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We Aren't Smart Enough

The show "Sick Around the World' is airing on PBS again tonight. I posted a link to the online video the last time it aired, but it's worth posting again.

I have spent a lot of time dealing with the medical system in my life. Watching this show, and others on the subject, I've come to some conclusions. To me, they are inescapable.

Our healthcare system is very poor. If you compare it to that in other nations, it is absolutely terrible.
It seems to be the general consensus among those opposed to national health care is that our government is too incompetent to run it. They may well be right. If so, we Americans should be embarrassed. I know I am.
Somebody is making a lot of money in the U.S. healthcare business. Looking at my own medical bills, and those for my mother, the prices for medical supplies are even higher than popcorn at a KU basketball game.

One telling statistic fact from the video. An MRI in the US costs about $1200. In Japan, it is $90. Who is getting the other $1010 here?

If you didn't watch the show on PBS, click on the link above.

By Dave Klamet

November 10, 2009

In Simple Words

From the Citizen Journalism Academy

Discussion

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11 November 2009
at 1:08 a.m.

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notajayhawk (Anonymous) says…

The MRI only costs $90 in Japan because the government fixes prices. Treatment of a wound - by a physician - less than, I believe, four inches is limited to something like a $12 payment. Hospitals and doctors are losing money. Yes, we could have cheaper healthcare if we allowed our government to put a freeze on the price of services that's far below what it actually costs to deliver them. Why don't we try that?

By the way, Dave, what business are you in, that you'd think it's okay if the government came along and said you had to sell your products/services for below cost because your customers were complaining of the price?
11 November 2009
at 6:47 a.m.

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devobrun (Anonymous) says…

Dave,
If you are wrong about health care, can I sue your butt off?

If a Japanese doc delivers a baby with a malady that might have been avoided by a c-section instead of delivery the usual way, do they get their butt sued off?

Why are c-sections used far more often in the U.S.?

Japan is a far more uniform society with people who are more educated, less dependent upon lawyers for their livelihood, and more in tune with their culture.

Our culture is whiny. Our culture is protective of whiners.

Who is making money in our system?

Whiners and the lawyers who enable them. The whiners feed the courts. The lawyers make money through the courts and through insurance premiums from both the patient and the doctor. John Edwards is very rich.
11 November 2009
at 8:02 a.m.

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dklamet (Dave Klamet) says…

The business I”m in is not a fundamental, critical service.

As a society, we have developed a tolerance to the plight of others. How many people do you know without health insurance? Do you worry about them?

Or just not care?

The $90 for an MRI may be unreasonably low, but surely it is less unreasonable than paying 10x that.

Are our hearts and minds with those who can't provide health care to their kids? Or on lawyers and the few who get rich on malpractice cases?

Just what kind of people are we, anyway?

From a business perspective, as a society we are paying more than other countries and getting less. Do we just settle for that?

As I said above, all this money is going somewhere, or I should say to somebody.

As to the business I'm in, notajayhawk, I'm an engineer. My engineering analysis of our healtcare system is that it wastes money, delivers a usually hiqh quality product but at an unreasonably high price. It cannot prevent illness when it would be cheaper (and less painful and destructive) and then society pays for the cases that have been allowed to become life threatening.

As an engineer, I compare one system to another. I measure different statistics. Percentage of population served, average cost per capita, average cost per treated person, expense to society as a % of GDP.

Speaking honestly and soberly. On this issue, we are no longer a world class power. Seriously, as a country we're a buffoon. It appears we no longer have the competence or will we exhibited during the depression of the 30's or WWII.

We can't treat our sick, but we surely still have the highest # of cars per capita. Of course we can't afford to maintain the infrastructure they need—but that's another story.

Notajay. I am in the business of computers and technology. When I compare our performance to that of other countries, we don't come off looking very good there, either. But that is yet another story.
11 November 2009
at 8:30 a.m.

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gccs14r (Anonymous) says…

“Who is making money in our system?”

Bill Frist, for one.
11 November 2009
at 8:38 a.m.

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porch_person (Anonymous) says…

We have a problem with health care in this country. It isn't due to too much litigation, smarter people in Japan (I found that rationale hilarious!!) or “price fixing”.

