Effect Measure

I don’t ordinarily write about health care reform here, partly because it isn’t my expertise, partly because other interests come first, partly because others do it much better. But I have been thinking a good deal about what needs to be done for our public health infrastructure and that necessarily brings health care reform into the picture, whether I want it there or not. My view of it is primarily as a consumer. I pay ridiculous health insurance premiums and still feel underinsured. But I also see it from the provider’s point of view, where the current system, while lucrative for some, is a major factor in provider work dissatisfaction. It isn’t fun to deal with the paperwork and transaction costs on either end (although it’s better to bill than be billed, of course). But the health care reform train is leaving the station and it better be on the same track and going in the same direction as public health. So I am starting to think about it.

I’m not the only one. The current crisis of 47 million uninsured n the US, almost a doubling of premiums in the last decade, the squeeze on businesses big and small coping with risking health care costs and the huge cost to each an every American is now a scandal, the more so because the insurance industry and Big Pharma are reaping record profits. In yesterday’s LA Times Ezra Klein has some revealing figures:

The American health system, put simply, is a mess. An expensive one. Indeed, in 2002, we spent $5,267 per capita on healthcare — $1,821 more than Switzerland, the nearest runner-up. And yet we had higher infant mortality, lower life expectancy, more price inflation and an actual uninsured population, a phenomenon virtually unknown in the rest of the developed world, where universal healthcare is, well, universal. (LA Times)

We have many readers outside the US, so it bears repeating for their information: alone among industrialized nations of the world, the US doesn’t have universal health care. When I say this to my European colleagues (usually in a conversation where they are grousing about their own national health service) they are first startled, then incredulous. In ten years, though, I’m guessing the last hold out will have given up its supremely anachronistic ways, too.

Already several states (Vermont, Massachusetts) and one city (San Francisco) are moving toward universal coverage, although in different ways, most of them partial and with many flaws. But the universal coverage genie is out of the bottle, at last, and it won’t go back in. Even the health insurance industry knows this. As Klein points out, is busily floating their own self-serving version of health insurance reform.

The reason for this inevitability is that the stars are finally lining up. Reacting to Klein’s op ed, Bonddad at The Agonist sets out what he thinks are the three drivers that will force universal care in the United States.

  • Universal care is cheaper, at least judging by the per capita costs of every other advanced industrical country that has it:

    The Organization of Economic Cooperation and Development studied the health expenses of all member countries – 29 in all including the United States. The median amount of GDP spent on health care of 29 countries has fluctuated between 7.9 and 8.4 for 2000-2003. For 2000-2003, US health expense as a percentage of GDP was 13.1%, 13.8%, 14.6% and 15% respectively – by far the highest total of all countries. Germany was the next most expensive country and their totals for the same years (2000-2003) were 10.6%, 10.8%, 10.9%, 11.1%, respectively. So, as a percentage of GDP basis, the US spends between 34% and 75% more as a percentage of GDP than countries that rely primarily on public funds to provide health service.

    The OECD also breaks health expenses down into amount spent per capita. For the last four years (2000-2003), the median per capital expense for 29 OECD countries ranged from $2010 to 2248. Over the same years, the US once again spent more than any other OECD country, with figures for 2000-2003 of $4539, $4888, $5287 and $5635. Over the same time, Switzerland ranked second in per capita expenditures and Germany third. It’s important to notice that the US’s private health care system routinely spends at least twice as much per person than other countries with public health systems. (The Agonist)

    As Ezra Klein noted, we also don’t get the benefits of greater expenditure, actually faring worse in most health indices than countries spending far less.

  • Transaction (administrative) costs are far less for government administered health coverage. Bonddad offers this, from The Angry Bear:

    We have a couple of estimates of how high administrative costs are – i.e., expenses incurred by the health care system to do things other than to provide health care services. One prominent study that appeared in the New England Journal of Medicine in 2003 estimated that the cost of administering the US’s health care system was about $300bn in 1999. A more recent study in the International Journal of Health Services found that in 2003, administration costs in the US health care system ate up about $400bn, or about 25% of total health care spending.

