidewalk. When you really want to ensure everyone has availability, reform the system and allow market forces to bring down costs, while reigning in the trial lawyers who grow fat on frivolous malpractice suits and driving up costs through the practice of defensive medicine.
Hi Mike, I'm glad you had a relaxing holiday/whatever it was.
I'll start by conceding that you have, as your President would say, a 'legitimate point' in that there is something uncomfortable about the government mandating that people purchase insurance policies. That said, we do something similar in mandating the purchase of car insurance (for drivers), don't we? (I presume it's the same in the States.)
There are some pretty impressive statistics out there for health care systems in which the state takes a more active role (which vary from genuinely 'socialised' systems like Britain to many which are something in between, like Switzerland and Singapore - see Momo's description of the German system too). I'd be impressed if you could back up your claim that the US system "meets the needs of most people" better. For people who can pay huge sums out of pocket (like Canadian premiers) it may be as good or better as other systems, and no one would wish to destroy that, but that's hardly the most important consideration is it?
As for a 2-tier health care system, isn't that what the US has already? Do you really think the poor will be worse off - more likely to have babies on the sidewalk - with a more active government role? The extent to which people have to wait in line, even in the comparatively underfunded British system (we spend about half what you guys do on healthcare as a proportion of GDP), is vastly exaggerated. And there's a real paradox in small government conservatives pointing to government rationing as a bad thing: it amount to complaining that the proposed government benefit isn't generous enough.
Not really. Driving a vehicle is a choice -- one dependant upon certain legal and voluntary agreements--you must be trained, licensed, and insured if you choose to operate a vehicle on a public road. Driving is a privilege granted by the state, not a civil right. No one is forcing you to drive. There are no such conditions attached to a bicycle or public transportation. No one is compellng you to buy a commodity simply as a condition of your existence (legal or otherwise) in this country. This is an unprecedented infringement of personal liberty.
Fair enough. I think its also fair to accept that people know what is and is not meeting their needs, right? Polls are consistent that the far majority of the people with insurance are satisfied with the quality of their coverage, but dissatisfied with its cost.
Of course, we are talking about people WITH coverage. The question naturally arises about the quality and availability of healthcare among those WITHOUT health insurance.
First, let's establish from the start that the law compels EVERY hospital to provide emergency medical care to anyone and everyone regardless of means to pay. So you may have to wait hours in the emergency room (no different from the UK according to my co-workers previously stationed there), you will receive care to stabilize any life-threatening condition.
Beyond emergency care, the uninsured demographic becomes a very contentious debate, identifying and quantifying who is represented in this demographic. This includes people who elect not to buy insurance because they are secure financially or those healthy people that choose to spend their money on consumer goods instead of health insurance. When you are in your twenties, a flat screen TV and new car is more attractive than health insurance. When a serious medical incident occurs, they find them selves part of risk pools in which coverage is unaffordable or not available because of some health condition. THESE (and only these) are the folks the government needs to assist though Medicare--the uninsurable.
Yes...but that is a reason for pursuing reform, not an argument for socialized medicine.
Absolutely (and glad you asked). I asked myself the same question when I read the article below. How can an "active" UK government role allow this woman to be refused an ambulance, forcing her to have her baby on the sidewalk?
Granted...there is buffoonery in the US as much as the UK. But the point of having an "active" government role is to prevent such occurrences, right? Certainly we cannot accept as fact that an active government role will prevent such abuses. Neither system fully lives up to its responsibility and both can use abuses as an argument to reform itself.
A belated reply to Momo...
But 'medically necessary' is a fuzzy term: at the end of the day, different treatments will have their own cost-benefit ratio, and any public system without unlimited funds will have to draw the line as to what it will pay for at some more-or-less arbitrary point. In my preferred system, private insurance would exist not just to provide luxuries like private hospital rooms but also to pay for treatments which fall on the wrong side of that line. This actually gets us to some issues which are of real interest, independent of the political debates going on in the States and elsewhere about which sub-optimal system can get implemented. Talking of this:
Well, Bismarck wasn't a revolutionary Marxist, no, but the post-war Labour government that gave Britain the NHS was avowedly socialist (since it wasn't seen as a horrific position to hold, unlike in the US). Hysterical cries of socialism seem a bit more effective in the States, but the fact that the public options polls as well as it does suggest the public wouldn't have too great a problem with it. The obstacle I was trying to point to was Congress - and here, we have to look to Republicans, as the House Dems passed a public option and a clear majority of Senate Dems favoured one (although I'm aware people are now accusing them of backing down from that now they theoretically have the option to bypass Lieberman et al and pass a P.O. via a straight majority vote).