Denial of the problem isn't going to solve it. Denial of the problem isn't going to get us out of the state of paying more per capita than any other country in the world for health care. We're not even in the top thirty in outcomes.
11 November 2009
at 8:41 a.m.

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Donnuts (Anonymous) says…

Yeahooo. Free Necessary Medical Care for all U.S. citizens !!!!!

What is the hold up? Are hospitals holding up the general citizen? What are we waiting for? Let's do it !!!!
What needs to be passed legislatively? Let's GO !

I want my knee scrapes to be covered and not held up on hospital bills. Am I dreaming of a healthier population of people that might be happier.

I think we should include education to the general citizen as well !!!!!!! I think we should educate people as to how to take care of their bodies in the process.
11 November 2009
at 8:46 a.m.

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RETICENT_IRREVERENT (Anonymous) says…

America has developed a health care system theat emphasizes health care over health and well-being, treatment over prevention.

The plans pushed, “reforms” , address access to health care by expanding government aid to those without health insurance, and trying to control costs through central adminstrated methods.

But, the comprehensive reform plans merely reinforces the current system, insurance based, employment centered, and administratively complex. By extending the current system to more people it will increase the cost of any true reform. Current plans will do more harm than good. To acheive the maximum good, and provide the most “coverage” at an acceptable cost and acceptable quality, health care will need to become subject to the same forces that have boosted efficiency and value through out the economy. We need to reduce the role of insurance, not expand it. We need to rely more on ourselves as consumers to be the guarantors of good service, quality, and reasonable prices. Medical care is just a small aspect of overall health, Nutrition, exercise, education, emotional security, and our natural environment are much larger portions in the pie of quality of life. Half of all deaths in the U.S. were the result of heart disease, diabetes, lung cancer, murder, and suicide. Those deaths were influenced more by lifestyle choice and living enviroment, as compared to the effect of medical care.

Our government influenced the “housing bubble” (which burst) by increasing incentives, special tax benefits, subsidized borrowing, which led to the willingness of people to borrow and spend more on houses than they otherwise would have. The government stimulated the growth of comprehensive heath plans by creating incentives for insurance to become the primary means of paying for any type of health care. When our government created Medicare and Medicaid they in essence adopted the same comprehensive insurance plan.

Many of our politicians have uttered “millions of Americans have no health care, where as they actually meant “millions of Americans have no health insurance”.

Why has a method of financing health care become synonymous with care itself?

Comprehensive health insurance is different than any other type of insurance. Health insurance is the primary payment method not just for expenses that are unexpected and large, but for nearly all health care expenses. Does you auto insurance pay for gas? Does your homeowner insurance pay for your electric bill? Most pregnancies are planned, and delivery can be forecast 9 months in advance, yet we pay for these using tyhe same way we fix our car after a wreck - by filing an insurance claim.

11 November 2009
at 8:52 a.m.

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RETICENT_IRREVERENT (Anonymous) says…

Insurance is probably the most complex, costly, and perverse way of financing any activity, and is usually used to pay for only the most rare, unexpected and large costs. For every two doctors in the U.S. there is on health insurance employee. With insurance paying health care expenses, we become less involved in making decisions, because someone else is paying the bill.

Of course much of out medical care is unavoidable, but if demand for health care is a response to unavoidable medical needs, why do hospitals, drug companies, health insurers and medical device manufactures spend over $6 billion on advertising? The message sent is you can get benefit from a product or service and pass the bill onto someone else, or the government. Most physicians finacially benefit from ordering tests, procedures, and followup appointments, and insurance/Medicare/Medicaid is paying for it, not the true consumer. It creates a disconnect. That is a big reason our health care system is so expensive.

Government has never been good at cost reduction, though all reform plans have an intrinsic component of cost control, but in reality all government efforts to control costs fail. Medicare/Medicaid focus on prices rather than costs. They try to control costs by limiting the payments to providers for each service. Providers then preform more services, and costs balloon. True cost control occurs in a decentralized, competitive market, not a centralized bureaucracy, and has to be quickly responsive, something government can not accomplish.