    By comparison, national health care systems incur administrative costs of a few percent of total health expenditures: according to the NEJM study Canada’s national health insurance system spends just 1.3% on overhead, and the US’s Medicare and Medicaid programs have administrative costs of between 2-5%.

    Currently, the US health system is a hodge-podge of numerous insurance companies with differing layers of paperwork that work against efficiency. The US public system spends 80% less on administration costs. (The Angry Bear)

  • An additional factor is that American businesses from small to large are finally realizing that it is better to have taxpayers foot the bill for their workers’ health care costs than that they do. It is becoming an intolerable expense and a major cause of labor unrest. Yesterday we cited the example of the seven times greater cost of worker health care in an American built car compared to a Japanese or Canadian car. It’s not just cars. American-based workers are at a competitive disadvantage if their employer pays health insurance, and if that disadvantage is made up by trimming their benefits they wind up uninsured or underinsured on their own nickel.

None of these factors are part of a specifically progressive view of health care reform. These are all issues a “sane Republican” could accede to. Progressives have this as a base to build on, but how to craft an effectie and equitable system of universal coverage and access and delivery of care to everyone will take much additional thought.

Meanwhile, it is important to acknowledge it isn’t possible to have a truly robust and resilient public health system if we are unable to provide services and distribute the fruits of preventive medicine to our communities. Vaccines have to be distributed and administered; for surveillance to work there has to be a system that “sees” the cases; if sick and infectious people aren’t to be walking our streets and workplaces they need to be treated and cared for; if children are to be healthy enough to withstand a bout of influenza we’ll need to provide prenatal care, well baby care and acute care. That’s just for starters. All of this articulates intricately and necessarily with the health care system.

Which is currently broken beyond repair. While we rebuild our public health infrastructure, we’ll need to do it in coordination with fixing our dysfunctional health care system. The rest of the industrialized world has a huge head start on us. They’ll do better than we will if there is a pandemic in the near future for this reason alone.

Then there’s the rest of the world.

Comments

  1. #1 Interrobang
    December 27, 2006

    We have a 30ish year head start on you, but looking at how Tommy Douglas did it. He was an interesting sort of Eugene Debsish figure, but he finally managed to be at the right place at the right time, and solidified a very nice legacy.

    A study you might find interesting is this one: A systematic review and meta-analysis of studies comparing mortality rates of private for-profit and private not-for-profit hospitals.

    There are lots of lies (outright lies, in most cases) floating around about particularly the Canadian healthcare system, mostly advanced by interested parties who are invested in the status quo. The two most commonplace ones are that there are no private practices here (false; almost all clinics are privately-owned), and that Canadians don’t get to choose their own doctors (also not true — the government doesn’t have the resources or inclination to make that kind of decision for people — I personally have “fired” a couple of doctors myself).

    I’m wondering what the social ramifications of the US finally moving to single-payer healthcare might be. For one, it might bring in a whole new wave of immigrants. There are a lot of us who simply won’t consider moving to the US because we’ve seen, firsthand, what happens to people who have even good insurance who need medical treatment. Hassle! Aggro! Who needs it?! Dealing with doctors is difficult enough without adding another layer of bureaucracy on top (patients rarely if ever deal with the provincial health administration directly).

  2. #2 Joseph j7uy5
    December 27, 2006

    Two comments: another factor that will favor the adoption of universal coverage is that many younger doctors are in favor of it. Traditionally, physicians have opposed it. But that is changing.

    Second, the various “fixes” that have been tried so far have resulted in a hodgepodge, patchwork system that is maddening for physicians to deal with.

    Where I work, some indigent patients have a county health plan. But for some infernal reason, there is a “Plan A” and a “Plan B.” They have different formularies. So before I can write a prescription, I have to find out if they are on Plan A, or Plan B. Usually, the patient does not know, so I have to look it up. Then, some have Medicaid, which of course has its own formulary, and some have both Medicaid and Medicare. Some of those have one of the 40 or so Medicare plans: each with its own formulary, of course.

    Often, when I write a prescription for a patient, I am asked, “Will my insurance cover this?” Usually, I have to say, “Honestly, I’m not sure.”