The 2-tier system has a few disadvantages, Mike. Both from the point of view of a wingnut, and from mine.
Let’s start with the nutters. The hornets (our black-yellow government) share your dislike of “socialised” health care. The want to privatise our system, and I am sure you sympathise with them. Give the market a chance is their motto. (Now who said “allow market forces to bring down costs”?)
Unfortunately for our government they have to answer inquiries of MP’s truthfully, so the Greens made an inquiry how much the costs would be, er, brought down if the government plans of privatisation were implemented. Our minister of finance had to admit they would go up (if the standards were maintained) by 22 to 35 billion € per year! Of course my guess is that they don’t want to maintain the standard, so I’d rather maintain the present system.
The present system spends too much on administration (we have about 150 “public” insurances), weighs costs along the wrong lines, and most important, runs a deficit because of the high unemployment rate, so it needs reform badly.
There is a new, very comprehensive study for our government on the differences of public and private insurances (under the present system). They wanted to keep it secret, but it leaked a few days ago.
It found that the private insurances will run an even higher deficit in a few years, if they don’t increase their prices considerably. They spend even more on administration. Privately insured patients have some advantages when they have less serious illnesses, but there is no difference when they have really bad illnesses. Private insurances grant pretty much the same as the public ones, they are only a lot more expensive.
Wikileaks is a wonderful thing… I can understand that our government wanted to keep this secret! By the way, I can link to all this, but it’s in German.
What do you suggest we do with our rich and politically connected? Let them pay a lot more or watch them drop out of health care? More and more of them are whining and begging to be allowed back into socialised health care (which at present they can’t—if you opt out, it’s for ever).
I am not a right-wing nut job, and therefore not cruel. (All these millions of US-Americans without health care insurance… really Mike!) My idea is a tax-funded system for all, including the rich and politically connected. It’s the only thing that works at reasonable costs and is just.
Thomas, in the post-war era “socialism” wasn’t seen as a horrific, but “capitalism” definitely was, all over Europe. Beveridge was pretty much in the same position as Bismarck was 70 years before, they had to give the working classes a morsel to keep them quiet.
This is of course completely different in the US, but even there I think voters want a lot more change than Congress. Their representatives aren’t their representatives. Congress represents corporate interests. And why should US-Americans be better off than you or me? It’s the same everywhere.
Of course there is no absolutely objective definition of the medically necessary, but there is the criteria if a treatment improves someone’s health. If it does, the treatment should be covered. By the way, it’s usually cheaper to treat a bad back. Trouble with the back is one of the main reasons why people have to get pensions early.
You can't really mean that literally? What if something improved someone's health in some very minor way, but cost a million euros/dollars/pounds - should the state still pay for it then? To take a more uncomfortable example, what if a similarly expensive high-tech surgery extended a terminally ill patient's life by a week - should the state pay for that, at the cost of driving it's health care system closer to insolvency? Recalling your earlier discussion with Pablo at the comments on Alex Erler's Killing is killing - or is it? post would the quality of that extra week's life affect your decision, or do you not want to do this sort of weighing?
I mean that literally.
At the same time I am aware that there might be the necessity of drawing a line (though not because of costs), and it’s a horrible thought. One of the issues where no absolute truth can be found, only positions on a scale, and you will always find me at the end of that scale.
Once you give in to refusing treatment (of serious illnesses) because of the costs, it’s like a dam breaking. Do you know that 1% of patients cause 30% of costs? If you concede that money can and should be saved by refusing treatment, where would you stop?