Look at lasik surgery, something that is never covered by insurance, and never covered by Medicare/Medicaid. Costs started out at $4000 dollars an eye, but now have dropped to nearly the $500 dollar and eye range. As more and more providers entered the market, prices dropped. Competitive markets have driven the cost down.

Do you know the true cost of that MRI before the procedure is preformed? Why are Governmental Certificates of Need restricting access to MRI's, keeping costs artificially inflated?
11 November 2009
at 9:09 a.m.

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mfowler (Matthew Fowler) says…

If the health care industry in this country were actually governed by free-market principles, then supply and demand would dictate that good, quality, adequate health care would be available at a price people would be able to afford.

But it isn't governed by free-market principles. It is actually a web of monopolies engaged in fraud and collusion.

It's as simple as that.
11 November 2009
at 9:14 a.m.

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porch_person (Anonymous) says…

Matthew, I think the word you're searching for is “oligopoly”. Good point though. You've accurately identified the problem.
11 November 2009
at 10:18 a.m.

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gccs14r (Anonymous) says…

A completely free market will stay neither free nor a market for long. There will be acquisition and collusion to consolidate power, control pricing, and reduce deliverables. For markets to remain free and fair, there must be 3rd-party oversight.
11 November 2009
at 10:30 a.m.

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porch_person (Anonymous) says…

Well stated, gccs14r!!
11 November 2009
at 10:57 a.m.

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Liberty_One (Anonymous) says…

gccs14r (Anonymous) says…

“A completely free market will stay neither free nor a market for long. There will be acquisition and collusion to consolidate power, control pricing, and reduce deliverables.”

That was tried and it failed. A free market will out every time. What happened was industry turned to government to eliminate competition via regulation. Look at the history of American Can or the Interstate Commerce Commission for examples. Your theory about consolidating power, reducing output and controlling prices only works with the aid of government. In a free market it simply doesn't work.
11 November 2009
at 11:21 a.m.

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jayhawklawrence (Anonymous) says…

This is becoming a one issue Presidency…and maybe that is what the Republican Party has been hoping for.

We still need to address:

Dependency on foreign oil.
The melt down of our manufacturing infrastructure and the ignorance that permeates all discussions about US Manufacturing.
Tort Reform
International Trade
CEO pilfering of our public companies
Monopolies and price fixing
Patent Reform
Our food supply and the giant agriculture companies that are putting us at risk.

There are many issues that are just as important or even more important than the ones the media gets focused on.

It makes you wonder about the viability of our political system when it doesn't work for the American people.
11 November 2009
at 11:34 a.m.

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jayhawklawrence (Anonymous) says…

Our foreign policy and the way we truck money into military bases and buy friends all over the world is not based on any free market idea that I know of.

We need to cut back on spending outside of our own country and make other people spend their own money.

Do we need ALL of these foreign military bases?

Our China trade policy is bankrupting the United States but making a lot of corporate executives a ton of money. Why are our politicians allowing this to happen?

Why do our Universities keep teaching that our transition to a service based economy is a good idea? Are they just stupid or what?

44% of our products are still manufactured in the United States. We still produce more than anyone else in the world. How is this happening?

Americans want to compete but if the government is going to crap on business and manufacturers in particular, we cannot compete forever. Wall street needs a kick in the butt every single day until we turn this thing around.

11 November 2009
at 11:43 a.m.

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porch_person (Anonymous) says…

Liberty_One,

(laughter)

gccs14r made the observation that markets inevitably progress to oligopoly / monopoly without intervention. History confirms this handily.

You think everything bad originates from government. Pretty simplistic analysis.

(laughter)
11 November 2009
at 12:31 p.m.

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Liberty_One (Anonymous) says…

porch, what's the point? You aren't going to defend your statements or explain anything you say. All you're going to do is lob random criticisms and once backed into a corner pull out your old standbys of “garfinkeling” and making personal attacks against this fantasy image you have of me. You haven't changed so why should anyone respond to you? Give it up.
11 November 2009
at 12:44 p.m.

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gccs14r (Anonymous) says…

“That was tried and it failed. A free market will out every time.”

Tell me of a completely free market that succeeded.
11 November 2009
at 1:03 p.m.