    And the worst of all: sometimes you spend months getting the medications just right, then the patient gets switched to a different plan, and you have to start all over again.

  3. #3 M. Randolph Kruger
    December 28, 2006

    So lets see, we are already broke and we will assume that the people (some) want universal healthcare. We have an indigentt invasion underway that dont Hable Engles. We have a boomer generation that is going to be unable to pay their taxes on their property as it is from years of boomtime spending. MIH quickly points out that we are a credit card nation and now we (some) want to “leave on the train” for the far away and totally misguided universal healthcare system. Government in charge of healthcare? The Canucks have it and some like it. Most dont and folks there is tons of stuff it dont cover that is out of pocket yet again. The deductibles keep rising and oh well it sounds like traditional healthcare coverage that no one can afford already. Companies in the US cant compete as Revere says because of it. But hmm those companies he cites as a rule are UNION companies when you are speaking of healthcare and that was negoitated away years ago. What do you think happens if GM bombs out? Not another governement bailout for someone who made 70 dollars an hour just to sweep floors.

    Plan A-We put it in, and the new children that are outnumbered 12-15 to one by the boomers taxes go straight thru the roof because they want not to have to pay for it on the front end. So it ends the birth rate in the country, so the problem begins to propagate outwards.Those boomers will be the first ones to bitch when their income taxes go up (that is just behind me-You know, I am the guy that believes the money that I made belongs to me and not someone else). Income taxes on stuff you have already paid into the system.

    Plan B-We leave things alone, the boomers die off because lets face it even though I am a tail end Charlie, I am a boomer and recognize that we cant afford it. You leave with what God gave you, your life. Have a nice day, our children go on to have more children because housing becomes astronomically cheap in the next 15 years as we bag it.

    Plan C- We talk ad naseum about it and use Tennessee as an example as Bill Clinton put it when TennCare was implemented, “The system that we should follow in the US government.” Then the US government if you go by the calculations and what was lost on TennCare-600 mill against a population that only 1/10th qualified for 60,000 and bankrupted the state in under three years will bankrupt the US government in under 5 years. Hmmm. So we create a huge bureacracy that sucks up all of the money, then they want more taxes to support a sinking system that is going to be constantly in the red. Suppliers will raise prices because as with Clinton and MedShares Inc. under Medicare he balanced the budget by not paying the bills for 9 months. So to cover the losses, they raised the prices for the doctors in their groups and then kerpop it all tumbled down. The government tried to sue because MedShares was in breach of contract. First part of every contract is that you get paid for your services. Not if you are Clinton or a Clinton system.

    Yippie! With Clinton it was gays in the military first thing out of the gate. Pelosi is likely to be just as stupid and if she isnt, Hillary is. She is still smarting from that spanking she got on it first time out.

    No, I hope they do come up with something for the no shit indigents out there but in reality universal health care is universal we are outta there. It will bring the country down completely along with the quality of care that exists now. One thing is sure that doctors know right now. Dead men sign no checks!
    Walgreens doesnt work for free and they will jack their rates up just to ensure constant profitability. So end result is that we would end up with a disaster as we introduce total socialism to a capitalistic society. If they get control of the healthcare, the government takes over completely. They will call all the shots on taxes, what you make, what you wont and dont, and when they want more, they will just take it.

    It gives the government cash flow for a while and they can hide all sorts of stuff in cash flow including red ink for about 5 years. Long enough to push the agenda in, goat rope it so we cant get out of it without destroying the system entirely. Yep, thats the plan…. lets go for it!

  4. #4 M. Randolph Kruger
    December 28, 2006

    Oh yeah. Time to get rid of some lawyers too else when that care sucks beyond all recognition and the ambulance doesnt show or the doctor was late we are going to be paying for those legal fees too out of “public money.” The founding fathers said limited governement, not healthcare would be provided!

  5. #5 LiberalDirk
    December 28, 2006

    $70 dollars an hour for sweeping the floor.

    An accusation that extreme is begging for some evidence to back it up.

    Or perhaps that portion, like the rest, is merely hot air being vented.