Your examples are extremely far-fetched. In practice these issues are much easier than in theory. What kind of surgery should be able to extend the life of a terminally ill patient? I don’t know if you have ever seen a person in their last says, but I have. A narcosis would kill them swiftly instead of improving their health. Besides, no dying person would want to waste time with enduring surgery. There is so much to say and to think of before death, and little time to do so.
And I don’t know of anything that improves someone's health in some very minor way, but costs a million. You use purely hypothetical cases to justify debates about someone else’s life and death, and you risk an erosion of values that you couldn’t stop when it goes to far for your ethical standards.
Now I can ask if you mean what you say really literally. Where is the point beyond which you wouldn't go in order to save money?
So anything goes, right? If you decide that bigger breasts "improves your (mental) health" I should pay for them with my tax dollars? How about a nose job? ...tummy tuck?
Mike,
Right. This is an argument we also use here against compulsory private health insurance. And our government knows we would take it to our constitutional court, if they go ahead with privatisation.
Our public health insurances have a board that is elected by all insured. State-run health care is subject to democratic decisions too. I can’t be compelled to buy profit-oriented insurance that I can't influence by elections simply because I am alive.
There is absolutely no argument in favour of private health care insurance.
I am not impressed. If someone has, say, diabetes, they can’t get treatment. Their health will deteriorate irrevocably. Only if their life is threatened, they can get treatment.
Very laudable, but profit is irrelevant. I hope you reserve the same disdain for the government compelling you to buy "public insurance." The issue is whether one is compelled to buy a commodity, not whether the seller provides it at a profit.
If they are indigent, then they fall into the high risk pool of uninsurable covered by Medicare. If they are not indigent, they foot the bill themselves...which is much cheaper once tort reform and insurance portability lower costs.
There is absolutely no argument in favour of public health care insurance.
"Granted...there is buffoonery in the US as much as the UK."
Whether this story (the woman giving birth on the pavement) is true or not (and I doubt it very much) it is an anecdote reported by a "newspaper" which probably has an entire department devoted to discovering negative anecdotes about the NHS. I'm sure that with the resources you could collect far more horrific anecdotes about your system.
I'm sure I could collect far more horrific anecdotes about your system too. But that would not change my point that both systems need reform and no amount of anecdotes points to the NHS as a panacea.
Mike,
You always emphasise that young and healthy people act irresponsibly if they don’t buy a health care insurance in time, and that they must suffer the consequences.
Civilised societies act differently. In matters of life or death we don’t watch people suffering the consequences of their behaviour. Since we neither want to watch passively nor come to their rescue, we restrict their taking risks. I remember a long argument I had with a French lifeguard who ordered me out of the Atlantic, just because his judgement of the weather and my capability as a swimmer differed from mine. I lost that argument, of course. He had the right to keep me from swimming.
I am sure that the US have similar laws. The same principle applies in the issue of health care. Even if it’s someone’s own fault if they haven’t got an insurance, it’s inhumane to let them cope without when it’s needed. On the other hand I don’t see why I should come to the rescue, it’s much better to make health care insurance compulsory.
This doesn’t justify compulsory profit-orientated insurance, though. The only aim of compulsory insurance must be to provide necessary health care at reasonable cost. The definition of “necessary” can only be done by democratic means, not by shareholders, and it’s less difficult to find a consensus on this definition than you think. You should try to find out how long intensive care for most US-Americans is paid, instead of thinking of my breasts or your nose.
It's not me saying they must suffer the consequences. It is the natural consequence of personal liberty. The freedom to say "No" to choices affecting your own welfare. The freedom to accept risk and the responsibility that comes with it.
I'm always amused by the smug certainty of Liberalism that assumes people are too stupid to make choices in their lives and government must "humanely" take over responsibility for their lives. At what point will the government humanely compel me as an adult citizen and taxpayer to lose weight, stop smoking, or ban me from McDonalds? Not that I do ANY of those, but what gives the government the authority to ban them? Nothing in our constitution...yet.
...which assumes the government is a better judge of what is "necessary". Frankly, it is up to me and my doctor to decide what is necessary for me, not the government or the shareholders. I have the freedom to choose to purchase what health options are important to me or the personal freedom to choose not to choose...if that is my choice.