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LoveThsLife (Anonymous) says…

I disagreed with much of what was portrayed on the PBS show last night. I felt they didn't tell the whole story and disagreed with a lot of their comparisons. I do believe health reform is needed, however, I do not support a public option. There are cheaper ways to reform our health care industry, without introducing a very expensive public option. I for one do not want my taxes to be as high as much of Europe or Britain. We need to quit spending money that we do not have. We are in debt, our jobs are going overseas.We give foreign companies (in particular Chinese companies) unfair tax advantages. We are creating some major problems for ourselves right now.
11 November 2009
at 1:29 p.m.

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Liberty_One (Anonymous) says…

gccs14r, one only has to look at the industrial revolution in America to see how effective freedom can be. Prices fell all throughout the 19th century, purchasing power increased for the average person, and what's more their lives were different. Travel, communication, energy, health care—the world was becoming a vastly different place. Look at the history of American Can. They tried to get a monopoly, but because of freedom they just couldn't. It doesn't work—they kept creating more competition and they ran out of money to buy the competition up. Look at the history of the Interstate Commerce Commission. Look at who ran the thing and the first acts they did. Because of freedom, cartels just couldn't work, so they turned to the government to use force to make them work. If you think this isn't so, look at who ran the ICC—what do you think their real motivations were? It's the same thing today. We have a bunch of former Goldman Sachs employees positioned throughout the federal reserve.

Freedom didn't fail, what happened was it was too successful. Cartels and monopolists couldn't get their schemes to work—they were thwarted time and again. What happened was they lobbied DC to intervene, to remove the free market.
11 November 2009
at 2:09 p.m.

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notajayhawk (Anonymous) says…

dklamet (Dave Klamet) says…

“As an engineer, I compare one system to another. I measure different statistics. Percentage of population served, average cost per capita, average cost per treated person, expense to society as a % of GDP.”

The problem is none of those statistics will tell you what the problem is. Statistics apply to populations, not individuals. As clinicians, we treat individuals, not populations.

An MRI might be a good example, at least the lucrative diagnostic imaging specialty. 95 out of a hundred people who present to an ER with stomach pain may be suffering from simple indigestion. But that doesn't mean that there's a 95% chance that any particular individual person is suffering from indigestion - for each person, there's a *possibility* that it is an emergent, life-threatening problem, so a CT scan or MRI is performed (along with a whole battery of other tests), changing the cost of that ER visit from a couple of hundred dollars to thousands.

A couple of weeks ago I picked up a copy of AARP's magazine in a waiting room, because there was an article in it that talked about why our healthcare costs so much. One of the things they cited (and I don't have the magazine in front of me so I don't know the source of the research) was that something like 40% of such diagnostic procedures are unneccessary. One of the reasons they're performed is because of our litigious society, but much of it is for altruistic reasons - healthcare providers really do want to make sure they're providing the best care possible, even when it's very often overkill. The over-utilization of expensive tests and the excessive referrals to specialist have a huge impact on what we pay for healthcare. But if *YOU* are the one in the ER with the pains in your abdomen, do you want the physician to tell you you can't have an MRI because the statistical odds are it's indigestion? What if it was one of your children?

[continued]
11 November 2009
at 2:10 p.m.

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notajayhawk (Anonymous) says…

[continued]

*Especially* if someone else is paying for it? Insurance is indeed part of the problem, not because of administrative costs or profits or whatever. It's because given the choice of being sent home with a bottle of Rolaids or getting an MRI, most people will make quite a different choice if they had to pay for that MRI out of pocket. But as long as it doesn't cost them anything (today, anyway), they will of course ask for all the bells and whistles. Remember that Obama's first choice for HHS Secretary said in his book that he admired the Europeans, not for the quality of their healthcare, but for the willingness of the *people* to accept catastophic diagnoses and the infirmities that come with age, rather than insisting on expensive treatments to try and beat them. The problem in this country is that we have come to expect, even demand, the best available options, and sue the bejeezus out of any doctor who failed to provide it.

BTW, Dave, food is a fundamental, critical need. Should the government fix prices there, too? How about housing? Energy costs? And whether a product/service is critical or not, if the government forces you to sell below cost, you don't stay in business long, and then nobody is providing that critical need.
11 November 2009
at 5:03 p.m.