  6. #6 M.Randolph Kruger
    December 28, 2006

    800-972-5387 Ask for Don. His unkle swept floors for 30 years. Donnie works the night shift but may be out until the first. Feel free to tell him that I sent you. He will rail on you for hours about how the #1 automatker iwill become the #2 this year. Yeah, tell him you are a lib Dirk and how the unions kept on asking for more and more and more. I guarantee you that no Japanese guys are running around in an auto plant making that!

    I remind you that health care is not a right in this country. It is a service and all premises that its anything but that are flat wrong. It is listed as such by the DOC.

    Do I think that 40 million Americans without health insurance is a travesty? Yup. How much they got in Africa? Zippo and the witch doctor. When the lawyers got involved in sixties it was a death knell. The system will evolve, just leave it alone.

  7. #7 revere
    December 28, 2006

    Randy: The system is evolving and you are the Neanderthal. Universal coverage is coming because it makes sense, is cheaper, is needed and the public wants it. Your $70/hour example is ridiculous. As for bankrupting us, you are already paying for universal coverage but not getting it. The inflated transaction costs of insurance companies are bankrupting us and the inflated profits of Big Pharma likewise. Please provide some data on “lawyers.” More than 90% of civil cases are contract and business cases, not tort cases. The proportion of out of pocket medical expenses in the largest tort class in US history, asbestos cases, is compensated at less than 10% on the dollar by lawsuits and workers comp. The costs of medical errors never compensated vastly exceeds the largest awards. With universal coverage we would greatly decrease litigation, too.

    Yes, we are evolving already. But some people haven’t. The rest of the world has done it with better results, health wise, for less money. If you want to know what’s bankrupting us, it’s the military. Take a look at the defense budget.

  8. #8 Stogoe
    December 28, 2006

    Honestly, any time I see a dozen long paragraphs in a comment on a blog, my ‘crazy person’ alert is already primed and ready. Alas, when I skimmed that impenetrable block and saw random shoutings of ‘Clinton!’ and ‘taxes!’ I knew in my gut that yes indeed, we were dealing with a crazy person. Quite possibly a libertarian crazy person.

  9. #9 peggy
    December 28, 2006

    The insurance companies may be inefficient at delivering health care, but they are quite efficient at lining their pockets in ever more creative ways. For example, the so-called “disease management” programs, where a nurse spends a couple of phone calls with someone, and, voila!, they now have control of their diabetes, obesity, whatever. Many times the nurse has little experience with the disease or is not current with standards of care for the particular health concern, there is little oversight of this industry, and results are short term, at best. But this piece of the health care pie is sure lining some pockets.

  10. #10 guthrie
    December 28, 2006

    Sure, it’ll evolve towards basic universal healthcare, hopefully.

  11. #11 Ompus
    December 28, 2006

    I think we’ve set up a false dichotomy between universal health coverage and the status quo. Changes can be made which preserve the free-market nature of health-care while increase the extent of coverage. Here are a couple ideas…

    1. Break the bond with employer healthcare. It prevents transportability of coverage, layoffs become health-care nightmares, and it prevents the employee from excercising choice.

    2. Create government defined “groups” to prevent cherry picking. i.e., all men, ages 30-40, regardless of health, must be accepted at the same price.

    3. Simplify insurance policies through standardization. Ensure that every company offering policy “A” offers the same thing. Policies “B-J” will be standard across the board. Comparision shopping will become realistic when consumers don’t have to wade through page after page of fine print to discover obscured differences.

    4. Subsidize the purchase of standardized policies. e.g., every citizen of the United States will get a $3000 credit to be used to purchase a standardized policy of their choosing from a government approved insurer/hmo of their choosing.

    Such a plan improves portability, prevents insurers from cherry-picking of healthy individuals, expands choice among consumers by making coverage comparisons meaningful, and increases the universality of health-care coverage.

  12. #12 revere
    December 28, 2006

    Ompus: All good suggestions and the caution that universal coverage does not mean the end of market forces is important. I agree with breaking the employer bond. Employers shouldn’t have that kind of leverage over employees and they can be made to pay through the usual tax mechanisms. Most of your other suggestions are variations on increasing the size of the risk pool, which I also agree with. Cheaper and more equitable and avoids the huge transaction costs of cherry picking the insurance companies engage in now. They spend large sums trying to figure out how to avoid paying benefits, a weird and counterproductive activity. We should also not give them a monopoly, however. There is room for private insurance but it should not be the only game in town.