Perhaps somewhere, but not here. I live in a beach community and this was a subject of considerable debate. The courts finally determined the law cannot compel people to get out of the water when it is dangerous. Police now simply remind swimmers that it is a red flag condition and request a "next of kin" to notify in the event of their death. Most people comply at that point.
As you noted, the principle applies. It's called accepting "personal responsibility" for oneself...clearly something foreign in your country.
Mike:
I expected you'd say that. However, we are all compelled to pay taxes as a condition of existing in a country, and this mandate is a really an indirect tax (personally I think that if you're going to turn insurance companies into proxies for the government as the Democratic plans to some extent do it'd be more efficient to have government do what it wants to do directly - maybe you actually agree?)
Call me a government-knows-best elitist, but no, I don't think that's entirely fair. Better to rely on admittedly imperfect statistics than on necessarily fuzzy subjective reports of satisfaction. Also, one thing this thread has shown is that the Americans think their systems better than the Europeans' and vice versa - what a bunch of patriots we all are! This must show that at least one side isn't fully aware of the merits of the alternative...
As for your NHS anecdote, take it from Charles and me - though maybe you won't want to! - that the Daily Mail isn't a credible source on this issue.
Dear Tom the "government-knows-best elitist" (as you invited me to call you),
I'm not sure how an 80% satisfaction rate by those on the receiving end of healthcare amounts to a "fuzzy subjective report." I think its tough to get 80% satisfaction rate on anything in life. Hard to dismiss it out of hand.
No...we are compelled to pay taxes as a requirement of our constitution for specific purposes, none of which include healthcare. The government can only act upon enumerated powers granted by law under the constitution. There must be a legal basis for government authority to act...including taxation for specific purposes.
Healthcare may be a commodity and a moral obligation to help those incapable of helping themselves, but it is not a legal obligation to provide or a constitutional right to receive as condition or obligation of citizenship (outside the context of emergency medical care which I discussed earlier).
I'm not sure how you make that connection. My advocacy for a reformed private health insurance system relates to my belief it is a better domestic policy decision. There are others in my country that believe socialized medicine is a better public policy. It makes neither of us less patriotic.
It's certainly related to political philosophy, but that is vastly different than national identity or patriotism. So the fact you may be a "government-knows-best elitist" does not make you less patriotic in my eyes. I respect anyone with the passion of their convictions and a willingness to be engaged with the process in service to their nation as a patriot. For that reason, I consider everyone who actively participates on oD to be committed to the advancement of democracy, even when I disagree with them. What could be more patriotic than that?
As an aside, I find Momo's conclusion of those who advocate private heathcare insurance as heartless and lacking compassion equally without merit as I do your suggestion that a difference of opinion on policy means a lack of patriotism. Can't we debate the merits of the policy instead of the policy advocate?
Okay, no authoritarian lifeguards where you live. Not even obligatory helmets for motorbikers I assume. And what would you do when you see someone drowning? I understand you wouldn’t come to their rescue or call the lifeguards, if there had been a warning not to swim, right? I understand, it’s a matter of personal freedom, and I won’t call you heartless and lacking compassion.
I wonder about the 20% dissatisfaction rate in the poll you quote. I suspect they are the people who would answer my questions (how many Americans can be sure to get intensive care as long as it is necessary, what about a limit on expenses during lifetime and more). The questions you never answer.
Most people are healthy enough to have no or little reason to be dissatisfied with their health care insurance, I should think. 20% who have had bad experience with it is a high percentage.
The healthier 80% are easy to understand: of course they complain their insurance is too expensive. They can only get private insurance, and we know this is more expensive than public health care of the same quality.
Why are you so sure that it is really in their own interest to pay the share-holders of private insurance companies?
I don't want to dismiss it out of hand, but based on the relative health care statistics for different countries, which are at least less fuzzy and susceptible to subjectivity. Unfortunately I don't have these stats before - but the Ezra Klein series I linked to re Germany's system has some of the key ones if I recall correctly (see also the entries on France, England and Canada.)