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gccs14r (Anonymous) says…

“for each person, there's a *possibility* that it is an emergent, life-threatening problem, so a CT scan or MRI is performed (along with a whole battery of other tests), changing the cost of that ER visit from a couple of hundred dollars to thousands.”

And yet you can get that MRI in Japan for $90. Yes, the price is fixed by the government, so the MRI manufacturers figured out how to lower the cost of the device so it's still profitable to use.

11 November 2009
at 7:18 p.m.

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dklamet (Dave Klamet) says…

notajayhawk,
I won't pretend to have an intimate knowledge of the day to day realities of health care. Regardless of those realities, I think that there are two important thing to note:

1. If other counties can deliver health care to all their citizens, I must believe that we can, too. Somehow we need to figure out how good a job we're doing. Measuring the things I mentioned (although maybe there are better ones) is the only way we can learn and improve.

2. Regardless of who is paying for it, resources are limited. For every test or procedure ordered for someone, one less is available for everyone else. Even if we could afford an MRI for everyone who had a stomach ache, could we also afford one for everyone who has a headache, too? However much we spend on healthcare, their are limits and our doctors are the ones who must make those decisions. Sometimes they will be life and death decisions. Sometimes they will turn out to be wrong no matter how good the system (or doctor…). I'd rather the doctor make them then an insurance bureaucrat.

We don't like to face some realities and one reality is that there is a dollar figure for a human life. I would argue that those who oppose national healthcare are putting a lower dollar figure on it than those who support it.
11 November 2009
at 7:22 p.m.

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dklamet (Dave Klamet) says…

There is another inequity in the system that I have to mention.

Insurance companies negotiate discounts with providers. I've seen my medical bills and they are significant.

So yet another crazy twist to our healthcare system is that those who don't have health insurance (i.e. those who can least afford it) are charged the most!
11 November 2009
at 7:47 p.m.

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notajayhawk (Anonymous) says…

gccs14r (Anonymous) says…

“And yet you can get that MRI in Japan for $90. Yes, the price is fixed by the government, so the MRI manufacturers figured out how to lower the cost of the device so it's still profitable to use.”

Why, yes, they did figure out how to make the MRI machine's cheaper. They reduced the quality of the image. Did you miss that line when you skimmed the transcript, gcc?

Q: “The price of that MRI is so much cheaper in Japan. Doesn't he have to pay the same price, $5,000, for an MRI machine like the man in America?”

A: “Well, it depends on what kind of image density the radiologist wants.”

In other words, the government fixed the price, so the only alternative was to provide inferior service. Great plan - hey, let's do that here!

And in any event, if an MRI machine costs more to buy here, it will drive up the cost of healthcare - but that's not the fault of the hospital or the insurance company or the healthcare provider (and none of them profit from the increased cost, only the manufacturer does).

In addition, the cost of providing an MRI is only partly due to the cost of the machine. There's also the cost of the personnel, which is cheaper in Japan. How come nobody's complaining about the salaries of doctors making healthcare unaffordable in this country, gcc?

Oh, and by the way, comparing the United States to Japan is troublesome for a number of reasons, but like many things in Japan (e.g. autoworkers' salaries), sometimes they just lag behind a little. Japan is trying so hard to control prices because they're facing an explosion in healthcare costs:

“Health care costs here are projected to double by 2020 and represent 11.5 percent of gross domestic product. ”

http://www.minnpost.com/globalpost/20…
11 November 2009
at 7:52 p.m.

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llama726 (Anonymous) says…

“If the health care industry in this country were actually governed by free-market principles, then supply and demand would dictate that good, quality, adequate health care would be available at a price people would be able to afford.

But it isn't governed by free-market principles. It is actually a web of monopolies engaged in fraud and collusion.

It's as simple as that.”

False. False. False! Supply and demand only applies to those who can be treated in a cost-effective manner. Our system still wouldn't have an answer for people who can't afford coverage or who are so sick that it will be very expensive for them to be treated. Try again.
11 November 2009
at 8:10 p.m.