    Subsidies will be required, just as we subsidize the auto industry with roads and the airline industry and many others (not to mention energy!). Here the subsidies should go to individuals to pay for health care.

    Your suggestions show that we can make good and rapid pogress if we have the will to do so and we don’t let the insurance companies and Big Pharma cloud the issue with propaganda.

  13. #13 MoM
    December 28, 2006

    Several years ago (too many) I was tangentially involved in the promotion of Universal Coverage. At that time, it was calculated that if the overhead was limited to the then-current administrative costs incurred by medicare/medicaid, the amount that was being spent on coverage would provide every citizen a universal policy equivalent to the one that the Senate and Congress voted for themselves. Anybody know if that is still true?

    Remember, our elected representatives already have (gold plated) Publicly financed universal coverage. And it follows them when they leave the House or Senate. That begs the question as to why they deny it to the rest of us.

  14. #14 Tom
    December 28, 2006

    I run a small (50 person) printing and publishing company in the midwest. During my tenure (15 years) the cost of the coverage that we offer our employees has more than tripled. We have opted not to pass most of the increase on to our employees and as a result our health insurance premiums (the portion the company pays on behalf of employees) now amount to 24% of our wage expense.

    In order to keep that increase to a minimum we have gone from virtually universal coverage (anything was covered anywhere) a decade ago, to a very narrow plan with coverage limited to a small list of local providers and no coverage outside of network. Certainly we pay much more for much less. And I do not relish the annual meetings explaining these restrictions in coverage to our people.

    When oil prices increased many of our suppliers tacked on “fuel surcharges” to our purchases. Perhaps its time for businesses to start tacking on “health insurance surcharges” to our invoices.

  15. #15 SCW GIlmore
    December 28, 2006

    M.Randolph Kruger,

    Aren’t you former US military??? They got your healthcare “6″ covered don’t they???

    .

    For want of a Dr’s appt, we lose an MDI (inhaler)

    For want of an inhaler, a child suffers asthma,

    then, asthma attack, then an ER visit. . .

    So rather than have a reasonably health kid in a preventative maintaince program, we have a kid who visits the ER one to four times a year. . .

    Which costs more???

  16. #16 BIMI WATSON
    December 28, 2006

    Ten years ago, I had an emergency laminectomy. WITH insurance that we paid $10,000 a year for, we still ended up paying $30,000. A friend in Canada had emergency surgery for a brain aneurysm and paid nothing.

  17. #17 BIMI WATSON
    December 28, 2006

    Ten years ago, I had an emergency laminectomy. WITH insurance that we paid $10,000 a year for, we still ended up paying $30,000. A friend in Canada had emergency surgery for a brain aneurysm and paid nothing.

  18. #18 rnnp
    December 28, 2006

    Peggy-In NYC, one hospital offered a very successful disease management program for diabetes. Great results but they had to close it, b/c the insurance companies would rather pay for some amputations, etc.

    And SCW-Those are kids (and adults) that I see all the time. This summer I sent one employee to the ER 3 times due to asthma. He gets one MDI, uses it, then goes back. Asthma management programs?? These part-time, uncovered employees have to choose between their salary (too high to qualify for public insurance, too low to pay for it) and long waits in clinics. And I can’t prescribe for them b/c they can’t pay for the medications….

  19. #19 M. Randolph Kruger
    December 28, 2006

    Stogie-You are entitled to your opinion but its always Big Pharma this and Doctors and health groups that. The assertion that UHC will solve all of that is bull. More and more private practices are busting out all over the place in the countries that have UHC because the people cant get what they need and then what do they do? They use a secondary policy to cover what isnt.

    SCW-Yep. I was and was 100% covered. But even with the military, you still got socked with a 20% deductible for family stuff. Used to be it was totally covered. So for one military guy you got the wife, dogs, kids. Tough on military pay, but it did have a cap under Champus fairly low. As far as my six was concerned, we pulled back on the coverage and everyone left for the private sector because numbers dont lie.