My comment on patriotism was meant as tongue in cheek (and also as a suggestion that we might all be partly biased in favour of our countries' system), but thank you for your affirmation of ours...
Thanks for the links. Certainly we can learn from other countries' experience. We can learn from both the successes and the failures.
I may have flogged that horse too much. But it becomes a mantra of both sides of the political spectrum over here to challenge the patriotism of those who disagree. It becomes a tiresome and pointless argument. So I might have been a bit oversensitized to your tongue in cheek comment.
"I'm not sure how an 80% satisfaction rate by those on the receiving end of healthcare amounts to a "fuzzy subjective report." I think its tough to get 80% satisfaction rate on anything in life. Hard to dismiss it out of hand."
I think it's very easy to dismiss it out of hand. 20% dis-satisfaction with an insurance policy is incredibly bad. Only a tiny proportion of users of such a product would stretch it to it's limits - otherwise it would not be economically viable. Remember that 100% of those who have never used it to it's testing limits it would be satisfied. They are under the impression that it will suffice for their needs or they would have bought something else. If 20% of the total are not satisfied then it means that a very large proportion (if not all) of those who have had to test the policy have found it wanting.
You are correct. In my state we call them "organ doners."
In most beaches in my state, there are no lifeguards! In fact, many municipalities have looked at Lifeguard programs and dismissed them because of the implied liability that goes along with it. The reality is no lifeguard program can guarantee to save your life and some people far too casually relinquish their common sense in the false sense of security provided by the presence of a lifeguard. They assume they will be saved from any stupid action they choose and their heirs will can always sue if the state does not save them from their stupid choices.
Frankly, if 1 out of 5 people is not satisfied with their healthcare plan, there maybe many reasons. You and BC assume it is because the plan itself is somehow at fault. That's pure speculation on your part. I suggest there may be many reasons for disatisfaction including unreasonable expectations on the part of the insured--much the same as the outraged relatives of unsafe swimming condition violators when the lifeguard did not reach them in time.
Some people haven't really looked to see the scope of their coverage and gripe when it does only what it says it will do. Some people fail to appreciate that medicine is an art as much as a science; it's not as precise as we would like. Sometimes science does not have all the answers. Sometimes things happen beyond anyone's control and people die despite our doctor's best efforts. Frankly, it is equally valid for me to speculate their dissatisfaction would diminish considerably or diasppear if the private system was reformed along conservative guidelines that increase accessibility and choice, while reducing costs through tort reform.
It has nothing to do with dividends paid to share-holders...especially since many of them are institutional investors paying out those same dividends to the working class pensioners who've trusted them to manage their retirement funds.
Tom,
I know you were a big fan of Obama's performance in the earlier Republican forum. Were you equally impressed with his performance during the more recent Healthcare Summit? I certainly agreed that he was impressive in the former, but his performance in the latter seemed hollow. Dems really focused an emotional-victim-sympathy based argument to sell their plan, while the Right finally showed the American people some real policy ideas and fiscally responsible recommendations.
Mike,
Wow. No authoritarian lifeguards, no obligatory helmets. “It's called accepting "personal responsibility" for oneself...clearly something foreign in your country.” With that attitude probably no restrictions on alcohol or drugs either… and guns everywhere. Hard to believe that there is still someone alive who might need health care. I begin to understand.
It’s sociologically interesting, but I think completely off topic. Why do people sue lifeguards? Perhaps we should start a thread on inter-cultural sadism.
Even if we take into account that it’s a US American national sport to sue lifeguards or doctors or anyone else they cross paths with, this does not explain why expenses for health care in the US are so much higher than in other countries, while providing no advantage in health or life expectancy.
If it’s not profit-orientated health care, especially the insurances that now spend so much on astro-turf and tea-bags, what then?
I know you have a deep mistrust for a lefty’s arguments, but you have taken in the number our conservative finance minister, have you? Farther to the right than that government is impossible, believe me. Private health care in Germany would cost the tax-payer 20-35 billion Euros more per year. For the US population that would be 50 to 88 billion € that could be saved. I can understand why the insurance companies oppose reform so fiercely.