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notajayhawk (Anonymous) says…

dklamet (Dave Klamet) says…

“Measuring the things I mentioned (although maybe there are better ones) is the only way we can learn and improve.”

Again, I respectfully disagree. I suggest the measures of cost you mention are meaningless, and that a better measure between systems might be per capita costs as a percentage of disposable income. It may be great if someone in a foreign country only pays $75/year for healthcare, but not if they only make $100/year.

As for the other measure you mentioned, this comes down to a fundamental difference of opinion on what makes the system 'better' or 'worse.' It seems the liberal side of the argument always includes everyone being covered as the most important benchmark. I don't agree with that. You can feed the entire population of a country dog food for what it would cost to feed a small portion of them filet, but that doesn't make American cuisine superior.

“Regardless of who is paying for it, resources are limited.”

If that were true, how can you claim that we can cover more people without sacrificing quality?

In any event, there's a flaw in your reasoning. Resources are not as limited as you might think. You only have to make a choice between giving the MRI to a stomach pain vs. a headache patient if the machine is operating at 100% capacity - and you can't build more. There are hospitals closing all over the country due to excess bed capacity - how can you claim limited resources?

And by the way, no insurance company makes life-or-death decisions, and I'm getting a little tired of that hooey being thrown around. Insurance companies only say that, according to the terms of the contract and the applicable regulations of the state, they will or won't *PAY* for a procedure. If the procedure is necessary to save the life of the patient, the physician is obligated to do it anyway - and if they don't, it's for the sole reason that they might not get paid.
11 November 2009
at 9:05 p.m.

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RETICENT_IRREVERENT (Anonymous) says…

“We don't like to face some realities and one reality is that there is a dollar figure for a human life. I would argue that those who oppose national healthcare are putting a lower dollar figure on it than those who support it.” - Dave

In 1965 when Medicare and Medicaid were created the government essentially adopted a comprehensive-insurance model for its own spending. By 1966 nearly 12% of the population was enrolled. Is it coincidence that that inflation of health-care costs began at that same time?
In 1966 Medicare and Medicaid made up 1% of total government spending, now that figure is 20%.
The federal government spends 8 times as much on health-care as it spends on education, 12 times what it spends on food aid to childrens and families, 30 times what it spends on law enforcement, 87 times what it spends on water supply, 830 times the spending on energy conservation.
How does society determine that $100 billion a year for health-care will make us healthier than $10 billion for cleaner air or water, or $25 billion for better nutrition, or $10 billion for recreation, or a combination of those?
11 November 2009
at 9:45 p.m.

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dklamet (Dave Klamet) says…

notajayhawk,

1. I don't know if there is a meaningful way to measure the cost and efficiency of health care. I don't know if I believe the accuracy of any numbers about the economy, we can only do the best we can.

2. I didn't say we could provide healthcare to all without sacrificing quality. I don't know if we can. However I'm not sure how we define quality. Some have really good health care (I'm going to consider myself one). Some have none at all. If you average everyone, how good does that make the current quality? I don't know.

I think we, as a society, must decide if this is an economic issue or a moral one. What is it worth to make sure everyone can be cared for when they are ill? If we could provide health care for all, but cut our standard of living in half, would it be worth it? If we could double our taxes and provide health care for all, would that be worth it?

I must believe that we could do it, the question is, do we care about each other enough?

The title of the post is “We Aren't Smart Enough”. Perhaps it should have been, “We Don't Care Enough”.
11 November 2009
at 10:14 p.m.

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gccs14r (Anonymous) says…

We spend twice as much for half the service. We could hardly do worse.

11 November 2009
at 10:14 p.m.

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blue73harley (Anonymous) says…

I think the title should be “We Don't Work Together”.

All the stats being cited give me a headache. But here is what hurts more. My corporation just announced our annual increases for 2010. Ouch!!! My contribution is up 12%. And deductibles have soared. Individuals went from $150 to 500. My total out of pocket could be $5K/yr for the family plan copays before my deductibles are satisfied.
11 November 2009
at 11:59 p.m.

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gccs14r (Anonymous) says…

And none of that increase will go to actual healthcare. It's the private insurers turning us upside-down and shaking the last pennies out of our pockets because they can.
12 November 2009
at 12:59 a.m.