    On the other hand even a Neanderthal knows when you have to pay for your tools with a certain number of pelts or reindeer. And if that pelt is needed to hold off the opposing tribes then you arent going to use it to wrap a sick person in even though you might want to. Thats called defense and occasionally based on crappy intel about SOME WMD’s you gotta go and do the nasty, even if you are wrong. VX was indeed in Iraq and what you could put on the pointy end of a pin will kill you in three minutes. Thats UN verified. I like a moderate sized military but not one thats carrying a club to go and hit the other tribe all the time. But if it comes down to defense and paying for healthcare, it all falls in behind defense first. You have to have physical and political stability before you can talk about this kind of stuff.

    Watson-Sorry for the problem. But again its based on a premise that you are entitled to healthcare. Try that in Indonesia. As for the Canucks, if say it cost 100,000 dollars USD and even 10,000 needed the procedures a year it would bankrupt the Canucks. Hell they just had to have yet another infusion of money into their system. Bottom line is that there is a bottom line. It costs whether you pay it as an individual or try the old “(well some peole just dont have insurance.” Its all based on the first premise that government is responsible for providing you life, liberty and the pursuit of happiness rather than what the constitution said which is that you shall have the right to it. Life doesnt mean government healthcare. Revere is a doctor, the realities of government are far different. Social Security alone will ensure that this never happens. Our kids are going to be tax smoked for sure. Six para’s aint enough to cover about how our kids futures were mortaged. Military, social security, medicare, unbalanced budgets and unfunded mandates. The ship was about to lay over during Carter and it slowly righted itself under Reagan.

    Me, healthcare for unemployed, indigents and ABOVE ALL US citizens should be out there. They some how get it now and its bankrupting every state to do it. As our population ages those systems are going to be taxed even if bird bug doesnt come. Add in the UHC and it will be over if it does. The last thing I would ever want to see is the USGOVT in charge of healthcare. Its bad enough that we pay taxes in and get shit for return now.

  20. #20 revere
    December 28, 2006

    Randy: As you say, you are entitled to your opinion. I don’t feel safer at $300 million a day, but most people would feel a lot safer with health insurance. Of course, you got yours.

  21. #21 bar
    December 28, 2006

    Australia has a two tier health care system, and a separate pharmaceutical scheme.

    The government contributes a basic amount to doctor visits, (about $25 out of a $35 visit), and most doctors will not charge the $10 excess if the patient is unemployed, retired etc.

    The government provides free hospital care, but the catch is, if it aint life threatening, (like a heart attack) but merely uncomfortable (like a hip joint) then you wait…. (if the list is long, sometimes for years).

    The government health service negotiates with the pharma company that holds the patent. If there is agreement, then the government will subsidize the drug. Otherwise, it will look for an alternative. Most drug companies come to the party.

    On top of that structure sit the (subsidized) health insurance companies. They primarily cover hospital cover for non fatal surgery. So if you want a hip joint or a new kidney (instead of 3 days/week at hospital on dialysis) then you would join a medical insurance company. For a single person on basic cover, that is (with subsidy) about $60/mo.

    It is my belief that the unions did the US people a disservice when they negotiated health care for employees. It made it easier for doctor to raise their fees (because insurance takes a percentage of cost), which blew out the health care budget.

    Other cost inflators are the education system, the stratification into two levels (nurses & doctors) of the profession and the blowout by medical equipment companies (how come the new artificial knee joints are not as unbreakable as the original knee joints?)

  22. #22 bar
    December 28, 2006

    Revere, readers:
    please replace last three words with “original artifical knee joints”

  23. #23 M. Randolph Kruger
    December 29, 2006

    One quick one about the 70 per hour. GM and others dont make the differentiation except between tiers on what a guy does at an auto plant. If you are turning wrenches or a welder or pushing a broom, you are making cars. Thats the reason they have high paid sweepers. The union right or wrong ensures that the guys are equal in all lights.

  24. #24 Susan Och
    December 29, 2006

    Health insurance costs are strangling our economy, and if we ignore the situation we put our nation’s economy at risk.