Nobody sues lifeguards...what's the point? Are you familiar with the term "deep pockets"? The deep pockets are not the lifeguards, but the municipalities that employ them. Hence, the hesitance of many municipalities to start a Lifeguard program and take on the liability if there is an incident with an unfortunate result.
Sure it does! Ever escalating malpractice insurance premiums become a cost of doing business. Doctors are forced to practice "defensive medicine" by ordering test to cover potential liability rather than out of medical necessity.
This is an estimated cost in one of the smallest states in the US. Extratpolate that nationwide and you begin to see the reason tort reform MUST be part of any healthcare reform.
Now look at the impact of states using their power to inhibit interstate commerce by health insurance companies. The restricted competition means higher costs. To the individual seeking better job opportunities, relocating from one state to another includes the price of giving up your health insurance and hoping to get reasonable rates in your destination.
Unfortunately, tort reform and insurance portability are advocated by Republicans and opposed by the Democratic majority.
"Frankly, if 1 out of 5 people is not satisfied with their healthcare plan, there maybe many reasons. You and BC assume it is because the plan itself is somehow at fault. That's pure speculation on your part. I suggest there may be many reasons for disatisfaction including unreasonable expectations on the part of the insured--much the same as the outraged relatives of unsafe swimming condition violators when the lifeguard did not reach them in time. "
You're trying to have it both ways. First of all you trumpeted what you erroneously analysed as a good satisfaction rate which proves the efficacy of your system then when you realise that you've blundered and publicised an abysmal satisfaction rate which suggests your system doesn't work at all well you're calling it a red herring.
An insurance policy is effectively a long odds bet. You bet a small amount of money at good odds that something unlikely will happen. The vast majority (maybe 80-90%? It can't be much less or the company would lose money) of people doing so will pay in much more than is paid out but that's fine because they are paying for peace of mind and security. You would expect all of these people to be satisfied - they would have no reason not to be. A small proportion will actually get paid out more than they paid in, a tiny proportion much more. You would expect most of them to be satisfied - if people had unreasonable expectations then it is because they have not had the limits of the policy properly explained.
But the figures you provide suggest that MOST of those who test the policy find it wanting. Of those who are satisfied, MOST will (mercifully) never find out that it is not what they thought it was. It's just a very clever confidence trick really because most of the people being robbed will never find out. A brilliant scam.
There is no blunder here at all. I do consider 80% approval rate to be remarkable. What I consider a red herring is your unsupported explanation for the 20% dissatisfaction rate.
And this is the most unsupported conclusion of all! Even if it were true (something for which you have yet to provide evidence), you have yet to define what is "wanting" about it. If Momo is refused breast augmentation and liposuction at taxpayer expense, might she consider her policy "wanting?"
Mike,
You needn’t convince me that a reform of your laws on liability would save costs, but you can’t claim that this is the only reason why health care in the US is so much more expensive than in other developed countries.
I claim that an important factor to drive up the costs is private health care insurance. I know that you choose not to take any left-wing source seriously, but this time even right-wing sources such as our government say the same, and you choose to ignore this.
Theoretically you private insurances should be much cheaper than our public ones, because they can pick the better risks. They are more expensive, though, and additionally 20% of their customers are dissatisfied with the service they provide.
I was not aware you had a right-wing government. I thought it was Left and Extreme Left, with you representing the latter.
And when are you going to support that claim? You are blaming the messenger instead of the message. External factors are driving up healthcare costs like defensive medicine, fraud, and lawsuit abuse, not internal factors like paying dividends to poor pensioner shareholders trying to live on their life savings and investments.
I agree. And if conservative reforms such as portability and tort reform were implemented, then private insurance would be cheaper and satisfaction rates will rise even higher than the remarkable 80% it is now. I point to our postal system as evidence. Private mail companies are turning are consistently turning a profit at lower prices than public mail carriers, while the bloated public system continues to cut service and raise rates. Why should I trust something as critical as healthcare to a government that can't even deliver the mail more efficiently than private industry?
Really? Let's see...our expenditure is 49% higher than yours. What accounts for our higher costs:
"There is no blunder here at all. I do consider 80% approval rate to be remarkable."