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notajayhawk (Anonymous) says…

dklamet (Dave Klamet) says…

“I don't know if there is a meaningful way to measure the cost and efficiency of health care.”

I'm not sure either, since no matter which method is used, it can't account for the inherent inequities, which makes any kind of 'average' figure meaningless.

“I didn't say we could provide healthcare to all without sacrificing quality.”

No, I guess you didn't. So are you saying that the only measures of 'better' you are reaching for are more people covered at a cheaper price? Again, you can feed everyone dogfood …

“I think we, as a society, must decide if this is an economic issue or a moral one.”

For the record - and I probably have never explicitly stated this in any of my numerous and voluminous posts on this topic - I *personally* believe everyone should have access to affordable quality healthcare, and I wouldn't even mind paying more in taxes to see that done. However, again I emphasize this is a *personal* belief based on personal *moral* values. And I do not believe it is the purpose of government to legislate morality - isn't that generally the argument of the 'progressives' when the topic of abortion or same-sex marriage is brought up?

I have no problem with expanding Medicaid/Medicare to cover those who otherwise have no way to afford healthcare. However, I think the eligibilty process needs to be revamped, to make sure it is only for those who absolutely need it. (Some of my objections to the expansion of S-CHIP that was vetoed - and rightly so - by former president Bush were that 20% of those added to the program were already insured, and the income threshold was a one-size-fits-all nationwide amount rather than being set to local income levels - like Section 8, for example.)

And no matter how we *PAY* for it, something needs to be done about the cost. My biggest objection to the current proposed legislation is that it will do nothing to lower costs, and will likely increase them. It makes no difference whether we pay out of pocket, in premiums, or through taxes, when it just costs too darned much. And providing third-party reimbursement for more people, adding a further layer of insulation between services and payment, means more people will consume more services, blissfully unaware of what it's costing *ALL* of us.

**********************************************

gccs14r (Anonymous) says…

“And none of that increase will go to actual healthcare. It's the private insurers turning us upside-down and shaking the last pennies out of our pockets because they can.”

Tell you what - I'll agree to support whatever reform measure that's put on the table if you agree to use the new coverage to get some treatment for those delusions, gcc. The fact that you think all the money is going to insurance companies is a wonderful example of the problem - you have absolutely no idea what the cost of health*CARE* actually is.
12 November 2009
at 2:32 a.m.

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notajayhawk (Anonymous) says…

blue harley is lucky. We also got our new plan information today, and it's up 50% (which incidentally includes a switch from a shareholder owned company to a not-for-profit!).

But if you think all the money goes in the pockets of insurance companies, follow along with me for a minute. I know this isn't an accurate way to compare, but just for illustration:

I believe the Frontline show mentioned that the premium for a family of four in Japan averaged about $140/month. That makes it about 1.4 times the cost of an MRI (the show said they were $98 in Japan).

Even with the rather exhorbitant increase in our premiums, the most expensive of the three plans offered by my employer costs $1,479/month for a family. Yes, that's a lot - but it's only 1.23 times the cost of an MRI.

And consider these two additional factors: 1) The Japanese insurance companies aren't allowed to make profits - yet as a percentage of a comparable service, their premiums are higher. 2) I can get an individual plan directly from the insurance company for about half (or less depending on what level of deductibles, co-pays, and optional coverages I *choose*), or about 0.60 times the cost of an MRI.

I agree, and have never stated otherwise, that health*CARE* costs too much in this country. But insurance companies are not the problem, and never have been.

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dklamet (Dave Klamet) says…

“So yet another crazy twist to our healthcare system is that those who don't have health insurance (i.e. those who can least afford it) are charged the most!”

Which, again, demonstrates that insurance companies are not the problem!!! If the problem was insurance company profits, executive salaries, overhead costs, or the administrative costs to providers to file insurance claims, then wouldn't it be *cheaper* for self-pay patients?
12 November 2009
at 5:25 a.m.

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grammaddy (Anonymous) says…

Medicare/Medicaid for everyone! Medical care should not be for profit anyway. Why must Americans be so greedy that they need to make money off of someone else's bad luck?