    Here in Michigan, nobody’s seen a raise in years, but the out-of-pocket costs of health care go up every year. If employers don’t pass the costs on, they must absorb it. Often they layoff full time (with benefits) people with part time (no benefits) or don’t replace them at all. You can’t find a salesperson to help you or you wait in long lines at the ticket counter because nobody works here anymore. Those of us who still have benefits are working overtime because time-and-a-half is cheaper than giving another person health coverage.

    Toyota chose to build a new factory over the border in Ontario, instead of Michigan, because their employee health costs would be so much lower. Michigan’s public schools are in financial crisis largely because the cost of health benefits for employees and retirees is rising faster than revenues will ever match.

    I could go on and on. The system is broken.

  25. #25 Emily
    December 29, 2006

    I do believe in universal health care, but given the profit-driven health care environment in the US, I don’t think that layering single-payer on top of it all will fix the problem of out-of-control costs. Read Maggie Mahar’s book, Money-Driven Medicine, for the dirt on corruption in the form of large-scale Medicare fraud; luxury hospitals and services for chasing market share; and overuse of expensive procedures of unproven benefit.

    Will these problems be solved by, for example, expanding Medicare to everyone, even if we can get rid of administrative waste in the form of insurance companies? I’d like to think so but I doubt it, and I don’t think that other countries’ costs serve as proof that it will work. We need to get control of the costs first, and given the fragmentation of the health care (non)-system, that will be a tough job.

  26. #26 M. Randolph Kruger
    December 29, 2006

    Bar-The US system is plenty screwed up I’ll say for sure. But the question is at what cost would this be provided? The prescription drug benefit that was voted in just a couple of years ago and Bush signed into law is something like a 3 TRILLION dollar unfunded mandate until the boomers are gone. That means our kids.Sorry guys but starting now into a system that will not be taking in anything to fund it will require the taxation of S. Security payments to the seniors. That will require an upping of the payments because they have to eat too and the spiraling cycle will begin and they will simply print money to cover what becomes a numbers game.

    Once that starts it turns the US into a third world nation economy. If they do it, then move to Greece or someplace like that where they will still have to pay you SS, provide for your healthcare, and you will be paying only on a percentage and no state taxes. You would live like a king over there.

    See there is always an angle. We can invade Greece.

  27. #27 revere
    December 29, 2006

    Randy: The war was an unfunded mandate, too, that no one wanted. Thanks. The prescription drug plan is a windfall for Big Pharma. We’ll drive the cost down a bit by competitive bidding by the feds. We’re already paying for health insurance (most of us) at inflated prices. Let’s stop it.

    If the military is to keep us safe and healthy, so is health care.

  28. #28 M. Randolph Kruger
    December 29, 2006

    So Revere your point is that if we ended the war and all things were equal that we could afford UHC here. Not while the S. Security disaster looms. But I DO have an answer and it would be like the French did in the 1920′s. Papillons friend Dega the master forger sold counterfeit bonds which caused a collapse of their economic system and their bonds became worthless. So its all on paper money and paper bonds. One day we just up and say, “We default.” The world banking system collapses and then reorganizes, lawyers get nothing because its…paper, from lawsuits. The til is empty and then we start over. It would be shaky and flaky for a while but not too long. The French had a huge economy until the 29 crash. But, it did work.

    Hey dont get me wrong. 43 million uninsured is nothing to laugh at but just to up and say that someone has to fund it when they dont want to via taxes is ludicrous. Its not an elective. Its just another tax that they’ll dream up and force you to pay so that someone else can enjoy the fruits of someone else’s labor. We all have the equal right to make enough money to pay for healthcare, but someone else thinks that when you do you should have to share it with those that are less fortunate so that they dont have to work for it. No incentives to do anything about your human condition. Its a takeover Revere, nothing more or less. If they do, it will shatter the economy for two or three generations all in the spirt of taking care of someone you have never met. Its socialism in the middle of a capitalistic society and the last guy that did that saw first hand that you cant fight wars or defend a country if you are in a giveaway mode to the less fortunate Johnsons “Great Society.” . What, we raise their standard of living at the cost of someone elses standard of living? I read your thing on this bidding by the feds. Look those guys arent stupid. They did the same thing here and that competitive bidding? Well they just indicted about 10 senators who had set up consultancies for contractors who were “bidding” on it. 600 million for 1/20th of our state to be on UHC. Those emergency rooms became office visits because no one got paid on time and the providers, doctors, suppliers, hospitals just jacked their rates up. MORE taxes please. They had four increases in three years and it still managed to nearly bankrupt the state. That little program was tanked back to the Fed Gov. in a hot and fast hurry. Businesses were leaving and heading to Honduras and out of the country because the state and local taxes were astronomical.