If 80% of all those who had tested the policy to it's extremes were satisfied then it would be not bad (4 out of five stars) but certainly not "remarkable". But we're talking about the 80% of ALL the people who have bought the policy. That is remakably LOW approval. Or are you claiming that most people who take out a health insurance policy get to find out it's limits?
"What I consider a red herring is your unsupported explanation for the 20% dissatisfaction rate."
I have not offered any explanation of the dissatisfaction rate. As far as I can tell, you are the only one here who has tried to thatt by attributing to it to unreasonable expectation.
"Even if it were true (something for which you have yet to provide evidence), you have yet to define what is "wanting" about it."
I don't understand what you're saying. You are the one who who pointed out that 20% are dissatisfied. I merely pointed out that, because of the peculiar qualities of an insurance policy, this is a very high dissatisfaction rate indeed. Health insurance is rather like a fire extinguisher. Everyone who has one attached to the wall is happy with it and most of those who have used it to put out a small fire will probably be satisfied. Only a tiny number will ever have tested it to it's limits. So if someone told me it only had an 80% satisfaction rate I would steer clear of it.
Sure you did.
You assert the 20% were those who tested the policy to its limits and found it wanting, but failed to provide anything other than your unsupported opinion that was the case. I suggested there were likely many reasons for dissatisfation and testing it to its limits and finding it wanting may only be one of those, but more likely the reason they found it wanting was their failure to understand the limits of the policy in the first place.
You are proving some points quite nicely that cropped up in this thread. You think that the Communist Manifesto was written by Bismarck or Benjamin Franklin or both of them, don’t you?
Umm. Cough. Maths.
Your expenditure is 103% higher than ours. (You do it this way: 7290 : 3588 x 100 – 100) If you calculate the other way round: our expenditure is 49% of the US one. Our life expectancy is higher too.
Possibly tort reform and insurance portability are a way to reduce costs (by 10%, or what did you say?), but I still claim that private insurance is an important factor (probably the most important one) to drive up the costs.
http://dip21.bundestag.de/dip21/btd/17/006/1700691.pdf
Yes, I know. First civics/history, then maths, now foreign languages. But the gaps in your education aren’t my fault!
You can’t tear your thoughts away from my breasts, can you? Okay, FYI: they are perfect. I wouldn’t let a surgeon touch them. You won’t touch them either.
By the way, there is quite a consensus here that this sort of surgery doesn’t belong to the things that are necessary to improve someone’s health.
You still haven’t grasped what I take to be essential parts of health care insurance: no limit on intensive care, for instance. How many US Americans can be sure that their insurance pays for that? I know that many of them had to find out that it isn’t included, but most of them probably don’t know, because they have never needed intensive care.
Do private companies deliver the mail reliably everywhere in the US? Here they are reliable and cheap if the mail goes from one city to another (or, preferably, within a city). They are extremely bad in delivering a letter from a Bavarian back of beyond village to a small Frisian island. They are only picking the best business, and it’s small wonder that they can do that cheaper.
LOL! Nor was I offering, even if you begged.
But this goes directly to the issue of what is a medical necessity. For you this is not a necessity, but for other women, their whole mental health might be dependant upon cosmetic surgery.
For you intensive care limits are an issues and I agree. But defining those limits is not a matter of agreement. Financial and medical realities require tough decisions somewhere in between a day and infinity.
Yes, they do and much more reliably than government mail delivery. Why do you think private companies have a steadily growing market share while turning a profit and the government system is steadily losing market share? People who want reliable delivery are voting with their wallets. The US Postal system has steadily increased rates to make up the loss in revenue and feed their bloated unionized personnel system.
Thanks for correcting my math, but it doesn't change my point about the variety of costs that contribute to our higher healthcare costs. Tort reform, fraud, and defensive medicine account for up to 30% of our healthcare expenditure. But you also ignore the capital costs of US medical innovation.
Ah, yes? Do elaborate. Where exactly is the point where you say someone must die because of “financial realities”? What is a human life worth?
Would you volunteer to pull the plug?
And who was that guy that complained about Obama's "death panels" a few months ago?
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