    Seems like a taking to me as defined under the Constitution and might set off a battle in the courts over it. I hear all of this about “what we need to do is” and regardless of how you feel about the war in Iraq it wont change the outcome of this in the slightest. The UK has it and across the years it has flattened their military to only a regional power with global reach. None of the countries you talk about ever have done a thing to defend themselves except as a token force. We ARE the friggin calvary and if we pull back those little fiefdoms around the world are going to have to defend themselves on their own without any fall back position. Thats a fast way to start something that we cant get out of and likely would cause WWIV.

    Sorry, I just disagree with the first premise and that is its a right to have healthcare. Its a service industry just like McDonalds. YOU get what YOU pay for.

  29. #29 g510
    December 30, 2006

    Hey Randy, I’ve had a libertarian streak through & through since I first learned what eminent domain was when I was nine years old. That’s nine, 9, single-digit. And I’ll tell you this:

    What we have now is not a free market in health coverage, it’s a captive market that is being manipulated by an oligopoly that has accrued para-statal power, and that is as much an anathema to real libertarianism as the more direct forms of state power.

    So onward to the practicalities.

    First of all, the risk of pandemic diseases is a national security issue, and since you’ve been reading this blog, it’s reasonable to assume you know the projected consequences of the next pandemic.

    Second, all of the science agrees on this: comprehensive detection of early cases is the first and most important measure in preventing a new bug from turning into a pandemic. But how are we to detect those early cases when they won’t go to the doctor because they are uninsured…? Clearly the answer is, we can’t.

    Thus as a matter of national security, it becomes necessary to develop a public health infrastructure geared to detection and treatment of infectious disease. You walk into the clinic, they determine you’ve got avian flu, they pull the fire alarm. Or they determine it’s a cold virus complicated by a bacterial upper respiratory infection and they send you home with some pills.

    But what if they determine that the thing that’s been making you feel like dog doo is, for example, leukemia…? “Sorry bub, that’s not an infectious disease, go home and die.”

    Meanwhile 25% of the cost of the present system is going into administrative overhead, which is to say needless paperwork, which is pure and absolute waste. If any government program was that inefficient, we’d all be screaming bloody murder about what Reagan used to call “waste, fraud, and abuse” back in the days when Republicans stood for a balanced budget rather than taxcut & spend profligacy.

    The entire medical insurance industry has become bloated and parasitical, it stands in the way of innovation, it is tens of times worse than if it was an overt monopoly, and it deserves to be swept away, burned to the ground, flushed down the toilet, and forgotten. It is inimical to a true free market in medical care and the surest evidence of this is the degree to which people get trapped into situations such as jobs and health plans that they would otherwise ditch if they were truly free to choose. It wastes hundreds of billions of dollars in the pure entropy of charging a price to prevent people seeing doctors rather than using the same amount of money to actually pay doctors for providing health care.

    And Randy, I’m not a doctor, and neither is that bureaucrat at the other end of the phone. If I told you which medications you could and couldn’t have, I’d be charged with the criminal offense of practicing medicine without a license. If that insurance company bureaucrat said exactly the same words, s/he would face no liability, civil or criminal. That’s more than a market distortion, that’s an abject failure of equal protection under the law, it’s special treatment for a favored category, affirmative action for bureaucrats.

    I say feed the f—ing bureaucrats to the alligators and pay for doctors instead.

  30. #30 caia
    December 31, 2006

    g510: Oh, be fair.

    Reagan tried his hand at “taxcut & spend profligacy” too. *g*

    Ah, trickle-down economics. That takes me back. (To grade school.)